Race and Medicine

More on Race and Medicine

• Medicine and Society May 26, 2022 Structural Racism in the Academic Residency Clinic
  R. Vanjani, A. Pitts, and P. Aurora N Engl J Med 2022; 386:2054-2058

  Physicians’ dual loyalties to their academic institutions and to patients may not only constrain their ability to act in patients’ best interests, they may also reflect and perpetuate structural racism — a reality of which academic residency clinics provide a case study.

• Perspective May 26, 2022 E Pluribus Unum
  I. Mulasi N Engl J Med 2022; 386:1969-1971

  A case that would otherwise have set off an avalanche of investigations and therapeutics, family meetings, and consultations was quietly referred for charity hospice care, though Ms. M.’s immigration status made acceptance even by a hospice agency precarious.

• Perspective Perspective Roundtable May 19, 2022 Long-Term Care in the United States
  S.L. Mitchell and Others N Engl J Med 2022; 386:e54

  Although the Covid pandemic drew renewed attention to problems in U.S. nursing homes, the underlying issues with long-term care are long-standing. Susan Mitchell moderates a Perspective Roundtable about shortcomings and possible solutions.

  Perspective Reforming Nursing Home Financing, Payment, and Oversight

• Perspective Apr 27, 2022 A Data Infrastructure for Clinical Trial Diversity
  D. Blumenthal and C.V. James

  Among the barriers to increased participation in clinical trials by members of underrepresented groups, one that requires governmental attention is the lack of robust, reliable data on race and ethnicity in patient databases maintained by clinical providers and insurers.

• Original Article Apr 21, 2022 Asthma Therapy in Black and Latinx Adults
  E. Israel and Others N Engl J Med 2022; 386:1505-1518

  Although reliever-triggered inhaled glucocorticoid therapy can reduce asthma exacerbations, this approach has not been well studied in Black and Latinx populations, who bear disproportionate asthma morbidity and mortality. In a pragmatic trial involving Black and Latinx patients, the asthma exacerbation rate was lower with reliever-triggered inhaled glucocorticoid use than with usual care.

  Editorial Breaking the Skin Color Barriers for Asthma Medications — It’s Not Black, Brown, or White

• Perspective Apr 21, 2022 Misusing Public Health as a Pretext to End Asylum
  A.G. Beckett and Others N Engl J Med 2022; 386:e41

  There is no public health evidence that singling out asylum seekers or other migrants for exclusion from the United States is effective in stemming the spread of Covid-19; a federal order supporting such exclusion violates both international obligations and U.S. laws.

• Special Report Apr 07, 2022 U.S. Medical Faculty Diversity over Four Decades
  S.C. Kamran and Others N Engl J Med 2022; 386:1363-1371

  An analysis of data from the Association of American Medical Colleges from 1977 through 2019 showed progress in female representation among clinical faculty, full professors, department chairs, and medical school deans. Much less improvement was observed for racial and ethnic groups designated by the AAMC as underrepresented in medicine.

• Perspective Mar 24, 2022 Digital Inclusion as Health Care
  J.A. Rodriguez, C. Shachar, and D.W. Bates N Engl J Med 2022; 386:1101-1103

  Digital inclusion is becoming intertwined with health care equity. The Infrastructure Investment and Jobs Act addresses drivers of digital health disparities, offers opportunities for community-based digital inclusion, and could be a lever for improving access to care.

• Perspective Mar 03, 2022 Oral Health for All
  R.N. D’Souza, F.S. Collins, and V.H. Murthy N Engl J Med 2022; 386:809-811

  The highest burden of dental and oral disease is shouldered by marginalized and chronically underserved groups. Moving forward, we will need to forge a path for oral health care that prioritizes overall health, prevention, expanded access, affordability, and equity.

• Correspondence Feb 24, 2022 Reductions in Racial Disparities in Colorectal Cancer
  C.A. Doubeni and Others N Engl J Med 2022; 386:796-798

  In this study involving non-Hispanic Black members and non-Hispanic White members of the Kaiser Permanente Northern California health plan from 2000 through 2019, colorectal cancer screening increased markedly among both Black members and White members, and racial disparities in colorectal cancer incidence and mortality were virtually eliminated.

• Perspective Feb 16, 2022 A Call for Antiracist Action
  D.A. Ansell, B. James, and F.G. De Maio

  The neo-Nazi march on Brigham and Women’s Hospital and attacks on health equity interventions are stark reminders of the obligation of physicians to denounce White supremacism and reaffirm race-conscious antiracism efforts.

• Perspective Feb 10, 2022 Racial Biology and Medical Misconceptions
  A. Deyrup and J.L. Graves, Jr. N Engl J Med 2022; 386:501-503

  Much of the medical community continues to view socially defined races as if they are accurate reflections of biologic variation; the racialization of disease is further propagated in textbooks and licensing exams. How do we solve this deeply ingrained problem?

• Perspective Feb 10, 2022 Beyond Diversity — Time for New Models of Health
  J.L. Delgado N Engl J Med 2022; 386:503-505

  Hispanic Americans’ health profile doesn’t adhere to the paradigm in which minority ethnic or poverty status determines poor health outcomes. But the U.S. health enterprise has not used this information to recalibrate or rethink our models of health and risk factors.

• Points of View Jan 27, 2022 Sitting in Our Discomfort
  K. Gates N Engl J Med 2022; 386:e8

  Despite renewed awareness of deep health disparities, many of the clinicians who had gathered for a talk on obesity chose to leave afterward, rather than stay to hear about implicit bias and risk facing the uncomfortable aspects of themselves and our health care system.

• Perspective Apr 21, 2022 Strengthening the Medicaid Reentry Act
  U.G. Khatri and T.N.A. Winkelman N Engl J Med 2022; 386:1488-1490

  Under the Reentry Act, Medicaid would be able to pay for health care for eligible people who are incarcerated starting up to 30 days before their release from jail or prison. Changes to this bill could bring care in these facilities in line with community standards.

