From 2021:
Medicine's Getting Major Injections of Woke Ideology (Two-Part Series)
"The national racial reckoning over reparations and critical race theory is taking over the world of medicine and health care. Prestigious medical journals, top medical schools and elite medical centers are adopting the language of social justice activism and vowing to confront “systemic racism,” dismantle “structural violence” and disrupt “white supremacy” in their institutional cultures.
Some activist physicians describe the present-day health care system with such ominous terms as a “medical caste system” or “medical apartheid”...
Rare is the doctor who is willing to publicly question claims of white privilege and implicit bias in the healthcare system, and already several doctors who have publicly pushed back have been demoted and have filed legal actions alleging retaliation. This year the medical profession received an unequivocal message when two editors of the prestigious Journal of the American Medical Association resigned under pressure over a podcast that aired opinions expressing skepticism that the United States is plagued by systemic racism.
While racialized politics has infused every corner of American life, the moral stakes in the health care arena go far beyond, say, the perceived slights called microaggressions. The medical literature, lately drawing on critical race theory, depicts the health care industry itself as a historical source of illness in — and even killing of — black and brown bodies. That would make medicine analogous to policing and criminal justice, the other social institutions directly blamed for maiming and murdering black people...
The movement is just beginning reshape the practice of medicine, but a primary assumption is that white doctors and institutions are pervaded with unconscious bias, and that black doctors, who are significantly underrepresented in the profession, would provide better care to black patients. But because black students typically get lower scores and lower grades, increasing the ranks of African American and other minority practitioners would likely require moving away from a reliance on conventional measures of academic qualification, such as undergraduate grades and standardized test scores...
Efforts to improve health outcomes for black patients are advancing on many fronts. They include a Boston hospital pilot project to offer preferential admissions to non-white patients for heart care; prioritizing non-whites for COVID-19 vaccinations; and the changing of a United States Medical Licensing Examination test from a graded score to pass/fail to help minority students succeed.
The Accreditation Council for Graduate Medical Education is adding a diversity requirement for accrediting U.S. residency and fellowship programs for newly minted doctors; and Northwestern University and its Feinberg School of Medicine are seeking to improve diversity by eliminating a six-decade-old Honors Program in Medical Education.
Medical schools are adding units on critical race theory, intersectionality, implicit bias, identity, oppression, allyship, power and privilege to their curricula. Medical students are learning about medical exploitation and medical experimentation on enslaved blacks, black prisoners and other unwitting subjects. And staple reading assignments in med schools feature such non-medical polemics as Robin DiAngelo’s “White Fragility” and Ibram X. Kendi’s “How to Be an Antiracist.”
This year alone, six state medical boards have added a requirement for training in “antiracism,” implicit bias or cultural competency for doctors in some practice areas to be eligible for a medical license, raising the total to 13 jurisdictions that require such training; eight other board are reviewing such proposals, according to the Federation of State Medical Boards.
All of this comes at a time when medical schools are experiencing dramatic changes on the gender front as well, where it is becoming customary for medical professionals to announce their gender pronouns as a matter of standard etiquette, and some medical schools are replacing the phrase “pregnant women” with “birthing people” in the interest of inclusiveness. Indeed, the issues of race and gender are intersectionally linked in the world of social justice advocacy, and some anti-racist and equity manifestos include a sex and gender platform, such as adding more chest binders and gender-affirming practices, reducing heteronormative bias, and advocating for “LGBTQIA2S+” causes...
Such developments trouble skeptics worried about the repercussions for patient care and for the training of physicians. They say the moral fervor reduces complex policy to simplistic slogans and indiscriminately blames all racial disparities on a nebulous menace – white supremacy or systemic racism – while discounting the influence of cultural differences and individual initiative. It then attacks the perceived problem through blunt weapons as such racial preferences, ideological conformity and emotional blackmail.
“The fundamental problem with social justice in public health is that there are no limiting principles to it,” American Enterprise Institute senior fellow and author Sally Satel wrote in the journal Liberties this year...
Satel is among those who doubt equity is attainable, given the complex underlying factors that shape human health. But some medical ethics experts are pushing in the other direction and going so far as to argue that equalizing group outcomes between blacks and whites may necessitate tolerating a greater loss of life...
“It’s a very ideological approach to things: ‘People are going to die, so you have to agree with everything I say. And if you disagree with it, you want people to die apparently,’ ” said William Jacobson, clinical professor of law at Cornell Law School and president of the Legal Insurrection Foundation, which runs the conservative websites legalinsurrection.com and criticalrace.org.
“And it also is extremely lucrative for consultants and administrators who have a vested interested in perpetuating the problem and these efforts,” said Jacobson, who is involved in litigation against SUNY Upstate Medical University for internal communications related to the school’s planned equity strategy.
