Opinion: Under fire on race, the AMA should drop its support for the war on drugs
Opinion by David L. Nathan, H. Westley Clark, and Joycelyn Elders
The American Medical Association (AMA) recently made the news for its stance on institutional racism, and not in a good way. The longtime editor in chief of the association's flagship journal, Dr. Howard Bauchner, was put on administrative leave after JAMA tweeted, "No physician is racist, so how can there be structural racism in health care?"
© Frederic J. Brown/AFP/Getty Images A jar of Insane OG, a strain of marijuana, is displayed at the opening of a California dispensary.
The now-deleted tweet promoted a podcast in which JAMA's deputy editor Dr. Ed Livingston said, "Structural racism is an unfortunate term ... Personally, I think taking racism out of the conversation will help. Many people like myself are offended by the implication that we are somehow racist." He wasn't the only one offended. Now Dr. Bauchner and JAMA are facing fellow physicians' outrage for these and other actions, an alleged "failure to diversify the editorial staff and/or displaying blatantly discriminatory behavior patterns."
The podcast episode has since been withdrawn and replaced online with an apology from Dr. Bauchner, who said comments made in the podcast were "inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA." He also said structural racism exists in the US and in health care.
The AMA's racist tweet was not a momentary lapse of judgment. JAMA's doubt about "structural racism in health care" lays bare the hypocrisy within an organization that has struggled with racism since its creation before the US Civil War. Through most of the AMA's history, Black physicians were refused membership in the organization because they were denied prerequisite membership in many state medical societies. As recently as 1966, the AMA successfully persuaded the federal government to exempt physicians from signing a statement of compliance with Title VI of the 1964 Civil Rights Act, which banned discriminatory practices in federally funded hospitals.
There have been a few bright spots in the AMA's long history of racism and misguided support for the drug war. In 1937, the AMA's Legal Counsel Dr. William Woodward testified before Congress in strong and unequivocal opposition to the prohibitionist Marihuana Tax Act. He eerily predicted our current crisis of mass incarceration, asserting that the government "would meet with the same difficulty that it met in prosecuting under the National (Alcohol) Prohibition Act; inadequacy of courts ... (and) the inadequacy of jails."
Woodward was an exceptional physician and lawyer for his time. In a career that spanned six decades, he served as a public health officer and president of the American Public Health Association. He also taught medicine and law at six prestigious universities, including Howard -- a historically Black medical school whose graduates were banned from the AMA of Jim Crow America. The association probably unknowingly accepted its first Black physicians in 1888 when the AMA set rules to offer membership to all state medical society members, and a few in Northern states were Black. Some Southern states, in contrast, didn't stop discriminating against Black physicians until at least the 1950s.
During the Black Lives Matter protests last year, the AMA issued a news release that denounced its own racist past. In November, the nation's largest physicians' association proudly declared that they had "detailed a plan to mitigate (systemic racism's) effects."
The AMA pointed to police brutality, unconscious bias and systemic racism without a single mention of its support for cannabis prohibition, a centerpiece of what is arguably the most powerful instrument of systemic racism: our nation's failed war on drugs.
The AMA actively supports cannabis prohibition, a cornerstone of the drug war, even as it hypocritically condemns systemic racism for creating inequity and limiting access to health care among communities of color. The organization fails to appreciate or chooses to ignore the fact that the uneven application of laws on cannabis prohibition contributes to poverty, which is one of the largest obstacles to health care access in communities of color.
Cannabis is demonstrably safer for the vast majority of adults than alcohol, but the AMA doesn't call for a return to alcohol prohibition. Cannabis is far less harmful to adults than tobacco, but the AMA advocates tighter regulation rather than the prohibition of tobacco products. While the medical community offers an evidence-based, nuanced assessment of the health effects of cannabis, the AMA hyperbolically asserts that "without question, the public health risks (of legalization) are immense."