• Perspective Jan 20, 2022 Combating Structural Inequities
  L.E. Boulware and Others N Engl J Med 2022; 386:201-203

  If the clinical and translational research enterprise is to help resolve health crises and ensure that all people in the United States have the opportunity to live healthy lives, it must shift paradigms and begin to center equity, diversity, and inclusion in its work.

• Perspective Jan 20, 2022 Research Participation in Marginalized Communities
  K. Armstrong and C. Ritchie N Engl J Med 2022; 386:203-205

  Despite an increased focus on community engagement in research, barriers persist, including burdensome institutional and federal policies regarding payment for research participation and inadequate mechanisms to support longitudinal commitments to community partners.

• Perspective Jan 20, 2022 Disability Inclusion and Research Study Diversity
  B. Swenor and J.A. Deal N Engl J Med 2022; 386:205-207

  The Covid-19 pandemic has deepened commitments to enhancing the diversity of the populations participating in research studies. But people with disabilities have been left out of most of these initiatives.

• Perspective Jan 13, 2022 Expanded Lung and Colorectal Cancer Screening
  D.M. Horn and J.S. Haas N Engl J Med 2022; 386:100-102

  New guidelines recommend expansions of the populations that should undergo screening for lung or colorectal cancer. Without other changes, a substantial increase in screening could exacerbate inequities in access and delay follow-up of abnormal test results.

• Perspective Dec 30, 2021 First Impressions
  A.S. Brett and C.W. Goodman N Engl J Med 2021; 385:2497-2499

  Given persistent racism in medicine and the growing recognition that racial and ethnic categories are socially constructed and not biologically coherent, the practice of mentioning race or ethnicity immediately in case presentations is worth revisiting.

  Perspective Calling Out Aversive Racism in Academic Medicine

• Perspective Dec 30, 2021 Calling Out Aversive Racism in Academic Medicine
  C.L. Chen and Others N Engl J Med 2021; 385:2499-2501

  Aversive racism is defined as exhibiting racist tendencies while denying that one’s thoughts, behaviors, or motives are racist. Aversive racism is pervasive in academic medicine and impedes diversity, equity, and inclusion efforts.

  Perspective First Impressions — Should We Include Race or Ethnicity at the Beginning of Clinical Case Presentations?

• Points of View Dec 30, 2021 Race and Health — A Persistent American Dilemma
  D.S. Tweedy N Engl J Med 2021; 385:e98

  In the quarter-century since H. Jack Geiger implied in an editorial that racism in the medical profession was contributing to health inequities between Black and White Americans, medical education has inched forward, but health equity remains elusive.

• Perspective Dec 16, 2021 Ms. Omega One
  M. Wilbur N Engl J Med 2021; 385:2309-2311

  What we knew about Ms. Omega One was limited to her presentation: dark-skinned Black female, about 20 years old, with a gunshot wound to the neck — and most likely a new mother. And as with so many Black people killed in Black neighborhoods, there was no news report.

• Perspective Dec 09, 2021 Inequitable Access to Hospital Care
  D.B. White, L. Villarroel, and J.L. Hick N Engl J Med 2021; 385:2211-2214

  Load balancing among hospitals is a critical public health intervention during emergencies: failing to balance patient loads will cause unnecessary loss of life, particularly in historically marginalized racial and ethnic groups and rural or low-income communities.

• Points of View Dec 09, 2021 Getting Proximate
  A. Vasan and Others N Engl J Med 2021; 385:e89

  To address root causes of health inequity, the University of Pennsylvania Health System developed a year-long experience in which community health workers mentor and educate executives about the realities of injustice and partner with them to create structural change.

• Perspective Nov 04, 2021 Racial and Ethnic Diversity at Medical Schools
  J.P. Guevara, R. Wade, and J. Aysola N Engl J Med 2021; 385:1732-1734

  In medicine, diversity at all levels is an essential component of efforts to achieve equity. But there has been little or no progress in recent years in the relative diversity of medical school matriculants and faculty.

• Perspective Dec 02, 2021 Is It Finally Time for a Medicare Dental Benefit?
  L. Simon and W.V. Giannobile N Engl J Med 2021; 385:e80

  Traditional Medicare still lacks dental coverage, which has contributed to inequities in pain, edentulism, and unmet need among lower-income people, people of color, and older adults. The federal government is now closer than ever to enacting a Medicare dental benefit.

• Perspective Oct 21, 2021 “All Labor Has Dignity”
  L. Ung, F.C. Stanford, and J. Chodosh N Engl J Med 2021; 385:1539-1542

  Clinicians need look no further than their own institutions to find large groups of employees facing economic and social deprivation. Racial justice in health care cannot be achieved without addressing the economic and social neglect of our low-paid colleagues.

• Perspective Perspective Roundtable Sep 30, 2021 Race in Medicine
  M. Evans and Others N Engl J Med 2021; 385:e45

  In this video roundtable, moderated by Dr. Michele Evans, experts from a range of clinical and biomedical backgrounds analyze and discuss complex questions about race in medicine, seeking common ground on which to build a system of equitable health for all.

• Original Article Nov 04, 2021 New Equations for Estimating GFR without Race
  L.A. Inker and Others N Engl J Med 2021; 385:1737-1749

  Equations for estimating GFR with serum creatinine overestimate measured GFR in Blacks. The authors report new equations, without race as an inflation factor, using cystatin C and creatinine that reduced errors in estimation between Black participants and non-Black participants.

