By Greg Ganske
August 5, 2022
Let us progress from the petty, but not inconsequential aspects of “woke” changes in American medicine, to the existential, serious consequences of “woke ideology” on your own health.
If you search online for “racism and medicine,” you will find screen after screen of medical papers purporting to show that doctors are racially biased, and this leads to poor care and worse outcomes for minorities.
Is this science? No. It is poor science at best, ideologically and frankly, politically driven. And that makes it political science, not medical science.
But should a physician dare question the assumptions of this politically pushed “science”—and isn’t science all about questioning assumptions?
For the sin of questioning a political assumption, a physician will most likely be declared an apostate to be driven from the profession of medicine.
Think about that if you’re unfortunate enough to be in a hospital or holding the hand of a loved one as tests are conducted, as judgments are made, as precious time passes.
I spent my career as a doctor, a surgeon, and later for years as a member of the U.S. House of Representatives. It concerns me, and it should concern you.
This new adherence to virtue signaling to press for political outcomes not necessarily backed by evidence has been going on for some time. Yet Americans have repeatedly been lectured and admonished to “Follow the Science!!!”
But medicine, like other institutions, has gone woke.
This phenomenon in American medicine began as political virtue signaling with the removal of portraits of doctors who were (wrongly) deemed offensive. And now it has reached the point where medicine turns to Critical Race Theory and its CRT hustlers to shape the process of how physicians are selected and trained.
When you or a loved one is ill, do you want a woke doc who has been trained through a push for politically/socially acceptable outcomes? Or do you seek the physician who has been challenged, repeatedly, in rigorous ways during training?
Changes in medical training and applying political science to medical science are putting that at risk.
A few years ago, the AMA removed the statue of its founder Dr. Nathan Davis from its place of honor in its Chicago headquarters lobby and assigned it to the basement. Dr. Davis was a Northerner and not a racist. He treated patients of all ethnic groups and skin colors equally. However, he is judged by “presentism” norms today.
“Presentism” as defined by Oxford Dictionary is the “uncritical adherence to present-day attitudes, especially the tendency to interpret past events in terms of modern values and concepts.” How does this apply to the question at hand? Dr. Davis has now been judged guilty of supporting a compromise back in 1868 to save the AMA organization from splintering into Northern and Southern groups on race by requiring state membership to be a member of the national AMA.
Like Lincoln with his Emancipation Proclamation which freed slaves in Southern states but not Union Northern ones, it was as far as he could get consensus.
Then my plastic surgery alma mater, the Brigham and Women’s Hospital, removed all 31 of its gold framed portraits of its surgical chiefs from the surgical amphitheater where Surgical Rounds and Morbidity and Mortality Conferences were held.
They were portraits of men such as Dr. Harvey Cushing who founded neurosurgery, Dr. Dwight Harkin who inserted the first heart valve and developed the concept of the ICU, Dr. Francis Moore whose “Metabolic Care of the Surgical Patient” saved patients from surgical shock, and my own chief, Nobel Laureate Dr. Joe Murray, who performed the first successful kidney transplants.
Were they racists? Absolutely not!
But some Harvard medical students complained they were “uncomfortable” because the portraits were of only White Men!
And just like that, Voila! Dr. Elizabeth Nabel, the past president of Brigham Health, summarily removed all the portraits to more private spots. They were segregated so as not to upset the new women and men of science. At least it was just portraits and statues that were cancelled. Then.
Dr. Jeffrey Flier, former dean of Harvard medical school, said removing the portraits did nothing to promote diversity and wrote an op-ed condemning the cancellation of these medical giants.
Contradicting Dr. Nabel who said no one complained, Dr Flier said many faculty were afraid to dissent, adding “More than anything else the explicit fear of speaking out against this by faculty at all levels drove me to write this piece. I felt that I had to do this, and that others more vulnerable to false criticism might then speak their minds.”
Dr. Edward Livingston, a top editor at the medical journal JAMA, did lose his job when on a podcast he said, “Personally I think taking ‘racism’ out of the conversation would help. Many people like myself are offended by the implication that we are somehow racist” in dismissing the idea that systemic racism existed in medicine.
JAMA’s top editor, Dr Howard Bauchner had to issue a mea culpa and resign, too. Why? Because they hadn’t toed the new woke line to parrot that medicine is systemically racist.
Woke AMA members like Dr. Raymond Givens at Columbia complained that the editors at JAMA were overwhelmingly white and male. The new JAMA editor, Dr Audiey Kao, was quick to invite the Critical Race Theory (CRT) spokesperson Ibram X. Kendi to address the AMA to make amends.
