The New Doctor’s Orders
Radical politics infect medicine
by Jack Butler (Originally appeared in National Review magazine on August 14th, 2023)
Is the American health-care system letting black babies die? Supreme Court justice Ketanji Brown Jackson thinks so. In her dissent in Students for Fair Admissions v. Harvard and UNC, which struck down racial-preference admissions schemes at these schools, Jackson lamented the majority’s failure to see how “health gaps” have tracked the financial disparities bequeathed by America’s legacy of racial discrimination. She likewise faulted the majority for not seeing affirmative action as a way to address these disparities. “Beyond campus, the diversity that UNC pursues for the betterment of its students and society is not a trendy slogan. It saves lives,” she wrote. As an example, she claimed that, “for high-risk Black newborns, having a Black physician more than doubles the likelihood that the baby will live, and not die.”
There’s just one problem: It’s not true. The citation on which she relies refers to an amicus brief filed in the case by the Association of American Medical Colleges, which argues that “for high-risk Black newborns, having a Black physician is tantamount to a miracle drug: it more than doubles the likelihood that the baby will live.” That brief itself cites a study titled “Physician–Patient Racial Concordance and Disparities in Birthing Mortality for Newborns,” which uses census data to measure mortality rates for black newborns in Florida between 1992 and 2015. The study’s actual finding, far more modest than what the brief made of it, was that the number of black infants who died while being treated by a black physician was less than half the number of black infants who died while being treated by a white physician. But in both cases the number of infants was a very small percentage of the total. The survival rate—what Jackson’s opinion refers to— remained above 99 percent for black infants in both groups.
There are other problems with the study as well. Stanley Goldfarb, a kidney specialist, formerly a professor and dean at the University of Pennsylvania School of Medicine and now president of the medical-advocacy group Do No Harm, has pointed some of them out. In Take Two Aspirin and Call Me by My Pronouns, Goldfarb noted of the study (which has been cited frequently since its 2020 publication) that its authors could not identify the race of all doctors involved, or even whether the caregivers were the attending physicians or instead nurses and doctors on call.
“The data sources simply do not provide enough information to judge the true situation,” Goldfarb concluded. But that didn’t stop the study’s authors from speculating about their results.
The lead author, Brad Greenwood (a professor at George Mason University’s school of business), told ScienceNews in 2020: “Black doctors may be more in tune with the specific experience that black newborns are facing,” such as “more challenging births as the result of increased socioeconomic pressures.” And there is little to no evidence of a “diversity benefit” in any other area of medicine, Goldfarb observed in his book. He cited a five-year survey of 22,400 patients that concluded: “Greater matching of patients and providers by sex and race/ethnicity is unlikely to mitigate health disparities.”
Supreme Court–watchers may have been surprised to find an extravagant, evidence-free claim to the contrary pop up in a decision. But not if they were paying attention to recent transformations in the field of medicine. Like a disease find- ing a new host, the rampant politicization of health care has begun to infect the law.
Medical-school curricula have become suffused with leftism. The Harvard Medical School course “Caring for Patients with Diverse Sexual Orientations, Gender Identities, and Sex Development” promises that “clinical exposure and education will focus on serving gender and sexual minority people across the lifespan, from infants to older adults.” An Indiana University Medical School “Sex and Gender Primer” for first-year students stresses that sex and gender “fall along a continuum, rather than being binary constructs,” and provides instruction on the use of “inclusive terminology.” A June 2020 letter from medical-school faculty at the University of California, San Diego, referred to the deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery and committed to creating “a curriculum which addresses the part we play in righting these systemic injustices” and using “these tragic events to strengthen our resolve.” One survey found that 39 of America’s 50 most prestigious medical schools contained some element of mandatory critical-race-theory training in their curricula.
These curricula are downstream from a myriad of medical- school initiatives, many of them recent, to make politically au courant views an essential part of their instruction. The medical school at the University of California, San Francisco, has produced a document titled “Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators,” which asserts the need for its faculty “to deepen our understand- ing of the complex mechanisms and manifestations of racism, and to intentionally dismantle racism in the learning environment and in clinical medicine.” George Washington University’s School of Medicine and Health Sciences launched a combined “Covid + HIV Screening and Testing Model” and offered as training for its use a webinar discussion moderated by 1619 Project creator Nikole Hannah-Jones and titled “Confronting U.S. History: We must end RACISM to end health disparities.” Leaders at the University of Michigan’s medical school, “in response to a nationwide call to stand in solidarity against racism,” created an “Anti-Racism Oversight Committee (AROC)” and “sought feedback from faculty, staff, nurses and learners about how we can eliminate racism and inequities that may exist today at Michigan Medicine.”
