Killing American Medicine

For all the anguished debates about medical care no one ever really considers a decisive aspect-- the intelligence of doctors. You can have the fanciest, best-equipped hospital with the most advanced medicines and with the best robot surgeons, but if the physicians in charge have been chosen for reasons that have nothing to do with their ability, you are not going to be receiving the best medical care.

This is a story about the end of American meritocracy. For decades now the academy has been dumbing itself down by admitting too many students who cannot do the work, and then inflating grades so that it appears that they can. As we have reported, the products of this diversity scam now hold jobs teaching in schools and universities, commenting in the media and preaching the gospel of wokery via television and the movies.

Until now, science has largely been shielded from this madness. When MIT decided to start admitting students according to holistic standards-- which meant affirmative action and diversity quotas-- it found that the diverse students could not do the work. Having failed freshman math, these students could not advance to sophomore level courses. So, MIT went back to using standardized testing. Surely, you do not want the engineer designing the bridge or tunnel to be incapable of doing the math.

And yet, the rage against meritocracy, the lust for idiotocracy, is so strong that the American medical profession has now gone completely woke. It is hellbent on producing physicians who do not know the science. It is excluding candidates on the grounds of race, that is, because they have white skin. Within a few years you will discover that large numbers of American physicians, who will be pronounced eminently qualified, do not know much of anything about medicine. But, they will know everything about racial justice.

So explains Heather Mac Donald in the Wall Street Journal this morning. It is a chilling tale.

Public and private research funding is being redirected from basic science to political projects aimed at “dismantling white supremacy” in medicine. The result will be declining quality of medical care and slowing scientific progress.

Virtually every major medical organization—from the American Medical Association and the American Association of Medical Colleges to the American Association of Pediatrics—has embraced the idea that medicine is shot through with racism and inequity. The AMA’s 2021 Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity is a thicket of social-justice nostrums: Physicians must “confront inequities and dismantle white supremacy, racism, and other forms of exclusion and structured oppression, as well as embed racial justice and advance equity within and across all aspects of health systems.”

It’s not about science. It’s not about medicine. It’s not about advancing research. It’s about addressing grievances. And it’s about white physicians feeling guilty for being white.

Medical and scientific leaders, in the name of opposing racism, are apologizing for their own race. In June 2020, the journal Nature identified itself as one of the “white institutions that is [sic] responsible for bias in research and scholarship.” In January 2021, the editor in chief of Health Affairs lamented that “our own staff and leadership are overwhelmingly white.” The AMA’s strategic plan blames “white male lawmakers” for America’s systemic racism.

Evidently, the profession is addressing the problem by instituting systems of racial preference. That is diversity and affirmative action programs. Considering how poorly these worked in the humanities and social sciences, you wonder how these people, who are supposedly to respect the verdict of experience, can be so stupid:

The remedy, naturally, is racial and other preferences. The AMA strategic plan calls for the “just representation of Black, Indigenous and Latinx people in medical school admissions as well as . . . leadership ranks.” The lack of “just representation,” according to the AMA, is the result of deliberate “exclusion,” which will end only when “we . . . prioritize and integrate the voices and ideas of people and communities experiencing great injustice and historically excluded, exploited, and deprived of needed resources such as people of color, women, people with disabilities, LGBTQ+, and those in rural and urban communities alike.”

How is this happening? Mac Donald explains the medical licensing system:

At the end of their second year of medical school, students take step one of the U.S. Medical Licensing Exam, which measures knowledge of the body’s anatomical parts, functioning and malfunctioning. Topics include biochemistry, physiology, cell biology, pharmacology and the cardiovascular system. High scores on step one predict success in a residency; highly sought-after residency programs, such as surgery and radiology, use exam scores to help select applicants. But some students complain that the pressure to score well inhibits them from “antiracism” advocacy.

To put a finer point on it, this means that students who have been admitted to fulfill diversity quotas, who cannot keep up with the work, spend their time on antiracism advocacy.

The result is, they do poorly on the licensing exams-- as though this is a surprise.

Writing in an online forum, a fourth-year Yale medical student describes how the specter of step one affected his priorities. In his first two years of medical school, he had “immersed” himself in a student-led committee focused on diversity, inclusion and social justice, and he ran a podcast about health disparities. All that political work was made possible by Yale’s pass-fail grading system for classes, which meant that he didn’t feel compelled to put studying ahead of diversity concerns. Then, step one “reared its ugly head.” Getting an actual grade on an exam might prove to “whoever might have thought it before that I didn’t deserve a seat at Yale as a Black medical student.”

The solution was obvious: abolish step-one scores. Since January, the test has been graded on a pass-fail basis. The Yale student won’t have to worry that his studying will cut into his activism. Whether his future patients will appreciate his chosen focus is unclear.

The unfortunate part is that once patients catch on to the scam they will probably manifest their knowledge in the way they choose their physicians-- assuming that they have the choice.

Of course, medical schools admit students who would never have qualified in the past:

Virtually all medical schools admit black and Hispanic applicants with scores on the Medical College Admission Test that would be all but disqualifying if presented by white and Asian applicants, and some schools waive the MCATs entirely for select minority students. Courses on racial justice and advocacy are flooding into medical school curricula; students are learning more about white privilege and less about cell pathology.

This means that the best white students are being systematically excluded:

A physician-scientist reports that his best lab technician in 30 years was a recent Yale graduate with a bachelor’s degree in molecular biology and biochemistry. The former student was intellectually involved and an expert in cloning. His college grade-point advantage and Medical College Admissions Test scores were high. The physician-scientist recommended the student to the then-dean of Northwestern’s medical school, where the scientist worked at the time, but the student didn’t even get an interview. This “white, clean-cut Catholic,” in the words of his former employer, was admitted to only one medical school.

The result, on the ground, is that white college students have discovered that the medical profession is now rigged against them. Therefore, they are looking elsewhere. The best and the brightest undergraduates are avoiding the medical profession. In the future, if we want quality medical care we are going to have to start importing physicians, from India.

So, science will suffer and you will in the future be treated by physicians who know more about racial justice than about medicine:

The scientific method is a natural corrective to such fatal errors. Now, when it comes to the dubious hypothesis that racism is the defining trait of the medical profession and the source of health disparities, opposing views have been ruled out of bounds. Political neutrality, essential to the scientific method, is a racist dodge that risks “reinforcing existing power structures,” according to the editor of Health Affairs. The guardians of science have turned on science itself.

When we think of nations that are compromising meritocracy in favor of ideology, as someone wrote in the comments section yesterday, we do not need to look across the ocean. The problem exists in our very own backyard.