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Fueled by the massive health disparities exposed by the coronavirus pandemic and the racial reckoning that followed the murder of George Floyd, health equity research is now in vogue. Journals are clamoring for it, the media is covering it, and the National Institutes of Health, after publicly apologizing for giving the field short shrift, recently announced it would unleash nearly $100 million for research on the topic.

This would seem to be great news. But a STAT investigation shows a disturbing trend: a gold rush mentality where researchers with little or no background or training in health equity research, often white and already well-funded, are rushing in to scoop up grants and publish papers. STAT has documented dozens of cases where white researchers are building on the work of, or picking the brains of, Black and brown researchers without citing them or offering to include them on grants or as co-authors.

A glaring example occurred in August when the Journal of the American Medical Association — a leading medical journal already under fire for how it handles issues of race — published a special themed issue on racial and ethnic health disparities in medicine. Meant to highlight JAMA’s new commitment to health equity, it served up an illustration of the structural racism embedded in academic publishing: Not one of the five research papers published in the issue included a Black lead or corresponding author, and just one lead author was Hispanic.

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A JAMA spokesperson said its editors do not consider the demographics of authors in selecting research papers, but critics say that neutral stance perpetuates long-standing inequities rather than addressing them.

Health equity researchers say they welcome new interest — and white allies — in their area, which focuses on finding solutions for poorer health outcomes in people from different races, ethnicities, genders, sexual identities, or income levels. But many are troubled by “health equity tourists” — some seen as well-meaning and motivated by their new awareness of racism, others as opportunistic scientific carpetbaggers — parachuting in to “discover” a field that dates back more than a century. Many of these newcomers, they say, are publishing naive and uninformed, and sometimes racist, research and “erasing” scholars of color who created much of the discipline’s foundational work.

“Medicine does that, they Columbus everything,” said Monica McLemore, an associate professor of family health care nursing at the University of California, San Francisco, who studies reproductive health and rights in marginalized communities. She said she is increasingly seeing “neutered and watered-down” work as people without proper training, background, or skills publish in her area. “People want to look like they’re doing the work without doing the work,” she said.

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Racism remains uncomfortable terrain for many people in academia and medicine. While numerous researchers and editors mentioned in this article refused requests for interviews, many others spoke candidly to STAT about their shock at being called out, their personal learning curves, and how they are trying to contribute to the health equity field while navigating the systemic racism that pervades academia.

“For this to be ethical and just, it requires you to redistribute some of your privilege and benefit.”

Elle Lett, statistical epidemiologist at the University of Pennsylvania

Rigorous health equity research can be challenging: Reliable and complete datasets are often not readily available, and studying marginalized populations requires collaboration, nuanced methodologies and analysis — and care to avoid causing additional harm. Missteps are all too easy to make, even for experienced researchers. Yet these studies become part of civic discourse and inform public policy, with their authors often called on to write op-eds and testify before Congress or advise Capitol Hill staffers.

Some also see the influx of new researchers as an existential threat: By taking a cut of the still relatively small amount of funding flowing into health equity research, newcomers may be squeezing out scientists of color from one of the few fields within academic medicine where they have long worked and led. “It all comes down to the tenure system. If we’re not getting funded, we’re not going to get promoted,” said Whitney Sewell, a lecturer in population medicine at Harvard Medical School who studies HIV prevention in Black women.

The issue is compounded by academic journals not having enough editors and peer-reviewers — an overwhelmingly white group — who have the knowledge to judge the quality and originality of health equity research.

One of the five studies in the recent JAMA themed issue, documenting the lack of Black medical school faculty and led by a white author, reported results similar to findings published three years earlier, in a lower-profile journal, by Black researchers.

“There’s nothing new under the sun in his paper,” said Elle Lett, a Black and trans statistical epidemiologist, postdoctoral scholar, and M.D. candidate at the Perelman School of Medicine at the University of Pennsylvania who published the earlier study. In fact, her 2018 paper in PLOS One was more comprehensive, including Hispanic faculty in its analysis. “It is troubling that a white man, who has had every privilege conferred on him, is writing a paper about the plight of Black academics,” said Lett. “He is extracting from our pain for his career advancement.”