  Editorial Time to Eliminate Health Care Disparities in the Estimation of Kidney Function

• Original Article Nov 04, 2021 Race, Genetic Ancestry, and Estimation of the GFR
  C.-y. Hsu and Others N Engl J Med 2021; 385:1750-1760

  The use of race in equations that estimate the glomerular filtration rate is problematic. In this study, the use of the serum creatinine level to estimate the GFR without race (or genetic ancestry) introduced systematic misclassification. Estimating GFR with cystatin C generated similar results but eliminated negative consequences of race-based approaches.

• Points of View Sep 23, 2021 Pathology of Racism
  K. Vinekar N Engl J Med 2021; 385:e40

  At our medical institutions, we immerse trainees in a two-tiered system. We teach them that some kinds of patients see residents and other kinds of patients see attendings. And worst of all, we teach them to pretend not to notice.

• Medicine and Society Aug 26, 2021 Remembering Past Lessons about Structural Racism
  A. White, R.L.J. Thornton, and J.A. Greene N Engl J Med 2021; 385:850-855

  Though the mounting resolve to address structural racism in U.S. medicine and public health is welcome, the theory and empirical grounding for this work was laid out more than a century ago by W.E.B. Du Bois and his colleagues in the Atlanta school of sociology.

• Perspective Sep 09, 2021 Environmental Racism and Climate Change
  R.N. Salas N Engl J Med 2021; 385:967-969

  A subtype of structural racism, environmental racism includes the use of racist practices in determining which communities receive health-protective, and which health-harming, infrastructure. What can physicians do about this underlying and often missed diagnosis?

• Points of View Aug 12, 2021 Holding Open the Door for Others Like Me
  L.H. Streeter N Engl J Med 2021; 385:e27

  When a Black, nonbinary Ob/Gyn residency applicant didn’t match to a position, they reexamined their experience: Was the discrimination their grandfather had overcome to become Arizona’s first African American board-certified physician still at work decades later?

• Special Article Jul 22, 2021 Racial Inequality in Prescription Opioid Receipt
  N.E. Morden and Others N Engl J Med 2021; 385:342-351

  This analysis of 2016 and 2017 claims data for disabled Medicare beneficiaries compared filled opioid prescriptions between Black and White patients treated within the same health systems. The mean annual opioid dose was 36% lower among Black patients than White patients. In 75% of the 310 health systems studied, the mean annual dose was at least 15% higher among White patients than Black patients.

• Points of View Jun 10, 2021 Code Switch
  A.K. Blanchard N Engl J Med 2021; 384:e87

  Code switching involves adjusting one’s style of speech, appearance, behavior, and expression to optimize others’ comfort, in exchange for fair treatment. As a Black physician, the author has found code switching essential to her success in academic medicine.

• Perspective May 27, 2021 Dilemmas of Double Consciousness
  A.L. Langston N Engl J Med 2021; 384:1978-1979

  How does one honor and protect the sanctity of one’s own Blackness while also giving so much of oneself to a health care system that in many ways continues to dismiss, ignore, and mistreat Black people? How can either of my existences thrive while the other survives?

• Perspective May 20, 2021 Minority Tax Reform
  T. Williamson, C.R. Goodwin, and P.A. Ubel N Engl J Med 2021; 384:1877-1879

  Black faculty members are often expected to engage in diversity initiatives, a drain on their time and resources known as the “minority tax.” But taxes can be reformed, and several strategies could help reduce the negative sequelae of the minority tax.

• Points of View May 20, 2021 The Pathophysiology of Racial Disparities
  A. Calhoun N Engl J Med 2021; 384:e78

  We were supposed to be talking about these Black teenagers’ aspirations to become doctors, not their fears about becoming patients. I wanted to tell them not to worry, that they could trust all doctors. But I didn’t. Because they can’t.

• Medicine and Society May 13, 2021 Deconstructing Inequities
  M.L. Givens and Others N Engl J Med 2021; 384:1861-1865

  An important step in addressing racism as a U.S. public health crisis is accurate measurement of progress necessary to hold ourselves collectively accountable. Public Health Critical Race Praxis provides guiding principles for analyzing myriad health equity challenges.

• Points of View May 13, 2021 I Can’t Breathe during Interviews
  S. Kemet N Engl J Med 2021; 384:e72

  Standing between the author and a residency match was an act of contortion: conveying her passion about closing racial disparities in maternal health without triggering a “White fragility” response in her interviewer. And she’d finally gotten the interview she feared.

• Perspective A Half-Century of Progress in Health: The National Academy of Medicine at 50 May 06, 2021 Understanding and Mitigating Health Inequities
  R.J. Lavizzo-Mourey, R.E. Besser, and D.R. Williams N Engl J Med 2021; 384:1681-1684

  Eliminating racial health inequities requires a movement away from disparities as the focus of research and toward a research agenda centered on achieving equity by dismantling structural racism.

• Special Report Apr 29, 2021 Diversity of the National Medical Student Body
  D.B. Morris and Others N Engl J Med 2021; 384:1661-1668

  The percentage of women enrolled in U.S. medical schools doubled during the past four decades; now, more than half the students are women. The percentage of Asian enrollees increased substantially. The percentages of enrollees from Black, Hispanic, and other underrepresented racial and ethnic groups remain well below the respective percentages of these groups in U.S. Census data.

  Editorial Medical School Admissions — A Movable Barrier to Ending Health Care Disparities?

• Perspective Apr 22, 2021 Advancing President Biden’s Equity Agenda
  N.K. Aggarwal N Engl J Med 2021; 384:1481-1483

  On his first day in office, President Biden signed an executive order on advancing racial equity and supporting underserved communities. This policy presents an opportunity to implement lessons from health disparities research that target systemic racism.

• Perspective History of Medicine Apr 15, 2021 Race, Policing, and History
  M.L. Edwards N Engl J Med 2021; 384:1386-1389

  In the 1960s, Pittsburgh’s Freedom House Ambulance Service supplanted the police in a role in which they were not effective, reimagined the role of Black citizens in improving community health, and helped establish national standards for emergency medical care.

