Wokeness M.D.
Wokeness M.D.
Twenty years ago, the physician Sally Satel argued in her book PC M.D.that political correctness had taken over medicine. PC M.D. described a lowering of standards to increase doctor diversity, the blithe use of dubious “recovered memories” in sexual-abuse allegations, and the endorsement for political reasons of questionable techniques such as “therapeutic touch.” Some of these concerns no longer have much purchase in our common cultural conversation. But Satel’s larger point continues to resonate: Politics, and especially leftist political theories emanating from the universities, can interfere with the practice of medicine in a deleterious way.
These days, the problem is not “politically correct” medicine, but “woke” medicine. PC’s impact on medicine was real, and worrisome, but the current fear is that PC’s implications could pale before woke’s troubling impositions, which are more intensive in both scale and scope across multiple sectors in health care.
To what extent is ideology influencing the medical field?
The first question is whether wokeness is directing doctors to treat patients unequally. Wokeness at its heart looks at intersectionality and judges people’s merits and worth on their place along the spectrum of oppression. This pernicious concept means that those with more claims to historic oppression should be granted preferable treatment over those with fewer claims—with white “cisnormative” males having none of said claims. The enshrinement of this concept contravenes the foundational principles enshrined in the Hippocratic Oath, the ethic that has guided medical practice for millennia.
The Hippocratic Oath does not actually say, “First, do no harm.” What it does say is this: “Into whatever homes I go, I will enter them for the benefit of the sick.” It specifically directs doctors to avoid the mistreatment of patients, “whether they are free men or slaves.” The practical effects of this doctrine are extraordinary. At the national level, for example, Israeli doctors famously treat victims of terror attacks and the perpetrators of such attacks the same way, with no distinction. This approach has long been widely accepted as a signal of a doctor’s morality and good character and has been broadly absorbed in our popular culture. In the 2018 movie Death Wish, the filmmakers introduce the protagonist, a surgeon played by Bruce Willis who unsuccessfully tries to save the life of a gravely wounded Chicago police officer. Willis then has to deliver the sad news to the dead officer’s partner, before being called away to operate on the murderer. He is scolded by the grieving partner, who says, “What? Now you’re going to save the animal that shot him?” Willis’s immediate and unhesitating reply—“If I can”—indicates how deeply ingrained the concept of equal treatment in the medical profession is.
Is this principle under threat? The indications are largely anecdotal at this point. An experimental program was proposed at Boston’s highly regarded Brigham and Women’s Hospital that would offer “preferential treatment” to patients of color, with, presumably, less preferential treatment going to white patients. A hospital spokesman told the Washington Free Beacon that such an initiative was “not currently underway at the hospital.” So far, so good. On the other hand, proffering this idea has not set back the careers of its authors as much as it should have. One of them, Dr. Michelle Morse, was recently named first Chief Medical Officer of the New York City Department of Health and Mental Hygiene, and she explicitly hopes to “advance race equity”—equity being the new woke buzzword for not treating people equally.
Another disturbing example came from the Yale School of Medicine, where a psychiatrist named Aruna Khilanani gave a talk called “The Psychopathic Problem of the White Mind.” She announced, “White people make my blood boil” and said, “I had fantasies of unloading a revolver into the head of any white person that got in my way, burying their body and wiping my bloody hands as I walked away relatively guiltless with a bounce in my step, like I did the world a favor.”
Yale, to its credit, issued a statement saying that it “found the tone and content antithetical to the values of the school.” It also limited access to the speech to people at Yale rather than a wider audience, leading Dr. Khilinani to complain about Yale’s “suppression of my talk on race.” Such a lecture and the lukewarm response highlights a problem that could spread—a world in which a credentialed medical practitioner could feel confident in publicly expressing such murderous views without paying any sort of professional price. Dr. Khilinani rightly observed of Yale faculty that “they knew the topic, they knew the title, they knew the speaker.” They did indeed.
