The Ally Book Club: A Tool for Challenging Racism

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Jeffrey B Ritterman, MD¹; Miranda Ritterman Weintraub, PhD, MPH²

Perm J 2021;25:20.253

https://doi.org/10.7812/TPP/20.253

E-pub: 03/01/2021

The Black Lives Matter movement has encouraged many of us to challenge our personal racism and to uproot the racism within our institutions. This is a national project, long overdue. While we have watched with interest the toppling of Confederate statues, we were surprised to learn that we, in medicine, have statues of our own that need removal. The marble statue of Dr James Marion Sims that once graced New York City’s Central Park no longer stands. For years, it proudly faced the New York Academy of Medicine. Other statues of Dr Sims can be found at South Carolina’s Statehouse and on the Alabama State Capitol grounds.

Dr Sims himself once stood at the top of the American medical hierarchy. In 1875 he was elected President of the American Medical Association. He has been venerated as the “Father of Gynecology” and as a selfless benefactor to women. But there was a malevolent side to Dr Sims. He not only was a slaveholder himself, but he practiced and perfected his gynecological surgery on slaves. Despite the availability of ether at the time, he chose to do this without anesthesia. The slave patients would cry out as they were forcibly held down while Sims sliced and sutured their genitalia. Our work in uprooting racism in medicine will not be finished while statues of Sims still stand. But there is much more that we also need to do.

One of us is a white doctor, the other a white epidemiologist. We both had the privilege of attending excellent colleges and postgraduate schools. We have participated in continuing education throughout our careers. But we did not learn about Dr Sims and his mistreatment of slaves in college, in medical or graduate school, nor during our many continuing education courses and trainings. We learned about Dr Sims from reading “Medical Apartheid”1 by Harriet Washington and “Medical Bondage”2 by Deirdre Cooper Owens. Since we did not learn about racism in medicine during our formal education, we began a self-education project. We also read White Fragility: Why it’s so Hard for White People to Talk about Racism3 by Robin DiAngelo, How To be an Antiracist4 by Ibram X. Kendi, and Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland5 by Jonathan M. Metzl.

The level of scholarship in these books is quite extraordinary. Washington has won many awards for Medical Apartheid, including the National Book Critics Circle Award for Nonfiction. Cooper Owens’ Medical Bondage breaks new ground by telling the stories of the exploited slaves who endured experimental surgeries that were the basis for advances in gynecology. Kendi won the National Book Award for his earlier book, Stamped From the Beginning. How to be an Antiracist is listed by the New York Times Book Review as 1 of 100 Notable Books for 2019. DiAngelo’s White Fragility is a New York Times #1 Bestseller. The American Journal of Public Health wrote that Metzl’s Dying of Whiteness “has the potential to transform thinking so thoroughly that if offers to change a paradigm.”

In addition to these books, we also found a journal article helpful in understanding how racism has penetrated American medicine. The article, in the prestigious journal The Proceedings of the National Academy of Sciences,6 showed that half of the medical students and medical residents tested had the misbelief that African Americans are less sensitive to pain than white patients and would have undertreated them in a clinical situation.

The books and the article changed us. We were shocked and horrified by some of what we learned. We also felt a responsibility to share the information widely with everyone involved in medical care. Our mission is to educate ourselves and our colleagues and then to actively uproot racism in medicine and in healthcare.

We have started a Book and Journal Club within Kaiser Permanente to begin to address racism in medicine. The leader of the Kaiser East Bay Club, Dr Noriko Yoshikawa, named it the “Becoming an Ally Book Club” and explained its purpose this way:

This book club is geared towards those who are wondering how to combat racism. The recent murders of George Floyd, Ahmaud Arbery and Breonna Taylor have been, for many of us, the most recent wake up call, that there is something very wrong in our society. And yet, we find ourselves not knowing exactly what we can do to help move things in the right direction. In this book club, we will be exploring books to help guide us, in better understanding racism in our society, and what part we are playing in racism.

