Sally Satel (a psychiatrist) and Thomas Huddle (an academic clinician) have an article in The Chronicle of Higher Education that you can read by clicking on the title below. If you’ve followed how med schools are changing their curricula to emphasize social justice (including rewriting the Hippocratic Oath that they must recite), this may not come to a surprise to you.
If you don’t have a free Chronicle subscription (you get a certain number of articles per month, you can find the same article on Glenn Loury’s Substack for free.
Some quotes:
Over the past decade, we’ve grown ever more concerned about dubious strains of social-justice advocacy infiltrating medicine. Following the murder of George Floyd in 2020, doctors’ pursuit of social reform coalesced, almost overnight, into a mission.
Within a week of Floyd’s death, for example, the Association of American Medical Colleges, which is a co-sponsor of a major accrediting body, announced that the nation’s 155 medical schools “must employ antiracist and unconscious bias training and engage in interracial dialogues.” A year later (and again in 2024), the American Medical Association released a Strategic Plan to Embed Racial Justice and Advance Health Equity that encouraged physicians to dismantle “white patriarchy and other systems of oppression.” Over two dozen medical schools issued their own similar plans.
. . . . Today, doctors perform political advocacy in myriad ways. State medical boards have added a requirement for training in “antiracism” in order to be eligible for a medical license, according to the Federation of State Medical Boards. The University of California at San Francisco (UCSF) created a document titled “Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators.”
Certain debates have become off-limits. Consider, for instance, a 2020 incident involving Norman C. Wang, a cardiologist with the University of Pittsburgh School of Medicine. After Wang published a peer-reviewed critique of affirmative action in a respected medical journal, his colleagues denounced him on social media for his “racist thinking” and condemned his paper as scientifically invalid and “racist.” The journal retracted his article and the school removed him as director of the electrophysiology program. (Wang sued for retaliation and discrimination, but was unsuccessful.)
Researchers are promoting unscientific modes of thinking about group-based disparities in health access and status. The University of Minnesota’s Center for Antiracism Research for Health Equity decrees “structural racism as a fundamental cause of health inequities,” despite the fact that this is at best an arguable thesis, not a fact. (The center was shut down last month.) The Kaiser Family Foundation states that health differentials “stem from broader social and economic inequities.”
In what borders on compelled speech, the State University of New York’s Upstate Medical University issued a 164-page report from a diversity task force insisting that “Health care professionals must explicitly acknowledge that race and racism are at the root of [Black-white] health disparities.” Other variables influencing the course of chronic disease, prominently the patient’s health literacy and self-care, receive scant attention.
But those disparities are far more complicated than that. This brings to mind the claim, promulgated in 2020, that black babies delivered by white physicians had over twice the mortality rate than when delivered by black physicians (see this PNAS paper). It got a lot of publicity, and cries of “racism” were loud and pervasive. But later analysis showed that racism was not a factor, but a difference among races in birth weight. As The Economist reported:
Now a new study seems to have debunked the finding, to much less fanfare. A paper by George Borjas and Robert VerBruggen, published last month in PNAS, looked at the same data set from 1.8m births in Florida between 1992 and 2015 and concluded that it was not the doctor’s skin colour that best explained the mortality gap between races, but rather the baby’s birth weight. Although the authors of the original 2020 study had controlled for various factors, they had not included very low birth weight (ie, babies born weighing less than 1,500 grams, who account for about half of infant mortality). Once this was also taken into consideration, there was no measurable difference in outcomes.
The new study is striking for three reasons. First, and most important, it suggests that the primary focus to save young (black) lives should be on preventing premature deliveries and underweight babies. Second, it raises questions about why this issue of controlling for birth weight was not picked up during the peer-review process. And third, the failure of its findings to attract much notice, at least so far, suggests that scholars, medical institutions and members of the media are applying double standards to such studies. Both studies show correlation rather than causation, meaning the implications of the findings should be treated with caution. Yet, whereas the first study was quickly accepted as “fact”, the new evidence has been largely ignored.
The reason why white doctors at first looked like such a “lethal” combination with black babies, say the authors of the recent paper, was that a disproportionately high share of underweight black babies were treated by white doctors, while a disproportionately high share of healthy-weight black babies were treated by black doctors. Being born severely underweight is one of the greatest predictors of infant death. Just over 1% of babies in America are born weighing less than 1,500 grams, but among black babies the rate is nearly 3%.