Cannabis use is not the "immense" public health threat that the AMA claims, but its prohibition is a powerful weapon of racially biased policing. In 2019, US law enforcement made over 500,000 arrests for simple cannabis possession alone. An American Civil Liberties Union report from 2018 found that Black people in America are nearly four times more likely than Whites to be arrested for cannabis possession, despite similar usage rates between the two groups. According to a 2013 ACLU report on race and marijuana prohibition, low-income people of color face disproportionate consequences from cannabis arrests due to their inability to pay fines, inadequate access to counsel and potential loss of housing, employment, and student loans.
Despite the cost in Black and brown lives, cannabis prohibition has failed in its most basic objective: the prevention of underage use. For decades, government statistics have shown that around 80% of American twelfth graders can easily access cannabis. Interestingly, as legalization spreads around the country, underage access is now trending downward, and underage use has remained level in legalized states. In fact, the US Centers for Disease Control and Prevention recently published a study showing that the number of US high schoolers who had ever tried cannabis increased from 2009 to 2013 and decreased from 2013 to 2019. The turning point was in 2013, a year after US states began legalizing and regulating cannabis for adult use.
In a nation where tens of millions of adults consume cannabis, and according to a November Gallup poll, more than two-thirds of Americans support the legalization of cannabis, groups like the AMA have retreated to a watered-down version of prohibition.
"Decriminalization" is a policy that theoretically reduces or removes penalties for cannabis possession while maintaining the illegality of cultivation and sales. Decriminalization encourages the illegal cannabis industry and prevents the government from regulating cannabis products. In practice, decriminalization doesn't stop arrests for minor cannabis offenses, and racial disparities persist.
Therefore, the AMA finds itself in the morally and logically indefensible position of opposing government regulation of a drug that it wants decriminalized. It sends the message that we are better off with an untested cannabis supply, vulnerable to contamination and adulteration. By opposing regulation, the AMA stands against standardized labeling of cannabis products with health warnings, ingredients, and potency. It would put the nascent regulated cannabis industry back in the hands of unregulated growers and dealers who don't pay taxes and sell cannabis -- sometimes with more dangerous drugs or heavy metals and pesticides -- to minors as well as adults.
Given that its policy runs counter to basic principles of scientific evidence, social justice, and common sense, there can be only one conclusion: The AMA still suffers from the institutional racism it claims to oppose.
Fortunately, a rapidly growing number of physicians recognize that only legalization can end the social injustice of the war on cannabis, and effective regulation is a no-brainer for a drug consumed by a significant percentage of American adults. In 2016, we launched Doctors for Cannabis Regulation (DFCR), which now has members in nearly every US state and territory and recently joined the broad-based Marijuana Justice Coalition. Along with our allies -- including the Drug Policy Alliance, the National Organization for the Reform of Marijuana Laws, the Marijuana Policy Project, and other organizations -- DFCR believes that regulation and education are the best tools for addressing cannabis misuse.
This year, the AMA has doubled down on its support for a social policy that criminalizes millions of Americans, disproportionately in communities of color. In an effort to invalidate the ballots of an overwhelming 74% of Mississippi voters, the AMA filed an amicus brief with the Mississippi Supreme Court in January to overturn the state's wildly popular medical cannabis ballot initiative.
Last week, AMA President Dr. Susan Bailey posted that "Our AMA does not support legalization of cannabis for adult use until additional scientific research has been completed to fully document the public health, medical and economic consequences of its use." She cites a webpage of the National Academies of Science, Engineering and Medicine (NASEM) to shoot down the health benefits of cannabis, but she conveniently overlooks NASEM's 486-page report in which experts evaluate decades of copious government-funded research into the health effects of cannabis, which are far less negative than those of alcohol and tobacco. Since the scientific method makes it impossible to "fully document" the impact of any drug, Dr. Bailey has now signaled that the AMA will not change its position no matter what the evidence tells us.
The organization's current position will not stop the nation's march toward cannabis legalization. But make no mistake: Its active opposition to legalization prevents cannabis regulation and delays the end of this racially biased policy. The AMA's blindness to its own institutional racism is a moral stain on our profession. And with every passing year -- every day -- a heavy cost is paid in Black lives.
