By Tevi Troy
Friday, October 22, 2021
Twenty years ago, the physician Sally Satel argued in her
book PC M.D. that political correctness had taken over medicine. PC M.D.
described a lowering of standards to increase doctor diversity, the blithe use
of dubious “recovered memories” in sexual-abuse allegations, and the
endorsement for political reasons of questionable techniques such as
“therapeutic touch.” Some of these concerns no longer have much purchase in our
common cultural conversation. But Satel’s larger point continues to resonate:
Politics, and especially leftist political theories emanating from the
universities, can interfere with the practice of medicine in a deleterious way.
These days, the problem is not “politically correct”
medicine, but “woke” medicine. PC’s impact on medicine was real, and worrisome,
but the current fear is that PC’s implications could pale before woke’s
troubling impositions, which are more intensive in both scale and scope across
multiple sectors in health care.
To what extent is ideology influencing the medical field?
The first question is whether wokeness is directing
doctors to treat patients unequally. Wokeness at its heart looks at
intersectionality and judges people’s merits and worth on their place along the
spectrum of oppression. This pernicious concept means that those with more
claims to historic oppression should be granted preferable treatment over those
with fewer claims—with white “cisnormative” males having none of said claims.
The enshrinement of this concept contravenes the foundational principles
enshrined in the Hippocratic Oath, the ethic that has guided medical practice
for millennia.
The Hippocratic Oath does not actually say, “First, do no
harm.” What it does say is this: “Into whatever homes I go, I will enter them
for the benefit of the sick.” It specifically directs doctors to avoid the
mistreatment of patients, “whether they are free men or slaves.” The practical
effects of this doctrine are extraordinary. At the national level, for example,
Israeli doctors famously treat victims of terror attacks and the perpetrators
of such attacks the same way, with no distinction. This approach has long been
widely accepted as a signal of a doctor’s morality and good character and has
been broadly absorbed in our popular culture. In the 2018 movie Death
Wish, the filmmakers introduce the protagonist, a surgeon played by Bruce
Willis who unsuccessfully tries to save the life of a gravely wounded Chicago
police officer. Willis then has to deliver the sad news to the dead officer’s
partner, before being called away to operate on the murderer. He is scolded by
the grieving partner, who says, “What? Now you’re going to save the animal that
shot him?” Willis’s immediate and unhesitating reply—“If I can”—indicates how
deeply ingrained the concept of equal treatment in the medical profession is.
Is this principle under threat? The indications are
largely anecdotal at this point. An experimental program was proposed at Boston’s
highly regarded Brigham and Women’s Hospital that would offer “preferential
treatment” to patients of color, with, presumably, less preferential treatment
going to white patients. A hospital spokesman told the Washington Free Beacon
that such an initiative was “not currently underway at the hospital.” So far,
so good. On the other hand, proffering this idea has not set back the careers
of its authors as much as it should have. One of them, Dr. Michelle Morse, was
recently named first Chief Medical Officer of the New York City Department
of Health and Mental Hygiene, and she explicitly hopes to “advance race
equity”—equity being the new woke buzzword for not treating people
equally.
Another disturbing example came from the Yale School of
Medicine, where a psychiatrist named Aruna Khilanani gave a talk called “The
Psychopathic Problem of the White Mind.” She announced, “White people make my
blood boil” and said, “I had fantasies of unloading a revolver into the head of
any white person that got in my way, burying their body and wiping my bloody
hands as I walked away relatively guiltless with a bounce in my step, like I
did the world a favor.”
Yale, to its credit, issued a statement saying that it
“found the tone and content antithetical to the values of the school.” It also
limited access to the speech to people at Yale rather than a wider audience,
leading Dr. Khilinani to complain about Yale’s “suppression of my talk on
race.” Such a lecture and the lukewarm response highlights a problem that could
spread—a world in which a credentialed medical practitioner could feel
confident in publicly expressing such murderous views without paying any sort
of professional price. Dr. Khilinani rightly observed of Yale faculty that
“they knew the topic, they knew the title, they knew the speaker.” They did
indeed.
A third example comes from the independent reporter Katie
Herzog, writing on Bari Weiss’s Substack blog. Herzog tells us of an anonymous
group of physicians, by no means all conservatives, who are worried about the
direction in which the “dogma” that “goes by many imperfect names—wokeness,
social justice, critical race theory, anti-racism” is taking medicine. An
anonymous West Coast ER doctor, according to Herzog, has “heard examples of
COVID-19 cases in the emergency department where providers go, ‘I’m not going
to go treat that white guy, I’m going to treat the person of color instead
because whatever happened to the white guy, he probably deserves it.’” This
attitude is abhorrent, but an ineluctably logical outgrowth of the woke
worldview. Herzog reminds us that ideas have consequences. The question is how
widespread this view is and what will happen as more embrace it.
