Jun 2021

Knowledge Is Power

Audiey C. Kao, MD, PhD
AMA J Ethics. 2021;23(6):E501-504. doi: 10.1001/amajethics.2021.501.


If knowledge is power, scholarly journals as information gatekeepers play a potent role in promulgating it. For health-oriented journals, decisions on what is published and promoted profoundly influence humanity’s well-being across time and place.1,2,3 During the COVID-19 pandemic, we have borne witness to deadly harms inflicted on communities of color. Despite these harms, journals continue disseminating content, including a recent JAMA podcast,4 that fails to recognize racism as a transgenerational source of health inequity.5,6 The existence of racism in health care is “not opinion or conjecture,” and its denial must be refuted.7

Contrary to ideals espoused in its founding, America was launched as a political and economic nation wherein Africans were enslaved and Indigenous peoples were herded. Given that pursuit of knowledge is a sociohistorical enterprise,8 the medical literature unsurprisingly has long reflected and served prevailing powers.9 Scientific racism based on reductionist and ahistorical premises justified White supremacy.9 Samuel Morton, who has been called America’s founding father of scientific racism,10 touted phrenology or study of human skulls as indicators of intelligence and character.11 Morton’s comparative measurements of cranial volumes from racial groups he recognized (Ethiopian or African, Native American, Caucasian, Malay, and Mongolian)12 lent pseudoscientific cover for White supremacy,13,14 manifest destiny,15 and Black slavery.16,17 Morton’s cranial findings fueled an onslaught of racist science that lingers, for example, in contemporary contestations about sociobiology.18,19

Yet there existed almost from scientific racism’s beginnings knowledge challenging the ideological basis of White supremacy.9 A notable contributor to antiracist knowledge was James Smith, the first African American university-educated physician.20 Denied opportunity to train in America, Smith earned his medical degree from the University of Glasgow. The author of the first case report by an African American physician, Smith was not permitted to present his case at the New York Medical and Surgical Society.21 He was also denied membership in the American Medical Association.22 Through public lectures, Smith exposed and refuted phrenology’s racist claims that human intellectual capacities were determined by skull sizes, shapes, and contours.23 In 1844, he became the first African American physician to pen a scientific paper in an American medical journal.24 Publishing “counter stories” like Smith’s is vital reparative justice work.25

If scholarly journals are to be trusted gatekeepers of knowledge, what more should we expect of them as intellectual platforms for antiracist scholarship? Recently, journal publishing standards on racial health inequities were put forth and demand adoption.5 To socially amplify and historically ground these standards, we must recognize that journals require editorial independence from their publishers, of which many are learned societies with racist histories.26,27,28 The ability to publish ideas and evidence free from undue influence and pressure cannot be undermined. That said, editorial independence should never be leveraged to excuse bad content, such as works using race as a crude proxy for ancestry, genetics, and biology.29 Care should also be taken to ensure that editorial independence does not manifest as editorial insularity and maintain White privilege.30,31,32

Knowledge that aims to promote human flourishing should be a public good and accessible to all. In March, the University of California (UC) struck a landmark deal with Elsevier, the world’s largest scientific publisher, specifying that all research (much of it publicly funded) with a UC lead author will be free to read for everyone.33 For the good of humanity, we should eliminate barriers to journal content and open access to antiracist science and health justice scholarship everywhere.

Stewarding knowledge, scholarly journals harnessed to right harms and advance good must rise to the moment, as justice delayed is justice denied.


  1. Hammonds EM, Herzig RM, eds. The Nature of Difference: Sciences of Race in the United States; From Jefferson to Genomics. MIT Press; 2008.

  2. Yudell M. Race Unmasked: Biology and Race in the Twentieth Century. Columbia University Press; 2014.

  3. Byrd WM, Clayton LA. An American Health Dilemma: A Medical History of African Americans and the Problem of Race: Beginnings to 1900. Routledge; 2000.

  4. Mandavilli A. JAMA editor placed on leave after deputy’s comments on racism. New York Times. March 25, 2021. Accessed April 12, 2021.

  5. Boyd RW, Lindo EG, Weeks LD, McLemore MR. On racism: a new standard for publishing on racial health inequities. Health Affairs Blog. July 2, 2020. Accessed April 12, 2021.

