In September 1968, I enrolled in the first entering class of the Mount Sinai School of Medicine. It was where I fell in love with medicine. My time at the school, and interactions with its remarkable faculty and classmates, enabled my professional journey as physician, scientist, educator, and eventually my nine years as dean of Harvard Medical School. It’s why, over the past 55 years, I have taken great pride in the growing reputation of what is now the Icahn School of Medicine at Mount Sinai. And it’s why I am so concerned about what appears to be underway at my alma mater.
As a medical student all those years ago, I was taught that proper prescription can only follow accurate diagnosis. This kind of precision and rigor is supposed to inform everything a doctor does. But when it comes to concerns about racism in medical education and practice, precision and rigor are left by the wayside.
Throughout my career, I have been aware of the disturbing history of racism and bias in medicine. Though much has improved in this regard, important problems remain. As dean at Harvard, I worked with colleagues to combat those problems. And so, when I saw a 2020 paper in the journal Academic Medicine authored by my alma mater’s educational leaders about their efforts in “addressing and undoing racism and bias” in medicine, I was eager to read about the work.
I was soon disappointed. Instead of a scrupulous analysis of an important problem, the paper consisted of dramatic, if unsupported, generalizations about the inherent racism in medical education and practice, and promises of sweeping but vague changes to come.
The authors—Leona Hess, Ann-Gel Palermo, and David Muller—write that at the Icahn School, “we have come to believe that dismantling racism in a complex, adaptive, deeply hierarchical and siloed structure built on a foundation of scientific racism demands approaches that are bold, transformational, adaptive, and systemic.” They also state that “there is no priority in medical education that is more important than addressing and eliminating racism and bias.” And, offering their “personal reflections,” they write, “It is impossible to embark upon this journey, especially for people who are White, without making an active effort to leave behind who we think we are, what we think we have accomplished, the titles and publications—all of it. These are meaningless in the face of what our colleagues and students of color face every waking moment of their lives. Worse than meaningless, they are unearned.”
Denigrating people’s accomplishments, no matter their race, seems a poor way to improve the practice of medicine. And focusing on the race of physicians and patients, rather than committing to providing excellent care for all, does not sound like an improvement.
Ironically, the paper also made no reference to the founding of Mount Sinai in 1852 as the Jews’ Hospital, created to provide care to poor Jewish immigrants who, because of antisemitism, could neither obtain jobs as physicians, nor care as patients, in other hospitals.
The paper posed many more questions than it answered—and I wanted to learn more. So I signed up for a Mount Sinai “Chats for Change” workshop last January, a regular call designed to “spark dialogue centered on racism and bias” that had been mentioned in the paper as part of the school’s “transformational change strategy.” After I logged on to Zoom, some of my concerns about the goals and methods of the program were confirmed.
The first slide we were shown purported to explain the characteristics of “whiteness” and “white supremacy.” On the right side was a picture of a fish in a bowl, with the words The longer you swim in a culture, the more invisible it becomes. White supremacy culture was defined to include worship of the written word, objectivity, individualism, a sense of urgency, power hoarding, and defensiveness.
The administrator leading the session proceeded with a series of questions that undermined the necessity of collecting unbiased evidence to establish best medical practices—questions like: “Why is anything that is documented or published valued more highly than other forms of knowledge and communication?” and “Are clinical trials more valuable than patients’ clinical experiences?”
The questions suggested ignorance about the progress of modern medicine by those leading the session. The advance of medical science and therapeutics requires documenting and publishing results and conducting clinical trials, and neither conflict with nor devalue the importance of patients’ clinical experiences. And what these questions had to do with undoing racism was not at all clear.
The session’s guidelines expressed encouragement for open dialogue, but no critical discussion ensued. I expressed concerns via chat and a feedback form, but these went unanswered. The session failed to stimulate productive discussion about racism and responses to it that might improve health or enable transformative change. Instead, it advanced a highly questionable ideology about white supremacy and its relationship to modern medicine.
I hoped this initial session might have been an outlier, but things only got worse. At a second online workshop in September titled “Anti-Racist Transformation in Medical Education,” the goal was to discuss strategies for engaging institutional leaders to achieve “necessary change.” But the conversation was disappointingly generic. When I pressed for the specific actions they wanted leaders to adopt, that was not provided.