You can find the Borjas and VerBruggen paper here. Their finding, as The Economist wrote, got far less publicity than the original finding, clearly because the real reason didn’t play into the social-justice Zeitgeist.
But back to Satel and Huddle’s article. Note that the following caveat appears later in the essay, accepting the possibility that past racism is involved in health disparities but questioning whether current structural racism is causing present disparities:
. . . . .We do not deny that much of the health disadvantage suffered by minority groups is the cumulative product of legal, political, and social institutions that historically discriminated against them. But past discrimination is not necessarily a factor sustaining those problems now. We must address the discrete causes that operate today.
Back to their text, giving a few more examples of social-justice medicine:
In what borders on compelled speech, the State University of New York’s Upstate Medical University issued a 164-page report from a diversity task force insisting that “Health care professionals must explicitly acknowledge that race and racism are at the root of [Black-white] health disparities.” Other variables influencing the course of chronic disease, prominently the patient’s health literacy and self-care, receive scant attention.
Some medical professionals have even endorsed racial reparations in health care decision-making.At one point,the CDC vaccine advisory committee proposed prioritizing the anticipated Covid vaccine by race rather than age, solely because older cohorts disproportionately comprised whites. This plan would have delayed vaccination of the elderly—the highest risk group—and, according to the CDC’s own projections, resulted in more overall deaths. Other sponsors of health equity lobbied for a rationing scheme that prioritized the assignment of ventilators to Black patients, negating customary triage procedures.
These “reparations” are unethical because they would cause deaths than would occur otherwise. Nevertheless, people proposed them knowing this.
But wait! There’s more!
Perhaps the most dramatic recent display of ideological intrusion into the medical sphere took place last June at the UCSF Medical Center, where keffiyeh-draped doctors gathered on the grounds to demand that their institution call for a ceasefire in the war between Israel and Hamas. Their chants of “intifada, intifada, long live intifada!” echoed into patients’ rooms.
These doctors were not putting patients first—if anything, they were offending and intimidating patients. They were putting their notion of social justice first.
You can see a video along these lines from UCSF here, though I’m not sure it’s the demonstration referred to in the article.
The authors then propose three guidelines that “should advocate for policies that 1) directly help patients and 2) are rooted in professional expertise, while 3) ensuring that their advocacy does not interfere with their relationships with their colleagues, students, and patients”:
1.) First, the reform they promote must have a high likelihood of directly improving patient health. “Dismantling white patriarchy and other systems of oppression” is not an actionable goal. Our primary job is to diagnose and treat, and to do no harm in the process. We have no expertise in redistributing power and wealth. Even seasoned policy analysts cannot readily tease out strong causal links between health and economic and social factors that lie upstream.
. . . . 2.) Second, physicians’ actions or their advice to policymakers should be rooted in expertise that is unique to their profession. Opining and advocating on behalf of general social issues exploits their moral authority, turns medicine into a vehicle for politics, and risks the trust of the public. Medical professionals will, of course, have their own views of the public good. They are free to take to the barricades as citizens—but not while wearing their white coats.
3.) Third, doctors must not lose sight of the impact of advocacy on patients and students. While advocating for one’s own patients is a basic obligation of being a doctor, advocating on behalf of societal change can work against those patients, drawing time and attention away from their care.
One action the authors suggest is that young physicians who are truly dedicated to helping the oppressed, poor, and those deprived of medical care, should work in rural areas that suffer from a shortage of doctors:
A new report in the Journal of the American Medical Association found that newly licensed clinicians from top-ranked medical institutions were half as likely to initially practice in socioeconomically deprived areas as graduates from other medical institutions. Specialists were also less likely to practice in deprived areas compared with primary-care clinicians.
Well, that sounds good, but do you really think that the entitled social-justice doctors are willing to leave the cities and work in rural areas with a shortage of medical care?
Though even that needs to be argued, not just assumed. (It’s not clear to me, for example, why greater rates of obesity would be the result of discrimination that pretty much ended decades before today’s 30-yr-olds were born.)