  6. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453-1463.
  7. Madara JL. Speaking out against structural racism at JAMA and across health care. American Medical Association. March 10, 2021. Accessed April 15, 2021.

  8. Shapin S. Never Pure: Historical Studies of Science as if It Was Produced by People With Bodies, Situated in Time, Space, Culture, and Society, and Struggling for Credibility and Authority. Johns Hopkins University Press; 2010.

  9. Krieger N. Shades of difference: theoretical underpinnings of the medical controversy on black/white differences in the United States, 1830-1870. Int J Health Serv. 1987;17(2):259-278.
  10. Stanton WR. The Leopard’s Spots: Scientific Attitudes Toward Race in America, 1815-1859. University of Chicago Press; 1960.

  11. Morton SG. Crania Americana; or, a Comparative View of the Skulls of Various Aboriginal Nations of North and South America: To Which Is Prefixed an Essay on the Varieties of the Human Species. Illustrated by Seventy-Eight Plates and a Colored Map. J Dobson; 1839. National Library of Medicine, National Institutes of Health. Accessed April 12, 2021.

  12. Morton Cranial Collection. Penn Museum. Accessed April 12, 2021.

  13. Horsman R. Race and Manifest Destiny: The Origins of American Racial Anglo-Saxonism. Harvard University Press; 1981.

  14. Gossett TF. Race: The History of an Idea in America. New ed. Oxford University Press; 1997.

  15. Bieder RE. Science Encounters the Indian, 1820-1880: The Early Years of American Ethnology. Reprint ed. University of Oklahoma Press; 2003.

  16. Brace CL. “Race” Is a Four-Letter Word: The Genesis of the Concept. Oxford University Press; 2005.

  17. Brown BR. Until Darwin: Science, Human Variety, and the Origins of Race. Pickering & Chatto; 2010.

  18. Segerstråle U. Defenders of the Truth: The Battle for Science in the Sociobiology Debate and Beyond. Oxford University Press; 2001.

  19. Jumonville N. The cultural politics of the sociobiology debate. J Hist Biol. 2002;35(3):569-593.
  20. Lujan HL, DiCarlo SE. First African-American to hold a medical degree: brief history of James McCune Smith, abolitionist, educator, and physician. Adv Physiol Educ. 2019;43(2):134-139.
  21. Chess. Anglo-African Magazine. 1859;1(9):272-278. Accessed April 12, 2021.

  22. Baker RB, Washington HA, Olakanmi O, et al; Writing Group on the History of African Americans and the Medical Profession. Creating a segregated medical profession: African American physicians and organized medicine, 1846-1910. J Natl Med Assoc. 2009;101(6):501-512.

  23. Harris LM. In the Shadow of Slavery: African Americans in New York City, 1626-1863. University of Chicago Press; 2003.

  24. Smith JM. On the influence of opium upon the catamenial functions. N Y J Med Collat Sci. 1844;2:56-58.

  25. Lindemann H. Damaged Identities, Narrative Repair. Cornell University Press; 2001.

  26. Baker RB, Washington HA, Olakanmi O. African American physicians and organized medicine, 1846-1968: origins of a racial divide. JAMA. 2008;300(3):306-313.
  27. Abrams Z. APA calls for true systemic change in US culture. Monitor. 2020;51(6):20. Accessed April 12, 2021.

  28. Harding S. The “Racial” Economy of Science: Towards a Democratic Future. Indiana University Press; 1993.

  29. Cerdeña JP, Plaisime MV, Tsai J. From race-based to race-conscious medicine: how anti-racist uprisings call us to act. Lancet. 2020;396(10257):1125-1128.
  30. Rankine C. I wanted to know what White men thought about their privilege. So I asked. New York Times Magazine. July 17, 2019. Accessed April 12, 2021.

  31. DiAngelo R. White Fragility: Why It’s So Hard for White People to Talk About Racism. Reprint ed. Beacon Press; 2018.

  32. Kendi IX. The greatest White privilege is life itself. Atlantic. October 24, 2019. Accessed April 15, 2021.

  33. Kell G. UC’s deal with Elsevier: what it took, what it means, why it matters. Berkeley News. March 16, 2021. Accessed April 14, 2021.


AMA J Ethics. 2021;23(6):E501-504.



Conflict of Interest Disclosure

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

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.