America's medical schools have begun transforming their institutional purpose. No longer do they exist to impart and share the "hard-won scientific gains" of the physicians whose steps they walk in, but rather to inculcate their students with the values of "diversity, equity, and inclusion" and "anti-racism."
Medical schools no longer turn a blind eye to the politics of their students and faculty, instead encouraging them to become "activists" and practice "anti-racism" and "equity." These new teachings ensure that patients are treated with equity, as opposed to equality." Historically oppressed minorities" are placed first ahead of "historical oppressors."
In this webinar, we hope to answer questions such as: What are the origins of this new medical education? What are the ongoing policy changes at medical schools to introduce "anti-racism" to a new generation of doctors? And what are the on-the-ground effects of this new ideology?
This webinar features Salley Satel, a practicing psychiatrist, lecturer at the Yale University School of Medicine, and Senior Fellow at the American Enterprise Institute; Aaron Sibarium, associate editor at the Washington Free Beacon; and John Sailer, a research associate at the National Association of Scholars and author of numerous articles on DEI in medical education.
Transcript
David Randall: ... The origins and consequences of woke medical education. And we are going to be discussing the origins of this new medical education, the ongoing policy changes at medical schools to introduce anti-racism "to a new generation of doctors and the on the ground effects of this new ideology." Now, I'm delighted to have as our panelists, Sally Satel, a practicing psychiatrist, lecturer at the Yale University School of Medicine and Senior Fellow at the American Enterprise Institute, plus a distinguished series of publications. Possibly, we'll be able to put some of those into the chat or Q&A, but if not, go look her up, she's written a lot of really good stuff. Aaron Sibarium, Associate Editor at the Washington Free Beacon, who's also been writing a lot lately. And then my colleague, John Sailer, a Research Associate at the National Association of Scholars and author of numerous articles on Diversity, Equity, and Inclusion in medical education.
Now, let me just briefly tell you about the format. Each of our speakers is going to be speaking for about 15 minutes. There will then be Q&A and moderated discussion. Questions and answers means, you, the audience. Please put in your questions into the chat or the Q&A buttons at the bottom. During the Q&A session, the speakers can speak, but also I can simply select questions to pass on to them, my moderating function. If I don't do this in chronological order, I just do questions in terms of, "Oh, that looks fun and this will make a good conversation," if your question doesn't get answered, send email to me, [email protected], I'll be glad to forward your questions to the panelists. So, don't worry, you will have a chance to get your question answered. And this will be recorded for posterity on the National Association of Scholars' YouTube channel within 24 hours. So, if you can't see it now, if you have to log off, if you want to show it to anybody, you'll get the chance and it's going to be very quickly. Having said all that, our first speaker is Dr. Sally Satel.
Sally Satel: I'm going to start by reading a sentence. “With increasing frequency, social activists, scholars, and even healthcare professionals assert that the culture of medicine, indeed culture itself is to blame for many illnesses, citing discrimination as a cause of the disparities in the health status of black and whites.” I wrote that 21 years ago, it was a book called PC, MD.: How Political Correctness is Corrupting Medicine, and it was inspired by something I became aware of in 1995. That's when I learned that fellow psychiatrists at a hospital called San Francisco General, a municipal hospital, were grouping their inpatients in psychiatry according to identity group. So, black patients were on a black patient unit, and Asians, and Latinos, and gay individuals, lesbians, bisexuals their own, and women their own. The guiding theory here was twofold. The first was that if therapists and patients are members of different groups, especially of different racial groups, the patients will experience miscommunication and mistrust. And two, that the psychiatric and psychological problems of minorities inevitably stem from living in a racist society.
This struck me as quite absurd. I mean, certainly people do struggle as victims of racism, they have and sadly they probably always will to some degree. But certainly any kind of psychotherapy that takes place under such conditions where patients are reflexively branded by therapists as oppressed and encouraged to see themselves as feeble victims is doomed to fail. The role of psychiatry is symptom reduction, people with severe depression, psychosis, whatever—and to help patients understand the inadvertent ways in which they undermine our best interest, and how they can adapt to certain situations if we can't change them. So, the inpatient segregation approach was so counter to what we do as a profession, it was striking to me.
And so, I followed this thread of oppression as a pathogen. Where did this start? Where did this concept start? And it led to public health. And the more reading I did I found a wealth of information, and in some ways, to be fair, there was definitely a point. I'm referring to the concept of social determinants of health. That term was coined in the 1990s but the idea is really probably quite ancient. And it has to do with the ways social context, the social context in which we live, will determine our access to care, to healthier environments, to enabling more health conscious choices. This is valid and this is true. And in fact, in the mid 1800s, about 1848, it was given a name, médecine sociale by a French physician, and taken up by a German physician named Rudolph Virchow, who became a very famous statesman and physician and pathologist. And at that time the evidence was overwhelming that the environment made all the difference.
Sanitation was very poor. Civil engineering was awful so sewage piled up. Starvation, abject poverty, industrial health was a massive problem with mills and mine work. There was no OSHA then, of course, and factories were very, very dangerous places. And there were no medications really at the time, probably short of opium and home remedies, so to speak. All medicine at that time was really social medicine, it's fair to say. Fast forward a bit to the antibiotic revolution that really started changing things from the sanitation era, then we got into the antibiotic and bacterial era, started in—well, penicillin was discovered in '28, it wasn't used till '42, but the sulfa drugs came along in the '30s. Then fast forward again, to the '60s and '70s, which was the lifestyle era, don't smoke, don't drink, exercise, all valid.
Then in about the 1970s, a cadre of epidemiologists began publishing the psychological, social and cultural forces that make people more vulnerable to disease. And they represented a very legitimate line of inquiry. These are important things to study and to study objectively, but they were also intertwined often, not always—there was some very objective work—but often intertwined with political agendas. I'll just read you some quotes from public health people at the time. “The practice of public health is to a large degree the process of redesigning society.” “Every problem is a public health problem.” “A school of public health is like a school of social justice.” The latter dictum was issued by the former Dean of the Harvard school of public health. Now, again, it's one thing to study the correlations and ideally the causes between these social factors of income inequality, education, health, and so on. But it's very much another to advocate for reform of these dimensions as a health expert. And that is kind of where we are going. The politicization began to migrate into medicine in the 1990s, late '90s, I think, but became really pronounced around 2014 when this group called White Coats for Black Lives, a fairly radical group that advocates defunding the police and dismantling capitalism, when it entered a medical school environment.
