They were whip-smart students from the side of town with unpaved streets and no sidewalks, twin sisters excluded from the gifted track because they were Black.
A comment from a white classmate in Twinsburg, Ohio still stings: “’I don’t even think of you as Black.’ I said, ‘’Thank you.’ And I felt pride,” Dr. Brittani James recalls, shuddering.
“I believed we were special. I believed other people in our neighborhood weren’t as good as us," she said.
The twins were indeed special — they won free rides to the Ivy League, earned medical degrees at prestigious universities, and have thrived in a profession where they are vastly outnumbered by virtue of their skin color.
But their mission now is to dismantle the entrenched bigotry behind that classmate’s backhanded remark.
At 33, James and her twin, Dr. Brandi Jackson, have taken on the medical establishment in pioneering work to eliminate racism in medicine.
“We’re teaching how to see it and how to undo it,” Jackson said.
James, an internal medicine doctor, and Jackson, a psychiatrist, have developed anti-racist coursework used in two Chicago medical schools. They’ve co-founded the Institute for Antiracism in Medicine, where physicians can earn continuing medical education credit for taking classes on how their profession has made Black patients sicker.
They’re seeking federal legislation to require hospitals to reveal outcomes by race, with penalties when Black patients consistently fare worse. They’ve even hatched a plan to create black physician coats. That’s not as radical as it might sound -- black coats were the tradition in the 19th century.
Their latest achievement? Helping lead a charge against the American Medical Association and the influential research journal it publishes.
The pandemic year and relentless police violence has fueled their resolve to fight structural racism.
“It is literally killing us,” James said.
In recent years the AMA has made an effort to atone for decades of excluding Blacks from its ranks. Even today, just 5% of all U.S. physicians are Black.
But in February, a podcast hosted by the AMA’s flagship medical journal caused a stir. The tweet promoting the podcast read, ‘’No physician is racist, so how can there be structural racism in health?’’
It was “a gut punch,” said Dr. Aletha Maybank, AMA’s chief health equity officer.
The sisters’ institute started a petition, demanding that the journal diversify its mostly white editorial staff and ensure that medical research relating to race and racism gets published. The effort has garnered more than 8,800 signatures so far.
AMA suspended the journal’s chief editor and a deputy editor resigned. The group held a meeting last month where James and other Black doctors voiced their concerns.
James says the AMA’s new anti-racism plan — in the works long before the sisters’ activism — makes her optimistic. In an 83-page document released Tuesday, AMA vowed to dismantle structural racism within the U.S. medical establishment, including diversifying its own staff and collaborating with outside groups.
The group reached out to James and other physicians to discuss the plan — a hopeful sign, she said.
“We still have to hold their feet to the fire," she said.
The sisters’ message isn’t new, said Dr. David Ansell, a Rush physician who has worked with their institute. But their timing is uncanny -- coming at the convergence of a deadly pandemic that has highlighted racial health inequities, a rise in white supremacism, and civil unrest over police brutality.
At such a moment, he said, the sisters can make a difference.
Their scientific curiosity started young. James remembers taking “field notes" while spying on people. Jackson remembers turning their mother’s blue bead case into a bug hospital.
“We emptied it and would go under rocks in search of potato bugs, worms. We gave each their own compartments ... then would examine them and took notes when they appeared sluggish.’’
Their parents were hard-working and supportive, but the twins didn’t tell them when they were accepted at Cornell University, knowing the cost was prohibitive. They broke the news when they landed full scholarships.
It was during a college summer program that James for the first time saw a Black doctor. She stared. “It was like a unicorn,’’ but it planted a seed.
They separated for medical school -- Northwestern for Jackson, University of Michigan for James.
Now, they serve as mentors to other medical students from nontraditional backgrounds. James treats patients at a clinic on Chicago’s South Side and teaches at the University of Illinois-Chicago. Jackson has taught at Rush Medical College and is the behavioral health director for a Chicago health network that treats LGBTQ and other underserved patients.
Medical resident Shan Siddiqi is a Canadian Muslim whose parents are from Pakistan. He works under James’ guidance at a clinic where James says “the sickest of the sick’’ go for treatment, patients with chronic illnesses worsened by poverty, stress from living in violent neighborhoods and now COVID-19. Siddiqi said he’s impressed by her compassion, taking the time to treat them as humans and helping them overcome challenges to getting medication or specialty care.
Jordan Cisneros, a third-year Rush medical student who Jackson has mentored, says her guidance has helped him get through a tough year. His father died from COVID-19 in January and George Floyd’s televised death last May felt personal.
“I’ve had run-ins with police. I’ve had run-ins with racism. I’ve seen things firsthand,” he said.
Jackson’s tears over Floyd’s death let students know its OK for doctors to be vulnerable, Cisneros said.
The sisters are extremely close, often finishing each other’s sentences, but there are differences too.
Jackson is single, loves to cook in her spare time and thinks like a scientist in the kitchen, marveling at how a humble carrot can transform into something sublime with just a little butter and brown sugar.
James is married to a white physician, a guy she thought was a math nerd when they met but is now her partner in battle. She tears up when asked what she wishes for their 1½-year-old daughter, Lillian.
“I don’t want her to have to live in a box like I did,’’ James said. ‘’I want her to raise her voice so she knows it’s OK to be everything that she is, especially when the world is trying so hard to make Black and brown girls small and not heard.’’
Follow Medical Writer Lindsey Tanner at @LindseyTanner.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.