Identity Politics Don’t Belong in Medicine, Either

T his election underscored that a person’s appearance is a bad predictor of how they vote. Americans know that despite the claims of the Left, skin color doesn’t determine how or what a person thinks. Yet medical associations still haven’t received the memo. While some companies and universities are retreating from DEI trainings that demand a focus on immutable characteristics, medicine is holding fast to a racial lens that exemplifies the very evils of racism it seeks to overcome.

In 2021, the American Medical Association (AMA) introduced an organizational plan to “embed racial justice and advance health equity” which rallied against the advantages of “white (also wealthy, hetero-, able-bodied, male, Christian, U.S. born) people at the expense of Black, Latinx, Indigenous and people of color.” Initiatives included conducting research “informed by social epidemiology and critical race theory,” training medical students and physicians in the pedagogy, and exploring medical reparations.

Success, according to the AMA, is not equality, but equity. This is because “seeking to treat everyone the ‘same’ ignores the historical legacy of disinvestment and deprivation.”

Medical boards have taken heed. My Massachusetts medical license renewal, for example, requires two continuing medical education (CME) credits of implicit bias training. I earned one credit by watching a recorded lecture titled “Reflecting on Health Disparities and Moving Towards Antiracism in Medicine.” Its message? White doctors situated in a medical system designed to preserve white supremacy are inflicting harm on people of color.

The idea that skin color predicts racist thoughts and behaviors began to gain steam over 20 years ago with the introduction of the Implicit Association Test (IAT). A version of this psychological tool measures subjects’ reaction times in response to images of dark-skinned faces versus those of light-skinned faces. Proponents of the test argue that increased reaction times to dark-skinned faces represent unconscious bias against black skin. But whether these reaction times actually measure bias is questionable. The IAT has low reliability and validity and hasn’t demonstrated that it predicts racist behaviors. Yet that hasn’t stopped institutions from incorporating it into antidiscrimination employment trainings.

Applying implicit bias principles, the CME instruction proposes that racial concordance between patients and physicians improves care, pointing to a study finding that black newborns treated by white physicians had a 50 percent greater mortality rate than those treated by black physicians. If true, this shocking conclusion paints a grotesque picture of white doctors who are directing their intrinsic racism at their most helpless patients.

But the CME omits a highly relevant piece of information: that the study of 1.8 million hospital births failed to consider very low birth weight, a major factor in newborn mortality. When controlling for this variable, researchers note that the connection between reduced infant mortality and physician-patient racial concordance disappears.

At the conclusion of the recorded lecture, an attendee asks a question: “Typical liberal white guy sitting in the room with, you know, the guilt . . . so . . . what can we do?” The lecturer suggests actions to implement in his medical practice, but fails to address his guilt, which hovers over the virtual space like a heavy cloud.

There is now sufficient evidence to suggest that training like the CME does more harm than good. A recent study found that diversity, equity, and inclusion programs promote hostility and increase racial suspicion rather than improving relations and decreasing discrimination. Unsurprisingly, activities that flatten individuals to their physical traits and then assign them into groups of oppression tend to encourage racist thinking.

Unfortunately, race-based thinking has invaded medicine beyond merely its training programs. New York State released guidelines at the height of the pandemic that prioritized patients with non-white skin to receive potentially life-saving Covid-19 treatments. Physicians in Boston have advocated for medical restitution, initiating a pilot study that utilizes ethnicity to influence admission decisions for heart failure patients. Abroad, clinicians in New Zealand use an “equity adjuster-waitlist tool” to prioritize patients of certain ethnicities for surgery.

While the CME highlights shameful medical history like the Tuskegee experiment — a decades-long study in which doctors withheld antibiotics from poor black men suffering from syphilis in order to investigate the disease — such travesties are not evidence for why a racial lens should be used, but exactly why it should be discarded. It is what results when doctors fail to see all humans as equally sacred, and instead see them as members of an identity group with allotted value according to their immutable characteristics.

Identity group stereotypes make for bad politics, and even worse medicine. Doctors risk abandoning their oath to “first, do no harm” when they focus on the veneer of the human rather than the soul within it.

This article is in memory of Dr. Marilyn Singleton, fierce defender of Hippocratic oath medicine.