Now there are about 70 Chapters. And White Coats for Black Lives became extremely intense after George Floyd. I think they were using or exploiting the medical profession as a vehicle for their ideas of social justice. And dismantling racism in the healthcare domain became much more targeted. And it went beyond closing health gaps, which is perfectly legitimate in practical ways. So, in the move to dismantle racism as a way to improve the health of minorities which—and the latter is of course a legitimate goal, improving the health of minorities, improving the health of everyone—but the move to dismantle racism has two very unhealthy implications for my profession. The first is, it introduced activism into medicine as a way that seems intended to alter its very mission. And two, it seeks to influence the identity of doctors, so that their overarching duty is fighting for social reform rather than addressing the primacy of the individual patient before him. And of course there are no limiting principles to this because in some ways you can connect dots, however shakily, between a current event and historical antecedents. Almost every social event can have some health implications. So, this was captured by the AMA a few months ago, they came out with a document called Advancing Health Equity, very concerned with language and narrative. And I'll just briefly read one paragraph, “where one might say low income people have the highest level of coronary artery disease,” instead we're urged to put it this way—hang tight—“people underpaid and forced into poverty as a result of banking policies, real estate developers gentrifying neighborhoods, corporations weakening the power of labor movements and so on, have the highest level of coronary artery disease.”
Now I will agree that much of the disadvantage in the black population in access to health and in health status is a cumulative product of legal, political, and social institutions that have historically discriminated, and systemic racism. I don't necessarily disagree with that, but as an analytic framework, it does not yield realistic prescriptions. I mean, just what are physicians supposed to do? Become health activists? Well, the answer is yes. And in a different strategic plan, the AMA urged doctors to, “push upstream to address all determinants of health and root causes of inequities, dismantle structural racism and intersecting systems of oppression.” In other words, there is no limiting principle if we are to address all determinants. What we have to do is stay proximate to health, endorse our rare expertise and keep the individual patient in the forefront of our practices.
In addition to this threat to the mission and our identity as doctors, which is now largely confined to training, we see all the predicted hallmarks of a woke project, the chilling—and I know my colleagues will talk about this a lot more—the chilling of academic discourse and collegiality, such as the case of a doctor being stripped of a the directorship of a fellowship in electrocardiophysiology l because he published a perfectly defensible paper on affirmative action. He was opposed to it. The paper was retracted, it was peer reviewed but retracted. I also see lot of hostility directed at the study of genetics as a factor in health disparities. I know Aaron's going to talk about that more, this kind of thing. Another is a loss of nuance in talking about health disparities, any difference whatsoever is immediately assumed to be due to a racist influence.
Now, in medicine we generate what's called a differential diagnosis. When you come in with a pain, a doctor has a whole list of possibilities it could be, and you take them one by one, but you don't decide from the beginning, what is wrong. You rule out various conditions. You don’t jump to “racism” as the answer. So, that's a problem. Another intrusion is a hostility towards the notion that people actually retain agency. I gave a talk last year in which I was icily treated or criticized by residents and psychiatry for implying that people who are addicted still retain some agency. What I should have focused on exclusively, according to them, are all the external factors impinging on them. And of course those external factors have great influence, but our whole job as doctors again, is to help people mobilize the remnants of agency that they do have. Lastly, there is that equity push, of course, more diversity in journal editors, grant recipients trying to circumvent the standard measures of merit. In one case at the Brigham and Women's, there was actually a plan to give minority patients priority for admission to a certain specialty unit.
So, I'll close by saying there are certainly consequences to this. Even though it's now at our level of training, we will have to see how this experiment is going to play out in actual patient care. But I list four things here. One, this effort to dismantle racism in medicine is woke intrusion. First, corrupts our relationships with patients because it's about groups, not individuals. Two, it, as I said, kind of perverts our job. We are not activists. Yes, doctors have promoted policies. I mean, I've been involved in policy promotion as well, but in ways that have direct approximate effects on health. It's very hard to be a pediatrician, a psychiatrist, or work in an emergency room, where you're not constantly confronted with how the environment impacts your patients' health, but upstream is too far to go. You can do that as a physician as a citizen, of course, but worrying about electoral politics and housing policies and dismantling capitalism, whatever exactly that entails, is not something doctors do.
We already have jobs and not enough time to do them. Also, we don't know how to, it's not our expertise. Frankly politicians debate all the time how to effect these larger social reforms. And fourth, and perhaps most pernicious is that this kind of enterprise is going to squander the trust that we have with the public. And that is a real problem. I know we'll talk more about what to do about it. One easy thing is for a lot of these doctors to work in Southern rural towns—that would be an enormous help and it would really improve the health of especially some of the black communities there. But right now I'd say, as for our concerns, I see one of the biggest agenda items as just exposing what's going on to the public, because once the public hears these kinds of things they do get energized.
We saw that with schools and CRT. I think we all know what we mean when we talk about the teaching of certain kinds of ideologies that are just not constructive for children, whatever you call it, CRT or whatever. And we saw that. And I know, again, my colleagues are going to talk about this. When there are policies to make priorities for vaccines or the monoclonal antibodies with respect to COVID we're giving a higher priority to race. So, when the public hears about these things, they don't like it. They push back. But right now we have to make these things more, people more aware of that, and we have to—and this is the hard part, and I sympathize with my colleagues and I understand why they don't speak out—but we have to really embolden more people within medicine to resist. Thank you.
David Randall: And thank you so much. John, would you care to speak next?
John Sailer: Absolutely. So, I want to start with an anecdote that was reported last year by the journalist Katie Herzog, where she described a medical school professor in the UC system who stopped in the middle of a lecture and began apologizing. I'll quote a little bit. "I don't want you to think that I am in any way trying to imply anything. And if you can summon some generosity to forgive me, I would really appreciate it. Again, I'm very sorry for that. It was certainly not my intention to offend anyone. The worst thing I can do as a human being is be offensive." What was he apologizing for? He says, "I said, when a woman is pregnant, which implies that only women can get pregnant, and I most sincerely apologize to all of you."
So, for a long time, this sort of display would have been blamed on students. Students are fragile, students are too ideological, students are captured by a kind of moral fervor. I believe that there's merit to this point, but I want to make the case that this assessment, that the current ideological state that is kind of the state of things in medicine, is not primarily the result of students anymore. Rather, it is institutional policy. So, I want to talk about today the extent to which identity politics has become medical school policy. And then I'll describe a little bit about why that's happened, which Sally has already touched on, and I'm sure Aaron will touch on as well.
So, the first point I'd make is that diversity, equity and inclusion efforts are especially dominant in medical schools, which might at first be a bit of a surprise because medical schools are very removed from the traditional disciplines where you might expect to find things like critical race theory. We're not talking about schools of English or any kind of studies, the various identity studies. These are what we would assume to be relatively objective scientifically based institutions. Last month, The James G. Martin Center, a think tank in North Carolina, released a report on social justice in the UNC system. And one point that they brought up that I found particularly interesting is that UNC Chapel Hill has 24 paid DEI officers, Diversity Equity and Inclusion officers. Eight of those officers are in the Medical School. Two are in the School of Pharmacy. One is in the School of Public Health, and one is in the School of Nursing. So, that means that literally half of all the DEI officers at the University of North Carolina are in fields related to healthcare, the majority of those in the medical school.