Lett discusses a new paper by a white physician documenting the low number of Black medical school faculty, something she published a paper about three years ago. Crystal Milner & Theresa Gaffney/STAT

Such criticism is surprising to many of the authors caught in its harsh glare. A number of them told STAT they meant well. Some have pushed back, defending the integrity of their research and their credentials to do it. Others have apologized, belatedly recognizing their privileged position and that they could have used it to help advance the careers of researchers on the outside looking in.

Christopher Bennett — an emergency room physician and assistant professor at Stanford — was the senior author of the JAMA paper that was similar to Lett’s. He did cite her earlier research but did not contact her to collaborate or find a Black co-author whose career could have benefited from being on such a publication. “For this to be ethical and just, it requires you to redistribute some of your privilege and benefit,” Lett said.

Only when the study was about to be published did Bennett reach out to ask Lett whether she would comment on his paper to reporters — something that would further Bennett’s career and profile even more. That was a hard no.

Bennett declined to be interviewed, but in a statement he sent to STAT and tweeted, he said he conducted the research because of his longstanding interest in the lack of diversity within the physician workforce — and apologized. “It was not my goal to be either colonial or extractive. Regardless of the intent, it is clear that a mistake was made on my part by not utilizing the opportunity and ensuring that a work on diversity included a diverse author byline. For this, I am sorry.”

For Lett, the apology wasn’t enough. The paper didn’t need a diverse group of authors from different backgrounds, she said; it needed an author, or better yet, several, from the underrepresented group — Black physicians — under study. “That sloppiness in language speaks to not knowing the field,” she said.

Because it’s published in a higher-profile journal, Bennett’s paper is likely to eclipse her work and get more citations, she added: “The reality is my highest-cited publication will be silenced by his.”

And the paper Lett published in PLOS One? “I had sent it to JAMA first,” she said. “They had no interest.”

Statistical epidemiologist Elle Lett at the University of Pennsylvania in Philadelphia. Hannah Yoon for STAT

While health disparities now command widespread attention — the Centers for Disease Control and Prevention, for example, recently declared racism a serious public health threat — this progress may come at a tremendous cost: Newcomers unskilled in the field may be producing poor-quality work that could mischaracterize or underestimate disparities. For scholars who strive to be inclusive, problematic papers are raising deep and sometimes uncomfortable questions about who can and should be doing this work.

“I’m not here for health equity tourists,” said Lett. “Eventually this interest will wane and we’ll go back to a place where resources are scarce. If the science has been polluted, not only will we have to do new work, we’ll have to go back and fix all the mistakes.”

One paper that raised a red flag was published by JAMA Network Open in June. The study indicated that Covid-19 death rates were higher in Black patients than white patients because they were more likely to receive treatment at poorer-performing hospitals. The study was shared widely on social media and covered by the press; two of the paper’s authors — both white — wrote an op-ed about their work that appeared in the Washington Post.

The study was immediately troubling to Jorge A. Caballero, a San Francisco Bay Area anesthesiologist and bioinformatics expert who co-founded Coders Against COVID and has focused on inequities in Covid cases and vaccination rates throughout the pandemic. While he said the study was “directionally accurate” and took on important issues of structural racism, he said it contained major data gaps that would have been obvious to health equity researchers and may have minimized true disparities.

First, he said, the dataset of about 44,000 patients excluded some 18,000 patients seen at hospitals that did not have, according to the study, “at least 1 Black and 1 White patient.” The disparities reported would likely have been worse, Caballero said, if the study had included hospitals that served primarily Black patients, as they often treat sicker patients and are historically under-resourced. (He noted that the shocking amount of medical segregation “may be the more important finding and should have been a paper in itself.”)

Second, to control for comorbidities, the paper excluded people who did not have six months of continuous insurance coverage in 2019. Caballero said this meant the paper was more likely to exclude Black people, who are less likely to have stable health insurance.

Most staggeringly to Caballero, the study did not consider ethnicity, a major factor in pandemic mortality. It grouped Hispanic patients, who had higher Covid-19 mortality rates, with white patients, a decision that likely shrank the apparent mortality gap between white and Black patients. (The paper found a 12.86% mortality rate for white patients vs. a 13.48% mortality rate for Black patients.)

