A gloomy time for medical education

August 15, 2022 • 9:45 am

Early this morning I received an email from a friend mourning the loss of meritocratic standards in colleges (indeed, everywhere), implying that it’s hopeless to fight the rising tide that values equity above quality. Then I got an email from another friend, whose school is promoting a “healthy at any size” initiative which began with this goal:

Implement a “Decline to Weigh” initiative at Student Health and Counseling Services to increase access to health care

Stigmatizing people for being overweight is immoral; as Grania used to point out to me, people know when they’re overweight. But it’s a different issue when it comes to going to the doctor. If you don’t want to be weighed, you’re withholding valuable information that could save your life. You should not encourage others to decline to have a doctor take their weight. Not only that, but promoting the idea that being obese is actually healthy—or at least not harmful—endangers other people, reinforcing obese people’s feeling that they’re actually in pretty good shape. The overweight, after all, are a stigmatized minority (true), who must be told that they’re healthy (often not true).

This same message—that offending minorities must be avoided even if it endangers people’s health—is the theme of Heather Mac Donald’s long but must-read essay in City Journal, which highlights the decline in admissions and evaluation standards in medical schools, all in the name of equity. Yes, it’s a conservative paper, and yes, Mac Donald tilts more rightward than I, but the facts are the facts, and you can’t depend on the New York Times or Washington Post to monitor medical schools and report on how standardized tests and medical-school evaluations are being downgraded. For those papers, too, value equity above merit. And without facing the facts, we can’t even begin to fix facts that are unacceptable.

The the other theme of Mac Donald’s piece is how those doctors who speak up for merit, or even cite the mere facts about the disparities among different groups in achievement and test scores, are being called racists or even demoted. I won’t discuss that, for we know how this kind of ostracism works.

Click to read Mac Donald’s piece. It’s long but we need to know these things:

A few quotes:

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 a priori truth: 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 solution to such academic pressure was obvious: abolish Step One grades. Since January 2022, Step One has been graded on a pass-fail basis.

The assumption in all of this is a kind of cultural blank slate-ism: if some groups score lower than others on tests, the tests must be “structurally racist.” (No matter that test companies do extensive research to ensure that this doesn’t occur.)

More:

Though mediocre MCAT scores keep out few black students, some activists seek to eliminate the MCATs entirely. Admitting less-qualified students to Ph.D. programs in the life sciences will lower the caliber of future researchers and slow scientific advances. But the stakes are higher in medical training, where insufficient knowledge can endanger a life in the here and now. Nevertheless, some medical schools offer early admissions to college sophomores and juniors with no MCAT requirement, hoping to enroll students with, as the Icahn School of Medicine at Mount Sinai puts it, a “strong appreciation of human rights and social justice.” The University of Pennsylvania medical school guarantees admission to black undergraduates who score a modest 1300 on the SAT (on a 1600-point scale), maintain a 3.6 GPA in college, and complete two summers of internship at the school. The school waives its MCAT requirement for these black students; UPenn’s non-preferred medical students score in the top one percent of all MCAT takers.

According to race advocates, differences in MCAT scores must result from test bias. Yet the MCATs, like all beleaguered standardized tests, are constantly scoured for questions that may presume forms of knowledge particular to a class or race. This “cultural bias” chestnut has been an irrelevancy for decades, yet it retains its salience within the anti-test movement. MCAT questions with the largest racial variance in correct answers are removed. External bias examiners, suitably diverse, double-check the work of the internal MCAT reviewers. If, despite this gauntlet of review, bias still lurked in the MCATs, the tests would underpredict the medical school performance of minority students. In fact, they overpredict it—black medical students do worse than their MCATs would predict, as measured by Step One scores and graduation rates. (Such overprediction characterizes the SATs, too.) Nevertheless, expect a growing number of medical schools to forgo the MCATs, in the hope of shutting down the test entirely and thus eliminating a lingering source of objective data on the allegedly phantom academic skills gap.

One more:

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.

Is this the way you want your doctors to be trained? No, it’s a way to ensure equity—not equal opportunity, but equal representation of all groups among medical schools and doctors. To do that, you deemphasize medical knowledge and emphasize critical race theory.

I see this as not only depressing, but irrational. If there’s a shortage of minority students in med schools (or other schools), one way of fixing it is simply to lower standards. But does that help minorities achieve the knowledge they need?