This plays out in medical school policy where at the University of North Carolina in 2020, the Medical School convened a task force to integrate social justice into the curriculum. That task force, in October of 2020, released a report with a number of recommendations. And until very recently, the Medical School indicated that it had accepted every one of these recommendations. If you went on a tracker on the Medical School website, each of the recommendations—each of the 42 recommendations—was listed as “on time.” These recommendations include the following, “all faculty in all departments will be evaluated on a growth mindset related to social justice in their annual review process by 2024.” And “all block directors and course directors,” that's Medical School teachers, “will have changed their curricula by the fall of 2021 to adhere to the following core concepts.” It lists about seven or eight core concepts that faculty are now required to adhere to, this includes, “explain the difference between sex and gender and how specific organs and cells do not belong to specific genders.” And “all lectures addressing known disparities will attend to those disparities and why they exist.”
These kinds of policies are not limited to the University of North Carolina at Chapel Hill. In fact, there's good evidence to say that this is the kind of institutional policy that exists almost everywhere, at almost every top or significant medical school out there. For instance, the University of Michigan recently released its own anti-racism plan, where it set the goal of “design undergraduate and graduate and continuing medical education curricula using an intersectional framework and critical race theory in partnership with health justice education professionals.” One of the ways that the university says it will measure the outcome of this goal is by “demonstrated basic proficiency in faculty teaching intersectionality and critical race theory.”
The list of universities and medical schools that institute this kind of policy goes on and on. At OHSU, they've issued a plan to make DEI and social justice a part of the tenure and promotion process. At the University of Utah, they've issued a plan that includes, among other things, a measure that would solicit student feedback on the cultural humility of faculty. At UC San Francisco, they're developing an advisory committee that includes experts in critical race theory, social justice bias, and health disparities that will assess the curriculum and make recommendations to the medical school. They've indicated that they will give a good bit of deference to these recommendations.
Needless to say, the kind of self-censorship that Katie Herzog and others have reported on in medical schools is not just the result of students with a particular passion for social justice or a particular conception of anti-racism. It's a part of policy. There are schools now that make DEI and social justice a part of the promotion and tenure process, which means that if you object to the standard definition of social justice or diversity, your eligibility for tenure could very well be in jeopardy.
There are several reasons that I think that this has taken hold. After spending a lot of time researching this kind of stuff, a few things stand out. The first, and Sally alluded to this a little bit, is successful student activism. It's not just that students are particularly incensed about a particular issue, rather, students have made an organized and concerted effort to elicit policy changes from medical schools. For instance, in June 2020, the Dean of the University of Minnesota Medical School wrote a letter to the White Coats for Black Lives student group on campus, responding to a list of demands that that group had sent to the Dean. He says, "Many leaders, staff, faculty, and stakeholders across both campuses have read your letter thoroughly. And we are all in awe of the depth and breadth of your action items." He then goes on to say, "We pledge to respond with a preliminary action plan by June 10th, 2020 for your review. We recognize that not every action item you outline is addressed in this preliminary plan... Our plan is grounded in the philosophy that anti-racism is healthcare."
This illustrates the reach and power of the group that Sally mentioned, White Coats for Black Lives, which originally started in 2014, but gained a significant amount of traction during the George Floyd protests and riots of 2020. And there are a few things that are noteworthy about this organization. First, it is a deeply, deeply radical organization. Its vision document, which was published only about eight months ago, calls for defunding the police, abolishing prison, dismantling capitalism, dismantling fatphobia, and queer and trans liberation, among many, many other things. The vision and value statement is really quite a stunning document. But any organization can espouse radical ideology. What's remarkable about White Coats for Black Lives is just how effective they have been in eliciting concrete policy changes for medical schools.
At Minnesota, the university responded with a curriculum review, with a new climate survey, with a cultural humility assessment. And the school, on the website to this day, says that they are continuing to work with that student group to continue to incorporate DEI into the curriculum and other parts of the medical school. The same goes for University of Michigan. University of Michigan was petitioned by White Coats for Black Lives to adopt a number of policy changes. And I've already mentioned that they have essentially mandated that critical race theory be a part of the medical school curriculum. They took that policy almost verbatim from the White Coats for Black Lives demand. UC Davis, in response to the White Coats for Black Lives—specifically their racial justice report card—said that they're going to establish clear consequences for microaggressions. And at a number of medical schools across the country, White Coats for Black Lives is credited as one of the main sources of relatively new racial justice or diversity equity and inclusion action plans. This includes Columbia University's medical school, University of Utah, and many, many others. It's really remarkable. I only found the quote I gave you from Minnesota today, and this is after quite a lot of research. So I'm literally, each new day, finding new places where White Coats for Black Lives has made a substantial impact.
It's safe to say that there's, first of all, widespread institutional policies that tip the scale heavily in favor of a particular ideology. And those institutional policies are affected in part by student activism. But I would also say that a second influence that I would highlight is other peer institutions. Once institutions have committed to diversity, equity and inclusion, once they have issued their own statements on diversity, equity and inclusion in their own plans, then other institutions face kind of a bandwagon pressure to join in. For instance, the Mount Sinai Icahn School of Medicine has actually led the way in many ways on DEI initiatives. They had an anti- racism program long before 2020. So when 2020 came around, a few administrators from the Icahn School of Medicine published an article describing this longstanding cultural change initiative. In that article, they say, "We have to go out there and seek the truth, part of which is accepting that if we are white, we are a big part of the problem. We are part of the reason that structural racism imprisons and oppresses people of color every day, everywhere they go, no matter what they do."
Now, this article received a lot of widespread attention, so much so that the Icahn School of Medicine began a program called the Anti-racism Initiative in Medical Education, soliciting other medical schools to come and be—or administrators from other medical schools to come and be trained to implement the same program that they've implemented at Mount Sinai. And schools from around the country signed up to join, including top schools like Duke University, Columbia University, and all of these schools have happily embraced this program, despite signs the actual training they receive is based on, really, pseudoscience. So a major feature of this program are the monthly chats for change put on by the Icahn School of Medicine.
These chats primarily focus on something called the characteristics of white supremacy culture. That's a widespread concept that, essentially white supremacy culture is characterized by things like—well, let's see—objectivity, or individualism, or believing that there is only one right way to do things. Now, some of those characteristics that are described by the Icahn School of Medicine are not necessarily flattering things, and some of them seem like they're neutral or even possibly good things, but what's crazy is that these are attributed to a particular race, to whiteness. And if you look into the literature that this is based on, you'll essentially find that most of it is based on nothing more than what's called autoethnography, essentially, someone doing an ethnography on themselves. It is essentially, for lack of a better word, pseudoscience. And yet this is what medical schools and medical administrators around the country are lining up to be trained in.
