Posted on June 7, 2021

What Happens When Doctors Can’t Tell the Truth?

Katie Herzog, Substack, June 3, 2021


They meet once a month on Zoom: a dozen doctors from around the country with distinguished careers in different specialities. They vary in ethnicity, age and sexual orientation. Some work for the best hospitals in the U.S. or teach at top medical schools. Others are dedicated to serving the most vulnerable populations in their communities.

The meetings are largely a support group. The members share their concerns about what’s going on in their hospitals and universities, and strategize about what to do. What is happening, they say, is the rapid spread of a deeply illiberal ideology in the country’s most important medical institutions.

This dogma goes by many imperfect names — wokeness, social justice, critical race theory, anti-racism — but whatever it’s called, the doctors say this ideology is stifling critical thinking and dissent in the name of progress. They say that it’s turning students against their teachers and patients and racializing even the smallest interpersonal interactions. Most concerning, they insist that it is threatening the foundations of patient care, of research, and of medicine itself.


I’ve heard from doctors who’ve been reported to their departments for criticizing residents for being late. (It was seen by their trainees as an act of racism.) I’ve heard from doctors who’ve stopped giving trainees honest feedback for fear of retaliation. I’ve spoken to those who have seen clinicians and residents refuse to treat patients based on their race or their perceived conservative politics.


While the hyper focus on identity is seen by many proponents of social justice ideology as a necessary corrective to America’s past sins, some people working in medicine are deeply concerned by what “justice” and “equity” actually look like in practice.

“The intellectual foundation for this movement is the Marxist view of the world, but stripped of economics and replaced with race determinism,” one psychologist explained. “Because you have a huge group of people, mostly people of color, who have been underserved, it was inevitable that this model was going to be applied to the world of medicine. And it has been.”


“Wokeness feels like an existential threat,” a doctor from the Northwest said. “In health care, innovation depends on open, objective inquiry into complex problems, but that’s now undermined by this simplistic and racialized worldview where racism is seen as the cause of all disparities, despite robust data showing it’s not that simple.”

“Whole research areas are off-limits,” he said, adding that some of what is being published in the nation’s top journals is “shoddy as hell.”

Here, he was referring in part to a study published last year in the Proceedings Of The National Academy Of Sciences. The study was covered all over the news, with headlines like “Black Newborns More Likely to Die When Looked After by White Doctors” (CNN), “The Lack of Black Doctors is Killing Black Babies” (Fortune), and “Black Babies More Likely to Survive when Cared for by Black Doctors” (The Guardian).

Despite these breathless headlines, the study was so methodologically flawed that, according to several of the doctors I spoke with, it’s impossible to extrapolate any conclusions about how the race of the treating doctor impacts patient outcomes at all. And yet very few people were willing to publicly criticize it. As Vinay Prasad, a clinician and a professor at the University of California San Francisco, put it on Twitter: “I am aware of dozens of people who agree with my assessment of this paper and are scared to comment.”

“It’s some of the most shoddy, methodologically flawed research we’ve ever seen published in these journals,” the doctor in the Zoom meeting said, “with sensational conclusions that seem totally unjustified from the results of the study.”

“It’s frustrating because we all know how hard it is to get good, sound research published,” he added. “So do those rules and quality standards no longer apply to this topic, or to these authors, or for a certain time period?”

At the same time that the bar appears to be lower for articles and studies that push an anti-racist agenda, the consequences for questioning or criticizing that agenda can be high.

Just ask Norman Wang. Last year, the University of Pittsburgh cardiologist was demoted by his department after he published a paper in the Journal of the American Heart Association (JAHA) analyzing and criticizing diversity initiatives in cardiology. Looking at 50 years of data, Wang argued that affirmative action and other diversity initiatives have failed to both meaningfully increase the percentage of black and Hispanic clinicians in his field or to improve patient outcomes. Rather than admitting, hiring and promoting clinicians based on their race, he argued for race-neutral policies in medicine.

“Long-term academic solutions and excellence should not be sacrificed for short-term demographic optics,” Wang wrote. “Ultimately, 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.”

At first, there was little response. But four months after it was published, screenshots of the paper began circulating on Twitter and others in the field began accusing Wang of racism. Sharonne Hayes, a cardiologist at the Mayo Clinic, implored colleagues to “rise up.” “The fact that this is published in ‘our’ journal should both enrage & activate all of us,” she wrote, adding the hashtag #RetractRacists.

Soon after, Barry London, the editor in chief of JAHA, issued an apology and the journal retracted the work over Wang’s objection. London cited no specific errors in Wang’s paper in his statement, just that publishing it was antithetical to his and the journal’s values. Retraction, in a case like this, is exceedingly rare: When papers are retracted, it’s generally because of the data or the study has been discredited. A search of the journal’s website and the Retraction Database found records of just two retractions in JAHA: Wang’s paper and a 2019 paper that erroneously linked heart attacks to vaping.

After the outcry, the American Heart Association (AHA), which publishes the journal, issued a statement denouncing Wang’s paper and promising an investigation. {snip}

As the criticism mounted, Wang was removed from his position as the director of a fellowship program in clinical cardiac electrophysiology at University of Pittsburgh Medical Center and was prohibited from making any contact with students. His boss reportedly told him that his classroom was “inherently unsafe” due to the views he expressed.

Wang is now suing both the AHA and the University of Pittsburgh for defamation and violating his First Amendment rights. To the doctors on the Zoom call, his case was a stark warning of what can happen when one questions policies like affirmative action, which, according to recent polling, is opposed by nearly two-thirds of Americans, including majorities of blacks, Hispanics, and Asians.


