Race-based medicine will cost thousands of lives by harming medical innovation and patient care

Race-based medicine will cost thousands of lives by harming medical innovation and patient care

Racial activists exploited the death of George Floyd and the tumult that followed to demand radical changes in institutions that are central to American life. Many key institutions, run by progressives, quickly acceded to their demands. They imposed racial quotas or racial preferences in hiring, and gutted or watered down merit-based standards.

In “The Corruption of Medicine,” Heather Mac Donald describes how American medical institutions bowed to these racial demands, which will lower the quality of medical research and medical care, and thus eventually cost thousands of lives:

The post–George Floyd racial reckoning has hit the field of medicine like an earthquake….Vast sums of public and private research funding are being redirected from basic science to political projects [about race]. The result will be declining quality of medical care and a curtailment of scientific progress.

Virtually every major medical organization—from the American Medical Association (AMA) and the American Association of Medical Colleges (AAMC) to the American Association of Pediatrics—has embraced the idea that medicine is an inequity-producing enterprise. The AMA’s 2021 Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity is virtually indistinguishable from a black studies department’s mission statement…. a thicket of social-justice maxims: physicians must “confront inequities and dismantle white supremacy, racism, and other forms of exclusion and structured oppression, as well as embed racial justice and advance equity within and across all aspects of health systems.”…. A key solution to this alleged oppression is identity-based preferences throughout the medical profession. The AMA strategic plan calls for the “just representation of Black, Indigenous and Latinx people in medical school admissions as well as . . . leadership ranks.”…

According to medical and STEM leaders, to be white is to be per se racist; apologies and reparations for that offending trait are now de rigueur….And so medical schools and medical societies are discarding traditional standards of merit in order to alter the demographic characteristics of their profession. That demolition of standards rests on an [the unsupported belief] that there is no academic skills gap between whites and Asians, on the one hand, and blacks and Hispanics, on the other. No proof is needed for this proposition; it is the starting point for any discussion of racial disparities in medical personnel. Therefore, any test or evaluation on which blacks and Hispanics score worse than whites and Asians is biased and should be eliminated.

The U.S. Medical Licensing Exam is a prime offender. At the end of their second year of medical school, students take Step One of the USMLE, which measures knowledge of the body’s anatomical parts, their functioning, and their malfunctioning; topics include biochemistry, physiology, cell biology, pharmacology, and the cardiovascular system. High scores on Step One predict success in a residency; highly sought-after residency programs, such as neurosurgery and radiology, use Step One scores to help select applicants.

Black students are not admitted into competitive residencies at the same rate as whites because their average Step One test scores are a standard deviation below those of whites. Step One has already been modified to try to shrink that gap; it now includes nonscience components such as “communication and interpersonal skills.” But the standard deviation in scores has persisted. In the world of antiracism, that persistence means only one thing: the test is to blame. It is Step One that, in the language of antiracism, “disadvantages” underrepresented minorities, not any lesser degree of medical knowledge.

The Step One exam has a further mark against it. The pressure to score well inhibits minority students from what has become a core component of medical education: antiracism advocacy. A fourth-year Yale medical student describes how the specter of Step One affected his priorities. In his first two years of medical school, the student had “immersed” himself, as he describes it, in a student-led committee focused on diversity, inclusion, and social justice. The student ran a podcast about health disparities. All that political work was made possible by Yale’s pass-fail grading system, which meant that he didn’t feel compelled to put studying ahead of diversity concerns. Then, as he tells it, Step One “reared its ugly head.” Getting an actual grade on an exam might prove to “whoever might have thought it before that I didn’t deserve a seat at Yale as a Black medical student,” the student worried.

The solution to such academic pressure was obvious: abolish Step One grades. Since January 2022, Step One has been graded on a pass-fail basis….Every other measure of academic mastery has a disparate impact on blacks and thus is in the crosshairs.

In the third year of medical school, professors grade students on their clinical knowledge in what is known as a Medical Student Performance Evaluation (MSPE). The MSPE uses qualitative categories like Outstanding, Excellent, Very Good, and Good. White students at the University of Washington School of Medicine received higher MSPE ratings than underrepresented minority students from 2010 to 2015, according to a 2019 analysis. The disparity in MSPEs tracked the disparity in Step One scores.