I'm sure that Aaron has a lot to say about the consequences of this kind of policy change. So with that, I will hand it over.
David Randall: Thank you so much. And yes, Aaron, if you would.
Aaron Sibarium: Thank you for having me. I thought John did a very good job of capturing the kind of institutional isomorphism here. It's not just one med school, it's all of them at once behaving in the same way. That's partly due to peer effects. I think he's right. But what I want to just start with is I think this is an important thing to emphasize is that many of the groups, some of the groups pushing for this aren't just activist groups, they’re not just medical schools, they're accreditation bodies. Sally mentioned this document from the American Medical Association and the American Association for Medical Colleges that has all this guidance about the language that doctors should use.
Well, the document also contains a number of concrete propositions that I'll get to in a moment, but what's significant about it is that the AMA and AAMC have an accreditation monopoly, they accredit every med school in the United States, so you can't really teach things that contravene what they believe, or you will be penalized and in the worst case scenario, lose your accreditation. No one wants to have that happen to them, so there's kind of a centralized, coercive pressure to adopt all of this stuff, hook, line and sinker. Now, what is that stuff? Well, in the language guide Sally mentions, here are a couple of the ideas and concepts that they think will advance health equity, and that they encourage all medical schools to teach. One of the concepts is that individualism and meritocracy are malignant narratives that create harm. Another concept is that using race as a proxy for genetics leads directly to racial health inequities, and that medical vulnerability is the result of socially created processes rather than biology.
Now, I would say that there are three consequences to this ideology being foisted on every medical school in the United States. And I'll go in sort of ascending order of what I think is probably the most important, although they really all are. The first consequence is that this guidance obviously is going to incentivize medical schools to do much more affirmative action—and they're already doing quite a bit of it. They've made tests easier, made the step one licensing medical exam pass, fail because whites and asians were outperforming blacks and hispanics. They thought, oh, we'll get rid of disparities. Let's just get rid of the test, make it pass, fail. Things like that are part of a broader project to eliminate disparities in who gets into medical school. It's coming from the accreditation bodies and the medical gatekeepers. And so, under this pressure, every medical school in the country is basically going to have to adopt evermore enormous racial preferences in order to stay in their accreditor's good graces.
This is all a rather obvious point, but I'll just say it outright. If you have people becoming medical school students, and then doctors who are not qualified, you will have fewer qualified doctors. You will also have a dynamic in which medical schools need to dumb down their curriculum to get everyone through because they don't want to be flunking tons of students, because of course, that's not going to look good, especially if the students they flunk disproportionately are of a certain race. And a more perhaps controversial implication of this, that I do think is worth just noting and taking seriously, is that when you do this level of affirmative action and you do it in something like medicine where people's lives are really on the line, it kind of creates a rational incentive for people to look at their doctor and think, well, did the guy get in here just ‘cause of affirmative action?
And taking to its logical conclusion, it almost makes it rational for people to have racial prejudices and to racially discriminate, which of course is not good and we don't want that, but I think that's just the logical consequence of affirmative action at least to this extreme degree in medicine. And then I think that just creates a toxic feedback loop because it makes doctors feel like they don't belong or that there is a kind of stigma against them, which just increases the demands for some kind of racial reckoning, which just increases the demands for the racial preferences. It's a vicious cycle, and I think, candidly, affirmative action in medical schools is probably a big danger. But ultimately, I think that there are two more, perhaps more substantive consequences here beyond just who becomes a doctor. What this ideology will do is it will change both what doctors are taught, how they take race into account, and also how they don't take race into account.
I mentioned genetics. There is now this idea that if you talk about the genetic determinants of racial health disparities, you are obscuring the social character of the disparities. You are obscuring the oppression and racism that has perpetuated them. And so therefore we just shouldn't talk about the biological drivers of these disparities. And of course, as Sally says, there are social determinants of health. That's a real thing, but there are also genetic determinants of health and the genetic determinants of health often are correlated and mapped fairly well onto modern constructs of race. And so, one concern that many doctors have expressed about this kind of anti-genetic turn in accreditation guidelines is that it will result in doctors being less willing to do genetic screening for various health conditions that do have a genetic component.
There are times where race can be a risk factor for disease independent of racism, socioeconomic status, what have you, for just purely biological reasons. For example, Tay-Sachs just for proportionately impacts Ashkenazi Jews. And that's not because of systemic antisemitism, it's because Ashkenazi Jews tend to have certain genes that predispose them to Tay-Sachs, triple negative breast cancer disproportionately affects black women, that has to do with a certain gene that is common in Africa because it confers certain advantages against, I believe it's African sleeping sickness, or maybe it's something else that's common there, but it also predisposes you to certain kinds of cancer. So if you're not going to take race into account when comes to the decision of, oh, maybe this person should really get a test of some kind, that's going to be a problem.
The other thing it can do is it can, this ideology is encouraging doctors to take race into account where it shouldn't be taken into your account, which is kind of the opposite problem. And the most clear example of that is, as I think Sally alluded to, there are now these proposals to ration care based on race, including monoclonal antibodies. That happened in Vermont with vaccines. It's happened in Minnesota, Utah, and New York with Paxlovid and Sotrovimab, which is the monoclonal that's effective against Omicron. It's happened at large hospital systems like SSM Health, which were giving race more weight than hypertension, diabetes, obesity, and asthma combined in their eligibility rubric for who could get the drugs.
I think it's worth noting that there is an important distinction between say taking race into account with genetic screening, where I think it's justifiable and taking race into account when it comes to distributing lifesaving drugs, where I don't think it is. And this is an important point, because you'll hear people say, well, you yourself acknowledge race is a risk factor here, here and here, so why not with COVID, but there's a difference between using race as an epistemic tool or proxy to find out more information about an individual. And then with all that information, to make individualized treatment decisions for the individual. There's a difference between that on the one hand, and on the other, using race as the basis for all allocation decisions themselves. In the first case, you're using race to gather individualized information, but you're making the decision based on an individual's health, not based on their race. In the second case you are using race itself to triage lifesaving medical care. The first thing does not violate the Civil Rights Act or the Equal Protection Clause or the Affordable Care Act, the second thing violates all three.
So what's happened is that there's this kind of elite consensus around racial preferences in medicine. And as it's coalesced, the policies that flow from that clearly violate the law. But because that elite consensus is now there, there's only so much power law has because not everyone's going to want to sue, institutions will just kind of do this as the default until there's a legal threat. I do think it's possible, and we'll get to this a little later. It is possible, I think for kind of organized legal efforts to push back on some of this. But if every doctor coming out of medical school just believes that racial discrimination is justified on utilitarian risk management, technocratic grounds, which of course are just sort of post hoc rationalizations for this deeper woke ideology, if they all think that, then it's going to be pretty hard, I think for law to police all of that.