“These are just glaring deficiencies that are obvious to BIPOC subject matter experts.”

Jorge A. Caballero, anesthesiologist and bioinformatics expert

“These are just glaring deficiencies that are obvious to BIPOC subject matter experts,” Caballero told STAT. “On the one hand, you don’t want to discourage the work, but this particular paper could do more harm than good,” he said. “It makes it seem like the disparities aren’t as pronounced as they really are.”

In an emailed statement, the study’s lead author, David Asch, a physician who directs the Center for Health Care Innovation at the University of Pennsylvania, said the study used rigorous analytical methods and that data separating out ethnicity were not available for the Medicare patients analyzed in the study. “Different analyses of other patient populations are always possible in theory, but often not possible in practice,” said Asch.

Asch said he does have expertise in health equity; he founded and ran a center to eliminate health disparities at Philadelphia’s Crescenz Veterans Affairs Medical Center; one co-author, Rachel Werner, also described health equity as one of her areas of expertise. This leads to the thorny question of who is qualified to do this type of work. There is no certificate or credential to be bestowed. Newcomers can sometimes bring important fresh perspectives. Many deeply respected health equity researchers are white. And science is full of papers that are flawed, can’t be replicated, or are retracted, some of them by established health equity researchers.

The problem in this case, Caballero said, may lie less with the researchers than with reviewers who should have flagged the issues he saw. “Why aren’t those people there? It’s not like I don’t exist,” he said. “It boils down to who these editors-in-chief know.” A JAMA spokesperson said the paper was managed by an editor and sent to reviewers with experience in health disparities research.

Another problem surfacing in recent papers is a refusal to take on, or even name, the issue at the heart of most health disparities: racism. It’s a longstanding issue that many say has, and continues, to cripple the field and its efforts to shrink inequities.

A review of more than 200,000 articles published in the past 30 years by the leading medical journals — the New England Journal of Medicine, The Lancet, JAMA, and The BMJ — found fewer than 1% of articles included the word racism. Of those that did, more than 90% were opinion pieces and not research articles. (Scholars in the field say they have long been relegated to writing only opinion pieces, which carry less academic weight and impact than research articles.)

Rhea Boyd
Rhea Boyd, a pediatrician who is calling for a new standard for publishing research on racial health inequities. Courtesy Greater Than COVID

Such papers, like this one in JAMA that studied birth outcome and air pollution without examining environmental racism, obfuscate the role racism plays in shaping and determining health outcomes, said Rhea Boyd, a pediatrician and health advocate who is calling for a new standard for publishing on the topic.

While structural racism is starting to be named more frequently in the literature, Boyd said much of the new work seeking to address racial health disparities focuses on issues such as implicit bias among providers, white authors’ attempts to understand their own feelings about racism, or factors like “lack of trust” among Black patients. She said exploring these areas as causes of racial health inequities can distract from more critical structural issues such as wage inequities, residential segregation, access to education, and access to health care.

Boyd also said in the past year, numerous journals have published papers asserting the long-refuted notion that health inequities are driven partly by biological differences between racial groups.

One study in Health Affairs, now revised, initially hypothesized that Covid disparities could be caused by “unknown or unmeasured genetic or biological factors that increase the severity of illness for African Americans,” while another in the Journal of Internal Medicine asked “whether there is a genetic difference in susceptibility, especially to severe disease, to COVID-19” that might explain emerging racial health inequities. A JAMA paper suggested Black people were more likely to become infected with Covid because of a difference in gene expression in their nasal epithelia, omitting the fact that the gene in question is upregulated by poor air quality, which has been linked to residential segregation and environmental racism.

Boyd calls such claims “troublingly frequent” and said there is no place in today’s world — and in academic journals physicians turn to for guidance — for unsubstantiated claims that Black people are somehow biologically distinct from other racial groups. “When science claims poor health outcomes in Black folks are genetic,” she said, “that pathologizes Blackness.”