Such efforts go far beyond reasonable attempts to accommodate different groups of patients; they function as signals of political commitments. UM’s report, for example, sensibly called for “funding for opportunities for medical students to rotate to Flint and Detroit hospitals,” but less defensibly advocated securing funding to “hire experts in critical race theory and health justice education to develop scholarship and update medical school/residency/faculty education” and to “market diversity of Michigan Medicine to various audiences.” Decisions to dedicate funding to such things in an environment as resource-intensive as a medical school are part of the same trend in which the University of Michigan generally has come to have one of the highest concentrations of “diversity, equity, and inclusion” staff in the nation.
The students at such institutions are not always passive receptacles of political instruction. Some cheer it on. White Coats for Black Lives, a medical-student activist group with chapters at more than 70 med schools across the country, identifies as its twofold mission “dismantling dominant, exploitative systems in the United States, which are largely reliant on anti-Black racism, colonialism, cisheteropatriarchy, white supremacy, and capitalism” and “rebuilding a future that supports the health and well-being of marginalized communities.” An essential part of that future is to abandon capitalism, which the group believes “is antithetical to the health and well-being of marginalized populations, particularly Black people in the United States,” because it “aims to maximize profit.” (“Socialism provides one alternative that establishes collectively-owned resources and prioritizes basic human rights,” the mission statement helpfully suggests.)
In some places, graduates have more of the same to look forward to once they begin practicing medicine. A law that went into effect this year in California, for example, mandates that “all continuing education courses for a physician and surgeon . . . contain curriculum that includes specified instruction in the understanding of implicit bias in medical treatment.” Such bias, the legislation claims, “contributes to health disparities by affecting the behavior of physicians and surgeons, nurses, physician assistants, and other healing arts licensees.” But this is no more than an assumption, given the lack of clear evidence that the race of providers and patients affects the quality of care.
And things are not much better in the various societies that inhabit the firmament of professional medicine. Leading the way is the American Medical Association. In 2021, it produced an “Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity” that begins by “acknowledg[ing] that we are all living off the taken ancestral lands of Indigenous peoples for thousands of years” and commits to “accountability towards the goal of eliminating inequities—systematic, preventable and unjust differences—in health for patients, families, providers and communities, as well as tackling the root causes for these differences and preventing new and further harm.” It has also released, as part of its continuing-medical- education programs, a video titled “Racism in Medicine: Historical Foundations and Strategies for Advancing Health Equity,” which urges viewers to identify “opportunities to cen- ter community and historically marginalized voices as you design interventions” and to “consider how your own deci- sions, whether at work or in the community, and at home, may be supporting false racial ideologies or beliefs.”
Other organizations act similarly. In their public-facing capacities, they now weigh in on a host of issues not explicitly pertaining to medicine—and always do so in a predictable way. “All of the medical societies, . . . they’re in unison on immigrtion, they’re in unison on affirmative action, they’re in unison on climate change, they’re in unison on gun violence,” Goldfarb tells me. “They just represent a left view of the world.” Their internal proceedings mirror this. In June 2021, the American College of Surgeons held a profession-wide leadership retreat at which the keynote speaker was Ibram X. Kendi, the fêted anti-racist who favors discrimination. (“The defining question is whether the discrimination is creating equity or inequity. If discrimination is creating equity, then it is antiracist. If dis- crimination is creating inequity, then it is racist.”)