So what we're seeing is that through private credentialing institutions, there's really been an attempt to almost circumvent the official colorblindness of the American state and institute a race conscious medical regime behind the public's back and in contravention of federal and local law.
Just to recap, for those who think this is just a silly distraction, whatever, well, no, it's going to result in some people not getting access to the treatment they need either because the doctor thinks it's racist to do a routine screening for some kind of cancer, or because the public health authorities will simply say, no, you're white or you're whatever, so you don't score enough points to get this life-saving drug, which will have nothing at all to do with your actual individualized risk. So yeah, I think it's pretty bad.
David Randall: Thank you so much. I think it's pretty bad, which is a dramatic, but depressing way to end our initial presentations. We now go to the discussions and Q&A. And again, there's been a number of questions already put in comments, put into chat and Q&A. Please do put more of them in. I am going to start, frankly, it is the $64,000 question, from Ron Bertie: it sounds like if we are to confront the DEI bureaucracy, we need to take it on head on, which would mean an anti anti-racist push. How do we inject some of this anti anti-racist or anti-social justice attitude into medical schools? We're on our own five yard line, I think. How the schools, the accreditation, the culture war, public opinion—what can be done? You can do this for the next five minutes or so, you have a plan, any and all.
John Sailer: I'll note that because a lot of these policies are adopted by bureaucrats who are not necessarily deeply invested in the policies themselves—they are medical school administrators following the orders of someone else—they're not necessarily deeply attached to them all the time. Now there are certainly true believers, and there's also a lot of passive agreement with the ideology that they espouse, for sure.
But there are also promising instances of this stuff being reversed. I gave you the example of UNC. Since I wrote my article on the UNC School of Medicine, there's been a substantial amount of pushback. Other articles have been written that cite my article, so much so that the Dean of the medical school gave a presentation both to the UNC Board of Governors and to the UNC Board of Trustees essentially saying, no, actually these are just recommendations, and even though their website says that all of those recommendations are on-time for implementation, he said, in fact, we have not accepted all of these recommendations and some of them we are now assessing to determine whether they align with the university's values.
Some of this stuff is just genuinely the result of a stark overreach. And if you expose it, people will actually raise enough trouble that individual medical schools might curtail it to some extent. So at least in my experience, that's one, but I think not the only avenue that we can affect real change.
Aaron Sibarium: Yeah. I do think that that's right. And after I wrote some stories about the racial triage, Utah and Minnesota, both jettisoned their allocation schemes, took race out of it. And this hospital system, SSM Health did too. New York is currently the only state that still has this on the books. Although I think they’re A) little less dramatic than the other states and B) they are being sued over it now. So I agree that sunlight is a powerful disinfectant. What's difficult though, is that if this stuff happens everywhere, journalists only have so much time and capital to limited rays of sun, that they can shine at each individual medical school. So ideally you would actively find, you would A) Not just expose it and say the accreditation agencies or the other kind of gatekeeping credentialing institutions.
I think you also need, frankly, politicians to find ways, within the bounds of liberal society, to put pressure on these institutions. I'm not saying we should have Josh Hawley go in and nationalize the American Medical Association, but if red states decide to change their standards for what they want to see with accreditation, or try to make it easier for, maybe, people to go outside of the normal accrediting process, it's not even that people need to take advantage of it. It's just, there needs to be some kind of pressure on these things. And there needs to be some kind of minor, I think, almost political harassment of them. And it just needs to be made clear: this will stop once you stop being insane. And I don't think that, that's necessarily bad or illiberal. And in fact, I think that's probably that or really, really, really intense media scrutiny. These are really the only tools and lawsuits that are going to move the needle here.
Sally Satel: I was just going to say, speaking of lawsuits, there's a group called FAIR, Foundation Against Intolerance and Racism, and it has as a medicine component, FAIR in Medicine, and it did sue—or it was about to sue, but I think it already did sue—the New York City policy on racial preferences for Paxlovid and the monoclonal Cetrelimab. So we’ll see. That's a good move, I think.
David Randall: I'm going to have a question. I think it's my own and not anybody else. How much have you been able to talk to actual doctors, both within the medical schools and amongst doctors as a whole to get a sense where they are? How many of them are true believers? How many of them are quiet supporters? How many of them are scared and go along? How many of them really do want to push back? And I might even say, and then particularly how many amongst those under 30, what's the story? It would be very helpful if there actually were a quiet majority of doctors who were against this, but are there?
Sally Satel: Well, I know in my generation, I do think there's a gradient that the younger, newer generations are more amenable, but I still think the majority really are not. But I have spoken to my colleagues, well, I've spoken to some younger ones too, but as I said, they're not in favor of this. A number of people I know have actually, to the extent they have discretion in terms of how much they interact with the residents and medical students, they've moved away from it, because they say any teaching opportunity is a chance to say something inappropriate and get reported. I do think, and I think we talked about this a long time ago, David, I wish there could be some sort of anonymous survey of medical students and faculty to get a sense of really what the sentiments are, because I still think as is true for most of society, although medicine is an overwhelmingly liberal, now becoming, there is good data on this from Stanford University on demographics within the profession.
It's now the younger generation overwhelmingly liberal, but still, I think there's a lot less consensus than it seems, but people are just very, very, very reluctant to speak out. And the group FAIR in Medicine, which I'm a part of, unless I'm wrong, there are, maybe, 12 of us who are pretty active and no one is with a medical center. They're all in private practice. So they have more freedom to speak out. And these will be the people who will be quoted in Aaron's articles or John's articles, but most people in a medical center—and I get it, I'm not condemning them for cowardice, I get it—won't say anything.
Aaron Sibarium: I will tell you why. For one of these articles, I talked to a person who is actually a member of the American Medical Association, and he said, “yeah, this is ridiculous, I think it's crazy, and privately, I know a lot of other people do too, but nobody wants to say anything because if we do, there will be a social media mob calling us racist and we will lose our jobs overnight.” And I suspect that that is an accurate prediction of what would happen.
David Randall:
So John, you're nodding your head, okay. Quiet assent.
John Sailer: Yup.
David Randall: All right. Well, in that case, I will, some of the other... This is actually a local question, but it matters, Gary Van Graafeiland, pardon me if I miss-pronouncing that, what impact, if any, might the loss by Harvard and UNC and the Supreme Court Racial Preferences case have on the DEI phenomenon in the medical schools, which I guess I'll just expand that. In fact, how much is DEI, just protecting racial preferences. And if you get rid of the constitutional protection for racial preferences, does that pull the plug on the larger DEI ideology?
