To the Editor:
In response to the editorial1 about the reporting of race and ethnicity in medical and scientific journals, we would like to highlight an initial call to action in Health Affairs2 and discuss guidelines that have been implemented across multiple journals of the American Heart Association portfolio.3,4
First, we are concerned that the editorial by Flanagin and colleagues1 failed to discuss the role of racism in the defining constructs of race. Instead of stating “Although race is a social construct and its utility in understanding biology is limited,” we favor: “Race is a social construct and its utility in understanding biology is limited.”
Second, much data supports the concept that racism, bias, and social determinants of health play a greater role in the development of disease than traditional risk factors.5 Since the definition of race from Merriam-Webster may perpetuate views that genetics are responsible for racial and ethnic health disparities, we suggest dropping this definition, or explicitly calling out its inherent flaws.
Third, the focus on ancestry in the section “Concerns, Sensitivities, and Controversies” missed an opportunity, since many of the described diseases may be a result of racism and social determinants of health rather than ancestry alone.
Fourth, race is distinctive from ethnicity. However, only the final example under “Race/Ethnicity” in this editorial1 classified patients in this manner. We encourage going one step further by offering write-in choices that allow self-description of one’s identified race and ethnicity, and developing new evidence-based categories, respectful of methods that populations use to define themselves. Concepts of race and ethnicity will likely continue to evolve as societal power structures change so that ultimately populations are empowered to self-describe themselves. Allowing self-description is preferred over groupings that may diminish the experiences of a specific population.
Fifth, as demographics shift over time, the categorization of people of color as racial and ethnic minorities will soon be inaccurate within the US. Moreover, since categorizing people of color as minorities may be offensive by suggesting a hierarchy among groups, we challenge the idea that people of color is a colloquialism.
Sixth, race and ethnicity in English do not directly translate to the same meaning in other languages. Since JAMA is an international journal, this point should be carefully discussed.
We look forward to future iterations of this important work. Updating this report with diverse perspectives from stakeholders will support ongoing efforts to develop and support an anti-racist society.
Acknowledgments
Conflict of Interest Disclosures: Dr Breathett reports grants from NIH/ NHLBI, grants from Women as One, and other from American Heart Association as Associate Editor at Circulation: Cardiovascular Quality and Outcomes during the conduct of the study. Dr Nallamothu reports personal fees from American Heart Association Editor-in-Chief, Circulation:Cardiovascular Quality & Outcomes during the conduct of the study; and a principal investigator or co-investigator on research grants from the NIH,VA HSR&D, and the American Heart Association. Dr Nallamothu is a co-inventor on U.S. Utility Patent Number US 9,962,124 as well as a Provisional Patent Application (54423) that use software technology with signal processing and machine learning to automate the reading of coronary angiograms, held by the University of Michigan. The patent is licensed to AngioInsight, Inc., in which he holds ownership shares and receives consultancy fees. The University of Michigan also has filed patents on his behalf related to the use of computer vision for imaging applications in gastroenterology, with technology elements licensed to Applied Morphomics, Inc., in which he has no relationship or stake. No other disclosures reported.
Contributor Information
Khadijah Breathett, Division of Cardiovascular Medicine, University of Arizona, Tucson, Arizona.
Erica S. Spatz, Division of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.
Brahmajee K. Nallamothu, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
References
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