Are Biomedical Ethics Journals Institutionally Racist?

So there’s this letter published in the Journal of Bioethical Inquiry that moots the idea that the top biomedical ethics journals might be institutionally racist.  In it, Subrata Chattopadhyay, Catherine Myser and Raymond De Vries point out that the editorial boards of a good number of journals are dominated by members who are located in the global North – countries officially listed as being high or very high on the development index, with only 1.3% drawn from countries classed as least developed.

Developing World Bioethics has the highest proportion of its editorial board located in the least-developed nations; but even there, the figure is only just over 11%.  On the face of it, this doesn’t look too good, especially given the proportion of the world’s population in general that lives in the poorest countries.  The JME, by comparison, draws 100% of its editorial board members from people located in highly and very-highly developed nations.

Still: this isn’t likely to be the whole story.  Udo Schucklenk – a founding editor of DWB, of course – takes issue with the letter on a number of grounds.  For one thing, he he suggests that Chattopadhyay et al might be performing a sleight of hand with their metrics; by lumping together countries ranked as high and very high on the development index, they’re lumping together the UK, Germany, and the US with Iran, Malaysia, and Jamaica.  Neither Iran nor Jamaica is a classic basket-case economy; but, still, “high” and “very high” development covers a vast range of income levels.  Treating all these countries in the same way obscures that there’s a huge range of locations from which editorial staff may be drawn.

I’ll come back to this in a moment.

Chattopadhyay et al also claim that

bioethics pays more attention to esoteric ethical problems facing wealthy nations than it does to issues such as poverty, hunger, and health inequities that are global in nature. Is this editorial bias (Lancet editor Richard Horton calls this institutional racism) mirrored in the editorial boards of leading bioethics journals?

What they don’t do is provide an answer to their own question, or evidence to suggest one.  I suppose that there might be institutional racism at work; but that isn’t the only explanation.  Here’s another: issues such as poverty, hunger, and health inequalities don’t get much attention in journals (or maybe, pace Udo, journals other than DWB) because they aren’t that ethically interesting*.  There’s not much scope to argue about whether poverty, hunger, and inequalities are good things.  The debate here is how to remedy them, not whether they should be remedied; and that kind of debate is perhaps better had in more general ethics journals, or those devoted to development, economics, or politics.  There is scope to ask questions about what global justice would look like – but that isn’t a uniquely biomedical question, and it might be better addressed elsewhere.

In other words, institutional racism, or Northern complacency, might explain the content of journals; but it isn’t necessarily the only explanation, and it isn’t necessarily the best.

As I noted a second ago, Chattopadhyay et al leave their question hanging; having raised it, they move on to look at the make-up of editorial boards, suggesting that

[the] severe underrepresentation of developing countries on editorial boards suggests that institutional racism also infects leading bioethics journals and is clearly a cause for concern.

Does it?  Again, it might; but there’s a range of other things we have to take into account.  Udo notes that all the journals considered are English-language:

Why should non-English speaking academics working in the global south submit content to English language journals that are not widely read in their home countries?  Are they doing wrong, in the eyes of our Letter writers, when they focus on journals in their mother tongue that are actually locally read by their fellow country men and women?

But there’re other things that need clarification, too.  First, the analysis is of the editorial boards is based on where their members are based.  It does not tell us anything about where their members are from, or their ethnicity.  Hence leaping to claims about racism quite so quickly doesn’t seem warranted.  Geography isn’t race.

Second, academia is very globally mobile – far more mobile than most other professions, I’d guess.  This allows talented people to move around the world in pursuit of ever-better jobs.  It’s reasonable to assume that the highest pay and the best quality of life will be found in the most developed countries; therefore the most talented people are most likely to gravitate towards those countries.  But since journals will want to draw their editorial boards from among the most talented, this means that those boards are likely to be drawn from the most developed countries.  At the same time, if you’re living in a less-developed country and are asked to join the editorial board of a journal, that could well be the sort of recognition that helps you get a job somewhere else.  Again, the location of editors doesn’t tell us a great deal that’s of any use; it’s not a sign of anything sinister.

Of course, we might think that there’s something unjust about a world in which the most talented people from the developing world leave to live and work in the developed world; but that’s a different matter entirely.

Third, the letter gives only a snapshot, and snapshots of phenomena don’t necessarily help us explain those same phenomena.  To see why, imagine that talented people are randomly and evenly distributed around the world, and that each individually has exactly the same chance of becoming an editor irrespective of where they live.  Maybe editorial posts are distributed among suitably talented people by lottery, for example.  In this picture, we’d expect that, over time, the composition of editorial boards would match world demographics.

However, that expectation could be unmet without it meaning that anything has gone amiss.  An unbiased coin – or a whole bag of them – might never come up anything other than heads; the selection of editors might never, as a matter of fact, yield any distribution other than the one we currently see.