Because I do want more representation of minorities in med schools, I recommend another way: an extensive program of mentoring along with perhaps pre-med-school evaluations and “make up” courses. This seems much more sensible and efficacious than simply lowering the standards by which medical students are evaluated. In the end, the latter strategy yields an eroded health-care system with more people dying or getting substandard care. If you deny that this is the result, then why have any tests and standards in the first place? Or are the existing standards too high? Given the importance of health and life, and American’s desire for a great health-care system, I don’t think so.

I know that I’ll be called “alt-right” for pointing this out, and even for highlighting Mac Donald’s article. But if we really want to solve the problem of unequal representation, we must begin with the facts, which is unequal performance among groups. Then, if we want to maintain quality medical care, which I think everyone wants, we need to level performance among groups. But not by lowering the bar for tests; instead, you give special mentoring and attention to underachievers. If they don’t make it after this, then they shouldn’t be doctors. But to devise a solution that creates more equity and also maintains quality medicine, mentoring and monitoring is the only solution.

I’ve done a lot of soul-searching this morning, having been inundated with emails from people who are sick of a crazy “progressivism” that levels the playing field by lowering standards.

But do I really need to write about it again?

And I decided “yes,” for two reasons. First, there are many people who agree with what I said, and the more people speak out, the more society will change. That’s what happened when the New Atheists made it okay to be an open atheist, and now America is secularizing faster than ever. True, “DEI” initiatives are different, for once in place they are hard to remove. (If you hire a gazillion DEI officers, they’re not going to fire them when equal opportunity is at last achieved. This ensures a constant drumbeat of “structural racism”.)

And then I wondered, “Am I getting obsessed with this issue? After all, Trump and the Right are looming, and they’re dangerous, too.”  I tender my usual answer: there are plenty of people in the mainstream media who call out Republicans, but few who highlight the excesses of the Left—particularly those on the Left.

And a decline in the quality of medicine is not innocuous: people’s lives are at stake.  No, I am not obsessed: I am reacting to a society that is obsessed—obsessed with inequities but unable to do the hard work needed to really solve the problem. It’s a lot easier to signal your virtue and lower standards than to set up programs mentoring lots of medical students.

54 thoughts on “A gloomy time for medical education

  1. Dear Jerry, please continue to write about these issues. This wave of progressive regression is coming to Europe as well, with a bit of a time lag. It is good to know in advance just how far this trend can go, and without your posts a lot of what is happening in the US and elsewhere would have passed me by (I’ll just speak for myself here, but I would not be surprised if that is true for many others as well). So thanks a lot and keep them coming!

    1. The best book on the topic of the “wokeification” of everything comes from an old-fashioned left-of-center/classically liberal British perspective. In her recently-published How Woke Won:The Elitist Movement That Threatens Democracy, Tolerance, and Reason, Joanna Williams has provided the definitive guide to this totalizing and totalitarian cult.

    2. Another good book on this topic is “Cynical Theories: How Activist Scholarship Made Everything About Race, Gender, and Identity—and Why This Harms Everybody” by Pluckrose and Lindsay. I’m not a fan of Lindsay as IMO he’s too aggressive while Pluckrose has empathy for her interlocutors. I recommend this book because it places today’s social movements in the proper historical context of postmodernism, and critical theory in general. With that context, one can clearly see the connections between the different Social Justice movements of today.

      Since the publication of her book, Pluckrose has started a website, Counterweight, with resources to help people push back against illiberal ideas.

      https://counterweightsupport.com/

      Here’s something of a backgrounder on her ideas…
      https://counterweightsupport.com/2021/02/17/what-do-we-mean-by-critical-social-justice/

      And for additional in-depth essays…
      https://counterweightsupport.com/in-depth-essays/

      Pluckrose talking briefly with Dawkins…

  2. It’s a bit akin to trying to treat cancer by Photoshopping the X-rays and MRI’s and PET scans so they don’t show any malignancy, and simultaneously modifying the records of blood and tissue test results so they read “normal”. It will, quite briefly, make the patient feel a bit better. But that’s not going to last long.

    1. I think the result will be that people will avoid Black and Hispanic Drs. The opposite of what is tried to be achieved. It will be a burden to the outstandingly good Black and Hispanic Drs. Would you go to a black dr. if it is known that several of them are not really up to the mark? Just be safe, go to an Asian or Jewish Dr, if they pass despite discrimination, they must be really good! I think it is a self-defeating strategy, in fact, it is defeating the black and hispanic Drs that really are good. How stupid can one get?

