AMAC Exclusive – By David P. Deavel
The reactions to Joe Biden’s vow to consider only black women for Justice Stephen Breyer’s replacement on the Supreme Court were perhaps surprising to Democrats and their Ruling Class junior partner Republicans. While the former have insisted on and the latter have acquiesced in the belief that the arc of history bends toward racial preferences, polling done in the aftermath of the decision shows yet again that the American people do not like them. The good news for the American people is that in the last month several programs using them have been defeated. The bad news is that these programs were in medicine, an area of life that people count on both for professionalism and impartiality.
While public health officials have detonated their credibility in the age of Covid-19, Americans have still largely retained their respect for and trust in medical professionals. Dr. Fauci may be less credible than Dr. Pepper or even Austin Powers’ nemesis Dr. Evil, most people reason, but the men and women at my clinic are trustworthy professionals, right? Frighteningly enough, for those following the medical profession and medical education, a fixation on the goals of Diversity, Equity, and Inclusion in both medical schools and healthcare systems is making our once-top-notch American medical care more politicized and racialized but less effective.
The drive toward racialized medicine in actual treatment programs in the name of fighting systemic racism has proceeded apace but not without recent defeats. The Biden HHS and FDA issued guidance on how to ration care that included “race or ethnicity.” Some states and healthcare systems immediately complied. For instance, prioritization guidance issued by the state of New York’s medical department for the distribution of scarce monoclonal antibodies gives this curious criterion, “Non-white race or Hispanic/Latino ethnicity should be considered a risk factor, as longstanding systemic health and social inequities have contributed to an increased risk of severe illness and death from COVID-19.” This has nothing to do with specific risk factors in a particular population; instead it’s all about putting white people last in line. The same reasoning applied when New York City distributed Covid testing kits on the basis of race. So too Minnesota, which “deprioritized” white people for monoclonal antibody treatments because the Minnesota Department of Health reasoned that the “FDA’s acknowledgment means that race and ethnicity alone, apart from other underlying health conditions, may be considered in determining eligibility for mAbs [monoclonal antibodies].” In other words, race and ethnicity alone can push you to the front or back of the line no matter your own personal health. Even red state Utah added points for race when making decisions about rationing resources.
Republican Representative Andy Biggs of Arizona was forthright in demanding the FDA and HHS abandon guidelines that do this. And though he was not successful, Minnesota and the large Midwest Catholic healthcare system SSM Health, the latter of which had actually put in place a rule against white people receiving monoclonal antibody treatments, both reversed their policies. Mitt Romney’s state joins New York in sticking by their racial preferences.
It will be tough to turn back the tide on this sort of thing in part because the medical guilds and medical schools are adopting the language and thought world of Critical Race Theory, which dictates that discrimination in favor of those who have suffered from inequities (which can be identified wherever there is a statistical disparity) and against those who have not is the way forward. As University of Tennessee law professor Glenn Reynolds has observed, “‘Equity’ is a term woke academics have chosen because it sounds kind of like ‘equality,’ which Americans like, but actually means active racial discrimination, which Americans don’t.”
But that’s what’s on offer. In 2021 the American Medical Association released two lengthy documents titled, respectively, Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity and Advancing Health Equity: A Guide to Language, Narrative and Concepts. While a great deal of attention was paid to the latter’s typically ridiculous language policing (“morbidly obese,” “inmates,” “high-risk groups” and other terms were struck down and replaced with rather awkward euphemisms), the reality is that they represent a shift in medicine. The writer Ann Bauer tweeted recently that she spoke with a University of Minnesota internist who told her that doctors are “being encouraged to shift from individual doctor-patient relationships to thinking of each patient as a component of a community and treating them so as to improve broader public health.”
If you are sick, whether with Covid or anything else, how you are treated will be determined by your race or ethnic group’s general health. In fact, even before the FDA’s calls for use of race and ethnicity in distributing Covid treatments, some hospitals already have adopted “preferential treatment” plans. Two doctors from Brigham and Women’s Hospital in Boston, a Harvard teaching hospital, announced in a March 2021 article in The Boston Review that their institution would be offering “preferential care based on race” despite the fact that it would elicit legal challenges because “objectivity” in current medicine is “tainted” by “structural racism.”
