Among the many responsibilities that fall to editors, one of the most important is encouraging authors to make thoughtful and sensitive language choices. This includes using patient-first language (patients with diabetes, not diabetics); language respecting the age, sexual orientation, socioeconomic status, and disability status of groups or individuals (when relevant); and language that avoids bias regarding race and ethnicity.

In reports of scientific research, specifying the race and/or ethnicity of participants can provide information about the generalizability of the results of a specific study. Because many people may have mixed heritage, a racial or ethnic distinction should not be considered absolute, and preferably it should be based on a person’s self-designation. Ideally, researchers should be required to provide an explanation of who classified individuals’ race or ethnicity, the classifications used, and whether the classifications were defined by the investigator or the participant. In addition, the reasons that race or ethnicity information was collected in the study also should be described (e.g., in the Methods section).¹

Updating the Language: Black and White

The committee members responsible for the AMA Manual of Style received a number of queries earlier this year about the presentation of racial and ethnic terms, in particular (but not exclusive to) the manual’s style preference of the lowercase black. The 11th edition originally specified capitalizing racial and ethnic terms that derive from geographic nouns such as Asian, Alaska Native, and Latina, but the terms black and white were lowercased as racial designators (i.e., not derived from proper nouns).

However, recent and ongoing events spurred us to reconsider this style recommendation. The manual’s committee met several times, conducted research, and sought input from multiple sources. We deemed this issue too important to wait for the next formal edition.

In weighing the options (keep black and white lowercase, capitalize just Black, or capitalize both Black and White), we looked to usage in a variety of places, including other style manuals (Chicago Manual of Style,² APA style,³ and the AP Stylebook⁴), writing by an array of scholars, and guidance on diversity from academic and government sources.⁵

We concluded that the best course of action would be to capitalize both Black and White, which aligns with the capitalization preference applied to other racial/ethnic categories.⁶ We acknowledge that there may be instances in which a particular context merits exceptions to this guidance, for example, in cases in which capitalization could be perceived as inflammatory, divisive, or otherwise inappropriate.

The Need for Precise and Updated Language

There are additional language issues the committee is weighing, including “other” as a category and racial and ethnic terms used as nouns. The nonspecific “other” is sometimes used for comparison in data analysis but may also be a “convenience” grouping and should be avoided when possible. It is important to be specific when reporting on racial or ethnic differences (even if these comprise a small percentage of participants).

The study included 200 White individuals, 100 Black individuals, and 100 of other race/ethnicity.

In the above situation, the editor should press the author for further explanation, considering that the racial or ethnic background of a quarter of the study is unknown. Furthermore, it is oversimplifying, potentially misleading, and possibly pejorative to define a group of people by what they are not. Avoid using “non-White” as a category label for the same reason (which can be interpreted as one category being a standard and one being “other” or nonstandard).

The study included 200 White individuals, 100 Black individuals, 75 Asian individuals, and 25 who indicated more than 1 race.

It would be ideal, in the above example, to have more granular information, such as the country of origin of Asian individuals. But often authors can only report what was collected in baseline demographic data.

Note that herein the racial and ethnic terms used are all adjectival; in the interests of person-centered language it is best to avoid labeling a person with a classification (Blacks, Whites) just as we avoid calling people asthmatics or diabetics.

This is also why the word minority, on its own, can be pejorative and vague. Terms that might be substituted—depending on context—include racial/ethnic minority group, underrepresented group, or people of color.

In addition, the AMA Manual committee is working on a further update to the Inclusive Language section to address other racial and ethnic terms, such as Latinx. Because Latinx and Hispanic have different meanings,³ it is best to be as specific as possible and not simply choose one or replace one with the other. Latino/a/x may be the preferred terms for those originating from Latin America,⁴ although it is preferable to be as precise as possible (e.g., “participants were from Argentina and Bolivia” instead of “participants were Latino”). Hispanic is often used as an umbrella term for people from (or whose ancestors were from) a nation primarily of Spanish speakers, such as Cuba or Mexico. Again, the more precise language that can be used, the better.

Another term that has emerged is brown, which has been used to describe people not classified into Black or White categories. Use of brown is controversial because it has been used inconsistently and does not characterize a specific racial or ethnic category.⁴ For this reason, the AMA Manual will likely discourage the use of brown in research reports in favor of more precise descriptors, but it may be a useful term in narrative or opinion pieces.

As evidenced by perpetual updates to style manuals, dictionaries, and other resources, nomenclature is never a static enterprise. Those of us in the business of communication have a responsibility to use and promote clear and accurate language, with words that reflect the world around us.

References and Links 

1. Instructions for Authors. JAMA. [accessed October 20, 2020]. https://jamanetwork.com/journals/jama/pages/instructions-for-authors#SecReportingRace/Ethnicity
2. Black and White: a matter of capitalization. CMOS Shop Talk. June 22, 2020. [accessed October 20, 2020]. https://cmosshoptalk.com/2020/06/22/black-and-white-a-matter-of-capitalization/
3. APA Style. Racial and ethnic identity. [accessed October 20, 2020]. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities
4. AP Stylebook. Race-related coverage. [accessed October 20, 2020]. https://www.apstylebook.com/race-related-coverage
5. National Institutes of Health. Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes. April 8, 2015. [accessed October 20, 2020]. https://grants.nih.gov/grants/guide/notice-files/not-od-15-089.html
6. Updates to the Manual. July 3, 2020. [accessed October 20, 2020]. AMA Manual of Style. https://www.amamanualofstyle.com/page/live-updates

Stacy L Christiansen, MA, Managing Editor, JAMA, and Chair, AMA Manual of Style committee.