      1. Presumably the acid test is to ask someone “If you are dangerously ill, which doctor would you choose? The smartest, or the nicest, or the equity placement?” Everybody says the smartest one, and who can blame them? They may die if they make the wrong choice. Now I have to admit, we are no good at selecting entrants to medical school. The very smartest are often unsympathetic types, and the warm and fuzzy who get in by washing the feet of the homeless for their after-school activity turn out to miss diagnoses. But it used to be we could assume the cold-hearted smart people would become academics and researchers, and the empathetic do-gooders would be GPs. But if you get picked because you happen to be from a group that is under-represented compared to the general population, what are you supposed to do?
        Much as I am a fan of female doctors, making them the majority of medical students has had an unforeseen effect on staffing—not just through maternity leave, but they don’t seem to feel they should work 24/7 and want something called a work-life balance! Yes, tongue in cheek, there. Of course, they are correct. But it does mean we need three of the new docs to do the work one of the old school used to do (at great personal cost). What unforeseen effects will equity-access to medical school seats bring?
        I have had the pleasure of dealing with several kinds of physician through my leukemia, from the brilliant white guy with a heart of granite, through the clever and kindly white lady, to the cheerful young brown immigrant who may have done me the most good via a bone marrow transplant. And I know I’m getting to see them making an extra effort to be nice and thorough since I’m in the trade. They were all excellent and up to the job. Would I be as content if I had a specialist who wasn’t so clever? Would I even be here to ask?

      2. Surely they still have to pass medical school – even with less science – & then compete with other junior doctors who WILL have the science?

        Does treating people with multiple identities (intersectionaliites ????) mean schizophrenics?

      3. Thanks for your comment, I am 73 and have a number of medical problems necessitating the need to see quite a few physicians over the years. Three of them are African-American (emergency, urology, nephrology) and they were among the best of them all. I taught clinical gross anatomy for over 20 years and had to endure several incompetent medical students, all of them were “white.”

  3. I echo Michael’s post. As usual, you are doing the hard work to keep us informed, which is the reason that this is the first site I visit every day.

  4. I know that I’ll be called “alt-right” for pointing this out, and even for highlighting Mac Donald’s article.

    Could you be so kind as to decline to indulge this particular disposition next time? The stated expectation of persecution really does nothing to advance deliberation.

        1. And yours violates #8. Unless you meant to type duck but even then you could wind up in trouble for insulting ducks.

      1. I will, and I will also apologize sincerely. I honestly did not think that I was exhibiting low character. That, too, is something for me to reflect on.

  5. For what it’s worth, from someone on the (Amefican) left, I too am glad you keep shining a light on this kind of dangerous nonsense. Too few dare, too few even can. It is voices like yours (there are others and, not surprisingly, many can found simply by reading WEIT) that keeps me from decsending into abject misanthropy; for as long as there are sane voices there is hope, no matter how slim.

    BTW, in light of what’s happened to Rushdie and the threats to Rowling, I hope that you, Dr PCCE, haven’t been the target of any serious threats. I understand that you get loons writing to you often, but I do hope it hasn’t gotten serious.

  6. No matter what cause you support, people on the other side will:

    1.) accuse you of being obsessed.
    2) wonder why you’re suddenly interested in medical schools/women’s sports/college admissions/etc. when you seemingly have no prior history of being involved in those areas.
    3.) point out all the other more deserving, serious problems in the world which you’re ignoring by focusing on THIS one.
    4.) speculate on what it is in your background or personality which draws you into supporting this (obviously wrong) cause.
    5.) find some way to couple your views with the religious right, Republicans, or neo-Nazis in order to discredit your claims and/or you, personally.
    6.) change the topic to something else you did wrong and get you defending that instead.
    7.) proclaim that you’re intractable and nothing anyone could say or show you would or could ever change your mind.
    8.) explain that you’re a troll, and nobody should argue with trolls, so bye..