Also worth highlighting is the euphemistic use of “minority group” as a synonym for “less-successful” group (some minority groups, such as Asian Americans and Jewish Americans, do not suffer from “health disadvantage”). It is an axiom of “critical social justice” that the majority group must be oppressing minority groups, but the facts don’t support that idea.
The hot link to the Borjas and Verbruggan paper did not work for me.
Thanks for this very important write-up.
I added the link; I forgot. It’s in the paper, and here: https://www.pnas.org/doi/abs/10.1073/pnas.2409264121
Many of those underserved rural areas will probably have a high percentage of conservatives white folk. The argument that racism is “institutional and found in systems so we shouldn’t focus on finding fault with individuals “ could mean that the institution needs to focus on underserving the undeserving individuals.
(It’s healthy to be reminded that sometimes I’m not cynical enough.)
In case there’s doubt, the Chronicle is full of articles over the past several yrs calling for politicizing the academy.
The primary product of this confused social justice era is just vacuous rhetoric signifying status amid the privileged. My wife works in affordable housing and she has to fight initiatives to prevent publishing of school rankings and crime data for listings. The proponents of which are all well to do and send their kids to private school in the Bay Area and possess the social capital to ‘just know’ the good schools and crime rates. They are smart people unwilling to acknowledge that these data are important for less privileged people than themselves when buying or renting a home. At some point the ruse that they are fighting racial injustice becomes transparently more important than the well being of the populations they claim to ally with. I find this trait repugnant and self serving.
(Ditto my reply to Sastra.)
“The University of Minnesota’s Center for Antiracism Research for Health Equity…was shut down last month”…
…after its director Rachel Hardeman (a black woman) was credibly accused of plagiarizing ideas and text for her own grant proposal from the work of Brigette Davis (another black woman). Hardeman was her mentor and the two were previous collaborators. The day after the allegations were aired Hardeman resigned her tenured faculty position at UM (!!!) while publicly denying wrongdoing, but she tacitly admitted to the plagiarism in texts and emails to Davis.
It was all shamefully predictable because the Center did no work and accomplished nothing but spent a lot of UM’s money. If this sounds similar to the money-burning facility that was Ibram X. Kendi’s Center for Antiracist Research at Boston University, well, yes it is.
Jerry linked to this piece from Inside Higher Ed which has all the juicy details including a comparison to Kendi. Folks should read it, it’s spectacular.
https://www.insidehighered.com/news/faculty-issues/research/2025/05/19/antiracism-center-closing-founder-copied-scholars-work
But isn’t “originality” one of the many oppressive attributes of Whiteness?
Yes. As is making an argument, which necessarily challenges other views, leading to hurt feelings and emotional distress. Welcome to Academia 2025!
This paragraph raises eyebrows for more than one reason:
The plagiarism is the least of it. The larger problem is: if the proposed methods were so confused and contradictory that the research aims couldn’t possibly be achieved by using them, then why the hell was the grant funded?
The cynical – and probable – answer is because the reviewers understood that the actual objective of the grant was to support a narrative, not to discover the truth. When the findings are pre-determined, any ‘method’ will do.
Or maybe the reviewers were just incompetents.
Either way, if the funder is the government, the people who made the decision to fund this grant need to be reviewed themselves and held accountable.
Not to be outdone, my own university’s brand new medical school is also going to “confront the colonial history of medical education by integrating reconciliation, anti-racism, and Indigenous health and wellness into the medical curriculum” because “systemic racism and discrimination continue to persist in healthcare settings.”
No word yet on whether the medical school will also be anti-Zionist or gender fluid.
https://www.sfu.ca/president/statements/presidents-desk/2023/how-simon-fraser-university-is-building-a-different-kind-of-medi.html
FWIW, “SFU” has a relevant imperative use. Almost makes me believe in Jungian synchronicity 🙂.
We all remember how fast “globalize the intifada” and “from the river to the sea” became the plat du jour and how fast the “words are violence” and the “microaggressions” crowd disappeared back into the woodwork. If these ideas were so fleeting and so disposable, one would have thought that the edifice upon which they rested would be reexamined right down to its shoddy foundations.