A third example comes from the independent reporter Katie Herzog, writing on Bari Weiss’s Substack blog. Herzog tells us of an anonymous group of physicians, by no means all conservatives, who are worried about the direction in which the “dogma” that “goes by many imperfect names—wokeness, social justice, critical race theory, anti-racism” is taking medicine. An anonymous West Coast ER doctor, according to Herzog, has “heard examples of COVID-19 cases in the emergency department where providers go, ‘I’m not going to go treat that white guy, I’m going to treat the person of color instead because whatever happened to the white guy, he probably deserves it.’” This attitude is abhorrent, but an ineluctably logical outgrowth of the woke worldview. Herzog reminds us that ideas have consequences. The question is how widespread this view is and what will happen as more embrace it.
The anonymous quote stands out precisely because it is so dissonant with physicians’ sworn duties. The problem here is not that there are legions of doctors who mistreat white patients, but that there are doctors who will openly speculate about mistreating white patients, that there are other medical professionals who will not rebuke them, and that the doctor who heard about this felt that he had to remain anonymous.
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THE anonymity here leads to a second question: Will wokeness get in the way of honest and needed research, or limit what doctors can say? Can doctors speak openly about difficult questions, and is there a prevailing political orthodoxy that is stifling speech in medicine? Here the evidence is unfortunately more compelling and is manifesting itself in two distinct and troubling ways.
First is the problem of research. Can medical researchers engage in studies that come up with conclusions that do not correspond to the regnant political orthodoxy? We have recently seen multiple high-profile examples of this problem. Most prominent among these was the case of Norman Wang, a cardiologist and associate professor at the University of Pittsburgh Medical Center, who wrote a paper questioning the efficacy of affirmative action in the medical profession. Wang’s peer-reviewed article, “Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America from 1969 to 2019,” was published by the Journal of the American Heart Association (JAHA). Among Wang’s anodyne conclusions was his belief that “all who aspire to a profession in medicine and cardiology must be assessed as individuals on the basis of their personal merits, not their racial and ethnic identities,” as well as his assessment that there “exists no empirical evidence by accepted standards for causal inference to support the mantra that ‘diversity saves lives.’”
The article’s peer-reviewed status did not help Wang once the controversy over its findings erupted. The journal retracted it, his medical center renounced it, and Dr. Wang was removed from his position and demoted by the university. His data were not at issue, but his conclusions were deemed unacceptable. Wang is suing both the University of Pittsburgh and JAHA.
On the other side of this question are the curious studies that make a politically favored point and therefore cannot be second-guessed. One such survey published in the Proceedings of The National Academy of Sciencespurported to show that black children suffered from worse results when their doctors were white rather than black. This led to the expected breathless headlines such as this one from CNN: “Black Newborns More Likely to Die When Looked After by White Doctors.” The study was imperfect and methodologically flawed, but, according to Herzog’s group of anonymous doctors, it was not seen as acceptable to question its findings.
Even more startling was a crisis that broke out at the primary organization of American doctors, the American Medical Association. The Journal of the American Medical Association (JAMA) hosted a podcast in which deputy editor Edward Livingston, himself a surgeon, asserted that doctors in general were not racist and that medicine as a whole is not systemically racist. As Livingston put it, “many of us are offended by the concept that we are racist.”
When the episode and the quote gained notoriety—due in part to a JAMAtweet reading “No physician is racist, so how can there be structural racism in health care?”—the fallout was far-reaching. JAMA memory-holed the offending episode. Dr. Livingston resigned. But the bloodletting did not stop there. JAMA editor in chief Howard Bauchner also had to resign, even though he did not make the statement, did not see the statement, and had nothing to do with the podcast. Bauchner had even denounced his colleague Livingston’s statements as “inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA.” No matter; Bauchner was shown the door. The message to editors, writers, and doctors alike could not have been clearer about the perils of speaking against the prevailing orthodoxies.
At a June meeting of the American Medical Association in which its policymaking arm highlighted systemic racism and implicit-bias arguments, delegates also voted in support of social-media efforts to limit dissent on these issues or, as they called it, to “crack down on medical misinformation.” This effort to suppress “medical misinformation” is increasingly deployed to limit discussion of a number of issues, not relating to systemic racism but also on the origins of the coronavirus or the effectiveness of COVID-19 treatments. Deployed wisely, social-media platforms can be helpful to doctors in disseminating new and successful treatments for a variety of conditions, or warning against ineffective ones. But using social media to enforce politically preferred dogmas makes it less likely that doctors will be able to use such platforms to find honest scientific answers on the right kinds of treatments or be willing to question the use of the wrong ones openly.