The anonymous quote stands out precisely because it is so
dissonant with physicians’ sworn duties. The problem here is not that there are
legions of doctors who mistreat white patients, but that there are doctors who
will openly speculate about mistreating white patients, that there are other
medical professionals who will not rebuke them, and that the doctor who heard
about this felt that he had to remain anonymous.
* * *
The anonymity here leads to a second question: Will
wokeness get in the way of honest and needed research, or limit what doctors
can say? Can doctors speak openly about difficult questions, and is there a
prevailing political orthodoxy that is stifling speech in medicine? Here the
evidence is unfortunately more compelling and is manifesting itself in two
distinct and troubling ways.
First is the problem of research. Can medical researchers
engage in studies that come up with conclusions that do not correspond to the
regnant political orthodoxy? We have recently seen multiple high-profile
examples of this problem. Most prominent among these was the case of Norman
Wang, a cardiologist and associate professor at the University of Pittsburgh
Medical Center, who wrote a paper questioning the efficacy of affirmative
action in the medical profession. Wang’s peer-reviewed article, “Diversity,
Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the
Cardiology Workforce in the United States of America from 1969 to 2019,” was
published by the Journal of the American Heart Association (JAHA).
Among Wang’s anodyne conclusions was his belief that “all who aspire to a
profession in medicine and cardiology must be assessed as individuals on the
basis of their personal merits, not their racial and ethnic identities,” as
well as his assessment that there “exists no empirical evidence by accepted
standards for causal inference to support the mantra that ‘diversity saves
lives.’”
The article’s peer-reviewed status did not help Wang once
the controversy over its findings erupted. The journal retracted it, his
medical center renounced it, and Dr. Wang was removed from his position and
demoted by the university. His data were not at issue, but his conclusions were
deemed unacceptable. Wang is suing both the University of Pittsburgh and JAHA.
On the other side of this question are the curious
studies that make a politically favored point and therefore cannot be
second-guessed. One such survey published in the Proceedings of The
National Academy of Sciences purported to show that black children
suffered from worse results when their doctors were white rather than black.
This led to the expected breathless headlines such as this one from CNN: “Black
Newborns More Likely to Die When Looked After by White Doctors.” The study was
imperfect and methodologically flawed, but, according to Herzog’s group of
anonymous doctors, it was not seen as acceptable to question its findings.
Even more startling was a crisis that broke out at the
primary organization of American doctors, the American Medical Association.
The Journal of the American Medical Association (JAMA) hosted
a podcast in which deputy editor Edward Livingston, himself a surgeon, asserted
that doctors in general were not racist and that medicine as a whole is not
systemically racist. As Livingston put it, “many of us are offended by the
concept that we are racist.”
When the episode and the quote gained notoriety—due in
part to a JAMA tweet reading “No physician is racist, so how can there
be structural racism in health care?”—the fallout was far-reaching. JAMA
memory-holed the offending episode. Dr. Livingston resigned. But the
bloodletting did not stop there. JAMA editor in chief Howard Bauchner
also had to resign, even though he did not make the statement, did not see the
statement, and had nothing to do with the podcast. Bauchner had even denounced
his colleague Livingston’s statements as “inaccurate, offensive, hurtful, and
inconsistent with the standards of JAMA.” No matter; Bauchner was shown
the door. The message to editors, writers, and doctors alike could not have
been clearer about the perils of speaking against the prevailing orthodoxies.
At a June meeting of the American Medical Association in
which its policymaking arm highlighted systemic racism and implicit-bias
arguments, delegates also voted in support of social-media efforts to limit
dissent on these issues or, as they called it, to “crack down on medical
misinformation.” This effort to suppress “medical misinformation” is
increasingly deployed to limit discussion of a number of issues, not relating
to systemic racism but also on the origins of the coronavirus or the
effectiveness of COVID-19 treatments. Deployed wisely, social-media platforms
can be helpful to doctors in disseminating new and successful treatments for a
variety of conditions, or warning against ineffective ones. But using social
media to enforce politically preferred dogmas makes it less likely that doctors
will be able to use such platforms to find honest scientific answers on the
right kinds of treatments or be willing to question the use of the wrong ones
openly.