For sure, if a highly unlikely distribution does occur across several journals, and remains for a significant amount of time, it does increase the chance that there’s something wrong.  But any distribution is only ever evidence for that – it’s not proof.  Merely pointing out that the distribution of editorial board members is thus-and-so is a starting point; it might require explanation; but – as I’ve just indicated, and Udo has indicated further – there’re explanations for the distribution that don’t require imputations of racism.

Is there a case for the journals to answer?  Well, there might be.  Chattopadhyay et al might have identified a problem.  But it’s not obvious that the case is unanswerable.


*UPDATE, 25.iii.13, 14:00: See the discussion in the comments.  By “ethically interesting”, I simply mean that there’s no real debate to be had about whether, say, poverty is a bad thing.  What is ethically interesting is what should be done about it – there’s a real debate to be had there.  However, it’s not the kind of debate that necessarily belongs in biomedical ethics journals – it would be at least equally at home in applied ethics, political philosophy, economics, development, or related journals.

  • Daniel Goldberg

    Without commenting on the underlying claims in the letter, the idea that poverty, hunger, and health inequalities are not ethically interesting is . . . unpersuasive, to put it mildly. I suppose what you mean by that is that there is little dispute on the ethical propriety of these matters, but if that is the criteria for “ethically interesting” than we have entirely reduced applied ethics to a narrow kind of “quandary ethics” that IMO has justly received all sorts of robust criticisms (we might, for example, almost do away with virtue ethics entirely if the study of applied ethics is nothing but the occurrence of ethical dilemmas. Robert Coles wrote evocatively on this as far [??] back as 1979 in NEJM, and Howard Brody touches on it as well in a number of pieces).

    Moreover, it does not follow from the fact that few believe poverty, hunger, and material deprivation to be ethically appropriate that in fact they are not ethically interesting. There are a huge number of ethically interesting issues there. To list but a few: which interventions should be prioritized over others? Should we funnel less resources to biomedical interventions than whole population measures? Are all health inequalities of equal moral significance? If not, which are paramount? Why? If ought implies can, what do the difficulties involved in changing international political economies signify? Which theories of justice can help sort through moral obligations regarding poverty, hunger, and inequalities? Rawls? Powers and Faden’s
    sufficientarian approach? A capabilities approach? What does the natural fact of compound disadvantage imply in terms of ethical priorities? Harvard had an enormously interesting conference in 2012 devoted to questions regarding identified vs. statistical victims and the rule of rescue, which are IMO at once fascinating, difficult, and highly relevant to issues of poverty, hunger, and inequalities.

    Respectfully, then, unless applied ethics is reduced to biomedical quandary ethics, I think that you have simply managed to suggest that the cluster of issues related to poverty, hunger, and inequalities are not ethically interesting to you. This is of course legitimate, just as issues related to enhancement, chimeras, and transhumanism
    are decidedly uninteresting to me!

    • I think that, actually, we’re pretty much on the same page. I thought I’d been clear in my meaning, but possibly wasn’t (and it might be worth my adding a codicil…): that the questions that arise from poverty aren’t necessarily the domain of biomedical ethics journals – they’d also appear in, say, development or economics journals. Whatever pool of such papers there is might well be fairly thinly spread.
      I’d add to that one other thought, which is that we might actually expect to see them in other kinds of journal before the biomedical ethics ones, because biomedical ethics journals tend to have comparatively short word-limits.

      • Daniel Goldberg

        You may well have been perfectly clear; but I admit to some sensitivity to these matters given that I identify as a bioethicist who works almost exclusively on issues like poverty, hunger, and inequalities.

        I agree that the fact that the majority of bioethicists work on biomedical issues means that insofar as such dominates editorial boards, we might see less papers on subjects of poverty and hunger in bioethics journals. But does that also imply something about the composition of the boards themselves? Maybe.

        Anyway, apologies if I misread your position.

      • Daniel Goldberg

        And, as an update to your update in the post, there is also a very important debate to be had regarding whether bioethics journals in fact SHOULD devote more space to the ethically interesting issues regarding poverty, hunger, and inequalities. (I think emphatically yes, but obviously I have a stake in this issue, and of course this latter debate is tangential to the specific subject of the post).

  • I do think its an unbalanced approach when it comes to the issue of publication in international journals .People from Eastern Europe have this issue as well.The map of Europe was devided by the Soviets ,Americans anf the British.We live only the consequences of that division.The gap is real but we have to return to history to understand where we are .Why are we here ?Who will help us recover from 50-60 years of aggresive communism? only ourselves. The West only forces us to run .If the West would have been in our place ?We have talented people in Easten Europe and also in other parts of the world.Bringing voice to the voiceless is to remind the West about history when they keep forgetting it.Racism is institutionalized.They sacrificed Easten Europe and we are still war survivors on the road to recovery.