The antiracist agenda for medicine — and the backlash it's received

"An Antiracist Agenda for Medicine," published by Boston Review on March 17, 2021, lays out a path for healthcare organizations to build a proactively antiracist agenda for medicine. The article has been highly controversial among the American public. 

The article is penned by Bram Wispelwey, MD, associate physician in the Division of Global Health Equity at Boston-based Brigham and Women's Hospital, instructor in medicine at Boston-based Harvard Medical School, senior fellow at Atlantic Fellows for Health Equity, co-founder and chief strategist of Health for Palestine, and senior project lead in Partners In Health's U.S. Public Health Accompaniment Unit; and Michelle Morse, MD, deputy commissioner for the Center for Health Equity and Community Wellness, first chief medical officer at the New York City Department of Health and Mental Hygiene, co-founder of EqualHealth and assistant professor at Harvard Medical School. 

The physicians examined 10 years of data at Brigham and Women's and found Black and Latinx patients were less likely than white patients to be admitted to cardiology service, which was tied to better overall outcomes. The two physicians, along with a coalition of fellow practitioners and hospital leaders, developed what they aim to be a replicable pilot program that directly addresses racial healthcare inequities. The program, called "The Healing ARC," is based around a reparations framework from William Darity, PhD, researcher and economist at Duke University. 

Below are the three steps of "The Healing ARC": 

1. Acknowledgment 

Providers must acknowledge how racism has contributed to unequal health outcomes. At Brigham and Women's, providers inform patients about the heart failure findings, claiming responsibility and incorporating community ideas for redress.  

2. Redress

Healthcare institutions should redress damage by providing restitution to the harmed population while also offering pathways for access to services and care that have historically been denied. Redress could take multiple forms, from cash transfers and discounted or free care to taxes on nonprofit hospitals that exclude patients of color and race-explicit protocol changes. 

Drs. Morse and Wispelwey have taken redress to mean providing what was denied for at least a decade: a preferential admission option for Black and Latinx heart failure patients to Brigham and Women's specialty cardiology service. The Healing ARC includes a flag in the EHR and admissions system suggesting providers admit Black and Latinx heart failure patients to cardiology, rather than rely on provider discretion or patient self-advocacy. The institution is  currently analyzing the approach to see how well it generates equitable admissions.  

Offering preferential care based on race or ethnicity may elicit legal challenges, the authors wrote. However, they said ample current evidence shows the U.S. health, judicial and other systems already unfairly preference people who are white, and they believe the approach is corrective and therefore necessary.  

3. Closure 

The community, patient stakeholders and institutional representatives must agree the institutional debt has been paid, and that a new system is in place to ensure the problem won't reemerge. 

The article has been the source of much controversy and backlash, according to a Feb. 16 report from The New England Journal of Medicine. Some media mischaracterized tenets of race-conscious medicine, "claiming that efforts to overcome inequities would result in white people being denied medical care," the article's authors write.

On Jan. 22, 2022, neo-Nazis protested at Brigham and Women's Hospital with a banner that said the hospital "kills whites" and flyers with pictures of Dr. Morse, a Black woman, and Dr. Wispelwey, a white man. The group denounced the physicians and hospital for "creating preferential healthcare treatment policies for non-white patients," according to NEJM.

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