Medicine’s Tricky Operation: Grafting ‘Systemic Racism’ Onto Hard Science
A few years ago, concepts such as “white supremacy,” “systemic racism,” and “structural intersectionality” were not the standard fare of prestigious medical journals. But a February special issue of Health Affairs, the Washington, D.C.-based peer-reviewed journal, analyzes racial health disparities not through biology, behavior, or culture, but through the lens of “whiteness,” along with concepts such as power, systems of oppression, state-sanctioned violence, and critical race praxis—a sampling of terms that appear in the issue.
The Health Affairs special issue reflects the effort of “antiracist” scholars to transform concepts still considered speculative and controversial—and some say unprovable—into scientific fact. It is being advanced by other high-profile publications as well, including the New England Journal of Medicine, the Journal of the American Medical Association, and Scientific American, which last year published articles entitled “Modern Mathematics Confronts Its White, Patriarchal Past” and “Denial of Evolution Is a Form of White Supremacy.”
But this scientific aspiration faces major challenges. Science demands verification, testability, and replicability, whereas race is a social construct that can be difficult to separate from factors like class or culture, and explaining the data often remains dependent on academic theories about systemic racism. The articles in Health Affairs indicate that elevating the concept of systemic racism from moral certitude to scientific fact will require developing new tools and methods.
In a Health Affairs paper titled “The Intellectual Roots of Current Knowledge on Racism and Health,” researchers from Harvard University and the University of Maryland identify “the critical need for paradigmatic shifts that incorporate racism as a driver of inequities,” noting that “scientific language has the power to encourage normative standards.” Those pushing the effort expect that it will take years to build up a knowledge base and critical mass of scholarly research. If successful, it would empower the antiracist movement with what advocates expect to be recognized as unimpeachable scientific authority.
According to researchers with this perspective, racial inequalities in lifespans, health, income, and other metrics largely result from one cause: cultural norms and unconscious beliefs that privilege whites and males at the expense of groups that lack power and are oppressed. Cultural elites advocating this view—whether one calls it wokeness, systemic racism, critical race theory, or just the truth—are now leaders of many top institutions in media, publishing, universities, scholarly journals, school systems, and government.
The American Medical Association’s 86-page strategic plan for racial justice and health equity challenges prevailing standards of quality and merit as a strategy of protecting the privileged domain of white males: The AMA condemns “equal treatment” and meritocracy as “malignant” white supremacist ideologies that obscure “true power and site of responsibility.” The Association of American Medical Colleges, which co-sponsors the accrediting body for U.S. medical schools, is working to establish an advocacy culture in medical schools that haven’t yet gotten with the program voluntarily.
Dissenters say that the medical establishment has become captive to a leftist ideological agenda. They argue that “antiracism” can be hard to distinguish from anti-science when it fixates on a single variable (race), selectively seeks out data to prove a hypothesis (confirmation bias), ignores plausible alternative explanations—and worst of all—silences criticism.
“Confounding science with political ideology is never good,” said Michael Shermer, the founding publisher of Skeptic magazine, whose monthly column was terminated at Scientific American after 18 years in a disagreement over what Shermer saw as woke ideology infecting the venerable publication. “They’re saying we already know the answer—the answer is racism,” Shermer said in a phone interview with RealClearInvestigations. “We’re going to ignore all the other variables. They’re just reducing complex problems to one variable.”
The Health Affairs articles in the February special issue rely on sociological theories, personal testimonials, and even poetry to augment traditional scientific protocols. Scholars “encourage the use of a theory-driven approach” to interpret data that would otherwise have to be treated as random or inconclusive.
“This approach just drives me crazy,” says Dr. Stanley Goldfarb, a kidney specialist who retired last year from the University of Pennsylvania’s Perelman School of Medicine. “It’s basically finding associations and claiming it proves causality. They are going to find evidence for their theory because they are trying to do everything they can to prove their theory. That’s why they keep saying: We have to find the evidence.”
One way of summarizing this dispute is that traditionalists like Goldfarb are suspicious of scholarly activism as a corrupting influence on science, whereas researchers like those writing for Health Affairs are suspicious of neutrality and colorblindness as a cloak for systemic racism.
“This feels like an example of institutional capture, where you’re only good if you buy into the theory,” says Chris Ferguson, a psychology professor at Stetson University in DeLand, Florida, who describes the race-focused scholarship as an example of stubborn data being shoehorned into an uncooperative theory. “What happens is, other scholars begin to pick at it, and it falls apart,” Ferguson added. “Twenty years out this is going to look like a huge embarrassment.”
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