In this op-ed, LaShyra ‘Lash’ Nolen explores the persistence of medical racism and importance of anti-racism in medicine.
One morning in December I woke up to a dozen messages from excited family and friends. I unlocked my phone expecting a video of the latest TikTok dance craze, but instead an illustration of a fetus appeared. It didn’t take me long to realize what made this image so special — the fetus and its mother were Black.
Created by Nigerian medical student and illustrator Chidiebere Ibe, the image illustrated a dark-toned pregnant woman with a chocolate fetus sitting in her womb. The viral anatomical image took the internet by storm. While the picture seemed trivial to some, it sparked a great sense of pride and sadness in me and many others. In my three years as a medical student, it was the first time I saw a medical illustration that expressed life through melanated skin. I was reminded once again that whiteness is the standard in medicine.
From the anatomical models we see to calculators we use to diagnose medical illness, white supremacy remains pervasive throughout medical education and medicine. For example, Black people are less likely to receive early diagnosis of Lyme disease because many medical students aren’t taught to recognize the characteristic “bullseye rash” on dark skin. This can lead to delayed treatment and medical complications from late detection of the disease — which affects Black people disproportionately.
Beyond creating disparities in health outcomes, the systematic underrepresentation of dark-skinned anatomical models can also contribute to the dehumanization of Black patients. One study found that as many as half white medical trainees believe Black people have “thicker skin," belief which study authors wrote “are associated with the perception that Black people feel less pain than do white people and with inadequate treatment recommendations for Black patients’ pain.” These problematic views harken back to the centuries old remnants of eugenics and medical racism historically perpetuated by scientists and doctors.
These views are embedded in the raced-based calculators and algorithms still used today to guide the treatment and diagnosis of medical disease. Although race has been proven to have no biological basis, a patient’s skin tone can still determine their likelihood to receive a lifesaving kidney transplant, be diagnosed with respiratory illness, or get proper treatment for a urinary tract infection, among other medical interventions.
Many students are taught about these health inequities as if they were a matter of fact. We learn Black people are more likely to die from cancer, hypertension, diabetes, and heart failure with little mention of the systemic factors behind these trends. Without context behind statistics, future generations of healers passively learn to accept the disparate suffering of marginalized groups as an inevitable reality, instead of the actionable threat to public health it truly is.
Following the lead of public health luminary and scholar, Camara Jones, MD, MPH, PhD, many researchers and health equity advocates have dedicated their careers to elucidating the ways racism manifests in medicine. One recent example is the work of Michelle Morse, MD, MPH, and Bram Wispelwey, MD, MPH, at Harvard Medical School.
In 2019, they collaborated with colleagues on a study that found Black and Latinx patients were less likely to be admitted to more specialized cardiology services for heart failure treatment, compared to their white counterparts. Since the publication of this study, they’ve worked with hospital administrators and clinical staff to identify systemic and interpersonal failures that contributed to the inequities they observed. The duo have collaborated to produce scholarship such as their piece, “An Antiracist Agenda for Medicine,” which promotes the use of race-conscious solutions to address racist policies and practices in healthcare.
Dr. Morse is now the chief medical officer for the New York City Department of Health and Mental Hygiene and continues to teach at Harvard Medical School. On the importance of antiracism in medicine, Dr. Morse, told Teen Vogue, “We should be concretizing and institutionalizing the policies we know are going to make racial justice and health equity more possible over the coming years… I think we have to keep demanding what we know is going to be the difference.”
Her work is a clear example of how antiracism efforts in medicine can improve the health of all patients. But as we navigate the public resurgence of neo-Nazism, book bans, and attacks on critical race theory, this work can often leave physician activists vulnerable.
On January 22, a group of neo-Nazis crowded the front entrance of Brigham and Women’s Hospital in Boston, where Dr. Wispelwey works and Dr. Morse was previously employed. In their hands were printed flyers of the two doctor’s faces proclaiming, “No Anti-White Policies in Hospitals”.
“What happened with our work is the right-wing world got a hold of it, shared it, and is trying to distract us from pushing forward with race conscious work as a solution for health inequities,” Dr. Morse said. “People need to be clear in what the path forward is. We need to demand it, we need our allies to demand it. But we have to be prepared for the backlash.”
Aletha Maybank, MD, MPH, the Chief Health Equity Officer and Vice President of the American Medical Association (AMA), has similarly dealt with significant backlash for her antiracism work. Through the AMA’s marred history of overtly racist policies, Dr. Maybank has worked diligently to institute transformative efforts to promote social justice within and beyond the organization. Since her instatement in 2019, she has released a comprehensive strategic plan to embed racial justice into the practices of the organization, helped produce a narrative guide for antiracism, and created a video series, “Prioritizing Equity,” which highlights the work of antiracism scholars across the country.
Dr. Maybank’s work is imperative but has also made her a visible target of antiracism detractors, so much so that she says someone once wrote profanities on her home’s front door. “That was scary. It’s not only what happens to us though. It’s what happens to our families and the people around us. That’s what racial trauma is. It’s not just one individual, it’s the context of the community.”
“This is the tactic and always has been the tactic of white supremacy to put fear upon people so that they either be quiet or leave,” says Dr. Maybank. From the anti-lynching campaign of Ida B. Wells to whistleblowers like, Dawn Wooten, there have been countless efforts to silence Black women when they’ve spoken out against oppression—and medicine is no exception.
“Medicine is such a conservative space and still a space that values whiteness in so many ways. From the lack of diversity, the textbooks we read, access to care, and coverage of care, medicine is still a very white space,” Dr. Maybank says.
White supremacy continues to have a stronghold on medicine. To combat the inequities it continues to create an antiracist approach to healing must be adopted. This means allies and those in places of privilege must openly denounce racism and also have the policies and practices to back up their words. This movement of antiracism must also be intersectional. “For example, we can’t do antiracism well if it’s not about feminism at the same time,” says Dr. Morse.
School deans, community members, and advocacy organizations have already released statements denouncing the acts against Drs. Morse and Wispelwey, but there is still more work to be done. It is my hope that with steadfast advocacy and the support of our allies, we can create a healthcare system where the diverse representation of all patients is the norm, and not the exception.
LaShyra ‘Lash’ Nolen is a writer, medical student at Harvard Medical School, and the founding executive director of the We Got Us Empowerment Project.
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