GUEST COMMENTARY - For better or worse, I have had a front-row seat to the meltdown of twenty-first-century medicine. Many colleagues and I are alarmed at how the DEI (Diversity, Equity, and Inclusion) agenda—which promotes people and policies based on race, ethnicity, gender, religion, and sexual orientation rather than merit—is undermining healthcare for all patients regardless of their status.
Five years ago, I was associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine, and prior to that, codirector of its highly regarded kidney division. Around that time, Penn’s vice dean for education started to advocate that we train medical students to be activists for “social justice.” The university also implemented a new “pipeline program,” allowing ten students a year from HBCUs (historically black colleges or universities) to attend its med school after maintaining a 3.6 GPA but no other academic requirement, including not taking the MCAT (Medical College Admission Test). And the university has also created a project called Penn Medicine and the Afterlives of Slavery Project (PMAS) in order to “reshape medical education. . . by creating social justice-informed medical curricula that use race critically and in an evidence-based way to train the next generation of race-conscious physicians.” Finally, twenty clinical departments at the medical school now have vice chairs for diversity and inclusion.
Although some discussion of social ills does belong in the medical curriculum, I’ve always understood the physician’s main role to be a healer of the individual patient. When I said as much in a Wall Street Journal op-ed in 2019, “Take Two Aspirin and Call Me by My Pronouns,” a Twitter mob—composed largely of fellow physicians—denounced my arguments as racist. Over 150 Penn med school alumni signed an open letter condemning me. Meanwhile, my name has since been scrubbed from the university’s website and I’ve been excised from a short history of the kidney division.
Similar outrage greeted the outgoing president of the Society of Thoracic Surgeons, John Calhoon, when, in a speech to members in January, he encouraged them always to “search for the best candidate” and noted “affirmative action is not equal opportunity.” Within 24 hours, the society denounced Calhoon’s speech for being “inconsistent with STS’s core values of diversity, equity, and inclusion,” and its incoming president announced, “We are going to do what we can to re-earn the trust of our members who have been hurt.” Apparently no one thought to ask the 170,000 Americans who annually undergo a coronary bypass—the most common form of thoracic surgery—if they, too, might prefer to be operated on by “the best candidate.”
After my drubbing by the Penn med school alumni, I didn’t stay quiet. At the onset of the Covid-19 pandemic, I noticed that trainees were unprepared to care for critically ill patients. It was becoming clear to me that discriminatory practices—such as reserving monoclonal antibodies against Covid-19 for minority patients, and preferential hospital admission protocols based on race—were infiltrating medicine as a whole. I responded with another Wall Street Journal op-ed, “Med School Needs an Overhaul: Doctors should learn to fight pandemics, not injustice.”
I retired as I’d planned in July 2021, my honorific status as professor emeritus intact, though I haven’t been asked to teach. In March 2022, I published a book, Take Two Aspirin and Call Me By My Pronouns, and started a nonprofit called Do No Harm with some acquaintances to combat discriminatory practices in medicine. We began a program to inform the public and fight illegal discrimination. We demand that any proposed changes in medical school admissions or testing standards require legislative approval and a public hearing—and we are getting results.
Our argument is that medical schools are engaging in racial discrimination in service to diversity, equity, and inclusion. We have filed more than seventy complaints with the U.S. Department of Education’s Office for Civil Rights (OCR), which exists in large part to investigate schools that discriminate based on race, color, ethnicity, sex, age, and disability. Surely the radical activists never expected anyone to turn the administrative state against them, but that’s what we did. And it worked—even under the Biden administration. Do No Harm has filed complaints through OCR over scholarships, fellowships, and programs with eligibility criteria that discriminate based on race/ethnicity (Title VI of the Civil Rights Act of 1964) and/or sex/gender identity (Title IX of the Education Amendments of 1972). Many of these are described as programs for students who are “underrepresented in medicine” (UIM).
For example, we brought the OCR’s attention to a Diversity in Medicine Visiting Elective Scholars Program(archived page) at the University of Texas at San Antonio’s Long School of Medicine, which excluded white and Asian students. This is illegal under Title VI of the Civil Rights Act, which made all racial discrimination associated with government programs illegal. As a result of our action, the OCR opened an investigation. However, Long School of Medicine took down the program page and scrubbed all evidence of it from its website, prompting OCR to close the investigation as “corrected.” While the original scholarship was meant for individuals from disadvantaged backgrounds, that worthy goal can and should be met without racial discrimination.
Or consider the University of Florida College of Medicine, which offered a scholarship solely to those who were “African Americans and/or Black, American Indian, Alaska Native, Native Hawaiian, Hispanic/Latinx, and Pacific Islander.” We asked the OCR to investigate, and the university eliminated the race requirement. Likewise, we filed a complaint against the Medical University of South Carolina over eight scholarships excluding applicants who did not qualify as “underrepresented in medicine.” The OCR opened an investigation, after which the school dropped the exclusionary policy.
Racially discriminatory scholarships are not the only sign of the decline of American medical schools. A colleague at Do No Harm and I examined the trend of re-segregating medicine, including the idea that black physicians provide better healthcare to black patients than physicians of other races. There is no question disparities exist in health outcomes for minority communities. But no valid studies support the rationale of creating a corps of minority physicians, and last month Do No Harm filed a complaint with the OCR against Duke University’s School of Medicine’s Black Men in Medicine program for race- and sex-based discrimination.
Even the highly touted New England Journal of Medicine is pushing for race-based segregation in medical schools. Last month, the journal published an article by several doctors and academics at the University of California–San Francisco and UC–Berkeley, calling for the expansion of “racial affinity group caucuses,” or RAGCs, for medical students. “In a space without White people,” the authors write, “BIPOC participants can bring their whole selves, heal from racial trauma together, and identify strategies for addressing structural racism.” The RAGCs include a caucus for white-only medical trainees, as if this would lessen objections to an agenda that has nothing to do with healing and everything to do with identity politics.
Do No Harm is also pushing back against the tide of race-based programs in the corporate world. In February, in the wake of a lawsuit we filed against Pfizer last September claiming a violation of Title VI of the Civil Rights Act, the pharmaceutical company ended a requirement that college junior applicants to its Breakthrough Fellowship program—which offers guaranteed employment—be black, Hispanic, or Native American.
At Do No Harm we have publicly and repeatedly pointed out that the likeliest basis for healthcare disparities is not racism, but patients presenting late in the course of their illness, too late to achieve best outcomes. Therefore, we push for better access for minority patients and encourage healthcare institutions to improve outreach to minority communities. We believe that focusing on racial identity will harm healthcare, divide us even more, and reduce trust between patients and physicians, all of which will lead to even worse outcomes.
We have heard from dozens of physicians, nurses, and medical students who feel prevented from speaking out. My advice to my colleagues, young and old, is this: fight back using every tool at your disposal. Highlight the damage that follows the lowering of standards. Call out discrimination done in the name of “equity” and “anti-racism.” Recognize that the majority of your peers may share your views, even if they stay quiet.
(Nephrologist, educator, proud father and grandfather. Chairman-Do No Harm, author of, Take Two Aspirin and Call Me By My Pronouns.)