Racism in medicine: why equality matters to everyone
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m530 (Published 12 February 2020) Cite this as: BMJ 2020;368:m530Read all of the articles in our special issue on Racism in Medicine
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Dear Editor,
Is there Racism in Academic Medical Publishing?
We read with great interest the BMJ issue "Racism in Medicine" devoted to issues confronting doctors and patients from ethnic minority backgrounds (1). We applaud the Journal for its courage in tackling such a sensitive issue.
We the undersigned, academic clinicians from a lower middle-income country (LMIC) - Sri Lanka, would like to highlight another aspect of the problem – that of discrimination in academic medical publishing that borders on racism.
Academia and the scientific community are not immune to discrimination, however subtle, and the academic publication process is an area which deserves to be examined. It is widely acknowledged in our circles that academic manuscripts originating from institutions in non-Western, emerging economies, such as, for example, those of South Asia or Africa, are often scrutinized more rigorously by medical journals based in the West than submissions originating from prestigious institutions in Western countries. Two recent examples are the papers that were retracted by two of the most prestigious medical journals of papers on the use of hydroxychloroquine in COVID-19 (2,3). Both originated from top western institutions, and the issue was data quality (2, 3).
Some editors and reviewers in the most prestigious medical journals, we feel, view data originating from LMIC with suspicion from the very outset, based on the assumption that medical research conducted in these countries is inherently inferior to research conducted in the West. This sort of discrimination against LMICs borders on racism.
We wish to point out, that research conducted in our part of the world, and we can speak with first-hand knowledge for Sri Lanka, undergoes the same scrutiny, ethics review processes, registrations (in the case of clinical trials), data monitoring and feedback as in any Western country, and we all have to comply with the need for data to be made available to journals.
Despite adhering to these conditions, we are dismayed at the rate of rejection by top journals, frequently without the benefit of peer review – sometimes with a short, arrogant, condescending letter to the authors. This has led to a process, described by some as "finding a Western mentor". In plain terms, this means to include one or more influential co-authors from a developed Western country so that a paper originating from our part of the world would be considered more favourably for publication in a prestigious journal. What a shame to need this subterfuge? Sir, we hasten to add, that this does not include the genuine, mutually beneficial research collaborations that result in top publications authored jointly by medical scientists based in Western and LMI countries.
References
1. The British Medical Journal. Racism in medicine. https://www.bmj.com/racism-in-medicine. Accessed June 09, 2020.
2. Mehra MR, Desai SS, Ruschitzka F, Patel AN. Retraction-Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet 2020. https://doi.org/10.1016/S0140-6736(20)31324-6
3. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2007621 [published online ahead of print, 2020 Jun 4] [retraction of: N Engl J Med. 2020 May 1;:]. N Engl J Med. 2020;10.1056/NEJMc2021225. doi:10.1056/NEJMc2021225
Competing interests: No competing interests
Dear Editor
Am I correct in thinking Victor Adebowale is actually Lord Adebowale as he has a life peerage?
I wondered whether using his title would be very relevant in a series of articles talking about the impact of racism on professionals and how it can lead to underperformance.
Lord Adebowale is someone to celebrate!
Competing interests: No competing interests
Re: Racism in medicine: why equality matters to everyone
Dear Editor,
“A good discussion increases the dimensions of everyone who takes part”
Randolph Bourne (1886-1918)
Firstly, we would like to acknowledge Niriella et al, 2020 for bringing up this discussion on racism and its effects on medical academic publishing. The authors state this discrimination is between countries of different economical rankings (reference). Whilst respecting the perspective of the authors, we express our disagreement to this belief.
Discrimination in the academic publications is evident even in the local context among different specialities and subspecialties. We feel it is an individual perception and would like to share our experience and invite everyone to view it more objectively.
As dental specialists from Sri Lanka, we have experienced discrimination from our own local reputed journals which consist of editorial boards of medical specialists. Surprisingly, the experience from reputed international journals from high income countries have been completely the opposite. Prompt responses, higher acceptance rate, constructive and heartening comments and even exemptions for the publication fee were some of the outstanding support we have received, which has emboldened us to pursue academic publications in the international arena vs the local context
From the experience we have had with the international journals, some of the reasons for initial unsuccessful results, mainly attributed due to below issues,
• manuscripts based on research from our local contexts may not exactly fit into international context.
• publication and dissemination biases. When results of published studies are systematically different from results of unpublished studies that gives rise to publication bias. Moreover, there is an array of
biases in research-dissemination process collectively known as “dissemination bias”, including outcome-reporting , time-lag ,gray-literature, full-publication, language, citation, and media-attention.
Such biases could often be misinterpreted as racism, however the underlying determinants are objective and well clarified.
Such detailed clarifications were very conducive for us to remedy our deficiencies and produce a more comprehensive and significant outcome
We feel that this is a good eye-opener for editors and reviewers to be more objective and encourage publications with transparent peer review processes to avoid any kind of discrimination be it locally or internationally.
Competing interests: No competing interests