• Perspective Jul 08, 2021 Addressing Vaccine Hesitancy in BIPOC Communities
  S.C. Quinn and M.P. Andrasik N Engl J Med 2021; 385:97-100

  As Covid vaccines are rolled out, it’s time to shift the focus from a sole emphasis on changing hearts and minds among members of BIPOC communities to ensuring that institutions are trustworthy, transparent, and engaged with communities.

• Perspective Mar 25, 2021 Addressing Workforce Diversity
  L.S. Rotenstein, J.Y. Reede, and A.B. Jena N Engl J Med 2021; 384:1083-1086

  Lack of workforce diversity in medicine has detrimental effects on patients and clinicians. The evolution of the modern quality movement represents a useful parallel for achieving a complicated goal like equitable representation in health care.

• Medicine and Society Mar 25, 2021 Embracing Genetic Diversity to Improve Black Health
  A. Oni-Orisan and Others N Engl J Med 2021; 384:1163-1167

  Ideally, race will be replaced with genetic ancestry as a variable in medical research and practice. But until more ancestry data are available, ignoring race and extrapolating research findings from European-ancestry populations to others is neither equitable nor safe.

• Perspective Jun 24, 2021 Combating Anti-Asian Sentiment
  J.H. Lee N Engl J Med 2021; 384:2367-2369

  On top of the social, emotional, and psychological effects of the Covid pandemic, many Asian American patients are feeling the stress of increased anti-Asian sentiment. Physicians can take practical steps to tailor their practices to meet this moment.

• Correspondence Mar 18, 2021 Face Transplantation in a Black Patient
  M. Kauke and Others N Engl J Med 2021; 384:1075-1076

  This letter describes early outcomes and challenges associated with a face transplantation in a Black patient.

• Perspective Mar 04, 2021 Without Sanctuary
  S.M. Ogunwole N Engl J Med 2021; 384:791-793

  I often reflect on how our society decides who deserves punishment and who deserves redemption. I think about grace, and how Black people get so little. And I think about the varied manifestations of Ms. A.’s pain — how no one, me included, offered her a sanctuary.

• Medicine and Society Mar 04, 2021 Misrepresenting Race
  C. Amutah and Others N Engl J Med 2021; 384:872-878

  Medical education and practice have not evolved to reflect advances in understanding of the relationships among race, racism, and health. Instead, race remains one of the most entrenched and polarizing topics in U.S. medical education.

  Correspondence The Role of Medical Schools in Propagating Physician Bias

• Correspondence Feb 25, 2021 Injuries from Less-lethal Weapons during the George Floyd Protests
  E.A. Kaske and Others N Engl J Med 2021; 384:774-775

  In this analysis involving patients treated in Minnesota during protests after George Floyd’s death, 89 patients were identified who had been injured by less-lethal weapons (45 by projectiles, including rubber bullets; 32 by chemical irritants; and 12 by both). A substantial number of patients sustained serious injuries, including injuries to the head and neck.

• Points of View Feb 11, 2021 One of Us
  R. Givens N Engl J Med 2021; 384:e18

  Susan Moore, Chaniece Wallace, Breonna Taylor. In 2020, even as Black people continued to die and get killed at disproportionate rates, Black health professionals continued to show up every day during the dual pandemics of Covid and police brutality.

• Points of View Feb 04, 2021 Beyond Tuskegee
  S.S. Bajaj and F.C. Stanford N Engl J Med 2021; 384:e12

  When we hyperfocus on a few historical racist atrocities, we ascribe current Black health experiences to past racism, rooting our present in immovable past events and undermining efforts to combat mistrust. Everyday racism, by contrast, can be tackled in the present.

• Medicine and Society Feb 04, 2021 Race and Genetic Ancestry in Medicine
  L.N. Borrell and Others N Engl J Med 2021; 384:474-480

  U.S. health inequities won’t be eliminated by abandoning the use of race and ethnicity in research and clinical practice, since these variables capture key epidemiologic information. But incorporating genetic ancestry, genotypes, or biomarkers requires further study.

  Correspondence Race and Genetic Ancestry in Medicine

• Perspective Feb 04, 2021 In Search of a Better Equation
  J.A. Diao and Others N Engl J Med 2021; 384:396-399

  Although many experts agree that we should reconsider the use of race in equations for estimated glomerular filtration rate and in medicine more generally, precisely how eGFR equations should change remains unclear.

• Points of View Dec 31, 2020 March On — Diversity in the Face of Adversity
  S. Jain, V.M. Arora, and K.D. Manning N Engl J Med 2020; 383:e145

  When a virtual White Coats for Black Lives “march” was disrupted by racist intruders, the organizers persevered. The diverse perspectives and collective support that allowed them to move forward are the tools needed for the long game of antiracism.

• Correspondence Dec 17, 2020 Racial Bias in Pulse Oximetry
  M.W. Sjoding and Others N Engl J Med 2020; 383:2477-2478

  The question of whether pulse oximetry measurements vary according to race has not been adequately studied, despite the wide use of this measure in clinical care. In this analysis, Black patients who had hypoxemia were more likely to have a normal pulse oximetry reading than were White patients.

  Correspondence More on Racial Bias in Pulse Oximetry Measurement

• Perspective Dec 17, 2020 Interviewed while Black
  J. Ellis and Others N Engl J Med 2020; 383:2401-2404

  Being interviewed as a Black applicant at the medical student, resident, fellow, or faculty level involves a collision of microaggressions and feelings and experiences related to stereotype threat, tokenism, imposter syndrome, and homophily.