It is not uncommon for these groups to turn against members who fail to adapt to the times. Earlier this year, the Society of Thoracic Surgeons (STS) condemned its own outgoing president, John Calhoon, for a slide presentation at its annual meet- ing that included bullet points such as: “Affirmative Action is not equal opportunity”; “Inclusion not the same as Diversity”; “Defining people by color, gender, religion only tends to ingrain bias and discrimination”; and “Best metric is simply whether someone does good.” In a statement after the fact, the STS felt compelled to reassure the public that Calhoon’s remarks were “hurtful” and “inconsistent with STS’s core values of diversity, equity, and inclusion.” It therefore “regret[ted] the pain they have caused to so many valued colleagues.” Of the controversy, Calhoon told me via email:
I expressed a view (my own) during a Presidential Address to a group of Thoracic Surgeons that we should “always look for the candidate (in training heart and lung surgeons) with the most merit.” I am a believer in inclusion by identifying and growing those that have climbed hurdles or overcome challenges to get where they are (often overcoming challenges in part due to race, gender, or religion) regardless of gender, religion, or their race (color). As for what happened . . . this view was not uniformly well received. Some people must have sincerely heard some- thing else and some must have really distorted what was said on social media, but I do not use social platforms like Twitter, Facebook, Instagram, or whatever. It hasn’t changed my feeling we should look for merit first and foremost.
What accounts for the politicization of medicine? The greater government role is a precondition: Though the state is not yet the majority health insurer, it is the largest entity in the field. Anything that becomes so government-influenced will unavoidably become political, and administrative bureaucracy is a redoubt of the Left. Richard Bosshardt, a surgeon and a member (for now; more anon) of the American College of Surgeons (ACS), tells me that “it may be that some of the kowtowing that you see in some of these organizations to DEI [diversity, equity, and inclusion] is simply the reality that if they don’t do this, they risk losing federal funding.” Goldfarb also fingers “the tie between academic life and the actual provision of health care to the vast population of the country.” Because “every physician has to come through this academic world and the academic world really guides what the practice is like,” medicine ends up exposed to permutations and gradations of the same theories that have run riot in academia as a whole.
As Bosshardt described it to me, an entire generation of students has been “primed to be very receptive to the idea of social justice.” They are moving “from the university out into the society, and they’re now populating, they’re becoming the managers and the corporate people, they’ve gone to medical school and become doctors.” And it’s hard to resist a crowd.
“I think it’s a virtue-signaling thing because it’s an easy out,” a different doctor who wished not to be named told me. “It’s easier than standing up and saying this is not based on science, this is not based on helping people, this is based on things that no reasonable person even five years ago would have stood up for and said, Yeah, I believe in that.”
Though the state is not yet the majority health insurer, it is the largest entity in the field. Anything that becomes so government-influenced will unavoidably become political.
For many years, these trends were working their way slowly but surely through the medical system. But the murder of George Floyd in the summer of 2020 provided what this doctor described as a “catalyst” for further radicalization, as medical schools and professional organizations reflexively declared allegiance to the racial consciousness suddenly ascendant in America. Goldfarb agrees. “When George Floyd was killed, that started into motion these strategic plans, bureaucracies, all devoted to eliminating racism and injustice from health care,” Goldfarb says. “And these bureaucracies are just playing their way into—now—action.”
Bosshardt paid a price for questioning this new consensus. He took issue with the ACS’s 2020 embrace of anti- racist orthodoxy, including its creation of a task force to deal with “structural racism” in the organization, and wrote a letter to the group’s president seeking clarity. “I want to see where the racism is,” Bosshardt told me, recall- ing the spirit of his letter. “If we discover racism in the ACS, let’s deal with it. But if we state blandly and generally that the ACS is racist, I think that’s wrong. And if we continue with this, I just can’t see myself staying here.” Getting no response even as the ACS task force came back with several recommendations—such as adding anti-racism to the values of the organization and opening a diversity department with its own executive director—Bosshardt posted his thoughts in a forum open to members. It blew up. Though he received clear majority support in the responding comments, in private he “was called all kinds of names,” he recalls. “One surgeon sent me a private message calling me a ‘bloviating male bovine spewing bullsh** out my a**.’”
Eventually, Bosshardt secured a Zoom meeting with the leadership at which he was allowed to state his case. Little of consequence occurred thereafter—until, without warning, the forum in which he had posted changed its rules to prohibit discussion of DEI and began deleting his posts. Eventually, Bosshardt was banned, completely and without warning, from the forum, losing access to his private messages and to the ACS membership directory.