Yet self-awareness and self-reflection are only useful to postmodernists in as far as reinforcing victim status is concerned. Any narrative that doesn’t support victimhood lands in the “no universal truths” bucket while victimhood affirming narratives are gospel. This is ideological immunity: the critical tools meant to deconstruct systems of power aren’t turned back on the frameworks doing the deconstructing. The result is dogma… not unlike religious orthodoxy.
Well said.
Surely a majority of medical school leadership cannot believe this crap…why isn’t there a rational set of docs, like in the rest of the unis who put together organized academic freedom societies (a la Pinker and friends at Harvard) to take on the post modernist rascals?
That last paragraph especially.
Re entitled social-justice doctors not being willing to leave the cities and work in rural areas with a shortage of medical care, I’d include “hypocritically self-serving” with “entitled”.
“Young physicians trained at elite schools are least likely to care for patients in the places they are most needed and could do the most good. At the same time, they are the most apt to promote vague goals of social justice as a professional duty. In so doing, they are helping neither patients nor the profession.” This is swiftly becoming a hallmark characteristic of the CSJ ideology…a “Do as I say, not as I do” type of mentality. Where privileged elite Left-wing activists virtue signal and make demands…but are absolutely unwilling to practice what they preach by actually taking real demonstrable action in service of those who actually need it.
Agreed. We also see this on the affluent Woke Right as well:
Woke right dude: “Bring back the trades! Not every kid should go to college!”
Question: “I hear your boy has a C average and has never read anything longer than a Spiderman comic. So, is he going to be a plumber, instead of an investment banker like you?”
Woke right dude: “Humina humina humina…”
Damn this presbyopia, but it is sometimes entertaining: I initially read your first line as “effluent”. Truly.
“Social justice warriors” seem to ruin just about everything they come in contact with.
Again, my working hypothesis is this. SJWs are people who are long on passion, but short on brains. Or, are opportunists who seek to make a living by grifting.
These are not problem solvers or talented people in general. I am wondering, has the number of SJWs increased, so that the immune systems of formerly healthy institutions have been overwhelmed? Or, did institutions used to have effective ways of keeping these people out of positions of responsibility, and those ways have now been forgotten?
They got feminized, Jeff. Institutional capture. Not just that women became numerically dominant in medicine, which they did, but that the men became feminized too, to get along. Which means “difficult” men like the “Dr. House” character go into business or engineering instead. Men with clear focus from Day One in med school will “gun” for family-unfriendly specialties like orthopaedic surgery and invasive cardiology, the guys (and some traditionally driven women) who are called out of bed in the wee hours to take a stranger with a heart attack to the cath lab. Drifting through school and ending up in the no-call but poorly paid specialties like family medicine or gerontology, which women do better at — women doctors have shaped these disciplines to be what they are, to play to their strengths and family needs — is a losing strategy for men. Not only are they poorly remunerated, (because no on-call and no lucrative procedures: women’s work as a second income), which makes the men doing them less attractive as potential husbands. Male doctors trapped in these roles also are easily intimidated because they are expendable at work if they don’t at least give lip service to the social-justice line. But it’s women who are taking institutional leadership roles where teaching policy is made. They really believe what they are doing and do it with zeal.
• Some “difficult” women too go into business or engineering (or mathematics). I do agree that more men than women seem “difficult” in this sense.
• Yes, lower pay and status occupations do tend to be majority female, for a variety of reasons. AIUI, over the years several occupations became lower pay and status because women became more numerous in them; e.g. telephone operators.
• I expect that more women than men tend toward risk-aversion. So maybe your easily-intimidated male doctors are not representative of the whole?
Things must have changed since my day. I started at UCL (L as in London) in 1976. The first med school class ever to have a majority of women, but still very traditional. Beer-drinking, rugger playing guys, upper middle class girls, and a remarkable percentage of Jewish kids, being “the godless institution of Gower Street.” Generally conservative, and very amused at the antics of the other students with their protests and “strikes.” Much muttering at having to go to a few sociology lectures (as the graffiti in the toilets said next to the paper “Sociology B.Sc.s—please take one”!) All rather embarrassed about the do-gooding aspect of our career choice. Nonetheless, I ended up working in an under-serviced rural community that no Canadian would agree to work in (hence permitting an immigrant like me to move in).