And large-scale institutions are determined to put
policies in place that call for unequal treatment based on woke principles. We
saw this most prominently in the discussion of how best to distribute the
COVID-19 vaccines.
The federal government establishes protocols for
vaccination priorities. It has general guidelines for doing this and creates
more specific recommendations as circumstances warrant. For example, when I
worked at the White House and in the Department of Health and Human Services,
there were general guidelines about how to apportion vaccines in the case of an
unspecified pandemic—with consideration given to first responders, vulnerable
populations, senior government officials, and the like. Since different
pathogens attack populations differently, these guidelines tend to be made more
concrete once government officials have a sense of the nature of the pathogen
and the effectiveness of the countermeasure.
In the case of COVID-19, we faced a disease that
disproportionately affected the elderly, with a vaccine that was also remarkably
safe and effective. Therefore, the scientifically appropriate protocol in this
case was to prioritize their vaccinations, along with those of first
responders. Such a protocol, however, would have disproportionately favored
whites, as the elderly in this county are more likely than younger populations
to be white. This did not sit well with many in the “public health” profession,
and as a result, the Centers for Disease Control openly considered changing the
protocols to vaccinate essential workers first, since the elderly—those most
vulnerable to the disease—are disproportionately white. The University of
Pennsylvania’s Harold Schmidt encapsulated this problematic perspective,
telling the New York Times, “Older populations are whiter. Society
is structured in a way that enables them to live longer. Instead of giving
additional health benefits to those who already had more of them, we can start
to level the playing field a bit.”
Reason prevailed. The CDC did prioritize the elderly. But
the fact that this idea got as far as it did was troubling. The state of
Vermont did signal that it would prioritize vaccine distribution to people of
color in an effort to promote “equity”—but since Vermont has a population of
only 640,000, of whom 94 percent are white, its declaration made little
difference in Vermont’s efforts to protect the elderly and most vulnerable.
Even so, it demonstrates how the very idea of preferential treatment is
becoming the norm.
Then there are the broader policies that tie the hands of
doctors and limit choice by patients, especially with regard to practices that
have the woke seal of approval. In her book Irreversible
Damage: The Transgender Craze Seducing Our Daughters, Abigail K. Shrier
notes multiple instances of doctors pursuing gender-reassignment treatments for
children against the parents’ wishes. In Live Not by Lies, Rod
Dreher interviews a physician—again anonymously—who had lived in the Soviet
system who notes that the indoctrination of the medical system in the U.S.
today reminds him of the regime he had escaped. He told Dreher of an
institutional policy that forbids doctors from questioning treatment demands
that come from gender-dysphoric patients, regardless of whether those
treatments run counter to the doctors’ best judgments.
In addition, doctors and public health officials are
increasingly using their credentials as a ballast for naked political activism.
Case in point: a recent statement by a group of health professionals in Scientific
American denouncing Israel over its most recent conflict in Gaza—a
statement couched in terms of their judgment as health professionals rather
than as a political opinion. After an outcry, Scientific American took
the piece down, replacing it with the words, “This
article fell outside the scope of Scientific American and
has been removed.” That is true. But it does not answer the question of why the
article was published in the first place.
The Scientific American episode was
reminiscent of an incident last spring during the height of the COVID-19
lockdowns. The message from the public health community had been uniform and
unyielding on the issue of social distancing and avoiding public gatherings for
any reason… until the Black Lives Matter protests following George Floyd’s
death. In the wake of these mass gatherings, over 1,000 public health
experts—many, but not all, M.D.s—issued a statement declaring these gatherings
acceptable because “the way forward is not to suppress protests in the name of
public health but to respond to protesters demands in the name of public
health, thereby addressing multiple public health crises.” The naked political
and ideological exception here made it clear that these experts were offering a
pseudo-priestly blessing for behavior they had otherwise condemned—and even
sought to outlaw.
The medical profession is supposed to be governed by
strict standards that promote the interests of the patient and rely on the use
of the scientific method to determine what is in the patient’s best interest.
In many of the cases discussed here, these standards are being tested, and
pushed to the edge, by an ideology that rejects science in favor of pursuing a
woke agenda. The line appears to be holding for now. Patients for the most part
can still go doctors and get equal treatment and the best advice that the
medical profession has to offer.
But the assault on these norms is relentless, raising the
question of what will happens if and when the strict and rigorous standards of
the medical profession wilt and the once unassailable tenets of medicine fall.
