MICHEL MARTIN, host:
I'm Michel Martin, and this is Tell Me More from NPR News. Coming up, cheap summer vacation may sound like an oxymoron, but we will offer some thoughts about enjoying time off without going broke. It's the first of our series for Cheapskate Week. But first, medicine and race.
Well, into the 1960s, many state and local medical associations openly discriminated against black physicians. The American Medical Association, the country's largest, and for many of the voice of the nation's health professionals, either ignored or abetted this discrimination. The AMA recently concluded a study about the history of medicine's racial divide, and that study, which is being published on the AMA website this week, culminated in an official apology towards the African-American medical community.
Joining us to talk about this are Dr. Carl Bell. He's a professor of public health and psychiatry at the University of Illinois at Chicago Medical School, and Dr. Ronald Davis, the immediate past president of the AMA. Gentlemen, thank you both so much for speaking with us.
Dr. CARL BELL (Professor, Psychiatry and Public Health, University of Illinois at Chicago): Thank you.
Dr. RONALD DAVIS (Former President, American Medical Association): Good to be with you.
MARTIN: Dr. Davis, if we could start with you. I understand the apology is the culmination of the study started in 2005 about the history of the racial divide. Can you tell us a little bit about the study?
Dr. DAVIS: Sure. We set up an independent research team to look at the history of the AMA and our treatment of African-American physicians. We opened up our archive of documents to that team, which goes back to 1847, the year that the AMA was born. And after several years, the group came out with their preliminary findings late last year. And after we took a look at the findings of the committee, the AMA leadership was profoundly apologetic for what had been discovered.
We knew that there had been problems in the past and after all of the detail was collected, we felt horrible about what had been uncovered, even more so than the anecdotal stories that we had heard previously. And we felt that we wanted to issue a very public, very official apology on behalf of the entire organization to African-American physicians and the organizations that represent them.
MARTIN: What does an apology accomplish in your view and in the view of the AMA leadership?
Dr. DAVIS: Well, obviously the people who are around today in the AMA leadership were not present many, many decades ago when these problems existed. These problems occurred around the time of the Civil War, all the way through the 1960s. But we felt that what a group apology like this does is it indicates the current moral orientation of the organization, and it lays down a marker that we can use to judge our current and future activities. This apology is really all about looking at our past so that we can build a better future working with people like Dr. Bell and leaders of the National Medical Association.
MARTIN: Dr. Bell, what's your reaction to the apology?
Dr. BELL: It's somewhat late. I experienced it, so I don't know that there was a study needed. I would like for the AMA to recognize that these things are still going on. If you look at health disparities in African-American people, that's I think directly related to the historical racism that was perpetrated against African-American physicians. And I understand the need to try to distance themselves from the past and say that wasn't us, we're this new group of people, but that stuff is still going on.
MARTIN: Could we talk about your experiences, Dr. Bell, for a minute? You'd indicated - you just said, you know, I lived it. Tell us, if you would, a little bit of...
Dr. BELL: Well, you know...
MARTIN: What you experienced.
Dr. BELL: Graduated from the University of Illinois with a B-plus average in two years, with a major in biology and two minors, one in math, one in chemistry. You would think they would have been able to let me into medical school, but back then in '67, I had to wind up going to Meharry, a black medical school. Which, by the way, was one of the better things because they taught me public health, and I suspect had I gone to the University of Illinois, I would be practicing money instead of medicine in 2008.
I've heard multiple stories from various impaired physicians, you know, physicians who get caught up in drugs or problems with mental illness, and they go to the AMA's impaired-physician program. And as usual in this country, when blacks commit crime they get harsher punishments than whites. That continues to occur, and just watching the poor health care that African-Americans receive, the AMA's constant trade-association refusal to endorse national health insurance so that we could join the rest of the civilized world. Things like that are offensive to me.
MARTIN: What are some of the patient impacts, Dr. Bell, of this history of discrimination? What do you think the impact on health has been?
Dr. BELL: Well, clearly the impact on health has been earlier death, 67 years in African-Americans, higher rates of infant mortality, cancer, lung disease, heart disease, diabetes, a lack of - I mean, when we worked on Dr. Satcher's culture, race, and mental health report...
MARTIN: The former Surgeon General.
Dr. BELL: The former Surgeon General, 16th Surgeon General. What became extremely clear was that there has been very little, very, very little research on African-American health problems, and all of that has fallen to the National Medical Association and black physicians, and we just did not and have not had the infrastructure or the resources to do a very good job at that.
And yet, we are on this planet together. We all share the same health ecology. So, I remember when Satcher was trying to go Zaire to study the Ebola virus, Congress said, what's that got to do with us? And he had to tell the germs don't need a passport. The AMA has done some good things. They did develop a prison health-care system that spun off to the National Commission on Correctional Health Care, but then they've just been benignly neglectful of African-American health issues.
MARTIN: If you're just joining us, you're listening to Tell Me More from NPR News. I'm speaking with Dr. Carl Bell and immediate past president of the AMA, Dr. Ronald Davis, about the AMA's apology for its past treatment of African-American physicians, and I would have to say African-American communities as well.