I doubt if the medical school sausage machine is doing a better job if it turns out grads with more emotion than good clinical skills. I’ve yet to meet a recent graduate who knows how to do a competent physical exam: such a shame as they are cheaper and quicker than automatic orders for MRIs, and the laying on of hands is an important part of building the trust of the doctor-patient relationship.
At my university’s SOM, there is an Office of Faculty Affairs, heavily concerned with “well-being”, “resilience”, and, of course, D,E, and I. Under the heading “Contact Us”, it shows a staff listing with a female:male ratio of 12:2. The staff of 14 includes no fewer than 5 Deans of the Vice-, Associate, or Assistant categories, all, as it happens, female. Needless to say, the possibility of “disparate impact” in the operations of such offices is never even whispered. If anything, the office’s highly asymmetric sex ratio is no doubt viewed as terribly Progressive.
This is an indication of what may be called the “toxic white male hypothesis”. Meaning, the real aim of DEI is not to increase diversity, but to reduce and even eradicate the presence of white males, who are considered toxic and the root cause of all of the ills of society. I mean, when is the last time you saw a “white male appreciation day”, perhaps slid between “Celebrating Latinas” on Tuesday and “Trans-Polynesian Persons Recognition Day” on Thursday?
In this light, DEI is not a principle, but a tool that is wielded selectively to actualize the ultimate goal of relegating males to second-class status. When white males are in the majority, we roll out DEI. When they are in the minority, we forget DEI exists. Once males are effectively neutered, the thinking is that a much safer and fairer society will emerge.
From The Retrievals podcast (but referring to the legitimate goal of new standards to deal with c-section pain):
“She began with the youngest people, the newest residents, because if you get them, you make it normal for the next four years and forever.”
My reply to Jeff Vader @9 also explains why social-justice-warrior grads of elite schools are unlikely to work in underserved areas: they are likely to be women. Just as in other walks of life, a (heterosexual) female physician probably has a husband, or is looking for one, whether a doctor himself or not, who earns more than she does. He (or a lesbian wife) may be unwilling or unable to locate to the rural boonies just because she felt the calling. (Traditionally the wife of a male full-service doctor would move with him to wherever he had a practice opportunity and start a family, which would be her full-time, 168-hr a week responsibility because it wouldn’t be his.) Practice as a single woman in a rural area is just not attractive for women who have choices and want children. You can’t date your patients. Practising in underserved dangerous neighbourhoods is just too, well, dangerous, especially for a white woman who will never be considered a “sistah”, even if she was made to feel like one when she wore a keffiyeh at protests. Let’s get real. If grocery stores close up and move out, so will medical practices. Posting a land acknowledgment and a Trans-Pride flag in the suburban waiting room feels just as good and costs nothing, although renovating the plumbing will prove expensive.
So realistically as long as two-thirds of medical classes are female, we are going to see most of them, regardless of race and politics, setting up primary-care or no-call specialty practices in already well-served suburbs where they focus on preventive care in mostly well women with insurance who don’t smoke or drink during their pregnancies, because they can make a living doing that, …and then a little gender-affirming care for the novelty. A system is perfectly optimized to produce what it produces.
Another aspect that a high percentage of female docs brings is that we need to train more of them. Possibly rightly, they choose a very different work-life balance than male docs, and usually work about half-time and avoid call like the plague.
So does feminization automatically = less rigor and objectivity? Because essentially what we are talking about with “political erosion” is a decrease in rigor, which will result in a decrease in the quality of medical care.
To the extent that feminization (to repeat, not femininity per se) includes embrace of DEI, “sex isn’t binary”, anti-racism, decolonization, and indigenization, yes. You can’t select for those ideological traits without selecting against objectivity and rigour. They don’t exist in the same person. There are only so many places in the school, and so many hours in the curriculum. More struggle sessions on white privilege means fewer hours for cardiovascular physiology, pharmacology, and recognizing subtle signs of sepsis or what a “dangerous” headache is. And remember the school has already selected students who say they believe these “find-it-and-fix-it” subjects, which doctors have a monopoly on are less important than anti-racism and applied marxism, which any fool can do.
An uncontrolled experiment is taking place, and all of you (and me, now that I’m retired) are the subjects in it.