  7. Further to the USMLE, Mac Donald carries on with an anecdote that illustrates a problem with attitude, not just aptitude. A Black medical student admitted under affirmative action (AA) recounted how he had been busy with Black activism in his first two years, even running a podcast, secure in the knowledge that his med school courses were pass-fail and the same lax grading standards that had got him into med school would keep him there, leaving him with ample time for activism instead of studying. (Nice life…). But then USMLE-1 reared its head and he became terrified that he had a lot of catching up to do on an international*, competitively graded race-neutral exam. From his point of view, the solution was to advocate to make that exam pass-fail too. Not only would it give him more time to pursue activism but it would undermine the exam’s ability to identify stand-out students who were not him. To me, this speaks to a limit to what can be achieved to bring Black (and Indigenous) candidates up to a merit standard.

    * Many Canadian med students sit the USMLE to keep open their option to apply to an American post-graduate residency program.

    By way of disclaimer, while I understand the rationale, I do not agree with your premise that having more minorities in any role in society is a good in and of itself. That’s why I’m particularly grateful that you decided after soul-searching to draw attention to this provocative article, which I had seen elsewhere just the other day.

    As a practical matter, all of you as patients have every right to refuse care from a student or trainee for any reason at all, including your assumption that the person is inadequately competent (for stage of training) because of his or her race or religion. This is a hot topic in the medical education literature but at bottom, hurt feelings are the institution’s problem, not yours.

    1. My PREMISE is that if a group is not achieving because of discrimination, whether it be in the present or past, we should make efforts to rectify it. And those efforts should consist of giving people equal opportunities.

    2. I believe that if someone’s racial background is a barrier to their achievement of professional success (in any profession) because of present or past discrimination that is a serious problem that we need to address. The question is how this should be achieved. Lowering entry standards for the under-represented group is problematic for the reasons given in this thread and it seems to me that it is likely to be more effective to look at the pipeline and how minority students from economically impoverished backgrounds can be supported through mentoring and such like early in their educational careers so that the aspiration to be a physician (for example) is seen to be realistic and those with aptitude can arrive at the point of university applications with a realistic chance of achieving the scores needed.

      I am not sure that your story about the black medical student who devoted his time to activism is sufficient evidence to demonstrate that there is a general problem of attitude amongst students from black or indigenous backgrounds. I am sure that as a physician you don’t rely on anecdotal evidence when making decisions about therapies so why do you think it ok to do so here?

  8. Didn’t someone, somewhere dream about medical students being judged on the content of their character (and hence on their competence, assessed as objectively as one can), and not on the colour of their skin?

    Obviously that person was a racist.

    And if equity does come to trump all, then it immediately becomes rational to avoid being treated by doctors who — judged by their apperance — could well have been a “diversity pass”.

    1. Calling out MLK as racist would be the perfect post for Titania McGrath. Perhaps s(he) has already done one.

  9. As a former anorexic and as a woman, I hate being weighed. I asked them not to tell me the weight because I will obsess over it and then start obsessing over food and exercise again.

      1. Perhaps. I find it a bit obsessive on their part sometimes. Like do we have to weigh me every week? It isn’t changing. I think it’s just something they do out of habit. We aren’t taking a helicopter ride so if I’m a pins off between weeks we are probably ok.

        1. I would certainly say that, if your weight has been stable for a while and there’s no reason to suspect any major changes (like if you were suffering from congestive heart failure, and changes in weight might mark increased fluid retention, or if you’re on dialysis, for similar reasons). checking your weight every week is unnecessary. EVEN IF they’re concerned about possible recurrence of anorexia, eventually there shouldn’t be any need to check in nearly so often, if you’ve been at a reasonably stable weight, and as you point out, checking too often can, if anything, be detrimental. That’s my judgment. Ask them to stop weighing you so often, and if they want to keep doing it, ask them to give you a good reason why. Maybe they have one, but it may just be habit.

  10. If you don’t need a bachelor’s degree to teach K-12 in Florida, there’s probably no reason to have an MD to practice medicine. s/k

  11. Mac Donald’s piece is a blockbuster—a major indictment of the medical profession for abandoning its traditional charter to care for the sick and improve health. Let’s hope that it is widely read.

    The distinction between equality of opportunity and equality of outcomes is at the base of this entire movement. It’s disastrous that what seems to be such a subtle difference is destroying the entire medical and scientific enterprise.

    I completely agree that the solution is better remediation for minority students and medical school candidates. Sweeping real problems of readiness and competency under the rug is no solution. Quite the contrary. Over time the medical profession will be filled by sub-par practitioners. Some patients will suffer and die as a result. Others will avoid going to minority doctors. Neither medicine nor social justice will be served.