We can see this with the issue of free speech itself. A generation ago, during
the PC wars of the early 1990s, an easy pushback against the excesses of campus
speech codes was to make the case for free speech. It was a concept embraced on
all sides of the political debate, and those opposed to free speech were
outliers and radicals. Today, this once universal precept is no longer
universal, making the creation of bipartisan coalitions against woke speech
codes much more difficult.
The same thing could happen in medicine if we allow the
walls protecting the institution of medicine to fall. Doctors are trusted
because they are known to value the patient above all, because they have gone
through a rigorous and often harrowing 12-year training period, and because
they base their judgments on long-tested treatments that have worked on actual
patients. All of those standards are under fire. One of the doctors Herzog
spoke to complained that he found himself unable to rebuke students for being
late. The University of Pennsylvania’s postgraduate surgery pro-gram has
eschewed grades and medical-licensing scores in favor of vaguer criteria such
as “leadership, teamwork, altruism, and research activity.” Columbia medical
students have demanded the elimination of grades as well, so far
unsuccessfully.
If doctors become known for making decisions based on
politics, if the training regimen weakens considerably, if scientific judgments
disappear in the face of woke political pronouncements, we will lose more than
a generation of dedicated professionals; we will also lose a broader sense of
trust in our medical system.
* * *
Medicine is literally a life-and-death profession. An
advertiser can make an ad that fails to sell a product. A lawyer can make a
lousy argument. A doctor who offers up the wrong treatment can kill patients.
The late John Silber made a point along these lines in his book Architecture
of the Absurd. The book argues that politics can infect most forms of art
with little consequence in the real world. But architecture differs in that a
building has to work. If it is poorly constructed, it could collapse
catastrophically. If it is designed according to wants rather than needs, a
building will not provide adequate shelter. The same point adheres in medicine.
The medicinal remedies that doctors offer must work, or they will fail to cure
patients. Medicine governed by woke principles will lead to the credentialing
of doctors who may make political decisions rather than medical and scientific
ones.
The wonders of modern medicine are of relatively recent
vintage. This new era has brought about numerous medical miracles—including the
recent COVID-19 vaccines in a startling nine months—by applying the scientific
method to lifesaving questions. This meant that doctors could constantly
question and improve their practices based on real-world experiments and
experience. As Jonathan Rauch shows in his book The Constitution of
Knowledge, our medical breakthroughs have been fueled by a profession willing
to question reigning orthodoxies in search of better solutions. As Rauch
writes, “instead of relying on hunch and anecdote, researchers could scrutinize
treatments, discard the ineffective ones, and develop the promising ones.” It
is important to remember that this system has been in place for only a
millisecond in the course of human history. To return to the old
non-questioning ways—ones in which folkways overtake hard facts and cranks
govern rather than scientists—would be devastating for human health and
development. But it is not beyond the realm of possibility if politics trumps
the ability to question scientific matters.
For this reason, those who believe in rigorous training,
who want medicine to work, who believe in medical innovation and in treating
patients equally need to be vigilant in watching these worrisome developments
and calling them out. The voices of conservatives alone cannot stop an assault
on the foundations of modern medicine, but conservatives can help raise alarms
about growing challenges to those foundations. To be successful, conservatives
need to broaden the target audience and ensure that non-woke liberals and
rational centrists are also willing to stand up and demand that the miracle of
modern medicine be allowed to continue to thrive.
Medicine is an intensely personal need, and the vast
majority of non-woke Americans will not give up its benefits so easily, if
alerted to the threat. Right now, the problem appears to be larger in the
training than in the practice of medicine, but training has downstream effects,
which is an essential point that must be made, and remade, as part of this
effort.
It is the application of modern science to the practice
of medicine that has led to better treatments, lifesaving preventive measures
like vaccines, and longer, healthier lifespans. Doctors are no longer barbers
who, by virtue of having sharp tools on hand, cut both hair and, when needed,
limbs. Doctors today are highly trained professionals, learning to treat every
human equally and constantly looking to refine and improve their practices.
Adjusting this system to meet short-term political goals risks the great
medical advances of recent years, as well as the magnet that attracts talented
and dedicated individuals to the medical profession. Changing doctors into
bureaucrats who must conform ideologically, who do not treat patients equally,
and who no longer go through intensive winnowing exercises to maintain the
highest standards risks creating a world that no longer attracts top talent to
the medical profession. It will also be a world in which patients no longer put
the highest faith in their doctor’s skills or the profession’s ability to
provide honest and unpolitical diagnoses.
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