John Sailer: I will say the impetus for a lot of these policies is recruitment and retention of underrepresented minorities. Now, does that constitute affirmative action? And if the Supreme Court rules against affirmative action would that overturn these policies? I'm not an expert in these matters, but I think, no. I think that it might actually, in some ways, if you cannot explicitly engage in affirmative action, you might get more policies that try to essentially implement this sort of thing in a roundabout way. Especially if medical schools are still scrutinized by outside agencies or by activist student groups on the basis of the school's demographics. So I think that it's very possible that DEI will get stronger if the Supreme Court rules against racial preferences.
Aaron Sibarium: Yeah. I guess I broadly agree, although I do think that especially at public schools, if affirmative action is outlawed, it could have some positive effects. I think it might also make it easier to sue the schools. And if there's just more harassment lawsuits, even if they can win them, it just may discourage some of the behavior at the margins. I think what it also does is, it, maybe, creates a discursive opening to argue that these preferences are illegitimate because, Hey, the Supreme Court said so, and it's sort of a difficult thing to quantify or predict, but I generally am someone who believes that law helps to set the boundaries of legitimacy. And indeed, historically you saw that when law changed, say, during the civil rights revolution. After it changed, it had a real material effect, not just on what people could do, but on culture and attitudes changed to catch up to the law. So, I'm not super optimistic. I think that what John is describing will happen, or at least they will try to do it. But I do think that the legal avenue is probably among the best chances still we have to pair back some of this stuff.
David Randall: I have a question based upon, I think, what Dr. Satel was saying about people in private practice feeling they had greater freedom, what can we do to make it easier for doctors to be in private practice? Is not part of the problem that there's a shift towards more doctors being in fewer institutions where they're vulnerable to this? This is an economics question, I know, and somewhat broad ranging, but is one of the solutions to make it more possible for more doctors to have self-reliant independent practices?
Sally Satel: Well, that would be one. And, this is not even the main reason why there'd be one, I think, and the short answer is I can't talk at length about all the regulatory hassles that private practice doctors have to deal with, but the paperwork burdens and others are just absolutely overwhelming. And I think their margins economically are really, not that they're in it to be billionaires, but it's very hard and Medicare and Medicaid don't pay. So a guaranteed salary of a university or some sort of HMO is more attractive. There's a massive literature on this, and I'm sure, and I can find an article to post, but yes, it should be easier. There are probably a million avenues that could make it easier and that doctors are already fighting, but many are giving up. And I know that the number of private practices and private practitioners, I think, is shrinking every year.
Aaron Sibarium: Could I ask a question actually myself?
David Randall: Sure.
Aaron Sibarium: To Sally. So, you're the only one, I think, on this call who has expertise in psychology, specifically. And we've mostly been talking about how this might affect non-psychological branches of medicine, but obviously there's a strong psychologizing impulse and wokeness. There's the stuff about gender identity and what's on the inside stuff like that, but there's more generally, I think this discourse of “we must validate the individual's identity,” and as someone who's actually trained in psychology, what do you think are the implications of this attitude for not just, maybe, the doctor's examining room, but the therapy session, how does this affect what psychiatrists do and what they tell their patients?
Sally Satel: Did somebody put you up to that question?
Aaron Sibarium: No, I just thought it would be interesting to ask.
Sally Satel: Oh, because I've actually written about that in the context of the counseling profession. And actually there are more counselors. If you imagine a pyramid, in terms of numbers, psychiatrists are at the top. Psychologists, clinical psychologists and then counselors, PhD level, and then master's level counselors. They provide most of the counseling, psychological help. And psychiatry, the American Psychiatric Association went through its required steps, to be honest, I think it was quite heartfelt on their part with anti-racism efforts and still undergoing that. But as far as the actual, I think, the worst example I gave was the one I started out speaking about this ridiculous segregation but the American Psychological Counseling Association, while actually negating, as an ethical principle, the idea that therapist should impose their own ideology on patients, has basically been supine while schools—in fact I’m writing a chapter about this now that psychologist colleague—schools of counseling have just been completely infested in a way that is substantive, in terms of how they are to relate to counselors, excuse me, patients first, the activism role is really emphasized. In fact, there are courses in social organizing. They even encourage their patients to become socially active. They approach a session with preformed ideas about—this is almost hard to believe, but I have some quotations in these various articles about, well, your problem, basically they jump right in and tell you what your problem is. My goodness, our whole job is listening. And often you don't figure out, in a way, the real problem for quite a while, but it's not some morality play based on identity politics. It's frankly, an insult to the complexity of humanity. And it's again, just counterintuitive to how you do therapy and you can't possibly form what's called a therapeutic alliance unless the person feels you're curious and have a non-judgmental attitude towards them. It's utterly pernicious. So I think the counseling profession is in significant trouble. The APA, American Psychological Association, I'm a psychiatrist, not a psychologist, is certainly gone through the motions and its statements and the APA so far, and believe me, I'd be watching, I'm not trying to protect it, so far somewhat not quite as bad, but that's, I'm watching.
David Randall: Anybody else want to speak to that question or continue that conversation.
Sally Satel: Someone says something about APA treatment guidelines. I don't know if they mean the American Psychological or the American Psychiatric, David Peterson.
Aaron Sibarium: I know the there's this—also sometimes this discourse of branding either say toxic masculinity or for that matter racism as a kind of almost mental illness or—
Sally Satel: That was the American, right.
Aaron Sibarium: Wasn't there that woman at Yale who said something like, it was the psychiatric problem of the white mind. I was saying that white people are inherently not just racist, but mentally ill racist. It was very weird.
Sally Satel: Yeah. Well, there's been a push for years to actually include racism as a psychiatric diagnosis and the DSM, that's not a new thing, but she was really ill.
Aaron Sibarium: Yeah, it seems insane.
Sally Satel: It is not to say that you can imagine someone in a hostile environment. Of course, it has an effect on psychology, but again, this is what the story the patient tells you. You don't assume these things. You don't go in with a preformed narrative of how you're supposed to respond and what you think their problem is. So I'm not denying the fact that these kinds of phenomena, it may exist and are very destructive, but again, it's the presumption of how the world's working and impinging on this patient. That's just completely—it's malpractice.
David Randall: I have a question from George Sievers, and do you think that the student aggressive activism comes from the administration specific criterion for admitting students? I know this is true at Harvard. In effect, in colleges we know in effect that the admissions staff, as the selecting for activists [inaudible 01:05:51] we know as much as we can tell from these black box, it sure it looks like it. Is that also happening in medical school? Are they actually deliberately selecting for activists and the admissions procedures for medical school?