Dr. Davis, the AMA is following the path of a number of institutions, particularly the states that have expressed regret for their past roles in discrimination or slavery for example. But some people argue that this is too little, too late, and that it actually lets the community off the hook for present and future conduct. What do you say about that?
Dr. DAVIS: Well, we look at it in a positive way, and certainly we wish that we would have been in a better position to issue an apology earlier on, but we felt that it was better to collect all the data and have this independent writing team produce a very scholarly report on exactly what happened through the years.
And let me just respond to some of the specifics that Dr. Bell raised, and we agree with him wholeheartedly that the AMA and all other health-care stakeholders need to pay much more attention to the problems of the African-American doctor, and the problems of the African-American patient and consumer. And so, for example, in recent years, about five years ago in fact, the AMA worked with the National Medical Association, which represents African-American doctors, and the National Hispanic Medical Association, which of course represents Hispanic physicians, to form a very important national coalition called the Commission to End Healthcare Disparities.
We've been working hard to raise awareness that health-care disparities by race and ethnicity do exist, and that we need to develop and implement strategies to reduce and ideally eliminate them, and that commission has been hard at work in doing exactly that. This year we've given out 120,000 dollars of scholarships to minority medical students to help deal with rising tuition and financial indebtedness. Now, that's not going to solve the problem, but it's our part which we hope other people will join.
We also have an important program that was started by the AMA's Minority Affairs Consortium, called Doctors Back to School, where we send physicians, typically minority physicians, to minority communities to talk to students in elementary school, middle school, high school, about how they too can aspire to become a doctor so that they can help take care of people in their own communities, so we can get more minorities into the physician pipeline. Only about 2.2 percent of practicing physicians and medical students are African-Americans in this country...
MARTIN: And that figure has been constant for what? Like a hundred years?
Dr. BELL: For - yeah, forever...
Dr. DAVIS: Yeah. A long...
Dr. DAVIS: A long time, a long time.
MARTIN: Why is that, Dr. Davis?
Dr. DAVIS: And clearly...
MARTIN: Why do you think that is?
Dr. DAVIS: It's clearly - it's way below the 13 percent of the general population that are African-American. And we are doing a little bit better in some aspects of the AMA, where five percent of our committee members and our section leaders are African-American. But all of us need to do more, so that - and here's the two goals for the future that I have to underscore. So that we have at least as much diversity in the physician population as we do in the general population, and so that we have zero tolerance for discrimination against any patient based on race, ethnicity, gender, sexual orientation, or any other characteristic.
MARTIN: Dr. Bell, this raises a final thought that I wanted to get from you which is, because of ongoing patterns of migration around the world, this country is increasingly diverse. There isn't just a black-white dynamic anymore...
Dr. BELL: Right.
MARTIN: And I know you see this in your work in Chicago. Is there a need for a discussion of racial dynamics in medicine apart from the historical black-white paradigm?
Dr. BELL: Well, you know, for me the solution to the problem and the multiculturalism that you're talking about is to focus on public health, which the AMA, predominantly a trade organization, has not been focused on. They've been focused on business instead of doing what the Hippocratic Oath suggests, which is to be moral and ethical, and responsible for the public's health. They do some of that, but that is not their driving force.
Dr. DAVIS: You know, Michel, I'm a public health...
MARTIN: Dr. Davis, final thought?
Dr. DAVIS: Doctor...
Dr. DAVIS: And I want to thank Dr. Bell for bringing up the issue of public health. I'm trained at the Centers for Disease Control and Prevention, and here I am just finishing my AMA presidency as a public health physician. And I've been raising this point for a long time, within the AMA and outside the AMA, and I couldn't agree with Dr. Bell more that this has to be at the top of our agenda.
I'm pleased to let people know, many of whom don't know, that one of our five priority areas at the AMA and our advocacy agenda is public health, focusing on healthy life styles, tobacco, alcohol, diet, physical activity, focusing on disaster preparedness, and also focusing on eliminating health disparities that we've just...
Dr. BELL: How about national health insurance?
Dr. DAVIS: Well, I'm glad you brought that up too, because I'm also pleased to say that the number one issue in our health-care advocacy agenda is covering the uninsured. We have a national campaign going on right now, three-year multi-million-dollar campaign called Voice for the Uninsured, where we say that we have one-in-seven Americans who lack health insurance, but everyone of us has a voice. And so, when we decide who to elect for the next president of the United States, let's take this issue into account when we vote for that person.
MARTIN: Dr. Davis, I gave you the first word, so I'm going to give Dr. Bell the last word. Dr. Bell, final thought?
Dr. BELL: Well, I mean I'm glad we got the apology. I hope it's not all spin.
MARTIN: OK, we'll leave it there. Dr. Carl Bell is a professor of public health and psychiatry at the University of Illinois at Chicago Medical School. He joined us from WBEC studios. Dr. Ronald Davis is the immediate past president of the American Medical Association. He joined us by phone from his home in Michigan. Gentlemen, thank you both so much.
Dr. DAVIS: Thank you.
Dr. BELL: Thank you.
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