• Medicine and Society Feb 25, 2021 How Structural Racism Works
  Z.D. Bailey, J.M. Feldman, and M.T. Bassett N Engl J Med 2021; 384:768-773

  As a legacy of African enslavement, structural racism affects both population and individual health in three interrelated domains: redlining and racialized residential segregation, mass incarceration and police violence, and unequal medical care.

• Points of View Dec 10, 2020 The Death of Daniel Prude
  D.A. Paul N Engl J Med 2020; 383:e135

  Mental health conditions are ubiquitous, and it is critical to seek help for them. For Black people, however, help comes with substantial risk. One manifestation of this risk ended Daniel Prude’s life, but it does not have to end his story.

• Perspective Dec 03, 2020 From Portraits to Role Models
  A.V. Owoseni N Engl J Med 2020; 383:2204-2205

  To become something, you must see it first — whether in the faces of those who have gone before you or in your own mind. The importance of role models is one reason why representation in medicine matters, because Black students need to see people who look like future versions of themselves.

• Perspective Interactive Perspective Dec 03, 2020 Mapping Inequities in Health and Opportunity
  The Health Opportunity and Equity (HOPE) Initiative N Engl J Med 2020; 383:e124

  Throughout the United States, health status and outcomes, access to care, and SES vary by race and ethnic group. An Interactive Perspective using data aggregated by the HOPE Initiative allows readers to view and compare data on a range of indicators for each state and for six racial and ethnic groups.

• Perspective Nov 12, 2020 Them and Me
  K.M. Simon N Engl J Med 2020; 383:1904-1905

  When an adolescent psychiatrist interviews parents of Black boys, he frequently comes away with a similar narrative — a story in which normative behavior is characterized as aberrant or behaviors classically associated with common diagnoses are misattributed.

• Perspective Nov 05, 2020 #WhiteCoatsForBlackLives
  J. Perritt N Engl J Med 2020; 383:1804-1806

  Just as interactions between Black people and police outside the hospital put our patients at risk, so does their criminalization within the health care system, which can be particularly harmful in the context of pregnancy, childbearing, and reproductive health.

• Perspective Nov 05, 2020 Community Health Workers and Covid-19
  P.J. Peretz, N. Islam, and L.A. Matiz N Engl J Med 2020; 383:e108

  Investing in community health workers and community-based organizations can help address the social determinants of poor health that disproportionately affect low-income, minority populations and that are magnified during times of crisis.

• Perspective Nov 26, 2020 Trustworthiness before Trust
  R.C. Warren and Others N Engl J Med 2020; 383:e121

  If Black communities are to participate in Covid-19 trials, clinicians, investigators, and pharmaceutical companies must provide convincing evidence — sufficient to overcome the extensive historical evidence to the contrary — that they are, in fact, trustworthy.

• Perspective Graphic Perspective Oct 08, 2020 A Sense of Belonging
  A. Blanchard, N. Koscal, and A.E. Burke N Engl J Med 2020; 383:1409-1411

  In this Graphic Perspective, an eager Black medical student wonders how she can compete when, lacking the generational privilege held by many White students, she is behind from the start. Her secret weapon is the mentorship of an accomplished senior professor.

• Perspective Nov 26, 2020 Reparations as a Public Health Priority
  M.T. Bassett and S. Galea N Engl J Med 2020; 383:2101-2103

  The Black–White health gap is inseparable from the enormous gap in resources between U.S. Blacks and Whites. The radical implication of this link is that what really needs fixing is access to resources. One means for fixing it is Black reparations for slavery.

• Points of View Oct 08, 2020 The Path Forward
  H. Yousif, N. Ayogu, and T. Bell N Engl J Med 2020; 383:e91

  Reversing the effects of hundreds of years of racism is a daunting undertaking, but academic medicine can begin by adopting an antiracist approach to training and supporting physicians with adequate representation, increased influence, and institutional resources.

• Perspective Fundamentals of U.S. Health Policy Sep 10, 2020 Health Equity
  M.K. Evans N Engl J Med 2020; 383:997-999

  Our health care system is a microcosm of U.S. society: its resources are not allocated fairly among races. Though various factors influence prevention and management of chronic diseases, access to care through stable insurance coverage may have the most profound effect.

• Correspondence Sep 10, 2020 Genetic Alterations in Prostate Cancer
  B.A. Mahal and Others N Engl J Med 2020; 383:1083-1085

  Among nearly 2400 men with prostate cancer, next-generation sequencing of 474 genes showed differences among racial groups in the frequency of mutations in certain genes. Such variations could affect both prognosis and response to therapy in these patients.

• Perspective Sep 10, 2020 Covid-19 and Disparities in Nutrition and Obesity
  M.J. Belanger and Others N Engl J Med 2020; 383:e69

  Though the factors underlying racial and ethnic disparities in Covid-19 in the United States are multifaceted and complex, long-standing disparities in nutrition and obesity play a crucial role in the health inequities unfolding during the pandemic.

• Points of View Sep 10, 2020 The Performance of “Antiracism” Curricula
  K.J. Gutierrez N Engl J Med 2020; 383:e75

  We have seen medical institutions being compelled to deliver statements on diversity and inclusion, with subsequent mandatory training on cultural competence, health disparities, and the like. These approaches fail because they do not reveal racism — they cover it up.

• Points of View Sep 03, 2020 Taking Black Pain Seriously
  O. Akinlade N Engl J Med 2020; 383:e68

  The onus of advocacy for suffering Black patients has been placed almost solely on this country’s disproportionately few Black clinicians — an unsustainable situation, particularly since they are already shouldering the effects of systemic racism on their own lives.

• Points of View Sep 17, 2020 Am I Racist?
  D.N. Korones N Engl J Med 2020; 383:e80

  “We’re Black,” said my teenage patient’s aunt, “and we know how the system works.” Having lived her life in a system that didn’t work for people of color, how could she see my unilateral decision to make her dying nephew DNR in any other way?