John Sailer: Well, I don't have that much to say. I'm not that familiar with the medical school admissions procedures, but there is a vicious cycle, where as schools have created things like advocacy competencies for their students and required those or strongly suggested that the best kind of medical student is somebody who engages in protest, which I believe the Association of American Medical Colleges has done, you do end up recruiting more students who display those kinds of tendencies, and then they institute more policies that just create a ratcheting effect. And that's worth saying about all of these DEI policies. They do create a ratcheting effect where you institute new climate surveys and the climate surveys ask questions that elicit strong feedback about the school that says the school needs to improve in X, Y, and Z anti-racist way. Yeah, I would strongly suspect that that's a factor here.
Sally Satel: I know we're over a little, but I've seen, frankly, they were from two Florida medical schools, their essay requirements for the application. And they did say they had to do, tell us what you've done to advance anti-racism in college or in your extracurricular activities.
David Randall: I'm going to go to a question, actually, right below George Sievers, is Robert Lunsford. How are the malpractice insurance providers looking at this, which I might expand we're looking for ways to get a lever, a handle on all this stuff is actually something like malpractice insurance, a way to handle all this DEI stuff.
Aaron Sibarium: Seems like it would be most useful for gender reassignment surgery that's foisted on kids who are really too young to understand what they're doing. I suspect there will be a big insurance lawsuit at some point, and that may move the needle on that. In the UK, they obviously have a socialized medical system, but part of why the UK actually has less insane gender stuff relative to the US is that A) Because it's a socialized medical system, they just don't have as much money to throw at everybody. So they can't just give you a surgery on demand, for anything. So they're just not going to give a 12 year-old surgery the next day because they literally don't have the resources. But also because everyone's paying for it, when there were these high profile cases of detransitioners, there was this deep sense of a front of the British public of, you made us pay for this surgery that mutilated this young girl's breasts, and now she regrets and seems to have ruined her life. So I think if something happens, the equivalent of that happens in the US with a big, big private insurer, or maybe, I don't know, even if it's public insurance, somehow I think stuff like that could be a lever to push back against some of the kind of early childhood gender transition stuff, if you're worried about that, although it might be useful in other ways too, but that's, that's the most obvious application I can think of.
David Randall: Anyone else on that? Let's see, going once, going twice. All right. From Ray Sanchez, what is or are the best ways to expose this woke medical education to the general public? And I guess I'm going to say, in fact, we know that journalism is part of the scene because in fact, all three of you are doing this, but I guess what step “B” beyond, continue to be Sally Satel, Aaron Sibarium and John Sailer and write articles?
John Sailer: I will note that all of this stuff you can find online, it's not hard. And public officials don't know about it. Just by and large they do not. You can send them stuff that people like us have written and I think all of us are in this webinar, paying attention to this issue and will continue to pay attention to this issue. But every medical school in the country will have a DEI page on their website and every medical school in the country—well, not every single medical school makes their DEI plan public, but most do. And you can just keyword search critical race theory, keyword search microaggression. And you'll be kind of, maybe not at this point, surprised at what you find, but you'll find things that are of relevance say to public officials who see the medical school in their state as providing a vital service, especially right now, as COVID, it continues to be an important part of public policy. So, kind of putting those two things together, what's going on in your particular state and talking to policy makers. I think not that hasn't been done that much and it should be.
Sally Satel: Yeah. There is a show on, I think it's on more than one night, but I think it starts on February 7th. You know, it's Fox. So unfortunately it won't have as wide an audience and I mean as in terms of, open mindedness about this issue. But it is covering this woke medicine. So we'll see.
Aaron Sibarium: I mean all I was going to add was if you have this stuff, sometimes I go and look it up on my own, but there's too much for any one person to realistically find it all on their own. So if you know a journalist like me or John or Sally who covers this stuff for a living, you should send it our way, DM us on Twitter, or like email, because we can't respond to everything. But I've gotten tips where just someone says, "Hey, wanted to make sure you saw this," and you see it and you're like, "Oh, this massive hospital system was just flagrantly discriminating on the basis of race. Huh. Got to write that up today." And then within hours, they've taken it off their webpage. So, if you just reach out to a journalist who is interested in this stuff, that's an efficient way, often, of getting attention.
David Randall: Let's see. I want to build on another question, John Krieger, I would appreciate recommendations for organizations that we can support to expose and confront this effort. I know Dr. Satel you mentioned FAIR. And NAS is on this feed, particularly John Sailer, Aaron Sibarium is on this feed. But are there other organizations which are good on this, which people should be supporting?
John Sailer: David, you kind of answered the question. I mean, FAIR in Medicine is new and they're doing really good stuff. And this is a new project for me and it's not going to stop being a project. And we will likely have more specific policy recommendations that you can take to everyone, from policy makers to university trustees, and push back in concrete ways. And Aaron's previous comment is also a great reminder. Send us tips.
Sally Satel: There is one organization that was set up as a parallel to the American Counseling Association. If you're interested in that, let me know, but I'm feeling you probably meant medicine, so there is one group. And so that was encouraging, but FAIR in Medicine is encouraging too. We have to get many more doctors and that's what we're trying to do.
David Randall: I want to follow up on something that's, again this is something being mentioned about how much this is spreading abroad, but how much is this spreading abroad? I mean, how much are American doctors talking to doctors abroad and is the influence all bad one way and out from America? Is there any chance that medical peers abroad can save us from ourselves?
John Sailer: I don't know that much on this subject. I would say that some of the developments abroad regarding gender are encouraging, like Aaron brought up in Britain, in other European countries where they've really changed policy and pulled back on a lot of the really radical stuff. So that's helpful. Regarding race, I really have no idea what policies are taking hold abroad, but at the very least on the gender stuff, there are some encouraging trends.
Aaron Sibarium: I also would note that not just on gender, but on COVID, you see the rest of the world often just acting very differently than the US. And the US has not actually really done a great job of exporting the gender mania to other countries. And you're seeing the pushback in the UK and other places. And also with COVID mania, right. You know, Denmark, I think Norway now, and there's some other Scandinavian Western European countries that are dropping all their restrictions, despite high cases on the perfectly reasonable theory that, well everyone's vaccinated so the cases are mild and we don't really need to treat this like the end of the world anymore. And it's really only the United States where I think the COVID stuff aside from I guess, Australia and New Zealand. Putting those aside, I mean, we're really kind of an outlier in terms of, like, masking kids and this kind of neurotic obsession with case counts.
And I see that as kind of a mixed bag, because on the one hand it shows that we are not actually capable of exporting all of our cultural insanity to other countries. Like Denmark is just like, “no, what the hell are you guys doing?” And the UK, even, too. So in that sense, that's encouraging that there's not actually going to be a kind of American led COVID bio regime encompassing the whole world. Which maybe suggests that there are limits to even how much we'll be able to transplant wokism in medicine to the rest of the world. On the other hand, the fact that the COVID mania is so intense here, as is woke medicine, while the rest of the world just says, “what the hell are you guys doing,” suggests to me that we are a very kind of self-centered people, incredibly capable of just ignoring what other countries are doing even when the data justifies it.