While change is difficult, especially at smaller journals without large budgets for hiring, things may be improving at larger journals. Late last year, the New England Journal of Medicine hired Winfred Williams, a nephrologist who has long worked on issues of health equity, to serve as deputy editor, the first time a Black person has held such a high-ranking editorial role there. JAMA has recruited a diverse group of physicians and academics to search for a replacement editor after a shakeup there following the distribution of a podcast questioning whether structural racism existed in medicine. JAMA is also recruiting a senior-level physician to serve as editorial director of equity.

Earlier this year, after publishing the paper that had to be revised, Alan Weil, the editor of Health Affairs, described how his journal is working to dismantle racism. It has hired an equity project director, created a health equity advisory committee, is trying to track how and why so many of its submissions come from white researchers at elite research institutions, and has started a mentoring program to increase the number of papers by researchers who are from underrepresented groups.

Weil said there is no question academic publishing is steeped in structural racism. “If you’re published, you’re asked to review. If you’re cited, you get tenure. If you get tenure, you get more resources to publish,” he said. “The problem is the people who are outside of the circle, who don’t have a track record of publication, who don’t get funded or mentored, or have a heavy teaching load. Opportunities are not equally distributed.”

He said journals must be actively antiracist and not simply send out papers for review to the handful of scholars of color on their boards and in their networks who are already overwhelmed. “The purpose of diversifying is not to give more work to the small number of people you’ve let into the club, it’s to let more people in,” he said. “It’s always easy to say, ‘I can’t find people.’ The question is, are you really looking?”

“It’s always easy to say, ‘I can’t find people.’ The question is, are you really looking?”

Alan Weil, editor of Health Affairs

Black and brown health equity researchers say work they have done that has gone unappreciated in the past is now increasingly being used by others, often without being cited. The issue has erupted in many academic fields. #CiteBlackWomen has become a hashtag, and a social movement.

For some, like Ray Givens, these are not just simple omissions, but active acts of erasure. Givens, a Black cardiologist at Emory University, examined the extreme lack of racial diversity among medical journal editors last year. He was stunned to see JAMA Internal Medicine publish a similar analysis in June that did not mention his own, especially because he had made his data public, and communicated them by email to JAMA editors, including the paper’s senior author, Rita Redberg of the University of California, San Francisco. He had also discussed the findings with the lead author, James Salazar, also of UCSF, when Salazar had interviewed with Givens for a position at Columbia.

In statements, the authors said their study was initiated prior to communications with Givens and they did not cite his unpublished work because it did not contribute to their analysis.

Givens is unpersuaded. “The issue isn’t just blind spots,” he said. “It’s refusal to see.” He said for the authors to not refer to his work in an acknowledgement, footnote, or as personal communication was intellectually dishonest and echoes a history of white people in power refusing to credit Black scholars and activists for their work.

“What does it mean when you tell people that their refusal to be fully truthful or allow different voices in the room is harmful to vulnerable ethnic groups like yours and they still refuse to budge?” asked Givens. “It’s hard for me to think of a better word than racism — though white supremacy and deliberate indifference are probably equally good.”

Caballero said that he, like many fellow BIPOC researchers, has been increasingly asked to share his research — in his case, a rich dataset on racial disparities in Covid testing — with other researchers for their publications. When he asked one researcher from a major university if he would be included as a co-author if she used his data, Caballero said he never heard back. “Crickets,” he said.

Anesthesiologist and Coders Against COVID co-founder Jorge Caballero at the Stanford School of Medicine campus. Constanza Hevia for STAT

In what many describe as “a minority tax,” Caballero said many researchers of color are asked to share their perspective on papers or grant applications — a kind of pre-peer review — without being compensated, offered authorships, or welcomed onto research teams. “Grants and publications are the coin of the realm,” he said. “We are essentially advancing our competitors’ careers, using time we could be advancing our own careers, especially now when people are flooding into this field because they see opportunities.”

This failure to credit scholars of color means they are less likely to advance in their careers, achieve tenure, or even stay in academia. Less than 4% of full-time faculty at medical schools are Black, and there has recently been an exodus of minority doctors from academic positions.

Givens likens what’s happening in the field of health equity research to the gentrification of a long-neglected Black neighborhood. “For so long, it was hard to get any attention to this field, now we’re competing with people who don’t have the depth, but have far more resources. You start to wonder if you can still afford to live here.”

