Whole areas of research are off-limits. Top physicians treat patients based on their race. An ideological 'purge' is underway in American medicine.
Thank you for taking this on. It is utterly despicable, both in theory and practice. It is important, however, to laser-focus on the elephant in the room, namely that the people who could possibly try to right these terrible injustices HAVE TOO MUCH TO LOSE, and the racist wokesters know this very well! It is an extremely rare person who will risk a lifetime of incredible effort to finish medical training to enter practice, and see it all evaporate to feed the the petty whims of the narcissistic/borderline cowards who are driving this narrative.
This is extremely serious: the turning away from excellence in admissions to health programs, the almost panicky drive to admit often underqualified members of protected groups to residency programs to avoid charges of "racism", the primacy of identity over clinical excellence, etc all these are creating a new "Dark Age" in medicine, where the grossest incompetence and quackery are celebrated. Patients are beginning to rightly fear interacting with a medical system that is actively abandoning any pretense of treating ALL patients with compassion and skill.
Thank God I live in Montana where doctors feel no pressure to be anything but good doctors, for now. I'm an RN. My husband is a physician. We lived in CA for 26 years. We both saw the quality of care declining. Some healthcare providers were far more interested in the color of one's skin than in providing compassionate appropriate treatment, and, frankly, I worked with a shocking number of poorly trained new physicians... Had zero to minimal diagnostic skills. I had to make lists of symptoms, systems, and differential diagnoses for them to check. Was called a racist for caring about my patients of all colors and socioeconomic status. Don't kid yourself. We are headed down a dark dark road and it's no good for anyone.
A few months ago, in what feels like years ago, The Lancet published a "study" or "report" that *personally laid* hundreds of thousands of deaths from COVID at the feet of Donald J. Trump.
Personally - they claim he was *personally* responsible for hundreds of thousands of COVID deaths. This, from one of the most formerly reputable journals in the world. This "study" was right next to other studies of, say, the cell signaling effects of a foreign body in yada yada yada. I.e. we're supposed to accept it with the same impartiality and gravity.
Last year, the New England Journal of Medicine, in total contravention and violation of its rights as a 501c3 non-profit, which should have been very publicly stripped of them, publicly advocated to vote Donald Trump out of office (of note - its Editorial Board are, to a man and woman, Democratic donors). Among their many baseless claims was that he was responsible for vaccine hesitancy. Mind you, this was published in about October - well before we were so certain of the massive vaccine uptake rates that we've seen, where the United States is one of the global leaders in vaccinations.. In other words, complete and utter hogwash.
These institutions, medical journals, scientific journals like Nature, etc - they're all irreparably damaged. Much like the FBI, the intelligence agencies in general, now the woke US military, our educational systems, the media, etc., etc. Or as the sagely David Burge put it:
1. Identify a respected institution.
2. kill it.
3. gut it.
4. wear its carcass as a skin suit, while demanding respect
This article solely focuses on race but there is, at least, one other important issue and that is transgender ideology and its effect on children and young adults. Therapists and medical personal are increasingly required to provide "gender affirming" care which may result in use of irreversible hormones and/or surgery for minors or young adults that may not have long-standing gender dysphoria as the term was commonly understood. We should provide open, loving and supportive medical and psychological care but not ideological care that leads in only one direction. We should not suppress inquiry and research about the exponential increase in surgeries on young women, permanent effects of treatment and later regrets.
Bari/Katie: Thank you for taking this on. I am a tenured professor at a good medical school and have been for a very long time. One angle that is not getting the attention it deserves is the absolute removal of virtually ALL measurement other than "wholistic claptrap" from both medical school admissions and residency selection. Classes are all now "pass/fail" with it being almost impossible to fail. Boards are now the same. The deliberate goal is to make sure that the better doctors (yes some people rock out in medical school and some just squeak through) cannot be differentiated from those that any patient should fear. Admissions are in many cases first about the race and "personal journey" of the student and seldom about whether they could succeed in being a good physician knowing the rigors involved to get there. Pointing out that this person might not have the mental acuity/desire to work to succeed will generally get one tossed from the admissions committee as "racist". I have watched substantial numbers of well-qualified applicants rejected in favor of those who are the "correct this week" demographic but who lack the mental and decision making skills of those rejected -- to the greater detriment of patients of all colors and descriptions for decades to come. The committee just announces that their "wholistic evaluation" says they will miraculously get smart in medical school...