• Correspondence Sep 10, 2020 Penetrating Injuries from “Less Lethal” Beanbag Munitions
  K.A. Olson and Others N Engl J Med 2020; 383:1081-1083

  This report from a level 1 trauma center located near the site of protests describes several serious injuries resulting from use of beanbag munitions by police for crowd control.

• Perspective Nov 12, 2020 Racism and Sickle Cell Disease
  A. Power-Hays and P.T. McGann N Engl J Med 2020; 383:1902-1903

  As medical leaders around the United States issue statements denouncing racial injustice and calling for the dismantling of racism, we must ensure that these pledges translate into durable improvements for patients with sickle cell disease.

• Perspective Aug 27, 2020 Racial Disproportionality in Covid Clinical Trials
  D.B. Chastain and Others N Engl J Med 2020; 383:e59

  To provide the necessary data for generalizing efficacy and safety outcomes across racial groups, Covid-19 clinical trials must prioritize inclusion of patient populations that reflect the demographics of the ongoing pandemic, especially in the United States.

  Correspondence Racial Disproportionality in Covid Clinical Trials

• Perspective Aug 27, 2020 Why Counting Black Lives Matters
  M.A. Schuster, A. Osherov, and P.J. Chung N Engl J Med 2020; 383:e60

  A confluence of events has substantially increased the likelihood of undercounts of non-White populations in the U.S. census, at a time when such undercounts might be particularly damaging to urgent societal efforts in the coming decade to improve racial and ethnic equity.

• Points of View Aug 20, 2020 What Is Liberty?
  S. Hébert-Magee N Engl J Med 2020; 383:e58

  I was grateful that in this final hour, the hospice nurse wanted to examine the details of my mémère’s health, to unpack her pain. But throughout her life, there had been no liberation in health care for the poor, just symptom containment.

• Points of View Aug 13, 2020 The Conversations We’ve Been Having
  N. Ncube N Engl J Med 2020; 383:e51

  It’s striking that the conversations about race being had by many racial justice allies are new to them. For many Black Americans, such talks are a nearly daily occurrence. And it has often fallen to Black medical students to have these conversations with Black patients.

• Points of View Aug 06, 2020 The Expert When the Only
  C. Phillips N Engl J Med 2020; 383:e42

  A lack of competency in engaging with Black patients is the reality in Canada, where Black communities have been undertreated for their pain and have reported barriers to Covid-19 testing. Reforming medical education and addressing institutional racism are the answers.

• Points of View Aug 06, 2020 The Goals of Care
  T. Williamson N Engl J Med 2020; 383:e43

  Why could I establish trust that White clinicians could not? Was it just the color of my skin? I believe that in this Black patient, I saw someone I knew, a story I recognized. I saw him, and his family knew that.

• Perspective Jul 30, 2020 Covid’s Color Line
  M.K. Evans N Engl J Med 2020; 383:408-410

  The disproportionate effect of the Covid-19 pandemic on African Americans, Latinx Americans, and Native Americans is not unforeseen. Inequities in health, health care access, and quality of care are ingrained in our health care system, and they must be addressed now.

• Perspective Oct 08, 2020 Beyond a Moment
  D.W. Paul, Jr., and Others N Engl J Med 2020; 383:1404-1406

  To go beyond declarations and move forward with fighting racism in medicine, we must understand the racial biases in our responses to past and present public health issues and plot an ethically and structurally different path to a new future.

• Points of View Jul 23, 2020 Why I Stay
  A. Forrester N Engl J Med 2020; 383:e24

  Many underrepresented-minority physicians have left academic medicine because they felt invisible and voiceless, lacked mentorship and support, and faced microaggressions. But some have stayed, recognizing that the voiceless cannot be heard without representation.

• Points of View Jul 23, 2020 Diversity, Equity, and Inclusion That Matter
  V. Grubbs N Engl J Med 2020; 383:e25

  Academic medical institutions’ idea of addressing institutional and systemic racism often begins and ends with naming a diversity-equity-inclusion chief. But in this unprecedented time, perhaps they will take real action to address these issues within their own walls.

• Perspective Sep 17, 2020 Structural Racism, Social Risk Factors, and Covid-19
  L.E. Egede and R.J. Walker N Engl J Med 2020; 383:e77

  The Covid-19 pandemic clearly illustrates the intersection of structural racism, social risk factors, and health. But with a concerted effort that encompasses multiple sectors, we can change the entrenched factors that lead to disparities in health.

• Perspective Sep 17, 2020 Covid-19 and Health Equity — Time to Think Big
  S.A. Berkowitz, C.W. Cené, and A. Chatterjee N Engl J Med 2020; 383:e76

  U.S. health inequities have structural causes warranting policy-level solutions. The Covid-19 health equity disaster carries some lessons from which we can derive actionable policy targets for both advancing health equity and improving the pandemic response.

• Medicine and Society Jul 16, 2020 Structural Solutions for the Rarest of the Rare
  K.M. Doll and C.R. Thomas, Jr. N Engl J Med 2020; 383:283-285

  Medical subspecialties continue to have extremely low numbers of racial and ethnic minority faculty, and their resistance to diversification can impede the success of minority hires. But there are ways to cultivate the retention and promotion of such faculty members.

• Perspective Jul 16, 2020 Stolen Breaths
  R.R. Hardeman, E.M. Medina, and R.W. Boyd N Engl J Med 2020; 383:197-199

  In the wake of George Floyd’s public execution, uprisings have ignited in cities throughout the United States. The words “I can’t breathe” hang heavy in the air. Black people cannot breathe because we are currently battling at least two public health emergencies.