Caballero, who came to the U.S. at the age of 10 from Mexico and overcame an impoverished childhood to attend Stanford as both an undergraduate and then medical student, had been on a fast track for academic success. He was a chief resident in anesthesiology, an NIH-HHMI research scholar with multiple publications, and head of data for a health care startup. But he has grown disillusioned with academic medicine and tired of being marginalized and passed over for positions he felt more than qualified to fill. In July, he left his clinical instructor position at Stanford.

One of the most contentious issues, because it is the lifeblood of academic research and crucial for advancement and tenure, is funding. Now that research dollars are finally flowing into health equity, many who have long struggled for funds are worried they may be locked out because NIH grants will flow, as they long have, to large and well-resourced groups. Studies show there is a persistent gap in funding for scholars from underrepresented racial groups, particularly those who are Black.

The availability of new money has been head-spinning for researchers who have spent careers scraping for funds and tiptoeing around the term health disparities for fear of offending grant reviewers. “When I entered the field, I was discouraged from pursuing this type of work,” said Luisa Borrell, a distinguished professor of epidemiology and biostatistics at the CUNY Graduate School of Public Health and Health Policy. “I was told it wasn’t going to get me tenure.”

Borrell has won some NIH grants. But it has been an uphill battle. “I’ve had so many rejections from NIH,” she said. “After a while, you stop counting.” Her grants, she said, often received the dreaded N.D. — or not discussed. “The comments were: ‘This won’t be successful, this won’t have a big impact, you can’t focus on race and ethnicity, you need to focus on a disease,’” Borrell said. When she addressed those comments and resubmitted grants, they often went to new reviewers, who were equally as dismissive.

Fears that well-funded, white researchers will nab the bulk of the new money are being expressed widely on social media.

“I literally know folks who have been fired (and/or stressed about taking bold stances…by uttering the word racism…let alone *structural* racism) their entire careers. Now, folks prance in like a savior,” epidemiologist Chandra Jackson of the National Institute of Environmental Health Sciences tweeted in June.

“Bothered that most of the awardees will be folks who benefit directly from structural racism and some of which who perceive this work as a ‘hot-topic’ and an opportunity to boost their tenure packet,” Sewell, the Harvard lecturer, tweeted in a widely shared post shortly after NIH issued its call for health equity funding applications in March.

“There are scholars out there who have been applying for NIH funding for decades and just hit a wall because of the nature of their grants,” Sewell told STAT. “They had to talk about health disparities without using the word because they knew they wouldn’t get funded.”

Sewell said the short turnaround — sometimes just a few months — for deadlines for the new grants, in the midst of summer, meant that many researchers who work at smaller institutions were at a disadvantage because they don’t have large support teams to assist with submitting grants. It’s the same for researchers who work with community partnerships that, by their complex nature, slow the grant-writing process. “When I saw that call for funding,” she said, “it was almost a slap in the face.”

Melissa A. Simon, a longtime health equity researcher and vice chair of research at Northwestern University’s Feinberg School of Medicine, agreed, though she is at a large research institution. She said there wasn’t enough time for her to put together a grant for a lucrative new NIH center to study multiple chronic diseases that affect populations with health disparities. “Only the wealthiest and most established researchers were able to respond that fast,” said Simon. “It’s the same as the business world, the wealthier just get more wealth.”

The deadline for the new centers was shorter than usual because it stemmed from funding that came through a special congressional request, but Sewell said NIH, by not providing longer deadlines for other grants to health equity researchers, is “inadvertently perpetuating what NIH seeks to end.”

Even the paperwork seems to have been drafted with white researchers in mind. Sewell, who is a Black woman, said one NIH grant application she filled out — seeking funding to help postdoctoral researchers from underrepresented groups transition to faculty jobs — asked for a plan on how she would contribute to diversity, equity, and inclusion. “I said, ‘Wait a minute now. I’m an only, and I have to be the diversity officer too?’”

Meanwhile, a number of health equity researchers say they are getting besieged by offers from white teams who have never worked in health equity to either pick their brains or collaborate on grants.

“I am seeing it all the time,” said Rachel Hardeman, a reproductive health equity researcher who directs the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health. She has been so overloaded with requests she’s put a bounce-back message on her email saying she cannot provide assistance or consultation for outside projects.