    Personally, I’m so glad that my doctor was trained during the heyday of scientific medicine. It’s a sad reality that the age of science seems to be coming to an end.

    Regarding obesity and the movement to end the practice of doctors weighing patients… . Fortunately for patients, obesity is visible and doctors can still offer help, unless they decide not to do so for fear of being labeled a racist. Not wanting your doctor to help you solve a serious medical problem? Sadly, a doctor can’t fix stupid.

  12. In the old days one looked for Jewish doctors because it was harder for Jews to get into medical school. In the future do we look for white doctors?

  13. The campaign against academic/professional standards is an utterly predictable outcome of the unbridled growth of campus DEI bureaucracies. Let me suggest a simple experiment to quantify its extent and operation. In your department or college unit, send around a brief recommendation to read Heather MacDonald’s “The Diversity Delusion” (2018), which analyzed the DEI epidemic. Then record the following data: the rate at which “bias complaints” about your recommendation are sent to the local DEI committees, directors, coordinators, deans, and vice-provosts; the number of meetings these individuals and groups hold in response to these complaints; and the volume of paperwork/Email these meetings generate. It will be informative to compare these metrics from different academic institutions. However, I am uncertain which journal would be most appropriate for publication of the results. Perhaps the Journal of Field Ornithology?

  14. PCE wrote: “The overweight, after all, are a stigmatized minority (true)”
    The overweight (which includes the obese) are stigmatized, but they are not, in the US, a minority: about 3/4 of the adult US population is overweight.
    Quote (for US):
    “Results from the 2017–2018 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that an estimated 42.5% of U.S. adults aged 20 and over have obesity, including 9.0% with severe obesity, and another 31.1% are overweight.”
    https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obesity-adult.htm

  15. The claim that people know that they are obese may be true for some but not all. I have three sisters, two are morbidly obese with BMI’s over 40. The older sister has always been at a healthy weight, BMI 16-18. Several years ago the two younger attempted to convince me to talk with the older as they were worried that she was malnourished and perhaps anorexic. I was incredulous at their ignorance but when surrounded by many others who are morbidly obese, one is convinced it is “normal.” Maybe so statistically but certainly not medically.

  16. Why is all the emphasis on trying to fix things in university, graduate, and professional schools? Perhaps we should redirect significant resources from the ever-growing DEI bureaucracy into front loading pre K-2 reading programs where an early impact on all children might prevent inequities later on. I do not know why K-12seems to get a free pass after they seem to be at least somewhat responsible for the problems that arrive at the university door.

    1. The effort isn’t intended to improve educational outcomes. The last thing the EDI bureaucracy would ever allow would be to shift resources away from itself to front-line early reading motivation programs. If these programs were effective, the EDIcrats would not want their own comparative uselessness to be exposed. “We have to eat, too, you know.” If they were ineffective, they would say, “See, we told you so. Forget about trying to merit up. Just hire by colour. We’re here to make sure you do.”

      Less cynically, if a K-2 reading program failed to close the gap or even improve Black/Indigenous reading over control, it’s failure would become obvious if measurements were taken serially in the same K-8 school and there would be pressure to bin it—pressure that would be resisted, true. But if efforts are delayed to college, the failures become harder to track and easier to fudge. Graduation rates instead of mastery. And the failures get passed on to Someone Else to deal with: grad schools, professional schools, the workforce, the criminal justice system.

      1. If a K-2 reading program failed, that would just show that “systemic racism” is even worse than anyone thought, and so they would need to hire a whole new slew of DEI bureaucrats on even higher salaries.

  17. The “healthy at any size” and “Decline to Weigh” initiatives give me a chance to bring up Rob Henderson’s idea of “luxury beliefs.” He defines these as “Ideas & opinions that confer status on the upper class while inflicting costs on the lower class.”

    Bari Weiss interviews Henderson here…
    https://www.commonsense.news/p/honestly-how-luxury-beliefs-hurt

    And here is Henderson’s piece on it…
    https://robkhenderson.substack.com/p/luxury-beliefs-are-like-possessions

    [I searched the website for mention of Henderson and his idea but couldn’t find if this had been discussed previously.]