{snip}That chill extends to teaching the next generation of doctors.


{snip} Increasingly, the doctors told me, this next generation of trainees seem to believe it’s also their duty to confront patients about their own prejudice — whether they’re open to it or not.

Last year at Harvard Medical School, a seasoned psychiatrist interviewed an elderly white patient about his battle with substance abuse on Zoom. The patient talked about shame. He felt so much guilt over his drinking and his past behavior, he said that the only person he could have ever confided in was an Eskimo in Alaska who didn’t speak English — and even then, he would have to slit his throat.

It was the sort of thing health-care workers occasionally hear. Historically, the guideline in a situation like that would be to ignore it: They were there to discuss addiction, not the patient’s insensitivity. But a Native American student named Victor Anthony Lopez-Carmen observing the session on Zoom was disturbed. He wrote about it later in Teen Vogue: “His words sparked an immediate, visceral reaction. I felt my blood pressure rise and anxiety overtake my mind and body. My next reaction was to look at how the rest of my classmates were responding. The blank, remote expression on some of their faces, and the silence that followed, remains burned into my psyche.”

When neither the psychiatrist nor any of his fellow students paused in the moment to educate the elderly man about his “violent and racist language,” as Lopez-Carmen described it, he complained. In response, the school organized a session for faculty and students on, Lopez-Carmen writes, “confronting anti-Indigenous racism in the field of medicine.”

Should clinicians police their patients’ language to protect the feelings of their health-care providers? One doctor from the Zoom chat said, unequivocally, no.

“How would chastising, and possibly shaming, a patient — however expertly — affect their comfort in confiding sensitive information important to their care? Patients’ life experiences, stories, attitudes, beliefs, whatever they may be, are data that help us take good care of them.”

As major medical institutions formalize their commitments to social justice ideology, the sentiment that medical professionals need to put aside their feelings in service of treating patients seems increasingly old-fashioned. Some institutions, including Harvard Medical School, the American Psychiatric Association, the American Academy of Pediatrics, and the American Medical Association (AMA), the largest association of physicians and medical students in the U.S., have released statements acknowledging their own history of racism, a trend one of the doctors described as “confessional.”


There are, of course, an array of diversity trainings, including some that simply lay out anti-discrimination laws and others that require white people to confess their privilege. Trainings that may have seemed obviously racist just a few years ago — like separating employees into “affinity groups” or “caucuses” based on race — are now commonplace, including at large corporationssmall non-profits, and medical institutions. (My wife, a nurse in Seattle, recently joined the “white caucus” at her hospital, and noted that she felt very strange asking to join a whites-only group.)

The diversity industry is now worth billions of dollars, but there have been surprisingly few evaluations of whether or not such trainings actually work. The research that has been done is not encouraging. One study found that these trainings can be counterproductive; another found that positive effects don’t seem to last.

What’s more, the doctors said, statements like the AMA’s seem destined to create backlash. “You have to wonder about the unintended consequences of these organizations falling over themselves to declare that they’re structurally and systemically racist,” one of the doctors said. “Clearly, they think they’re going to get virtue-signaling points. But is it possible these claims are also playing into vaccine hesitancy among people of color? I mean, would you want to get vaccinated at an institution that’s enthusiastically broadcasting to the world, ‘We’re racist!’ I wouldn’t.”


One prominent organization, White Coats for Black Lives, was formed by medical students in 2014 and now has at least 75 chapters all over the U.S. In addition to publishing a Racial Justice Report Card that grades medical schools, the group encourages medical students to make specific demands of their institutions, including that medical schools and hospitals end all relationships with local law enforcement.

When asked what severing ties with police would do in his urban emergency room, one ER doctor said it would be a “total disaster.” Police, he told me, are a vital part of emergency operations, from securing crime scenes so emergency responders can see victims to helping transport patients to keeping hospital staff and patients safe when private security is inadequate.


As another example of the generation gap, an ER doctor on the West Coast said he sees providers, particularly younger ones, applying antiracist principles in choosing how they allocate their time and which patients they choose to work with.  “I’ve 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.’”

Some in medicine would like to see such race-conscious bias mandated on an institutional level, particularly in regards to Covid-19, which has killed black, Hispanic, and Native American people at three times the rate as whites. These discrepancies are likely due to an array of factors, including income, housing, work, language, pre-existing conditions, access to health care, and, yes, possibly some degree of racism.

But some politicians and public health officials decided the remedy was to distribute vaccines by race.

In April, Vermont’s Republican Governor Phill Scott announced that any resident over age 16 who identified as a black, indigenous, or a person of color would be eligible for the vaccine before white people, a decision that, according to some legal scholars, likely violated federal law. The CDC itself considered recommending that states prioritize essential workers over the elderly despite the fact that the number one risk factor for dying from Covid is age. The idea had plenty of supporters. Harold Schmidt, a professor of medical ethics and health policy at the University of Pennsylvania, told 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.”

Ultimately, the CDC did recommend prioritizing vaccines by age, but race-conscious policies go beyond Covid. In May, the Boston Review published an editorial by physicians Bram Wispelwey and Michelle Morse entitled “An Antiracist Agenda for Medicine.” In it, the doctors argue that in order to address discrepancies in health-care access and outcomes, hospitals should commit to “preferentially admitting patients historically denied access to certain forms of medical care.” That is, they should admit people to health services based on their skin color.