The parallel between MSPE and Step One evaluations might suggest that what is being measured in both cases is real. But the [woke dogma] holds that no academic skills gap exists. Accordingly, the researchers proposed a national study of medical school grades to identify the actual causes of that racial disparity. The conclusion is foregone: faculty bias. As a Harvard medical student put it in Stat News: “biases are baked into the evaluations of students from marginalized backgrounds.”

A 2022 study of clinical performance scores anticipated that foregone conclusion. Professors from Emory University, Massachusetts General Hospital, and the University of California at San Francisco, among other institutions, analyzed faculty evaluations of internal medicine residents in such areas as medical knowledge and professionalism. On every assessment, black and Hispanic residents were rated lower than white and Asian residents. The researchers hypothesized three possible explanations: bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment. University of Pennsylvania professor of medicine Stanley Goldfarb tweeted out a fourth possibility: “Could it be [that the minority students] were just less good at being residents?”

Goldfarb had violated the [woke dogma]. Punishment was immediate. Predictable tweets called him, inter alia, possibly “the most garbage human being I’ve seen with my own eyes,” and Michael S. Parmacek, chair of the University of Pennsylvania’s Department of Medicine, sent a schoolwide e-mail addressing Goldfarb’s “racist statements.” Those statements had evoked “deep pain and anger,” Parmacek wrote. Accordingly, the school would be making its “entire leadership team” available to “support you,” he said….That same day, the executive vice president of the University of Pennsylvania for the Health System and the senior vice dean for medical education at the University of Pennsylvania medical school reassured faculty, staff, and students via e-mail that Goldfarb was no longer an active faculty member but rather emeritus….

Despite the allegations of faculty racism, disparities in academic performance are the predictable outcome of admissions preferences. In 2021, the average score for white applicants on the Medical College Admission Test was in the 71st percentile, meaning that it was equal to or better than 71 percent of all average scores. The average score for black applicants was in the 35th percentile—a full standard deviation below the average white score. The MCATs have already been redesigned to try to reduce this gap; a quarter of the questions now focus on social issues and psychology.

Yet the gap persists. So medical schools use wildly different standards for admitting black and white applicants. From 2013 to 2016, only 8 percent of white college seniors with below-average undergraduate GPAs and below-average MCAT scores were offered a seat in medical school; less than 6 percent of Asian college seniors with those qualifications were offered a seat, according to an analysis by economist Mark Perry. Medical schools regarded those below-average scores as all but disqualifying—except when presented by blacks and Hispanics. Over 56 percent of black college seniors with below-average undergraduate GPAs and below-average MCATs…, making a black student in that range more than seven times as likely as a similarly situated white college senior to be admitted to medical school and more than nine times as likely to be admitted as a similarly situated Asian senior.

Such disparate rates of admission hold in every combination and range of GPA and MCAT scores. Contrary to the AMA’s Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity, blacks are not being “excluded” from medical training; they are being catapulted ahead of their less valued white and Asian peers….Meantime, medical professors need to be reeducated…Increasing amounts of faculty time are spent on such antiracism activities….

[Activists believe] The medical school curriculum itself needs to be changed to lessen the gap between the academic performance of whites and Asians, on the one hand, and blacks and Hispanics, on the other. Doing so entails replacing pure science courses with credit-bearing advocacy training. More than half of the top 50 medical schools recently surveyed by the Legal Insurrection Foundation required courses in systemic racism. That number will increase after the AAMC’s new guidelines for what medical students and faculty should know transform the curriculum further.

According to the AAMC, newly minted doctors must display “knowledge of the intersectionality of a patient’s multiple identities and how each identity may present varied and multiple forms of oppression or privilege related to clinical decisions and practice.” Faculty are responsible for teaching how to engage with “systems of power, privilege, and oppression” in order to “disrupt oppressive practices.” Failure to comply with these requirements could put a medical school’s accreditation status at risk and lead to a school’s closure….[Yet] being indoctrinated in “intersectionality” does nothing to improve a student’s clinical knowledge. Every moment spent regurgitating social-justice jargon is time not spent learning how to keep someone alive whose body has just been shattered in a car crash. Advocates of antiracism training never explain how fluency in intersectional critique improves the interpretation of an MRI or the proper prescribing of drugs….