  18. Fascinating article and so many insightful comments. My partner is currently interviewing for med school. He has been flatly told he is not under consideration because he’s a straight, white, middle-aged male. It doesn’t matter that he’s spent his entire life below the poverty line, that he worked his tail off to achieve a 4.0 GPA after 30% of his brain was surgically removed, or that his research led to treatment protocol changes at Barrows Neuro Institute. He has an extremely competitive application and personal statement, but is being openly denied opportunities due to “white privilege.” It breaks my heart because he’s all but given up, and I’m certain he’s not alone.

    I completely agree that we should have mentorship programs–give everyone access to the tools and resources to meet the same standards. I don’t know how to achieve that, practically, but I think that would change medicine for the better, for practitioners and patients alike.

    1. Has your partner considered Canada?
      No Canadian medical school would reject an applicant on those grounds. Wouldn’t happen. Reverse discrimination has never been a part of our public life. Don’t mistake some of the strange things our criminal justice system does for affirmative action in the larger merit culture, which pushes back vigorously against it. Applications for anything aren’t even allowed to ask about race or sexual orientation. The applicant can work it in if he’s trying to play the race card but it doesn’t gain him much sympathy. It rubs us the wrong way.

      Foreign nationals face an uphill battle getting admitted to Canadian medical schools because our taxpayers want the grads to stay here to practise and merely going to school here doesn’t by itself allow you to immigrate and work. Return to the U.S. to practise with a foreign medical degree is not always straightforward for licensing but our grads are fully competitive in your residency programs. Once he passes the USMLE and gets board-certified he can practise in most states no matter where he went to med school, (with the usual AFAIK disclaimer.) Moreover, many states offer automatic acceptance of Canadian specialty credentials for licensure. If he really feels called to become a physician at this point in his life, he seriously should give a Canadian school a thought.

      1. Leslie, thank you so much for your response! I don’t believe he had considered Canada, but that sounds like a great option. We were aiming to staying in the US because he’s in a program that has agreed to fund his education (and that of those who are disabled and wishing to reentering the workforce). This would allow him to start his career in his late-40s with no student debt and the opportunity to start aggressively. We’ll have to look into the cost of medical school in Canada. Depending on the costs, that may be a viable option. Thanks again–this is a great idea!

        1. Has your friend applied to Osteopathic (DO) Medical Schools? Most of them are much more open to non-traditional students, and the older schools, e.g. Ohio where I am emeritus professor of clinical gross anatomy, have excellent educational programs.

          1. No, I don’t believe so, though I think he had applied to a naturopathic school. I’ll recommend a DO program, and have him look into Ohio in particular. Thank you!

  19. Please keep writing about these issues. Its not like we will hear about them in the mainstream media (I hate that term, but sometimes one must use it). When reasonable people stop highlighting current absurdities then we are doomed.

  20. Regarding weight, one important consideration is the dosing of medications. At least in vet med, I can’t prescribe medications without knowing an accurate weight to ensure I’m not under- or overdosing. I’d presume it’s similar in human med… If not on any sort of prescription medication, then commence with the pro/con weighing argument. I still fall on the ‘pro’ side, as it can be a ‘canary in the coal mine’ for various disease processes where other clinical signs manifest late, or for managing conditions where weight can fluctuate rapidly (e.g. any number of processes related to fluid retention/depletion).

  21. I simply will not go to a doctor educated under this system. There are certainly many doctors that completed medical school and residencies prior to this silliness.

  22. The reason this is an issue must come down to the standards in your public school system. Young people are surely as intelligent or dull as people ever were. Fix education at school level, by improving the life chances of people from under-privileged backgrounds. Then you will get better candidates at medical school.

    Obesity however is a problem that is – pardon me – growing across the wealthy countries. For that you need to stop cheap food using poor ingredients & adding sugars to everything, & ‘super-sizing’ meals. The U.S.A. (not alone sadly) makes it hard for poorer people to eat decent food, & this contributes hugely to obesity.

    Re-distribute wealth, make societies fairer & more equal.

  23. I agree with your general denouement about speaking out in these areas in particular, and what’s more, I appreciated the explicit restatement of it. The “New Atheists” push, and my memory of the “before and after” around that time, was a great supporting example.

  24. I know someone (very, very well) who has (relatively minor, but very annoying) disability because, after a stupid accident, he was treated by an astonishingly incompetent doctor who happened to be young and black. My friend tries to be very kind, but in his darkest hours cannot avoid feeling that the doctor who treated him was the product of a very inclusive policy in medical school. You know, when your life is permanently shattered due to malpractice it is very difficult to have a positive attitude towards certain woke initiatives…

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