“In the past few weeks alone, I’ve had six inquiries from research teams that don’t typically do this work asking me about collaborating,” she said. “They know they need an expert to hitch their wagons to.”

Some health equity researchers worry about tokenism — that a single minority researcher may be added to a large team without being truly involved in decision-making. Others, like Native American health researcher Lisa Richardson, say they feel patronized by white researchers who ask to partner for grants, saying they can “lend credibility.” Or they are infuriated by suggestions they need help writing grants when it is the funding and review process that is the problem.

In an interview, Eliseo J. Pérez-Stable, director of NIH’s Institute on Minority Health and Health Disparities, which is doling out some but not all of the new NIH money, described the funding concerns of health equity scholars as valid and said he had also struggled to fund his own community-based disparities research in the past. “We’re very tuned into this,” he said.

Pérez-Stable said his division was working on ways to ensure funds are spread more fairly, including reviewing grants from wealthy institutions separately from those coming from those with less resources. “We want this money to go not just to the Harvards, Stanfords, and Dukes of the world,” he said. While the awards for health equity grants have not yet been publicly announced, Pérez-Stable said several principal investigators selected for major grants come from underrepresented groups.

He said the NIH had been tackling the issue of bias among grant reviewers through training and was supporting scholars of color in many ways beyond the new grants, including funding institutions to hire clusters of minority scholars so they don’t feel isolated, and funding student loan reimbursement programs for those who study health disparities.

Many argue that NIH needs to go much further to reach equity, including funding all Black researchers whose grants receive high scores from review panels or creating special funding opportunities for researchers from underrepresented racial and ethnic groups, as it does for early-career researchers. (There are so few Black applicants, this would represent a tiny fraction of the NIH budget.) Some have even called for “research reparations” to make up for past gaps.

Sewell, who is at the beginning of her research career, said obtaining research dollars is likely to remain an uphill climb despite the new NIH initiatives. But she thinks her work, and saving the lives of Black women through that work, is too important for her to stop. “I will always apply,” she said. “I was trained by people who have always been running against the wind and that is how I will train my mentees.”

McLemore’s desk in her office in Oakland, Calif. Constanza Hevia for STAT
Dr. Monica McLemore
“Medicine does that, they Columbus everything,” says McLemore. Constanza Hevia for STAT

In many ways, the tensions playing out in the field of health equity research are a microcosm of those in the larger world, as the nation comes to grips with deeply entrenched racism some have endured all of their lives and others have only recently become aware of. Are there ways for Black, brown, Asian, and white scientists — and people — to work together to dismantle racism?

That’s what McLemore is trying to find out. Last year, the UCSF associate professor was asked to review a paper for the journal Public Health Nursing on reproductive justice, a movement that strives to protect the bodies and rights of marginalized women, including those of color and trans people, who did not feel included in the white feminist movement. “I read the paper and was stunned,” she said. “An all-white team of nurses decided to do a concept analysis on reproductive justice?”

She said the paper seemed rushed; it was sloppy, undertheorized, contained errors, and did not cite pivotal research, including that of the Black women who founded the field and coined its name. “That is like leaving out Watson and Crick when you talk about DNA,” she said.

McLemore submitted six pages of comments and assumed the journal would reject the paper. She was shocked a few months later to see it published — without her concerns being addressed. “That’s a way to invisibilize the essential work of women of color,” McLemore said.

McLemore could have easily laid the authors flat in a merciless Twitter thread; in addition to having stellar academic credentials (a background in molecular biology, a master’s in public health, a Ph.D., and a nursing degree), she’s a formidable social media presence. But McLemore sought a more positive solution. She reached out to the journal’s editor and one of the paper’s lead authors, Robin Evans-Agnew, an associate professor of nursing at the University of Washington, Tacoma, School of Nursing and Healthcare Leadership. It was an uncomfortable conversation for them all.

“That is like leaving out Watson and Crick when you talk about DNA.”