  Correspondence Correcting “Stolen Breaths”

• Points of View Jul 30, 2020 Professionalism 101 for Black Physicians
  D. AbdelHameid N Engl J Med 2020; 383:e34

  For a Black physician, “professionalism” can be exhausting, back-breaking. It often means suppressing her rage, biting her tongue, wiping her tears over racist outrages, and wearing forced smiles to cover the layers of sadness she feels.

• Perspective Sep 17, 2020 Sticks and Stones
  L. Caulley N Engl J Med 2020; 383:1103-1105

  Even as we focus greater attention on combating racist violence, we should remember that racialized language and discriminatory behavior can also have dire consequences, including effects on mental and physical health. We need to fight racism in all its manifestations.

• Perspective Oct 22, 2020 Taking Back Our Voices — #HumanityIsOurLane
  C.T.M. Anderson N Engl J Med 2020; 383:1609-1611

  How does racism affect our patients? What traumas do they face daily? And what can physicians do about it? In pondering these questions, a psychiatry resident realizes that medicine itself, with its inherent bigotry, has conditioned him to silence: he’s lost his voice.

• Special Article Jun 25, 2020 Black Patients and White Patients with Covid-19
  E.G. Price-Haywood and Others N Engl J Med 2020; 382:2534-2543

  A retrospective cohort study analyzed data from a Louisiana health system whose population is 31% black non-Hispanic. A total of 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died from the disease were black. Black race was not associated with higher in-hospital mortality after adjustment for patients’ baseline characteristics.

• Perspective Jun 25, 2020 How Medical Education Is Missing the Bull’s-eye
  L. Nolen N Engl J Med 2020; 382:2489-2491

  If medical students and trainees are taught to recognize symptoms of disease in only white patients and learn to perform lifesaving maneuvers on only male-bodied mannequins, medical educators may be unwittingly contributing to health disparities.

• Correspondence Jul 23, 2020 If I Die Tonight
  M.E. Dingle N Engl J Med 2020; 383:402

  In this poem, a surgeon reflects on civil rights activism in response to killings of black people. He touches on both family history and the complexity of being black in America.

• Medicine and Society Aug 27, 2020 Hidden in Plain Sight
  D.A. Vyas, L.G. Eisenstein, and D.S. Jones N Engl J Med 2020; 383:874-882

  Diagnostic algorithms and practice guidelines that adjust or “correct” their outputs on the basis of a patient’s race or ethnicity guide decisions in ways that may direct more attention or resources to white patients than to members of racial and ethnic minorities.

• Editorial Jul 16, 2020 Diagnosing and Treating Systemic Racism
  M.K. Evans and Others N Engl J Med 2020; 383:274-276

  Our country’s long and troubled history of racism has permeated the physician–patient relationship with mistrust. Now, amid an acute public health crisis that is transforming medicine, perhaps we have an opportunity to reset our priorities to face this deeper, more chronic crisis as well.

• Perspective Jul 16, 2020 Creating Real Change at Academic Medical Centers
  M. Morse and J. Loscalzo N Engl J Med 2020; 383:199-201

  Capitalizing on the urgency generated by the Black Lives Matter movement, residents and faculty at an academic health care institution take steps to recognize racism within the hospital environment and act to address it.

• Editorial Audio Interview Jun 11, 2020 The Impact of Covid-19 on Minority Communities
  E.J. Rubin and Others N Engl J Med 2020; 382:e111

  In this audio interview conducted on June 10, 2020, the editors are joined by Dr. Michele Evans of the National Institutes of Health to discuss a new study examining the disproportionate effect of Covid-19 on minority communities.

• Perspective Jul 23, 2020 Inequity in Crisis Standards of Care
  E. Cleveland Manchanda, C. Couillard, and K. Sivashanker N Engl J Med 2020; 383:e16

  Recent state-based crisis standards of care that provide a color-blind process for determining whether a patient with Covid-19 respiratory failure lives or dies are alarming, since color-blind policies result in discrimination against communities of color.

• Perspective Jul 16, 2020 Racial Health Disparities and Covid-19
  M. Chowkwanyun and A.L. Reed, Jr. N Engl J Med 2020; 383:201-203

  In documenting Covid-19 racial disparities, we must contextualize such data with adequate analysis. Disparity figures without explanatory context can perpetuate harmful myths and misunderstandings that actually undermine the goal of eliminating health inequities.

• Medicine and Society Nov 07, 2019 Health, Social Reform, and Medical Schools
  M. Chowkwanyun and B. Howell N Engl J Med 2019; 381:1870-1875

  The current revival of activism among U.S. medical students can be understood in the context of a dissenting tradition in medical training. Though never in the mainstream, trainee-activists have repeatedly reimagined what the profession could be at its best.

• Perspective Aug 29, 2019 Insight Medicine Lacks
  S. Kemet N Engl J Med 2019; 381:800-801

  The story of Henrietta Lacks’s treatment by the medical system remains relevant today. Black American patients still express greater concern than white ones about the likelihood of experiencing harm from participating in clinical trials, and they are right to worry.

• Perspective Aug 01, 2019 “Browner” — Creating Narratives of Race
  T. Vijayan N Engl J Med 2019; 381:404-405

  Creating narratives based on race is both a cultural norm and a primal response to a desire to understand our world. By acknowledging how much race shapes our identities and interactions, we can begin documenting our experiences as perpetuators of these narratives.

• Perspective Aug 01, 2019 Ghosts of Our Collective Subconscious
  D.W. Paul, Jr. N Engl J Med 2019; 381:402-403

  What do racist images in a 1980s medical school yearbook mean for medical education today? The real and persistent fear among medical students of color is that we are all so bathed in a culture of racism that we are blind to the biases that lie hidden within us.

• Perspective Case Studies in Social Medicine Apr 18, 2019 Structural Racism
  K. Pallok, F. De Maio, and D.A. Ansell N Engl J Med 2019; 380:1489-1493

  A woman on Chicago’s primarily black South Side is seen for a breast lump at a community hospital that lacks the resources for high-quality cancer care. A navigator from the Metropolitan Chicago Breast Cancer Task Force reroutes her to a qualified medical center.