I suggested that the term anti-racist, though central to the mission of the school’s Racism and Bias Initiative (RBI), lacked a clear definition in their materials. The RBI discussion leader dismissively responded that “anti-racism was simply opposition to racism,” and that “anyone with a terminal degree should know that.” She then stated that the school’s anti-racism program was not about “encouraging pointless discussions of what anti-racism means.”
I couldn’t disagree more. As my friend, the physician and bioethicist Lachlan Forrow, points out, unclear terms lead to unclear solutions. If we can’t agree on what race, racism, diversity, inclusion, and equity actually mean, the initiatives based on these terms are likely to be ineffective. But the message of the sessions I attended was clear: much like a devotee accepting holy writ, we were to forgo questions and simply embrace the doctrine, even without knowing what it means.
In response to this ill-considered approach to anti-racism at Mount Sinai, last summer I submitted a paper to Academic Medicine outlining some of the concerns I am now airing here. This is the way ideas are supposed to be contested in the academy. The paper was rejected in two days, without peer review or editorial explanation, which I found surprising.
This past December, I contacted one of the authors of the original report, David Muller, who had recently left the position as Mount Sinai’s dean of medical education. I was interested in what the “comprehensive review” of their curriculum for racist elements had revealed, and whether the findings were written up as a scholarly paper to permit analysis and discussion. He reported that in the three years since the paper promising sweeping changes was published, no findings have been reported.
Mount Sinai has positioned itself as a leader in the field when it comes to combating racism at medical school. Eleven other medical schools have joined them as “partners” in their Racism and Bias Initiative program. And yet what they have actually accomplished is not clear.
There are some parallels to this story at Harvard Medical School. In spring 2021, the school announced a task force to review racism in medical education and devise responses to counter it. Last spring, the school announced that the review and recommendations were completed in the form of a 72-page report. To my surprise, this report has never been made public.
A copy that I obtained suggested that many aspects of the findings required discussion and debate, which has not occurred. When I was dean, we published the conclusions of reports by appointed committees, after which faculty had the opportunity to discuss and provide feedback in town hall meetings and other settings, sometimes with votes by faculty council. Though I don’t know how this story will end, the handling of this important report on racism in medical education is a matter of concern.
In conversations with faculty members at both schools, concerns about the approach to anti-racism, not unique to me, are typically met with requests to discuss the topic “off the record,” and without attribution. Faculty concerned about the ideological capture of anti-racism initiatives are reluctant to express this openly for fear they will be labeled insufficiently anti-racist, causing reputational damage they prefer not to risk.
But it is exactly because the issues of racism and bias in medicine today are so important that precise definitions and rigorous critical discussion are so crucial in medical education. The training of physicians requires that they understand the scientific basis of medicine while being aware of the social determinants of disease, and exhibit the ethical, moral, and behavioral standards that constitute medical professionalism. All of these are needed to treat patients with the highest level of expertise—whatever patients’ racial and ethnic backgrounds, economic and educational status, or political and social views. Inculcating students and trainees with contestable ideological notions and bringing less rigor to the issues of racism than we bring to other serious topics makes this more difficult to accomplish.
The goal should not be performative discussions and empty virtue signaling; it should be better healthcare outcomes for all. Medical education, when done correctly, should give future physicians the tools they need to treat patients effectively, without racism or bias. But as the focus drifts from evidence-based practices to ideological dogma, we risk graduating doctors who excel in social justice jargon while faltering in the expert delivery of care.
The Hippocratic Oath tells us to “do no harm.” This oath extends beyond surgical theaters and clinical wards into medical education, where the principles of science and the virtues of care combine to forge the next generation of doctors, and they’re the inspiring goals that motivated me to serve as dean of a great medical school. Sadly, I fear that diluting rigor and precision with ideological agendas will degrade the quality of medical education. In a rush to embed vague, contestable, and potentially harmful versions of social justice into medical education, we risk compromising the very foundation of medical training, and ultimately, patient care.
Jeffrey S. Flier, MD is Harvard University Distinguished Service Professor and Higginson Professor of Medicine and Neurobiology. He is a former dean of Harvard Medical School. Follow him on X @jflier.
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