One Midwestern doctor I interviewed recently emphasized the role of universities in forming physicians to think and act in such ways. Though the Boston doctors cited a Joe Biden executive order as their inspiration, the Midwesterner was not wrong. The AMA’s documents cite a group called White Coats for Black Lives (WC4BL) that has been instrumental in pushing the “antiracist” narrative in medical schools. A report by John Sailer at City Journal on this organization of radical medical students that has chapters on over seventy medical schools shows that pretty much everything you don’t want to happen in medicine is in their wheelhouse: black queer socialism, the abolition of prisons and police, the destruction of “cisheteropatriarchy,” faculty schooled in critical race theory, and everything else. They have been largely successful in steering medical schools and, given the AMA’s citation, the medical field in general.
This “antiracist” policy is not limited to preferential care but also affects hospitals in other ways. Twin Cities doctors tell me that the use of off-duty police officers as security at hospitals has become controversial. At one hospital, the limit is one at a time—and the unofficial policy is that it is always a black officer. The reasoning given is that minorities feel uncomfortable with police around, but woe to the doctor or nurse who complains that he or she feels unsafe because guns often appear in the ER and the parking area at night has sketchy characters. Such complainers will be told to “overcome your biases.”
Perhaps not as controversial as the WC4BL group is another with a similar name. The doctor above sent me a trailer for a movie called “Black Men in White Coats,” which is a group recruiting black men to become doctors. That sounds like a good idea, but here’s the problem. It operates on the theory that young black men are not in medical schools because of representation, which is not clearly true. According to one of the trailer’s medical talking heads, if more black men are not recruited to the medical profession, “black people are gonna continue dying.” This narrative makes it sound as if medical outcomes for black people are getting worse and ignores a continuing narrowing of the gap in life-expectancy for blacks and whites—and the fact that the gap might improve a great deal were it not for progressive policies in blue cities that make life much more precarious for minorities living in them.
But the doctor who sent the trailer to me tells me that the logic of all this has two very serious problems. The first is that it legitimizes the idea that the race of one’s doctor is really the important thing. At least for some—he asks me to imagine what has now become more common among some patients: to ask for a doctor of the same race. It wouldn’t fly for a white person to ask for a white doctor, but is it any more illogical than a black person demanding a black doctor?
The second serious problem is that the push for minority doctors is so strong that the evaluation of other achievements or characteristics necessary for success in medicine is seen as merely secondary to race. Dr. Norman Wang, director of a program at the University of Pittsburgh, was removed from his position after publishing an article in the Journal of the American Heart Association that argued against racial preferences in recruiting doctors for cardiology. Among other problems, he noted the problem of “mismatch,” by which lower standards are required for candidates for some races to enter a field—making the search for professional success more difficult and not less. While the JAHA retracted the article and other doctors rebutted it, it’s not clear that the rebuttals actually showed Wang wrong, as Dr. Zachary Robert Caverley demonstrated in an article at Quillette. Doctors I have spoken with affirm that this is true in other specialties, sometimes leading to a great deal of frustration on the part of the minority doctors themselves.
Doctors I talked to for this article worry about the continued decline not only of the esteem given to the medical profession in the U. S. but its successful record. While the cutthroat competition of the medical profession always had incentives to bad behavior, when allied to a strong sense of medical ethics, it yielded the kind of expertise that made the U. S. the envy of the world in terms of the kind of care one could receive. Now with the concerns for remaking the social order, focusing on the race of the patient (instead of his or her personhood) and the race of the doctor (instead of his or her skill and experience), the question of whether American healthcare is top of the line has begun to be asked a bit more insistently.
One doctor cites the words of one of his medical professors: “Cancer keeps score. It knows when you’re not very good.” It doesn’t care what color or race the doctor is. It does care whether the doctor knows how to kill it. Most Americans of all races, like cancer, keep score the same way. And they all want to be treated as individuals.
David P. Deavel is editor of Logos: A Journal of Catholic Thought and Culture, co-director of the Terrence J. Murphy Institute for Catholic Thought, Law, and Public Policy, and a visiting professor at the University of St. Thomas (MN). He is the co-host of the Deep Down Things podcast.