Extraction and Elevation-Antiracist Equity Research Requires a Consideration of Positionality


September 17, 2021


Note: This is a Letter to the Editor I submitted to JAMA in response to this
article. The related twitter threads with the lead author can be found here and here. The Letter was rejected by JAMA and it was originally posted on medium channel which I have since migrated here. 

I read with interest Bennett and Ling’s piece on “Proportions of Faculty Self-identifying as Black or African American at US Medical Schools, 1990–2020”.[1] In their letter, they re-demonstrated the well-described phenomenon that that self-identified Black/African-American physicians are underrepresented in US medical faculty across medical specialties. [2]

The authors’ letter implicitly demonstrates the systemic racism that Black physicians and trainees experience that limits our access to resources and opportunity, thereby impeding our ability to obtain and sustain faculty positions in medicine. It is recapitulated in the knowledge production infrastructure where a persistent trend of Black scientists underfunded by the NIH relative to their white counterparts, [3] undoubtedly contributes to their decreased representation in the academic faculty physicianship.

Considering this context reveals a paradox in Bennett and Ling’s article. Publishing in high impact journals like JAMA confers clear career benefits that directly impact faculty promotion and retention. In publishing their letter, Bennett and Ling are extracting benefit from the harms inflicted by systemic racism on their Black colleagues. By doing so without collaborating with Black scholars to redistribute those benefits, the authors contribute to the same unjust system that they critiqued in their article. Unfortunately, this paradox is not new, and has been criticized by other scientists with marginalized identities; notably transgender scholars maligning HIV research on their community conducted by all cisgender colleagues. [4]

In this historical moment there is more emphasis on understanding the costs of systemic racism than ever before. However, to move towards equity in medicine, we need a concurrent and sustained commitment to antiracist practice. It is not sufficient to only consider what the research is, but also how it is conducted, and who benefits from it. With the proliferation of “equity tourists”, or researchers beginning to study injustice in response to the current political climate, scientists need to evaluate their positionality, and understand their relationship to marginalized groups under study. Bennett and Ling missed an opportunity for this critical introspection; had they considered the hierarchy imposed by systemic racism between their racial identities and those of their subjects, they would have identified their article as an opportunity to redress the injustice that underlies their findings by mentoring a Black trainee or collaborating with a Black colleague. I hope that future scientists engaged in equity work take this critical step so that we can move beyond observation of racial inequities and carve a path to racial justice.

References

1. Bennett CL, Ling AY. Proportions of Faculty Self-identifying as Black or African American at US Medical Schools, 1990–2020. JAMA. 2021;326(7):671–672. doi:10.1001/JAMA.2021.10245

2. Lett LA, Orji WU, Sebro R. Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties. PLoS One. 2018;13(11):1–21. doi:10.1371/journal.pone.0207274

3. Stevens KR, Masters KS, Imoukhuede PI, et al. Fund Black Scientists. Cell. 2021;184. doi:10.1016/j.cell.2021.01.011

4. Scheim AI, Appenroth MN, Beckham SW, et al. Transgender HIV research: nothing about us without us. Lancet HIV. 2019;6(9):e566-e567. doi:10.1016/S2352–3018(19)30269–3

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