Here’s another read for you, this time from Bari Weiss’s Substack column. Weiss seems to have been farming out the writing part of her site to others (Katie Herzog in this case) and concentrating on podcasting, a genre I don’t listen to. Herzog’s piece, below, discusses the kind of wokeness in medicine that is either potentially injurious to people or makes doctors keep their mouths shut when they shouldn’t.
Click on the screenshot to read:
Herzog readily avers that there are inequities in medicine, many stemming from racism in the past that has led Hispanics and blacks to be unable to afford good medical care or to be shunted to ineffective adyts of the system. These have to be addressed.
But the object of the current fracas is what’s seen as “ongoing systemic racism” in medicine. This, claims Herzog, has led to doctors being reluctant to criticize others for being late, for criticizing wokeness and—in my view, the worst violation—”whole research areas being seen as off limits”. I’ll give two examples, one of which doesn’t show research as being off-limits, really, but showing criticism of presumably weak research being off limits. Herzog:
“Wokeness feels like an existential threat,” a doctor from the Northwest said. “In health care, innovation depends on open, objective inquiry into complex problems, but that’s now undermined by this simplistic and racialized worldview where racism is seen as the cause of all disparities, despite robust data showing it’s not that simple.”
“Whole research areas are off-limits,” he said, adding that some of what is being published in the nation’s top journals is “shoddy as hell.”
Here, he was referring in part to a study published last year in the Proceedings Of The National Academy Of Sciences. The study was covered all over the news, with headlines like “Black Newborns More Likely to Die When Looked After by White Doctors” (CNN), “The Lack of Black Doctors is Killing Black Babies” (Fortune), and “Black Babies More Likely to Survive when Cared for by Black Doctors” (The Guardian).
Despite these breathless headlines, the study was so methodologically flawed that, according to several of the doctors I spoke with, it’s impossible to extrapolate any conclusions about how the race of the treating doctor impacts patient outcomes at all. And yet very few people were willing to publicly criticize it. As Vinay Prasad, a clinician and a professor at the University of California San Francisco, put it on Twitter: “I am aware of dozens of people who agree with my assessment of this paper and are scared to comment.”
“It’s some of the most shoddy, methodologically flawed research we’ve ever seen published in these journals,” the doctor in the Zoom meeting said, “with sensational conclusions that seem totally unjustified from the results of the study.”
“It’s frustrating because we all know how hard it is to get good, sound research published,” he added. “So do those rules and quality standards no longer apply to this topic, or to these authors, or for a certain time period?”
At the same time that the bar appears to be lower for articles and studies that push an anti-racist agenda, the consequences for questioning or criticizing that agenda can be high.
The article below is the PNAS article at issue, and you can read it for free by clicking on the screenshot:
The popular summary from the article which, if true, is a pretty serious finding, and is apparently imputed to white doctors mistreating black newborns in a way that doubles their mortality! Here’s the author’s popular precis:
A large body of work highlights disparities in survival rates across Black and White newborns during childbirth. We posit that these differences may be ameliorated by racial concordance between the physician and newborn patient. Findings suggest that when Black newborns are cared for by Black physicians, the mortality penalty they suffer, as compared with White infants, is halved. Strikingly, these effects appear to manifest more strongly in more complicated cases, and when hospitals deliver more Black newborns. No such concordance effect is found among birthing mothers.
As Herzog notes above, many people see this study as weak (confession: I haven’t yet read it). If you want a series of problems that Ethan Milne found in the paper, he has a critique of the paper on Medium, though he hastens to add:
While I have included many disclaimers throughout this post, I want to be clear that I am 1) not a medical researcher, and 2) that you should read the paper yourself. The research itself has merit, and the biggest issue here is the way in which uncritical reporters overhype findings to satisfy their personal biases. The solution isn’t to throw our hands in the air and cry foul when research is flawed, but to build on that research in future work.
Milne shows how grossly the popular press distorted the results of this paper.
So read the paper or, if it’s above your pay grade, look around the Web to find other takes on it.
I’ll cite just one more example: somebody losing their position and status for maintaining that medicine is hyperracialized and is not systemically racist:
In February, the Journal of the American Medical Association (JAMA) released a podcast hosted by surgeon and then-deputy journal editor Edward Livingston, who questioned the value of the hyper focus on race in medicine as well as the idea that medicine is systemically racist.
“Personally, I think taking racism out of the conversation will help,” Livingston said at one point. “Many of us are offended by the concept that we are racist.”
It’s possible Livingston’s comments would have gone unnoticed but JAMA promoted the podcast on Twitter with the tone-deaf text: “No physician is racist, so how can there be structural racism in health care?”
Even more than in the case of Norman Wang, this tweet, and the podcast it promoted, led to a massive uproar. A number of researchers vowed to boycott the journal, and a petition condemning JAMA has received over 9,000 signatures. In response to the backlash, JAMA quickly deleted the episode, promised to investigate, and asked Livingston to resign from his job. He did.
If you try to access the podcast today, you find an apology in its place from JAMA editor-in-chief Howard Bauchner, who called Livingston’s statements, “inaccurate, offensive, hurtful and inconsistent with the standards of JAMA.” Bauchner was also suspended by JAMA pending an independent investigation. This Tuesday, JAMA announced that Bauchner officially stepped down. In a statement, he said he is “profoundly disappointed in myself for the lapses that led to the publishing of the tweet and podcast. Although I did not write or even see the tweet, or create the podcast, as editor in chief, I am ultimately responsible for them.”
Seriously, do you think that Livingston’s comments were inflammatory and odious enough to warrant this kind of “uproar,” much less forcing him to resign with the usual abject apology? I doubt it. And the JAMA’s promotion of the podcast was invidious and inflammatory enough to ignite this controversy.
There’s more in Herzog’s piece, including stuff about differential treatment of patients of different races. I will add that the study of infant mortality noted above has such serious implications that it, and studies like it analyzing disparate races of caregivers and care receivers, need to be repeated. We can’t just blow off the result, weak as the study may be, because people’s health and lives are at stake.