Voters around the nation approved all five cannabis initiatives on the ballot in November -- three for adult use, one for medical use and one for both uses -- so the need to properly regulate this drug has never been greater. If the AMA is serious about righting the wrongs of its past, it must renounce the racist war on drugs and support effective regulation of cannabis as the only logical alternative to the destructive policy of prohibition.
The now-deleted tweet promoted a podcast in which JAMA's deputy editor Dr. Ed Livingston said, "Structural racism is an unfortunate term ... Personally, I think taking racism out of the conversation will help. Many people like myself are offended by the implication that we are somehow racist." He wasn't the only one offended. Now Dr. Bauchner and JAMA are facing fellow physicians' outrage for these and other actions, an alleged "failure to diversify the editorial staff and/or displaying blatantly discriminatory behavior patterns."
The podcast episode has since been withdrawn and replaced online with an apology from Dr. Bauchner, who said comments made in the podcast were "inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA." He also said structural racism exists in the US and in health care.
The AMA's racist tweet was not a momentary lapse of judgment. JAMA's doubt about "structural racism in health care" lays bare the hypocrisy within an organization that has struggled with racism since its creation before the US Civil War. Through most of the AMA's history, Black physicians were refused membership in the organization because they were denied prerequisite membership in many state medical societies. As recently as 1966, the AMA successfully persuaded the federal government to exempt physicians from signing a statement of compliance with Title VI of the 1964 Civil Rights Act, which banned discriminatory practices in federally funded hospitals.
There have been a few bright spots in the AMA's long history of racism and misguided support for the drug war. In 1937, the AMA's Legal Counsel Dr. William Woodward testified before Congress in strong and unequivocal opposition to the prohibitionist Marihuana Tax Act. He eerily predicted our current crisis of mass incarceration, asserting that the government "would meet with the same difficulty that it met in prosecuting under the National (Alcohol) Prohibition Act; inadequacy of courts ... (and) the inadequacy of jails."
Woodward was an exceptional physician and lawyer for his time. In a career that spanned six decades, he served as a public health officer and president of the American Public Health Association. He also taught medicine and law at six prestigious universities, including Howard -- a historically Black medical school whose graduates were banned from the AMA of Jim Crow America. The association probably unknowingly accepted its first Black physicians in 1888 when the AMA set rules to offer membership to all state medical society members, and a few in Northern states were Black. Some Southern states, in contrast, didn't stop discriminating against Black physicians until at least the 1950s.
During the Black Lives Matter protests last year, the AMA issued a news release that denounced its own racist past. In November, the nation's largest physicians' association proudly declared that they had "detailed a plan to mitigate (systemic racism's) effects."
The AMA pointed to police brutality, unconscious bias and systemic racism without a single mention of its support for cannabis prohibition, a centerpiece of what is arguably the most powerful instrument of systemic racism: our nation's failed war on drugs.
The AMA actively supports cannabis prohibition, a cornerstone of the drug war, even as it hypocritically condemns systemic racism for creating inequity and limiting access to health care among communities of color. The organization fails to appreciate or chooses to ignore the fact that the uneven application of laws on cannabis prohibition contributes to poverty, which is one of the largest obstacles to health care access in communities of color.
Cannabis is demonstrably safer for the vast majority of adults than alcohol, but the AMA doesn't call for a return to alcohol prohibition. Cannabis is far less harmful to adults than tobacco, but the AMA advocates tighter regulation rather than the prohibition of tobacco products. While the medical community offers an evidence-based, nuanced assessment of the health effects of cannabis, the AMA hyperbolically asserts that "without question, the public health risks (of legalization) are immense."
Cannabis use is not the "immense" public health threat that the AMA claims, but its prohibition is a powerful weapon of racially biased policing. In 2019, US law enforcement made over 500,000 arrests for simple cannabis possession alone. An American Civil Liberties Union report from 2018 found that Black people in America are nearly four times more likely than Whites to be arrested for cannabis possession, despite similar usage rates between the two groups. According to a 2013 ACLU report on race and marijuana prohibition, low-income people of color face disproportionate consequences from cannabis arrests due to their inability to pay fines, inadequate access to counsel and potential loss of housing, employment, and student loans.