Monica McLemore, associate professor of family health care nursing at UCSF

Evans-Agnew was surprised when he got an email from McLemore about the paper. He works on environmental justice, conducting research with low-income and minority children whose asthma is linked to the poor environmental conditions in their neighborhoods. He cares deeply about these youngsters, he said, and the unacceptably high rates of Black mothers and babies who die during childbirth.

The paper in Public Health Nursing came about, he said, because he noticed that the term reproductive justice was not being discussed in nursing journals, something he saw as a major gap. “I acted kind of on impulse,” he said of his decision to write his paper despite not being Black, female, or an expert in the area. “When you see a burning building, you run toward it.”

Pat Kelly, a white professor of nursing who has edited the journal for the past six years, said when the paper crossed her desk, she jumped at the chance to publish something on reproductive justice to bring the issue “to the forefront of nursing.”

It has been a difficult episode for Kelly, who spent 25 years conducting nursing research in prisons, and has worked to usher articles about health equity into the journal’s pages. “I felt sort of gobsmacked,” she said. “To say that I’m not aware this is a terrible, racist country with terrible racist problems isn’t true.”

Kelly said she published the paper because she felt Evans-Agnew and his co-authors addressed criticisms of the manuscript and that two other reviewers were happy with the revision. Evans-Agnew declined to discuss the specifics of the peer review process and Kelly said she could not recall whether McLemore’s comments had been sent directly to Evans-Agnew. In retrospect, Kelly said she should have sent the paper through more revisions and back to McLemore for comment, and found more reviewers familiar with reproductive justice. But she said finding reviewers is a struggle. And she knows minority researchers are overloaded. “They’re asked a lot to review. They’re asked to be a spokesperson for oppression. They’re asked to be on every committee.”

Kelly said she’s committed to doing better. She’s issuing an open call for new people to join her editorial board. Though the position is unpaid, she’s hoping for new blood. The fact that many retirees populate editorial boards may be one reason social change at journals is slow, she added.

As was the case with this paper, many conflicts stem from white people newly entering the area because they are moved to do something to help. “I’ve fielded a lot of calls from people who haven’t worked in the field but want to now,” said Lance Gravlee, a medical anthropologist at the University of Florida who studies issues of health equity in the African diaspora and is white. “A lot of people are motivated by good reasons. They want to use their scientific skills to do something good.”

But Gravlee, who recently wrote a widely praised essay on how problems at JAMA illustrate white supremacy, said good intentions are not enough. People need to enter the field with humility, do their homework, and make sure they cite, partner with, and support scholars of color, he said.

Newcomers to the field also must familiarize themselves with a culture very different from other areas of academic medicine. Health equity work is highly collaborative, with large teams and multiple principal investigators working with community partners; people from populations under study are often included as full research partners. Every one of Gravlee’s papers on racism and stress has a co-author from the Tallahassee community where he conducts research.

McLemore was recently asked to write an op-ed for Scientific American. While she could have had the authorship to herself, she instead invited six colleagues to co-author the piece. “When you can,” she said, “you pass the mic.”

Health equity research also is often solutions-based. Many researchers see new publications, like the JAMA piece on Black faculty numbers, as re-documenting problems that are known to exist for the sake of having another publication — without doing the work that will lead to solutions.

Evans-Agnew said he was looking for solutions. The crisis of Black infant mortality, he said, requires urgent attention. After speaking extensively with McLemore, Evans-Agnew said he realizes the reproductive justice paper was lacking and “somewhat perhaps amateur,” but he also lays some of the blame on the peer review process. Discussions since then, he said, have given him a dose of humility and an important reminder that white researchers need to be vigilant about their “white colonial perspective and white colonial biases.”

“I’m not crying myself a river,” he said, adding that he’s grateful for the learning experience. “I leave my white fragility at the doorstep. This is work I have to do.”

While McLemore is still upset about the original paper, the two are now planning to work together to write a rebuttal. These difficult and direct discussions, said McLemore, need to happen more often. “It’s our responsibility to model the kinds of behavior we would like to see. That means really engaging, reaching out with respect and dignity, and using things like this as teachable moments.”

Correction: An earlier version of this story misidentified the journal that published a study in June on Covid-19 death rates. It was JAMA Network Open.

This is part of a series of articles exploring racism in health and medicine that is funded by a grant from the Commonwealth Fund.

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