Healthcare has been infected by the radical “systemic racism” ideology of Critical Race Theory (CRT). The public is largely ignorant of what medicine’s “woke” conversion is bringing and the racism that CRT paradoxically inflicts on our nation’s healthcare.
My op-ed for the Des Moines Register last year “Critical Race Theory is Harmful to Race Relations” explains the basis of Critical Race Theory and how it is leading us to worse race relations.
Interestingly, as most medical organizations’ liberal academic leaders have adopted the ‘medicine is systemically racist’ mantra, many try to deny they are making CRT based changes at their physician organizations, medical schools and hospitals. This, despite CRT advocates such as Ibram Kendi making fortunes by giving speeches and promoting CRT at AMA, American College of Surgeons and other medical meetings across the country.
And woe to physicians who challenge the premise of this radical ideology.
Florida surgeon Dr. Rick Bosshardt lost his privileges on the American College of Surgeons (ACS) Forum because he challenged the ACS leadership on its assumption that American surgery is systemically racist.
As a doctor and former politician, I worry about politics entering the doctor’s office. I echo statements of Dr. Stanley Goldfarb, esteemed nephrologist and former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine.
In an op-ed in the Wall Street Journal, Dr. Goldfarb states his case knocking down the growing and absurd idea that healthcare is “systematically racist” and that most physicians are biased and therefore give worse care to minorities.
In his op-ed, Goldfarb writes:
“Health disparities do exist among racial groups, but physician bias isn’t the cause. The psychological test at the root of this narrative, the 1998 Implicit Association Test, has been widely discredited. I know from long experience as a medical educator and practitioner that physicians address the needs of each patient, regardless of skin color. Moreover, attacking physicians is dangerous. It degrades minority trust in healthcare while undermining health outcomes for everyone.”
For a more complete argument, read Dr. Goldfarb’s book, “Take Two Aspirin and Call Me by My Pronouns: Why Turning Doctors into Social Warriors is Destroying American Medicine”
It is true that blacks have shorter lifespans and worse clinical outcomes for many diseases, including higher infant and maternal mortality. However, societal dysfunction such as poverty, crime, gangs in main cities, drug abuse, riots and arson, lack of jobs, sub-standard public education options for families and the dependency on the welfare state among minorities seem to get lost in all the politics and analyzing.
The popular story today, the easy answer, the answer that fits neatly into a Tweet, is that a racist medical establishment is the reason. Dr Goldfarb documents that the claim is unsupported by evidence.
There is a difference between documenting different outcomes and showing that the reason for different treatment due to racism.
A review of the multiple studies that allege racism as the cause of different outcomes is simply not supported by evidence. Scientific research requires scientists to disprove their own theory. The researcher should start by doubting the hypothesis and try to disprove it by carefully designed and controlled experiments.
Unfortunately, too many researchers are looking to confirm their own bias that the health care system is racist. A biased experiment can easily lead to a desired outcome and faulty conclusion.
An example is a research paper done by Nancy Krieger, a Harvard epidemiologist who has made a career out of claiming that racism is the cause of many poor health outcomes of minorities.
Dr. Krieger wanted to prove that racial discrimination gives Blacks high blood pressure. In her study, she asked 831 Black men and 1,143 Black women their experience with racial discrimination and measured their blood pressure. She found that professional-class Blacks had lower blood pressure than working class Blacks, even though the professionals reported more discrimination.
Instead of admitting her hypothesis was wrong she concluded that there was a class difference in the discrimination-blood pressure effect. Then she found that among working class Black men, the more instances of health care discrimination they reported, the higher their blood pressure.
Still, the highest blood pressure among this group was in those who reported no discrimination at all. So, she then assumed that those who reported no discrimination were lying while those who reported discrimination were telling the truth!
Every time the data failed to support her diagnosis; she added another assumption. Yet, it was reported as factual in the Journal of Public Health, the New York Times, the Washington Post and television. The scientific method doesn’t get you published, but the narrative does.
Compare this to the study by Durant, McClure, et. al. in Ethnicity and Disease Journal in 2010, “Trust in Physicians and Blood Pressure Control in Blacks and Whites Being Treated for Hypertension in the Regards Study.”
In a well-controlled study of 2843 black and white adults over 45 years of age there was no relationship between trust in physicians and BP control. The higher odds of uncontrolled hypertension in Blacks compared to Whites was not attributable to racial differences in trust.