Despite the cost in Black and brown lives, cannabis prohibition has failed in its most basic objective: the prevention of underage use. For decades, government statistics have shown that around 80% of American twelfth graders can easily access cannabis. Interestingly, as legalization spreads around the country, underage access is now trending downward, and underage use has remained level in legalized states. In fact, the US Centers for Disease Control and Prevention recently published a study showing that the number of US high schoolers who had ever tried cannabis increased from 2009 to 2013 and decreased from 2013 to 2019. The turning point was in 2013, a year after US states began legalizing and regulating cannabis for adult use.
In a nation where tens of millions of adults consume cannabis, and according to a November Gallup poll, more than two-thirds of Americans support the legalization of cannabis, groups like the AMA have retreated to a watered-down version of prohibition.
"Decriminalization" is a policy that theoretically reduces or removes penalties for cannabis possession while maintaining the illegality of cultivation and sales. Decriminalization encourages the illegal cannabis industry and prevents the government from regulating cannabis products. In practice, decriminalization doesn't stop arrests for minor cannabis offenses, and racial disparities persist.
Therefore, the AMA finds itself in the morally and logically indefensible position of opposing government regulation of a drug that it wants decriminalized. It sends the message that we are better off with an untested cannabis supply, vulnerable to contamination and adulteration. By opposing regulation, the AMA stands against standardized labeling of cannabis products with health warnings, ingredients, and potency. It would put the nascent regulated cannabis industry back in the hands of unregulated growers and dealers who don't pay taxes and sell cannabis -- sometimes with more dangerous drugs or heavy metals and pesticides -- to minors as well as adults.
Given that its policy runs counter to basic principles of scientific evidence, social justice, and common sense, there can be only one conclusion: The AMA still suffers from the institutional racism it claims to oppose.
Fortunately, a rapidly growing number of physicians recognize that only legalization can end the social injustice of the war on cannabis, and effective regulation is a no-brainer for a drug consumed by a significant percentage of American adults. In 2016, we launched Doctors for Cannabis Regulation (DFCR), which now has members in nearly every US state and territory and recently joined the broad-based Marijuana Justice Coalition. Along with our allies -- including the Drug Policy Alliance, the National Organization for the Reform of Marijuana Laws, the Marijuana Policy Project, and other organizations -- DFCR believes that regulation and education are the best tools for addressing cannabis misuse.
This year, the AMA has doubled down on its support for a social policy that criminalizes millions of Americans, disproportionately in communities of color. In an effort to invalidate the ballots of an overwhelming 74% of Mississippi voters, the AMA filed an amicus brief with the Mississippi Supreme Court in January to overturn the state's wildly popular medical cannabis ballot initiative.
Last week, AMA President Dr. Susan Bailey posted that "Our AMA does not support legalization of cannabis for adult use until additional scientific research has been completed to fully document the public health, medical and economic consequences of its use." She cites a webpage of the National Academies of Science, Engineering and Medicine (NASEM) to shoot down the health benefits of cannabis, but she conveniently overlooks NASEM's 486-page report in which experts evaluate decades of copious government-funded research into the health effects of cannabis, which are far less negative than those of alcohol and tobacco. Since the scientific method makes it impossible to "fully document" the impact of any drug, Dr. Bailey has now signaled that the AMA will not change its position no matter what the evidence tells us.
The organization's current position will not stop the nation's march toward cannabis legalization. But make no mistake: Its active opposition to legalization prevents cannabis regulation and delays the end of this racially biased policy. The AMA's blindness to its own institutional racism is a moral stain on our profession. And with every passing year -- every day -- a heavy cost is paid in Black lives.
Voters around the nation approved all five cannabis initiatives on the ballot in November -- three for adult use, one for medical use and one for both uses -- so the need to properly regulate this drug has never been greater. If the AMA is serious about righting the wrongs of its past, it must renounce the racist war on drugs and support effective regulation of cannabis as the only logical alternative to the destructive policy of prohibition.