But what does it mean to combat racism? Ibram Kendi asserts that the only way to combat racism is to “become an antiracist.” He explains:

But there is no neutrality in the racism struggle. The opposite of “racist” isn’t “not racist.” It is antiracist…One endorses either the idea of a racial hierarchy as a racist, or racial equity as an antiracist…There is no in-between safe space of “not racist.”7

Kendi teaches us that, “the only way to undo racism is to consistently identify and describe it—and then dismantle it.”7 In his remarkable book, Kendi shares with us his successful struggle against advanced colon cancer. He goes on to describe racism as a cancer and asks, “What if we treated racism in the way we treat cancer?” For a medical audience there could be no more apt analogy. Kendi’s prescription:

Saturate the body politic with the chemotherapy or immunotherapy of antiracist policies that shrink the tumors of racial inequities, that kill undetectable cancer cells. Remove any remaining racist policies, the way surgeons remove the tumors. Ensure there are clear margins, meaning no cancer cells of inequity left in the body politic, only the healthy cells of equity…Detect and treat a recurrence early, before it can grow and threaten the body politic.”8

One of us (J.B.R.) joined Kaiser Richmond in 1981, while the other (M.R.W.) was just a child. Since that time Kaiser Permanente has made enormous strides in providing excellent health care and has become a leader in American medicine. What will it take for Kaiser to become the leader in uprooting racism from medicine and healthcare?

We owe our excellence in providing healthcare to an integrated team of primary care providers, specialists, subspecialists, nurses, technicians, engineers, pharmacists, housekeepers, managers, planners, researchers, epidemiologists, phlebotomists, medical assistants, and more. We also benefited from visionary leaders. To become a leader in uprooting racism, we need everyone on our team to unlearn their own personal racism and to learn how to become an antiracist. We need our leadership to once again provide us with a vision that propels us into a positive and just future.

Many of us in medicine have attended journal clubs to help keep us up to date. It will take a lot of education to get us up to date on uprooting racism. What will Kaiser be like a year from now if all of the white staff, and everyone else who wants to, join Ally Book Clubs? While we have just begun and our experience is limited, we happily offer our help to anyone who would like to begin an Ally Book Club.

While reading books and articles is a great place to start, we must be mindful that we also need to act. In the “Book Club” discussion groups, we can begin, together, to address larger issues. What hiring practices should Kaiser Permanente adopt in order to diversify our workforce? What can Kaiser do to build the educational pipeline to support African American success from elementary school through college and medical/nursing/physician assistant school to a successful career at Kaiser? What trainings do we need to develop to ensure that our workforce is antiracist? What should the Kaiser Medical School curriculum include to educate future doctors to become antiracist providers? What special efforts are needed to address racial disparities in health outcomes? What research should Kaiser engage in to lessen racial health disparities?

Together, we can begin to address these questions, and more, as we move toward a healthier and more just society. It’s what the work of doctoring is all about.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Acknowledgments

Kathleen Louden, ELS, of Louden Health Communications performed a primary copy edit.

Author Affiliations

¹Department of Cardiology, Kaiser Permanente Richmond Medical Center, Richmond, CA

²Department of Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, CA

Corresponding Author

Miranda Ritterman Weintraub, PhD, MPH, ()

Author Contributions

JBR development of manuscript. MRW revision of manuscript.

Funding

None.

References

1. Washington HA. Medical apartheid. New York, NY: Anchor Books; 2008.

2. Owens DC. Medical bondage. Athens, GA: University of Georgia Press; 2017.

3. Diangelo R. White fragility. Boston, MA: Beacon Press; 2018.

4. Kendi IX. How to be an antiracist. New York, NY: Random House; 2019.

5. Metzl JM. Dying of whiteness. New York, NY: Basic Books; 2019.

6. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA 2016 April;113:4296-301. DOI: https://doi.org/10.1073/pnas 15160471131073 Accessed August 20, 2020.

7. Kendi IX. How to be an antiracist. New York: Penguin Random House LLC; 2019; p 9.

8. Kendi IX. How to be an antiracist. New York: Penguin Random House LLC; 2019; p 237-8.

Keywords: antiracist, Black, racism, race, White