Anti-Affirmative Action Paper Blows Up on Twitter

A paper advocating against affirmative action in cardiology programs is melting under a blast of Twitter heat.

Published in the Journal of the American Heart Association as a self-styled "white paper," it included the following statements:

"Racial and ethnic preferences at both the undergraduate and professional school levels for blacks and Hispanics result in relatively weak academic starting positions in classes. This has been postulated to lead to poor performance through compounding 'academic mismatch,' stress‐related interference, and disengagement. Many do not complete their intended programs or do not attain academic success to be attractive candidates for subsequent educational programs or employment."

The paper's conclusion:

"As Fitzgerald envisioned, 'We will have succeeded when we no longer think we require black doctors for black patients, chicano doctors for chicano patients, or gay doctors for gay patients, but rather good doctors for all patients.' Evolution to strategies that are neutral to race and ethnicity is essential. 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."

It was originally published in March, stirring some indignation at the time, but the controversy blew up on Twitter this past weekend, with the #MedRacism hashtag now in vogue. The reaction also called to mind the recent #medBikini outburst that followed another ill-advised journal publication.

McMaster University cardiologist Harriette Van Spall, MD, MPH, tweeted about the JAHA paper: "This article affirms historic stereotypes, doesn't account for structural biases that kids face leading up to their applications, & appears to be a lengthy, solo viewpoint vs white paper. Until editorial teams fully reflect the membership, we'll continue to see articles like this."

Duke cardiologist Ann Marie Navar, MD, PhD, countered a number of the paper's arguments in a series of Twitter posts.

Interventional cardiologist Seyi Bolorunduro, MD, MPH, of NOVA Cardiovascular Care in Woodbridge, Virginia, said the paper aligns with systemic racism in sending the message that minority trainees are in their position only because of affirmative action, rather than through merit, and that their presence reflects a decline in standards.

"The fact that this is published in 'our' journal should both enrage & activate all of us," tweeted Sharonne Hayes, MD, director of diversity and inclusion at the Mayo Clinic in Rochester, Minnesota.

The journal doesn't fall under the direct editorial control of the AHA, noted its immediate past-president, Robert Harrington, MD.

Even so, "I want to be very clear that this paper is not at all aligned w our values as an organization," he tweeted.

AHA president-elect Donald Lloyd-Jones, MD, agreed, questioning how it could have been published "given the unbalanced, unscientific, and untrue statements made."

The journal tweeted that the paper was being reevaluated. On Tuesday, Editor Barry London, MD, PhD, attached an apology to the paper, saying JAHA "will support all efforts to correct this error, including but not limited to the publication of alternate viewpoints, which we solicited at the time of publication but have not yet been submitted to the journal. In addition, we will work to improve our peer review system to prevent future missteps of this type."

The paper's author, Norman C. Wang, MD, is at the Heart and Vascular Institute at the University of Pittsburgh Medical Center, and had been director of its electrophysiology fellowship program. Some cardiologists, like Navar, questioned how Wang's opinions affected his role as fellowship director.

"He was removed as EP PD as soon as this was known," tweeted director of UPMC's general cardiology fellowship, Kathryn Berlacher, MD. That happened on July 31, 2020, according to UPMC media relations. (Wang did not respond to MedPage Today's request for comment.)

Wang's "opinions are incompatible with the values of our training program," Samir Saba, MD, chief of cardiology at the University of Pittsburgh, said in a statement to MedPage Today. "We are fully committed to racial justice in medical training and practice, and believe it is critical to attract, train, support, and promote diverse people in medicine and cardiology."

Massachusetts General Hospital heart failure cardiologist Nasrien E. Ibrahim, MD, recalled a past interaction with Wang on another social justice topic:

Now I know why the name Norman Wang sounded so familiar. He tried to mansplain to me that gender pay gaps were made up and I was scaring women from choosing careers in cardiology. Unfortunately, he deleted those Tweets @AHAScience pic.twitter.com/8gTG9mt7SF

— Nasrien E. Ibrahim, MD (@DrNasrien) August 3, 2020

Nor is the JAHA piece the first time Wang has made such arguments about Black and Latinx trainees in cardiology. A 2019 opinion piece in the Journal of the American College of Cardiology presented similar ideas in arguing against the idea of proportional representation for racial and ethnic groups that would come "primarily at the expense of Asians who are, by extension, viewed as overrepresented."

"Proportional representation has never been demonstrated to be achievable in any profession in a large multiracial and multiethnic nation such as the United States," he wrote. "Certain demographic groups may simply have proclivities toward one profession over another."

He concluded that the main effort to boost the number of Latinx and Black persons in cardiology should be focused on supporting undergraduates with interest in medicine to be qualified applicants:

"Increasing diversity and inclusion is conceptually a noble endeavor. ... It should be clear that the majority of resources should be directed toward increasing the number of qualified medical school applicants. Social engineering to create proportional representation needs to be approached with caution. Equality of opportunity, even if present, does not necessarily lead to equality of outcome. Race and ethnicity, if considered, should be examined in the entirety of what a person has to offer, not in isolation."

Mayo Clinic resident Shruti Patel, MD, responded to the JAHA piece arguing against pitting one minority against another. "People of Asian decent [sic] have a responsibility to recognize our privilege despite our own experiences with racism."

Update:

On Thursday, August 6, JAHA formally retracted Wang's article.

"The author's institution, the University of Pittsburgh Medical Center (UPMC), has notified the Editor-in-Chief that the article contains many misconceptions and misquotes," according to the retraction notice, "and that together those inaccuracies, misstatements, and selective misreading of source materials strip the paper of its scientific validity."

The notice said Wang had not agreed to the retraction.

"JAHA will be publishing a detailed rebuttal. This retraction notice will be updated with a link to the rebuttal when it publishes,"the notice also stated. "The Editor-in-Chief deeply regrets publishing the article and offers his apologies."

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