Viewpoint
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.

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Citation

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

DOI

10.1001/amajethics.2021.501.

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.