Despite the persistent academic skills gap, a minority hiring surge is under way. Many medical schools require that faculty search committees contain a quota of minority members, that they be overseen by a diversity bureaucrat, and that they interview a specified number of minority candidates. One would have to be particularly dense not to grasp the expected result. In recent years, the Memorial Sloan Kettering Cancer Center, the Cleveland Clinic Taussig Cancer Center, the Uniformed Services University of the Health Sciences, the University of Chicago Cancer Center, the University of Pittsburgh Division of Medical Oncology, the Massey Cancer Center at Virginia Commonwealth University, the University of Miami Miller School of Medicine, and the Department of Medicine at UCLA’s medical school have hired black leaders….In at least one case, the runner-up possessed a research and leadership record that far surpassed that of the winning candidate. But he lacked the favored demographic characteristics.

It matters who heads research ventures and medical faculties. Top scientists can identify the most promising directions of study and organize the most productive research teams. But the diversity push is discouraging some scientists from competing at all. When the chairmanship of UCLA’s Department of Medicine opened up, some qualified faculty members did not even put their names forward because they did not think that they would be considered, according to an observer.

College seniors, deciding whether to apply to medical school, can also read the writing on the wall…A UCLA doctor says that the smartest undergraduates in the school’s science labs are saying: “Now that I see what is happening in medicine, I will do something else.”

Funding that once went to scientific research is now being redirected to diversity cultivation. The NIH and the National Science Foundation are diverting billions in taxpayer dollars from trying to cure Alzheimer’s disease and lymphoma to fighting white privilege and cisheteronormativity. Private research support is following the same trajectory. The Howard Hughes Medical Institute is one of the world’s largest philanthropic funders of basic science and arguably the most prestigious. Airline entrepreneur Howard Hughes created the institute in 1953 to probe into the “genesis of life itself.” Now diversity in medical research is at the top of HHMI’s concerns. In May 2022, it announced a $1.5 billion effort to cultivate scientists committed to running a “happy and diverse lab where minoritized scientists will thrive and persist,” in the words of the institute’s vice president….If an applicant’s “happy lab” plan fails to ignite enthusiasm in the diversity reviewers, however, his application will be shelved, no matter how promising his actual scientific research.

The HHMI program and others like it amplify the message that doing basic science, if you are white or Asian, is not particularly valued by the STEM establishment. How many scientific breakthroughs will be forgone by such signals is incalculable…

The fight against cancer has been particularly affected. White and Asian oncologists are assumed to be part of the problem of black cancer mortality, not its solution, absent corrective measures. According to the NIH, leadership of cancer labs should match national or local demographics, whichever has a higher percentage of minorities.

Cancer grant applications must now specify who, among a lab’s staff, will enforce diversity mandates and how the lab plans to recruit underrepresented researchers and promote their careers. As with the Howard Hughes Medical Institute’s Freeman Hrabowski scholarships, an insufficiently robust diversity plan means that a proposal will be rejected, regardless of its scientific merit. Discussions about how to beef up the diversity section of a grant have become more important than discussions about tumor biology, reports a physician-scientist. “It is not easy summarizing how your work on cell signaling in nematodes applies to minorities currently living in your lab’s vicinity,” the researcher says. Mental energy spent solving that conundrum is mental energy not spent on science, he laments, since “thinking is always a zero-sum game.”

A lab’s diversity gauntlet has just begun, however. The NIH insists that participants in drug trials must also match national or local demographics. If a cancer center is in an area with few minorities, the lab must nevertheless present a plan for recruiting them into its study, regardless of their local unavailability. Genentech, the creator of lifesaving cancer drugs, held a national conference call with oncologists in April 2022 to discuss products in the research pipeline. Half of the call was spent on the problem of achieving diverse clinical trial enrollments, a participant reported. Genentech admitted to having run out of ideas….

In May 2022, a physician-scientist lost her NIH funding for a drug trial because the trial population did not contain enough blacks. The drug under review was for a type of cancer that blacks rarely get. There were almost no black patients with that disease to enroll in the trial, therefore. Better, however, to foreclose development of a therapy that might help predominantly white cancer patients than to conduct a drug trial without black participants.

This is just a small excerpt. Much more at this link: https://www.city-journal.org/the-corruption-of-medicine

LU Staff

LU Staff

Promoting and defending liberty, as defined by the nation’s founders, requires both facts and philosophical thought, transcending all elements of our culture, from partisan politics to social issues, the workings of government, and entertainment and off-duty interests. Liberty Unyielding is committed to bringing together voices that will fuel the flame of liberty, with a dialogue that is lively and informative.


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