Seeking redress internally through a designated disciplinary board, he was told that it could pro- vide no help because the matter never came before it in the first place.
All this as the ACS continued to accept his dues and consider him a member in good standing. The complete loss of due process rankles Bosshardt, but so does the smothering of a discussion that should be had openly. “To say that I can’t raise an objection to something as controversial as DEI—I don’t care if you’re for it or against it, I like to see the conversation,” he says. “And this is what’s being basically prevented.”
And will likely continue to be. “I’m just a tiny little fish in the ocean,” Bosshardt says. “This kind of cancellation has been going on everywhere.” He is considering legal action and has started a petition to get his ACS privileges reinstated. Other doctors, as evident above, prefer to provide information about the decline of their organizations anonymously. Goldfarb, whose advocacy group Do No Harm is trying to con- test these trends in medicine, confirms this: “They tell us all the time, Keep me anonymous, I have to feed my family.” Still others remain silent. “For a surgeon to be running scared of speaking out for their careers or livelihoods, that’s terrifying, that’s a terrible thing to hear,” Bosshardt says. “But I heard a lot of that.”
Do those resisting the trend have any hope that things will get better? Goldfarb does, albeit not in the short term. “I think we’re going to see a lot more public discussion of these issues, and I think the public, in general, when they’ve been polled, they’re not really thrilled with these approaches that the academic elites have taken on, and they don’t really believe in it, for the most part,” he says. “But I think the bureaucracies are just getting rolling here.” Bosshardt considers himself a “cautious optimist” because of “the simple fact that the whole idea of systemic racism is so crazy and absurd and indefensible” that “it’s going to collapse under the weight of its own weak arguments.” In the meantime, however, real damage is being done to the relationship between doctors and patients, and especially those patients who may be most in need of care. The doctor who requested anonymity put it to me bluntly:
Instead of looking at an MRI and seeing if the guy’s got a herniated disc or joint arthritis, people are worried about his lived experience the past 30 years, how he identifies today, and yesterday, tomorrow, all that stuff. I think that’s going to have a major negative effect on the standpoint of patient to physician. And on the flip side, if this gets into the lay press more robustly, I think patients are going to see the opposite. They’re going to go in and they’re going to say, Wow, I’m a gay black guy, I should only find a gay black doctor because a straight white guy is never going to pay attention to me, he’s never going to be a good doctor, he’s going to discriminate against me, and all this stuff, which is completely asinine. And so you’re going to have that distrust coming from the patient towards the doctor. It’s going to be very difficult for anybody to get reasonable medical care.
Proponents of more-racialized provision of medical care say their approach is necessary to eliminate the disparities they cite as reasons for which medical care is more necessary for—or less available to—racial minorities. The doctors I spoke with did not object to measures to increase medical access or to improve patient trust.
What they objected to was the notion that adopt- ing the trendiest left-wing theories, or transforming medicine into political advocacy, will achieve those ends.
“I’ve treated patients from every background that you can think of,” the same doctor tells me. “I don’t care if they’re gay or straight or what- ever. What I care about is what’s their problem and how do we fix it based on the data I have available to me.” Goldfarb says: “Either treat or cure suffering, that’s the job of physicians.”
The doctors who resist politicized medicine want to treat patients as individuals, not as abstractions or generic mem- bers of an aggregate. That is, they want the medical version of what Justice Clarence Thomas advocated in his concurring opinion in Students for Fair Admissions v. Harvard and UNC. Rejecting Justice Jackson’s use of “broad observations about statistical relationships between race and select measures of health, wealth, and well-being to label all blacks as victims,” he noted that “none of those statistics are capable of drawing a direct causal link between race—rather than socioeconomic status or any other factor—and individual outcomes.”
‘Either treat or cure suffering, that’s the job of physicians.’
As if in implicit rebuttal of Kendi, Thomas wrote that “the solution [to racial inequality] announced in the second found- ing is incorporated in our Constitution: that we are all equal, and should be treated equally before the law without regard to our race.” For him, “only that promise can allow us to look past our differing skin colors and identities and see each other for what we truly are: individuals with unique thoughts, perspectives, and goals, but with equal dignity and equal rights under the law.” For the sake of medicine, and of our country in general, let’s hope that America chooses the Thomas route in all facets of national life.