An article published in March in the Journal of the American Heart Association that raised a ruckus on #medtwitter this week has now been retracted.
It's unclear what prompted the public explosion of anger, sadness, and recrimination that ultimately led to the retraction of this article — which flew almost completely under the radar when it first appeared online and in print — but it's clear why.
To many readers, the paper, written by Norman C. Wang, MD, MSc, an electrophysiologist at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, was what some called "racist," and they took to Twitter to say so.
Officially, the article, "Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019," was retracted after the American Heart Association "became aware of serious concerns after publication. 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 and that together those inaccuracies, misstatements, and selective misreading of source materials strip the paper of its scientific validity," the retraction reads.
JAHA will be publishing a detailed rebuttal, the notice adds. "This retraction notice will be updated with a link to the rebuttal when it publishes."
"The Editor‐in‐Chief deeply regrets publishing the article and offers his apologies," it further reads. "The American Heart Association and the Editor‐in‐Chief have determined that the best interest of the public and the research community will be served by issuing this notice of retraction. The author does not agree to the retraction."
In the paper, Wang argues that affirmative action policies designed to increase minority representation in medical schools and cardiovascular training programs result in unqualified applicants being admitted, where they will struggle to succeed.
The article itself is a dense review of the topic of diversity, inclusion, and equity, aiming to "critically assess current paradigms, and to consider potential solutions to anticipated challenges," according to its author. Supported by 108 references, Wang concludes with a lengthy quote from tennis great Arthur Ashe, an opponent of affirmative action who died in 1993.
Affirmative action, said Ashe, is "an insult to the people it intended to help." Wang suggests that "racial and ethnic preferences for undergraduate and medical school admissions should be gradually rolled back with a target end year of 2028…"
He cites the $16 billion in federal funding that cardiovascular disease training programs receive every year to support graduate medical education in support of this contention.
"My entire lived experience contradicts everything in that racist @JAHA_AHA article, as does the experience of so many others. So, I know it's just a bad opinion piece passed off as "research" that shouldn't have been published. Still the damage has been done. We MUST do better," tweeted Bryan A. Smith, MD, University of Chicago Medicine, Chicago, Illinois.
According to its Altmetric score, the article received very little attention back in March and April. There were three tweets referencing it, including one from JAHA announcing its publication. Since August 2, an additional 390-odd Tweets from 347 Twitter users have been registered. None appear to be complimentary.
Today, several days into the Twitter storm, the article was officially retracted. In an email to theheart.org | Medscape Cardiology, an AHA media relations rep noted that "the author does not agree to the retraction."
"This article is shocking and makes me sad," Martha Gulati, MD, University of Arizona, Phoenix, told theheart.org | Medscape Cardiology. "We are all working so hard to make cardiology more inclusive and diverse, and this takes us like 1000 steps backwards."
For her part, Gulati would have liked a retraction earlier in the week. "The analysis was selective and incorrect, and the statements made intimate that minority trainees were selected based on affirmative action rather than their merits," she said. It also suggested that their presence was representative of a decline in standards in cardiology programs that take underrepresented minorities (URMs).
Standard Arguments Against Affirmative Action
According to Wang, who did not respond to a request to comment for this article, allowing minority students into medical school with academic records that are weaker than their classmates sets them up for failure.
"Many do not complete their intended programs or do not attain academic success to be attractive candidates for subsequent educational programs or employment," he wrote.
This is a standard argument of opponents to affirmative action, said Quinn Capers IV, MD. Capers, a longtime advocate for diversity in medicine, acknowledges that, "on average," test scores for Blacks, Hispanics, and Native Americans tend to be lower than for White applicants for a wide range of reasons, many of which are related to systemic racism.
"This is the strongest weapon opponents to affirmative action have, and they keep coming back to it, but it's out of step with how many in academic medicine feel," said Capers, who is an interventional cardiologist and the vice dean for faculty affairs at Ohio State University College of Medicine, Columbus.
This is why, he added, most medical schools have embraced the Association of American Medical Colleges' concept of "holistic review," which judges potential physicians on their academic records, their personal experiences, and their individual attributes.
"Standardized tests and academic records are important, but so are the experiences one has gone through and the individual attributes they may have. How resilient are you? How compassionate? Our embrace of this more holistic approach, I believe, is helping many medical schools move toward having a more diverse class that is closer to reflecting the needs of our multicultural and multiracial society," Capers said.
To be clear, Capers is not afraid of having a discussion on this topic and denies that the uproar against this article represents "cancel culture."
"Hey, I love to debate and I'm not against hearing divisive voices, but then let's have a debate and hear both sides. But there are several problems with the way they did this. Number one, they called it a 'white paper,' which to most people means it reflects the views of the organization, not a specific individual, and, secondly, it's more than an opinion piece in that he manipulates facts to make his points, with no chance for rebuttal."
Several have also questioned how this paper, which is written by a non-expert in the field, passed peer review.
The article contains some accurate historical references, said Capers, but intertwined with this history the author editorializes in a fashion that is "charged with racism." In other places, Wang is just outright wrong, he added.
"I can also tell you that in one place where he quotes me specifically, what he says is quite damaging and completely wrong. He quotes something we wrote but cuts off the final sentence, making it seem as though we acknowledged that we had to artificially rank minority applicants high, just so we could say we have a diverse fellowship program.
"It's frankly very hard to believe that was an accident," Capers added.
AHA Backs Away, Promises Investigation
The article has been disowned by all levels of the AHA leadership — past, present, and future.
In an Editor's Note, Barry London, MD, PhD, the Editor-in-Chief of the Journal of the American Heart Association, apologized for his role and the role of his staff in publishing the article.
"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," London wrote. "I can only hope that igniting a discussion around diversity in cardiology will ultimately fuel new ideas and lead to real advances."
"I want to emphasize in the strongest possible terms that this paper does not represent the views of the AHA as an organization or its leadership. This paper should never have been published. A thorough investigation is rightly being conducted," tweeted Mitchell S.V. Elkind, MD, MPhil, who took over the AHA presidency last month.
"Author's views are racist and not consistent with my values nor AHA," tweeted Robert Harrington, MD, immediate past-president of the AHA. "Investigation is underway into how it made it through the editorial process. Like you, I want to know what happened. I am angry, frustrated and disappointed that this piece was published; expect review soon."
"Agree with @HeartBobH. It is impossible not to hear and feel the hurt and pain out there on a very personal level, especially among our young colleagues. You are valued, and worthy. Please stay tuned and then help all of us work to be better," tweeted Donald Lloyd-Jones, MD, president-elect of AHA.
J Amer Heart Assoc. Published online August 6, 2020. Retraction
J Amer Heart Assoc. Published online March 24, 2020. Original Paper (full text)
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Cite this: Anti-Affirmative Action Paper Blasted on Twitter Now Retracted - Medscape - Aug 06, 2020.