And large-scale institutions are determined to put policies in place that call for unequal treatment based on woke principles. We saw this most prominently in the discussion of how best to distribute the COVID-19 vaccines.
The federal government establishes protocols for vaccination priorities. It has general guidelines for doing this and creates more specific recommendations as circumstances warrant. For example, when I worked at the White House and in the Department of Health and Human Services, there were general guidelines about how to apportion vaccines in the case of an unspecified pandemic—with consideration given to first responders, vulnerable populations, senior government officials, and the like. Since different pathogens attack populations differently, these guidelines tend to be made more concrete once government officials have a sense of the nature of the pathogen and the effectiveness of the countermeasure.
In the case of COVID-19, we faced a disease that disproportionately affected the elderly, with a vaccine that was also remarkably safe and effective. Therefore, the scientifically appropriate protocol in this case was to prioritize their vaccinations, along with those of first responders. Such a protocol, however, would have disproportionately favored whites, as the elderly in this county are more likely than younger populations to be white. This did not sit well with many in the “public health” profession, and as a result, the Centers for Disease Control openly considered changing the protocols to vaccinate essential workers first, since the elderly—those most vulnerable to the disease—are disproportionately white. The University of Pennsylvania’s Harold Schmidt encapsulated this problematic perspective, telling the New York Times, “Older populations are whiter. Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”
Reason prevailed. The CDC did prioritize the elderly. But the fact that this idea got as far as it did was troubling. The state of Vermont did signal that it would prioritize vaccine distribution to people of color in an effort to promote “equity”—but since Vermont has a population of only 640,000, of whom 94 percent are white, its declaration made little difference in Vermont’s efforts to protect the elderly and most vulnerable. Even so, it demonstrates how the very idea of preferential treatment is becoming the norm.
Then there are the broader policies that tie the hands of doctors and limit choice by patients, especially with regard to practices that have the woke seal of approval. In her book Irreversible Damage: The Transgender Craze Seducing Our Daughters, Abigail K. Shrier notes multiple instances of doctors pursuing gender-reassignment treatments for children against the parents’ wishes. In Live Not by Lies, Rod Dreher interviews a physician—again anonymously—who had lived in the Soviet system who notes that the indoctrination of the medical system in the U.S. today reminds him of the regime he had escaped. He told Dreher of an institutional policy that forbids doctors from questioning treatment demands that come from gender-dysphoric patients, regardless of whether those treatments run counter to the doctors’ best judgments.
In addition, doctors and public health officials are increasingly using their credentials as a ballast for naked political activism. Case in point: a recent statement by a group of health professionals in Scientific Americandenouncing Israel over its most recent conflict in Gaza—a statement couched in terms of their judgment as health professionals rather than as a political opinion. After an outcry, Scientific American took the piece down, replacing it with the words, “This article fell outside the scope of Scientific American and has been removed.” That is true. But it does not answer the question of why the article was published in the first place.
The Scientific American episode was reminiscent of an incident last spring during the height of the COVID-19 lockdowns. The message from the public health community had been uniform and unyielding on the issue of social distancing and avoiding public gatherings for any reason… until the Black Lives Matter protests following George Floyd’s death. In the wake of these mass gatherings, over 1,000 public health experts—many, but not all, M.D.s—issued a statement declaring these gatherings acceptable because “the way forward is not to suppress protests in the name of public health but to respond to protesters demands in the name of public health, thereby addressing multiple public health crises.” The naked political and ideological exception here made it clear that these experts were offering a pseudo-priestly blessing for behavior they had otherwise condemned—and even sought to outlaw.
The medical profession is supposed to be governed by strict standards that promote the interests of the patient and rely on the use of the scientific method to determine what is in the patient’s best interest. In many of the cases discussed here, these standards are being tested, and pushed to the edge, by an ideology that rejects science in favor of pursuing a woke agenda. The line appears to be holding for now. Patients for the most part can still go doctors and get equal treatment and the best advice that the medical profession has to offer.