Lurking just under the surface of this debate is the sensitive question no one wants to discuss on the record: the quality of med students and doctors who have lower test scores and worse grades, and presumably would not have been admitted if not for affirmative action. That’s an issue broached by Norman Wang, a University of Pittsburgh cardiologist whose peer-reviewed article questioning the legality of racial preferences was, four months after publication, retracted, leading to Wang’s demotion and public denunciation by his employer and by the journal that initially saw fit to run his article...
Among the 164-page task force report’s charges: “Health care professionals must explicitly acknowledge that race and racism are at the root of these health disparities.” All students and staff are to receive training in “bystander intervention” for bias, all new faculty hires would be required to sign a written pledge affirming a commitment to diversity, equity and inclusion, and staff with advanced training in anti-racism would be identified by wearable buttons. Medical school applications would add questions about the applicant’s commitment to social justice, and include “a statement that if the student does not have this desire they may not want to consider [SUNY] Upstate.”
WhiteCoats4BlackLives, a medical student organization that has grown to some 75 chapters out of the National White Coat Die-In demonstrations in 2014, represents up-and-coming leaders in the medical profession. The organization supports the Palestinian liberation movement, advocates the “abolition of police forces,” and urges medical schools to research the backgrounds of their founders and leaders for racist and oppressive pasts. WC4BL’s 289-page report from 2019 says the med school curriculum must explicitly teach that “it is the dominant groups’ pursuit of power that contributes to illness.” Among the group’s policy proposals: Medical schools must eliminate racial grading disparities, compensate “community advocates and people of color” for anti-racist activism, and equip physicians-in-training with tools to dismantle systemic racism, including “training in activism and organizing.”...
A 2019 study, referencing more than 300 papers on racial health disparities, noted that the racial outcomes are impervious to social class: “At every level of education and income, African Americans have a lower life expectancy at age 25 than do whites and Hispanics (or Latinos), and blacks with a college degree or more education have a lower life expectancy than do whites and Hispanics who graduated from high school.”
For the past quarter-century, public health experts had accepted a general explanation for these disparities – attributing them to “social determinants of health” – a term that covers living conditions and socioeconomic factors that ultimately determine one’s life expectancy. But these social determinants existed somewhere out in the world, beyond the scope of doctors, and the medical solutions seemed speculative, unknown or ultimately unknowable.
Over time, public health researchers began attributing the racial disparities with growing insistence to an anterior cause – an invisible force operating within American society, ranging from unconscious bias to policing patterns and even to the practice of medicine itself. In other words: systemic racism. Framing the disparities as the result of social determinants of health left the medical profession powerless – for how can a health care provider treat a patient suffering from social conditions? But zeroing in on systemic racism has thrown open the doors to a whole new set of interventions, which translate into the anti-racism movement now sweeping through the medical profession.
“It’s the thing that causes the adverse impact of social determinants of health on specific communities,” said Matthew Wynia, a University of Colorado professor of medicine and director of the Center for Bioethics and Humanities. “To just say it’s because ‘they live in bad neighborhoods,’ that is not a full explanation. This is all about 400 years of history.”
Wynia said there are only a handful of possible explanations for why black people have consistently worse health outcomes: bad genetics, irresponsible behavior, individual racism on the part of whites, or social structures. Wynia said the first two explanations – bad genes and bad choices – are the very definitions of racism, and individual white racists do exist but within the context of a larger problem: “Societal factors have got to be the favorite there.”...
One advocate suggests a redefinition of a physician’s scope of practice: Doctors have a moral obligation to become politically active so they can work to dismantle the social structures that harm their patients’ health...
The critics say that applying critical race theory to medicine too often devolves into an exercise in confirmational bias that seeks only the evidence that confirms the theory of systemic racism, ignores or disallows contradictory evidence, and imposes forced interpretations on complex data.
“They start with the conclusion. And there can be no deviation from the conclusion,” said Jacobson, the conservative law professor at Cornell. “You cannot question the conclusion because the conclusion of systemic racism is the starting point. It stifles dissenting views. It stifles open inquiry.”
Other scholars express similar frustrations. Satel’s article in the Liberties journal, titled “Do No Harm: Critical Race Theory and Medicine,” cites an anonymous colleague who related participating in a group discussion about stress and suicide among black youth. “The tacit rule was that only fear of police aggression and subjection to discrimination were allowable explanations,” the anonymous doctor recalled, “not the psychological torture of bullying by classmates or the quotidian terror of neighborhood gun violence.”"
Clearly when you a priori rule out answers you don't like, you can only get the answers you want - "societal factors", aka racism/opression, are always to blame.
Part 2 (live 12 February)