I think a lot of this is also a function of America's bureaucratic and administrative class being so far removed from the population, which in turn is a function of I think of how big and diverse a country we are. Obviously Denmark doesn't really have that problem, which I suspect is part of why their COVID policies are more sane than ours. So the international stuff does give some reasons for optimism, but I would just say that there are structural features of the United States that probably make us more susceptible to some of the craziness than these other countries. And that's just something that we have to deal with.
David Randall: I'm going to have a question about the disparate impact of wokeness on different branches of medicine. Let me divide it this way: Medical research, medical psychological care, medical primary care, and then physical surgery. Where I must say the nightmare is the doctor with a knife is going to be using woke ideology to decide whether to operate on you properly or not. Is it hitting them all the same amount? Let's say those four baskets, or how would we categorize the relative impact of wokeness on these different areas?
Sally Satel: Well, in terms of clinical, this is the question I always have is honestly cannot believe, and I hope I've never proven wrong, that when a doctor's alone with a patient with diabetes, the doctor doesn't talk with a person about her diet, the need to exercise, take medications if they need insulin or other meds with frequency, I just cannot fathom that—when the rubber meets the road and the doors closed—this will affect the way doctors interact. Maybe I'm too optimistic, but I haven't seen that many instances—again, this is largely limited to the training sphere. And of course, it's going to go downstream or upstream depending on how you look at that at some point, because the trainees are going to be becoming mature doctors. But when the rubber meets the road, with the exception of that counseling examples I gave, I don't know. To me, that's why I keep calling it an experiment.
So I really don't know. All I can tell you is that the more, and there's data on this, the more classically left of center professions, psychiatry, family care, family practice, psychiatry, pediatrics, obviously public health, you expect to see more sympathy with the general ideas, but how they will actually manifest. And even how all this lunacy that Aaron and John have been enumerating about what the task forces are going to do. I can't fathom that it's not going to displace some really needed instruction, but that's really important to know, what is this displacing on the ground?
I did have an example from one colleague who said, ironically, some of it was displacing their little bioethics module. And so they were teaching about the Tuskegee experiment, which is a bizarre irony, but I don't know. I think that's why real, on the ground, real granular kinds of information is needed. And I do try to ask my colleagues, but medical students are the ones who really know, and the residents, and someone even talked me off the record, but you guys may have better luck.
John Sailer: To add to this, there are a lot of incentives that have been created by research-oriented universities to produce more research, especially in the category of health equity. Which at times, because of how much emphasis schools place on this, leads to not especially helpful scholarship. So it's, it's diverting scholarship, placing kind of an overt emphasis on just one topic. And then the level of rigor is not always as strong as you would want a research university to, to produce. And there are probably other negative effects of a research university obsessing with just one particular topic. Not to mention the fact that often it's informed by just kind of overtly problematic ideologies.
If you're, if you're saying that we're going to approach our research in primary care medicine from a critical race perspective, already I'm going to be a little bit suspicious of what you come up with. And I think if you read these articles, you might be inclined to agree.
And then you see universities, often what they'll do is they'll not only create a plan for action, but they'll also require each department to create their own miniature action plan or display what actions they've taken. I would say that anecdotally—I haven't done any kind of systematic study of what different departments do—but anecdotally, I would say that the disciplines that lean left have more stringent requirements. University of Minnesota comes to mind, their pediatrics department gave a long list of seminars that they've produced for faculty in the department. And this includes on topics like white supremacy culture and microaggressions. University of North Carolina's pediatrics department gave all of their incoming residents a “gender bread person” card to put on their university badge. So you get the impression there is a distinction and that falls along predictable lines.
Sally Satel: You know, someone posted some articles that are almost—frankly, they sound like parodies, "I had to be anti-racist hand surgeon." But I've noticed some articles with titles like that, some of them have no MDs. Or they have four authors and one is a doctor. That to me, parallels that sort of infestation of the bureaucracy—it's like they're running the show. It's like, my gosh, you don't want to be—I mean doctors have been accused, and rightly sometimes, of being quite arrogant. But we can't seed our specialty of what we really know. And there seems to be constantly trying to beat back the influence of, of some other forces, who just, I'm sorry, they don't know the area, they don't know the science, they don't know how it works.
Aaron Sibarium: I would just add one thing, which is, it's obviously important to collect data on certain kinds of racial disparities and disparities in general. But one of my worries about these health equity programs is that they're just dedicated to—they presume that the disparities are due to racism. And what they end up doing often, I think, is just getting data that documents the disparities and then they present it in a way that strongly implies that that's all due to racism, and they, they're not necessarily controlling for everything they should, or maybe they control for some of it.
But there's a lot that is hard to control for frankly. And what, what worries me is that when you have all the data on health disparities, it kind of creates this constant sense of moral crisis. Look at this disparity, look at that disparity. And obviously look, some of the disparities are pretty shocking and not saying that we shouldn't have any data on them, but there is a point after which you start getting so much of this data and it's all sort of tailored to promote a particular narrative.
I mean, there may be cases where we either don't want that data, or at least we don't want entire departments dedicated to kind of manufacturing it. Because it's clearly not just being done for sort of impartial reasons. I mean, there's a political aim here, and you do have to consider that the very act of producing and curating certain forms of data can serve a particular ideological end. And, again, it's like, I don't want to tell scholars, "don't research X just because has someone might use it in the wrong way." Of course not, but like when it comes to say deciding what you're going to fund, I think it's reasonable to ask, "okay, if this is just going to produce a lot of data, that's all going to be used to promote a very tendentious, partisan narrative and implement a very particular set of potentially destructive policies. Do we really want to fund that program? Even if the program is just claiming to be about data?" I'm not sure.
David Randall: Thank you. And I'm going to interrupt. More can and should be said, but we're getting hard up to our deadline. In fact, it's so near, I'm just going to go right now to a “thank you.” Thank you one and all. It's been a wonderful program. So I'm going to say thank you to you, thank you to our audience. I want to tell the audience again, you can send email with your questions if they haven't been answered. I'm at [email protected], and I'll be glad to forward questions to our panelists.
And this webinar will be up within 24 hours, as I say, not I think, transcribed or anything. But if you're interested in having it be transcribed or something, send us email and I will see about that. Because I mean, this is actually, I think one of the first good discussions on woke medicine and it might actually be useful to have it transcribed. But NAS is going to be continuing on the DEI and medicine beat. So will Sally Satel and Aaron Sibarium. Follow all of us, all of them, as they continue to do good work. And if you can get in touch with your own public representatives yourself, it's clearly stuff that needs to be done right now. So thank you again to all of you. And it's been wonderful having you here.
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