While other factors such as poor medication adherence were related to BP control, none completely explained the differences in control of hypertension.
More important than statues and portraits, even loss of editorships of medical journals, this adherence to CRT ideology is leading us to decreased standards for future doctors.
Objective measures of ability and predictors of success in medical school such as the Medical College Acceptance Test (MCAT) are under attack as being racist. Some medical schools are dropping them (and even undergraduate grades) as determinants of admission. Moving away from merit-based testing and grades only benefits applicants of certain racial groups. Whereas actually the MCAT gives working-class, first-generation students a shot at making the top medical schools. The result of not using the MCAT will be to lower standards and fewer talented physicians providing high-quality care to patients.
We have had affirmative action admission to medical schools since 1965. Minority students with lower grades and MCAT scores are already given preference over students of other races. Black students with 50ish percentile MCATS are 9 times more likely to be admitted to medical school than White students. Only one in five Whites with medium GPAs and MCATS get into medical school while 85% of Blacks are admitted.
It used to be that medical students could flunk out. Schools bent over backwards to graduate affirmative action students and still do. It would take a Breaking Bad crime to get a student dismissed from medical school these days. As medical schools themselves stop grading because it is “racist,” admission to residencies on the basis of medical school performance is supplanted by racial preferences, as well.
If that isn’t bad enough, The Association of American Medical Colleges (AAMC) has released new standards that require students to achieve competencies” in “White privilege”, “anti-colonialism” and “Race as a social construct” among other “racist” ideas.
According to the AAMC it is necessary for medical school curriculums to reflect the American left’s social justice nostrums. Those entering must demonstrate the “value of diversity by incorporating dimensions of diversity into the patients’ health assessment and treatment plans” as well as “knowledge of intersectionality of a patient’s multiple identities and how each identity may result in varied and multiple forms of oppression or privilege related to clinical decisions and practice. . .(e.g. White privilege, racism, sexism, heterosexism, ableism, religious oppression).”
The AAMC document states, “The origins of these inequities are often rooted in systemic racism and discrimination.” Dr. Goldfarb warns, “This document will become the template for how medical students will be educated throughout the country and it is a profoundly political and discriminatory document. It will force students to accept the tenets of critical race theory in their medical training and undermine the trust that patients must have in their physicians.”
Ask yourselves: are medical students being educated in the complexities of social/political policy? Or are they being indoctrinated, in the pursuit of a woke utopia that likely does great harm and undercuts the patients’ trust in physicians?
All this emphasis on racism obscures what physicians of my generation were taught: To treat all equally without consideration for race or class and treat the individual to the best of your ability.
I really don’t care what skin color my doctor has: a very talented Asian cardiac surgeon saved my father’s life, an Indian doctor did my coronary stents because I knew he was excellent, a deceased Black surgeon from Des Moines, had great hands and could take out a diseased gallbladder through the tiniest incision with very low morbidity. None received preferential treatment in medical school or residency.
Politics is one thing. All I care about is that the standards be kept high and that the best and brightest—regardless of race, ethnicity, creed or political connections—become the next generation’s doctors.
Emphasis in medical schools on reforming the political system and society takes time away from the study of clinical medicine by the students. When physicians are compelled to discriminate and hospitals, state authorities and the federal government authorize race-based formulas for rationing Covid treatments, racism is made worse. After taking down the portraits, the Brigham and Women’s Hospital is now moving toward “preferential care based on race” social activism and that hurts healthcare.
Dr. Goldfarb is correct that there is no credible evidence that physicians are systemically racist and that minority patients will get better care if healthcare is based on an “anti-racist” ideology (CRT).
“Current and future physicians must tell the country that healthcare is being profoundly damaged by a radical and divisive ideology,” Goldfarb writes. “The health and well-being of every American depends on it.”
When the public becomes aware of lowered standards based on race for acceptance and graduation from medical school and residency selection, it will actually damage the reputation and practices of the excellent Black surgeons already in practice because of loss of public confidence.
So many American institutions are now subject to woke politics. But if you’re in a hospital in need of cardiac surgery, are your nerves truly soothed by the skin color or politics of the surgeon?
Or do you expect your doctors to have undergone rigorous training—without political considerations—to make them the best as they administer care?
It might be worth considering, before you’re taken to a hospital Emergency Room or before you’re on the table, being prepped for surgery.
Greg Ganske, MD, is a retired surgeon and represented Iowa in Congress for 8 years from 1995-2002