• Perspective Feb 28, 2019 Patient-Experience Data and Bias
  K.G. Poole, Jr. N Engl J Med 2019; 380:801-803

  Although patient-experience data are important to U.S. health care organizations, the best way to interpret them remains elusive, in part because such variables as race–race concordance between physician and patient correlate with improved patient satisfaction.

• Perspective Case Studies in Social Medicine Jan 17, 2019 The Structural Violence of Hyperincarceration
  G. Karandinos and P. Bourgois N Engl J Med 2019; 380:205-209

  After an uninsured Puerto Rican man with back pain, other chronic conditions, and a history of incarceration admits to a doctor at a free clinic that he’s bought oxycodone illegally, he refrains from filling his prescription or returning to the clinic, fearing rearrest.

• Perspective Feb 28, 2019 Racist Like Me
  D. Cohan N Engl J Med 2019; 380:805-807

  I am racist, shaped by the sometimes subtle tendrils of white supremacy deeply embedded in our culture. I mean this not as a sanctimonious admission of guilt, but as a call to self-reflection and action for us white physicians.

• Perspective Dec 01, 2016 Structural Racism and Supporting Black Lives — The Role of Health Professionals
  R.R. Hardeman, E.M. Medina, and K.B. Kozhimannil N Engl J Med 2016; 375:2113-2115

  Structural racism leads to increased rates of premature death and reduced levels of overall health and well-being — an epidemic affecting our whole society. As clinicians and researchers, we wield power, privilege, and responsibility for dismantling structural racism.

• Perspective Mar 19, 2015 #BlackLivesMatter — A Challenge to the Medical and Public Health Communities
  M.T. Bassett N Engl J Med 2015; 372:1085-1087

  U.S. medical students have staged “white coat die-ins” in support of the #BlackLivesMatter movement, but should the medical community do more? Should health professionals be accountable for fighting the racism that contributes to poor health in the first place?

• Perspective Mar 19, 2015 Bias, Black Lives, and Academic Medicine
  D.A. Ansell and E.K. McDonald N Engl J Med 2015; 372:1087-1089

  Biases within academic medical centers affect the lives of black people in the United States. Doctors' racial stereotypes can influence their clinical decisions, and black–white disparities persist in patient outcomes, medical education, and faculty recruitment.

• Special Article Dec 11, 2014 Racial and Ethnic Disparities among Enrollees in Medicare Advantage Plans
  J.Z. Ayanian and Others N Engl J Med 2014; 371:2288-2297

  In this sample of enrollees in Medicare HMOs, control of blood pressure, cholesterol, and glycated hemoglobin was better for whites than for blacks. Disparities in 2006 persisted in 2011, except in the West, where Kaiser Permanente plans closed the gap in these measurements.

  Editorial How to Achieve Health Equity

• Special Article Dec 11, 2014 Quality and Equity of Care in U.S. Hospitals
  A.N. Trivedi and Others N Engl J Med 2014; 371:2298-2308

  In this study, performance improved between 2005 and 2010 on quality measures for white, black, and Hispanic adults hospitalized for myocardial infarction, heart failure, or pneumonia. The 2005 differences in quality of care for whites and minority groups were smaller by 2010.

  Editorial How to Achieve Health Equity

• Original Article Sep 02, 2010 Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease
  L.J. Appel and Others N Engl J Med 2010; 363:918-929

  This trial tested whether intensive blood-pressure control retards the progression of chronic kidney disease in black patients with hypertension. Although there was an apparent benefit among patients with baseline proteinuria (urinary protein-to-creatinine ratio, >0.22), those with a normal protein-to-creatinine ratio had no benefit. Among all patients, intensive blood-pressure control had no effect on disease progression.

  Editorial Hypertension Control in African-American Patients with Chronic Kidney Disease

• Special Article Aug 18, 2005 Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002
  V. Vaccarino and Others N Engl J Med 2005; 353:671-682

  This study compared treatments and outcomes after myocardial infarction according to sex and race from 1994 through 2002. As compared with white men, black men and both white and black women had lower rates of reperfusion therapy and coronary angiography, and black women had higher mortality. Sex and racial differences did not change substantially between 1994 and 2002.

  Editorial Health Disparities — Less Talk, More Action

• Special Article Aug 18, 2005 Racial Trends in the Use of Major Procedures among the Elderly
  A.K. Jha and Others N Engl J Med 2005; 353:683-691

  More than a decade ago, it was established that there were significant differences in the rates of major surgical procedures between blacks and whites. These investigators examined nine surgical procedures and found that the racial differences noted in 1992 persisted in 2001.

• Special Article Aug 18, 2005 Trends in the Quality of Care and Racial Disparities in Medicare Managed Care
  A.N. Trivedi and Others N Engl J Med 2005; 353:692-700

  In this study examining trends from 1997 to 2003 for white patients and black patients enrolled in Medicare managed care, performance on all nine quality measures improved for both blacks and whites, and racial disparities narrowed for seven of the nine measures. These findings suggest that efforts to improve care for all patients result in reductions in racial disparities.

• Special Article May 02, 2002 Participation in Research and Access to Experimental Treatments by HIV-Infected Patients
  A.L. Gifford and Others N Engl J Med 2002; 346:1373-1382

  There is concern that minority groups and women are underrepresented in research trials and are less likely to receive experimental treatments for human immunodeficiency virus (HIV) infection. This study of patients with HIV infection in the United States found that blacks and Hispanics were less likely to participate in trials than whites and to have received experimental medications. Women were not underrepresented in trials and were as likely as men to receive experimental treatments.

  Editorial Racial Disparities in Clinical Trials