Similarly, organizations like Alpha Omega Alpha that were built to recognize academic excellence in medicine have now been reduced to "wholistic-based" vote-ins, deprecating 100% of the value of this once envied organization for which people worked hard to seek admission. (For those not in medicine, Alpha Omega Alpha was an honorary society for medical students/schools, similar to Phi Beta Kappa for the arts and Sigma Xi for scientific research.) It has now become a joke or chapters are being shut down for being "racist" because, apparently, hard work, industry, and success are white cultural icons and should be dismissed. This sounds bizarre but pretending that intelligence/industry/commitment are not pivotal requirements of being a physician is equally bizarre and is becoming the norm.
I check with my classmates regularly to make sure that at least one of us will be around to treat the others before we expire. Otherwise, those graduating now will just, I expect, speed us along on that journey toward expiration, however well intentioned they might be. I have never seen good intentions diagnose or cure a patient yet.
I am dropping the AMA membership I have held for decades because it has become an embarrassment; I note that many of my peers are doing so as well. I also note that many of the physicians that read this substack would love to become a member of the group described herein. Maybe if enough of us are there, we might make a difference.
Treating people differently on the basis of immutable characteristics is wrong and evil. Always.
Meritocracy is being attacked - as racism. I’m just glad that I’m retired and don’t have to deal with this nonsense in the workplace. Like John Galt in Ayn Rand’s novel, Atlas Shrugged, I have withdrawn my brain and capital from a society that has lost its way. Liberalism is under attack from the far left, and unless and until liberals and conservatives alike join in the fight against this scourge, they will be eaten alive. Remember, this is all about power, nothing else.
All of Katie's work is excellent, and this one is too. But, it falls into the same bucket as most coverage of this topic, which is basically gesticulating at the problem and saying, "can you believe this shit?"
Needless to say, many people would read this and not see a problem with what is being described. So, what we need are well written rebuttals of the ideology, or proposals for what sane people can do to help push back. More and more exposition about what is happening doesn't do much good at this point - we can see what is happening, but now what?
When you see articles about the increasing numbers of retiring physicians over the past two years, think of this article. The pandemic was an incitement but this article details many of the underlying causes.
Thank you again, Bari! And Katie, I just want to let you know that I remember reading your article in the Stranger regarding detransitioning, and being very, very grateful for your journalistic integrity and empathetic, truthful, reporting of the issue. I know you took a huge risk in getting that story published and you experienced a lot of backlash for it. From one Seattle-area writer to another (and a formerly gender dysphoric female to boot) thank you for continuing to pursue the truth. It means the world to me that there are folks like you and Bari willing to risk it all for the pursuit of truth. Thank you 💙
I read this with tears in my eyes, I have two boys both under the age of two. Both white and born with a rare but treatable congenital heart defect called Tetrology of Fallot. My older boy already had successful corrective heart surgery when he was 4 months old and my 4-month-old goes in for open-heart surgery at the end of this month. Suffice to say my nerves are a bit raw. They will need follow-up care and potentially more surgery throughout their lives. It breaks my heart to think about my boys on that operating table where the margins are so thin, where a bad outcome is an impossible one to come to terms with.
There isn't a space for this thinking in that field, there can't be, it's too important to too many people. I've met with parents of all backgrounds whose children are born with congenital heart defects and I assure you they care not who is treating their kid, only that it's the best possible care available.
Suppose parallel medical systems developed in which medical schools operated on anti-racist principles produced medical professionals who served patients based on anti-racist values, while medical schools operating on merit principles produced medical professionals who served patients based on scientific principles.
Which patients would end up with the better medical outcomes?
It seems there is a new generation of doctors - and most likely, nurses and other caregivers -who are incapable of understanding both that 1) racial disparities in healthcare exist and must be addressed, and 2) making a point-of-service healthcare decision for a patient based on skin color is vile, immoral, unethical, and will ultimately lead to a place none of us should want to go. It falls to the institutions and teaching physicians responsible for their training to root out this hubris, enforcing respect and humility with dedication to quality research and patient care. Young enthusiastic doctors who want skin in the game, who want to create more equitable medical institutions, should be seeking work in underserved communities, not denying treatment to patients in their practices they perceive as privileged or morally lacking. Senior doctors who deplore this "woke" way of thinking should act as stewards of their institutions and educators of the next generation, not stand aside and watch them crumble.
This is the Lysenkoism of our time.
I’m a physician and am afraid to forward this article to my colleagues. Cowardice at its finest.
One of the concerns mentioned in the article, though not touched on directly in the comments, is the reluctance of teaching physicians to criticize a student intern solely because of the individual's ethnicity or sex. That does not speak well for the ultimate competence of that student and those who fall under his care. Better to learn from those that know, than learn from your mistakes for which the patient suffers or dies.