AHA, Editors, and Cardiologists Ask: How Did ‘Racist’ Paper Make It to Print?

A new “white paper” arguing against affirmative action has drawn blistering criticism from the cardiovascular community, including the American Heart Association (AHA), which is now investigating how the article came to be published in the first place.

In the Journal of the American Heart Association (JAHA), electrophysiologist Norman Wang, MD (University of Pittsburgh Medical Center, PA), argued that programs designed to promote diversity, inclusion, and equity can lead to the selection of students unqualified for medical school or cardiovascular disease training programs.

“Long-term academic solutions and excellence should not be sacrificed for short-term demographic optics,” according to Wang. “Ultimately, all who aspire to a profession in medicine and cardiology must be assessed as individuals on the basis of their personal merits, not their racial and ethnic identities.”

Thanks to affirmative action programs, Wang argues, some minority students start their education or training from a relatively weak academic vantage point, and the end result is that “many do not complete their intended programs or do not attain academic success to be attractive candidates for subsequent educational programs or employment.”

Moreover, “as top-tier schools admit blacks and Hispanics with lower academic credentials, lower-tier schools are forced to do the same if they hope to reach a ‘critical mass’ of individuals from underrepresented groups,” according to Wang. “Students who may not be academically qualified for medical school at all may be admitted, particularly to less competitive medical schools.”

Unsurprisingly, the article, which was originally published in March but gained traction on social media this past week when it was tweeted by cardiologists and trainees, prompting widespread criticism from prominent academic physicians.

Sharonne Hayes, MD (Mayo Clinic, Rochester, MN), urged fellow cardiologists to denounce the article. “Rise up, colleagues,” she tweeted. “The fact that this is published in ‘our’ journal should enrage & activate all of us.” Harriette Van Spall, MD (McMaster University, Hamilton, Canada), called the paper incompatible with the AHA’s core values, describing it as “rife with stereotypes” that fail to account for structural biases that students from underrepresented minorities face leading up to their applications for medical school and future employment.

On August 6, 2020, just a few days after the article was extensively criticized on social media, Wang’s employer, the University of Pittsburgh Medical Center, notified the journal that the article “contains many misconceptions and misquotes and that together those inaccuracies, misstatements, and selective misreading of source materials strip the paper of its scientific validity.” Following that, JAHA retracted the article, although Wang does not agree with the retraction, according to a notice on the website.

Example of Systemic Racism   

While many were bewildered the article slipped past reviewers unchallenged, interventional cardiologist Oluwaseyi Bolorunduro, MD (Inova Fairfax Hospital, VA), said he wasn’t surprised the article was published, citing it as a reflection of systemic racism. “We definitely need to address this,” tweeted Bolorunduro. “Unfortunately, due to arguments like this, minority trainees are told that no matter how hard they work, they only occupy that position [because] of affirmative action.”

Robert Harrington, MD (Stanford University, CA), the immediate past-president of the AHA, also was unsettled by the published paper, stating that it reflects neither his personal values nor the values of the organization he recently led.  

“It’s very disturbing,” he told TCTMD, noting that the AHA has launched a formal investigation into how the article came to be published. He pointed out that JAHA has editorial independence from its parent organization and the AHA does not interfere with the publishing process. “However, in a case like this where it’s such an egregious discordance with our values as an organization, it’s pretty critical that we named people from the science volunteer committee and other staff to begin an immediate investigation, he said. “That’s underway. I’m hopeful we have information from that as soon as possible.”

Barry London, MD, PhD (University of Iowa Carver College of Medicine, Iowa City), the editor-in-chief of JAHA, apologized for his and his staff’s roles in publishing the article. “Much more needs to be done to increase diversity, equity, and inclusiveness in medicine and cardiology,” London writes in a brief commentary published on August 3, 2020. “In my opinion, the article by Dr. Wang does nothing to get us towards that goal.” The journal solicited alternate viewpoints at the time of publication, according to London, but nothing had yet been submitted. He adds they will be improving their peer review and publication process “to prevent further missteps of this type.”

On Twitter, the AHA denounced the views expressed in the paper, reiterating that while JAHA has editorial independence, that’s not an excuse and they’ll “do better.” In a formal statement published today, the AHA called the ideas contained in the white paper a misrepresentation of facts and contrary to the organization’s core values. “The Association believes much more—not less—needs to be done to increase diversity, equity, and inclusion in science, medicine, and cardiology,” the statement reads.

In light of the criticism, TCTMD reached out to Wang for his response, but he hadn’t replied by the time of publication.

Misguided Opinion

While the Wang article was deemed a “white paper,” which is generally defined as an authoritative report buttressed by science about a complex topic, Harrington said it shouldn’t have been classified as such. “It’s pure opinion, an opinion that is really, really disturbing and distasteful,” he said. For example, Wang argues that while patients might feel more engaged and communicate better with doctors of the same race and ethnicity, “there exists no empirical evidence by accepted standards for causal inference to support the mantra that ‘diversity saves lives.’”

That’s simply not true, Harrington stressed to TCTMD. Research out of Stanford, for example, has shown that Black patients were more likely to talk about their health problems and to engage with available preventive cardiovascular screening if they had a Black physician. That study suggested that Black doctors could lower reduce the number of deaths from cardiovascular disease and close the gap in cardiovascular mortality between white and Black men.

“For a lot of the things we know are critically important, diversity does matter,” he said.

One of the unfortunate consequences of the paper is that it undoes some of the work the AHA is doing to promote diversity in research and clinical cardiology, said Harrington. “It’s really important as we think of things like health equity to have a workforce that looks like the population we’re being asked to care for,” he said. “We also believe very strongly that science is better when there are diverse viewpoints. At the AHA, we have been very supportive of increasing diversity in the scientific workforce.”

Just last week, the Journal of Vascular Surgery was embroiled in a social media dustup when it published a research paper by physicians studying “unprofessional content” among surgeons who posted pictures on social media. The paper, which sparked the #MedBikini hashtag calling its methods sexist and misogynistic, was retracted.