But the assault on these norms is relentless, raising the question of what will happens if and when the strict and rigorous standards of the medical profession wilt and the once unassailable tenets of medicine fall. We can see this with the issue of free speech itself. A generation ago, during the PC wars of the early 1990s, an easy pushback against the excesses of campus speech codes was to make the case for free speech. It was a concept embraced on all sides of the political debate, and those opposed to free speech were outliers and radicals. Today, this once universal precept is no longer universal, making the creation of bipartisan coalitions against woke speech codes much more difficult.
The same thing could happen in medicine if we allow the walls protecting the institution of medicine to fall. Doctors are trusted because they are known to value the patient above all, because they have gone through a rigorous and often harrowing 12-year training period, and because they base their judgments on long-tested treatments that have worked on actual patients. All of those standards are under fire. One of the doctors Herzog spoke to complained that he found himself unable to rebuke students for being late. The University of Pennsylvania’s postgraduate surgery pro-gram has eschewed grades and medical-licensing scores in favor of vaguer criteria such as “leadership, teamwork, altruism, and research activity.” Columbia medical students have demanded the elimination of grades as well, so far unsuccessfully.
If doctors become known for making decisions based on politics, if the training regimen weakens considerably, if scientific judgments disappear in the face of woke political pronouncements, we will lose more than a generation of dedicated professionals; we will also lose a broader sense of trust in our medical system.
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MEDICINE is literally a life-and-death profession. An advertiser can make an ad that fails to sell a product. A lawyer can make a lousy argument. A doctor who offers up the wrong treatment can kill patients. The late John Silber made a point along these lines in his book Architecture of the Absurd. The book argues that politics can infect most forms of art with little consequence in the real world. But architecture differs in that a building has to work. If it is poorly constructed, it could collapse catastrophically. If it is designed according to wants rather than needs, a building will not provide adequate shelter. The same point adheres in medicine. The medicinal remedies that doctors offer must work, or they will fail to cure patients. Medicine governed by woke principles will lead to the credentialing of doctors who may make political decisions rather than medical and scientific ones.
The wonders of modern medicine are of relatively recent vintage. This new era has brought about numerous medical miracles—including the recent COVID-19 vaccines in a startling nine months—by applying the scientific method to lifesaving questions. This meant that doctors could constantly question and improve their practices based on real-world experiments and experience. As Jonathan Rauch shows in his book The Constitution of Knowledge, our medical breakthroughs have been fueled by a profession willing to question reigning orthodoxies in search of better solutions. As Rauch writes, “instead of relying on hunch and anecdote, researchers could scrutinize treatments, discard the ineffective ones, and develop the promising ones.” It is important to remember that this system has been in place for only a millisecond in the course of human history. To return to the old non-questioning ways—ones in which folkways overtake hard facts and cranks govern rather than scientists—would be devastating for human health and development. But it is not beyond the realm of possibility if politics trumps the ability to question scientific matters.
For this reason, those who believe in rigorous training, who want medicine to work, who believe in medical innovation and in treating patients equally need to be vigilant in watching these worrisome developments and calling them out. The voices of conservatives alone cannot stop an assault on the foundations of modern medicine, but conservatives can help raise alarms about growing challenges to those foundations. To be successful, conservatives need to broaden the target audience and ensure that non-woke liberals and rational centrists are also willing to stand up and demand that the miracle of modern medicine be allowed to continue to thrive.
Medicine is an intensely personal need, and the vast majority of non-woke Americans will not give up its benefits so easily, if alerted to the threat. Right now, the problem appears to be larger in the training than in the practice of medicine, but training has downstream effects, which is an essential point that must be made, and remade, as part of this effort.
It is the application of modern science to the practice of medicine that has led to better treatments, lifesaving preventive measures like vaccines, and longer, healthier lifespans. Doctors are no longer barbers who, by virtue of having sharp tools on hand, cut both hair and, when needed, limbs. Doctors today are highly trained professionals, learning to treat every human equally and constantly looking to refine and improve their practices. Adjusting this system to meet short-term political goals risks the great medical advances of recent years, as well as the magnet that attracts talented and dedicated individuals to the medical profession. Changing doctors into bureaucrats who must conform ideologically, who do not treat patients equally, and who no longer go through intensive winnowing exercises to maintain the highest standards risks creating a world that no longer attracts top talent to the medical profession. It will also be a world in which patients no longer put the highest faith in their doctor’s skills or the profession’s ability to provide honest and unpolitical diagnoses.
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