Freedom

By Laurel Duggan

The Biden administration proposed giving bonus payments to physicians who acknowledge systemic racism as the primary cause of health differences between racial groups and incorporate so-called “anti-racism” into their medical practices.

The move to pressure healthcare professionals to repeat the claim that racial health disparities are caused by racism and not lifestyle choices is part of a broader, years-long push to hardwire “race Marxism” into the medical field. The effort stretches from medical schools and research institutions to patient care and medical administration, with potentially devastating effects for patients and the healthcare system as a whole.

“Race Marxism,” analogous to “anti-racism” as popularized by Ibram X. Kendi, seeks to promote equal outcomes across racial groups, as opposed to a “colorblind” approach which favors equal opportunity and does not take race into account.

Dr. Erica Li, a pediatrician, told the Daily Caller News Foundation that “race Marxism” — a phrase for which she does not take credit — pits “classes” of people against each other on the basis of race, gender or sexuality rather than economic class, as classical Marxism did.

The ideology’s newfound popularity caused a frenzy in the medical community in 2020 as doctors, researchers, medical schools and other medical institutions sought to infuse “anti-racist” practices into their work.

PATIENT CARE

Doctors and medical institutions are questioning how they allocate limited resources in crisis situations in light of unequal health outcomes for different racial groups. Specifically, some medical professionals have advocated for prioritizing black and Latino patients on the basis of race when rationing limited, life-saving medical resources.

When deciding which groups would receive the first vaccines, the Centers for Disease Control and Prevention (CDC) recommended prioritizing essential workers over the elderly — despite the elderly facing higher risk of death from COVID-19 — in order to be more racially equitable (the elderly tend to be more white while essential workers tend to be less white, demographically), according to the Los Angeles Times.

The CDC walked back the suggestions after public outcry, according to Dr. Sally Satel, but Vermont explicitly granted vaccine priority on the basis of race to non-white households before the general public became eligible. The vaccination rate for white residents (33%) had been outpacing that of non-white residents (20%); Republican Governor Phil Scott said this gap was unacceptable at the time.

Dr. Harald Schmidt of the University of Pennsylvania medical school advocated for updating guidance for rationing ventilators to account for race and other socioeconomic factors in April 2020. He suggested that hospitals use a zip code-based “Area Deprivation Index” to avoid the “legal complications” of explicitly race-based allocation of medical resources. Dr. Schmidt and the University of Pennsylvania medical school did not respond to DCNF’s requests for comment.

Brigham and Women’s hospital in Boston considered a pilot program which would prioritize patients for cardiovascular care explicitly on the basis of race. Described by doctors Michelle Morse and Bram Wispelwey in a March article in Boston Review, the program would have given preferential admissions to black and Latino people for cardiological services to reduce heart health gaps between white and non-white patients.

Morse and Wispelwey argued that health gaps between different racial groups are driven by racism, and they viewed their plan as a form of racial reparations. The proposal drew from the 2010 proposal titled, “Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis.”

Brigham publicly distanced itself from Morse and Wispelwey’s article following public outcry, and it released a statement denying that the hospital offered or planned to offer preferential care on the basis of race, repeatedly stating that the pilot program was merely under consideration.

Brigham’s statement said news stories about the proposal were misleading, but it did not denounce the Boston Review article or its authors or contest the article’s claim in the article that “[racial reparations are] exactly what we have tried to achieve in the design our new pilot initiative at Brigham and Women’s Hospital.” Brigham also did not challenge the authors’ claims that the colorblind approach to medicine was insufficient.

Mark Murphy, a Brigham spokesman, told the DCNF the final version of the pilot program set to be implemented later this year to address racial health disparities would give “educational notices” to clinicians admitting patients with heart failure to the hospital. The notices would educate employees that black and Latino individuals are historically less likely to be admitted to cardiological services, but they would not restrict clinicians’ individual judgement and decision-making, according to Murphy.

Murphy told DCNF the Boston Review article was “an opinion piece and reflects the perspective of these two physicians,” but the article’s authors, who work at Brigham, called the pilot program “our pilot program,” a fact Brigham has not disputed. Murphy confirmed that both Morse and Wispelwey helped create the final pilot program going into effect this year.

More than 1,000 health professionals publicly supported mass protests in the wake of George Floyd’s death in June 2020 despite COVID-19 concerns, arguing that racism was a public health threat which superseded the medical community’s social distancing advice. Jennifer Nuzzo of Johns Hopkins argued at the time that “in this moment the public health risks of not protesting to demand an end to systemic racism greatly exceed the harms of the virus.”

RESEARCH

Three scientists argued that “researchers must name and interrogate structural racism and its sociopolitical consequences as a root cause of the racial health disparities we observe” in the prominent Journal of the American Medical Association in September 2020. Their insistence that researchers ignore the impact of personal choice and environmental factors is part of a broader effort within medicine to erase individual agency and blame all health disparities on systemic racism.

The National Institutes of Health (NIH), the largest funder of biomedical research in the world, has also turned its attention to racial issues. Its plan for ending structural racism in biomedical sciences includes pouring funding into research projects on structural racism and expanding diversity and inclusion programs for NIH administrators.

The NIH plays a major role in determining what kind of scientific research goes on in the U.S., funding more than $30 billion of biomedical research each year. Its new emphasis on race has driven important research on racial health disparities and their causes. It has also resulted in millions of taxpayer dollars being poured into research which is distinctly ideological rather than scientific.

The NIH gave $3.4 million to a Tulane researcher in October to develop an app that helps white parents teach “anti-racism,” as opposed to color-blindness, to their children. It also gave $600,000 to a University of Michigan professor to teach “anti-racism” to middle school students, Campus Reform reported.

ACADEMIA

A 2020 study on racial disparities in birthing mortality for newborns found that black newborns cared for by black doctors are half as likely to die compared to black babies treated by white physicians. The study failed to note that, in cases of a bad NICU outcome, the department chair or division chief is more likely to be listed as the doctor of record regardless of whether that doctor was ever involved in the care of the newborn. Department chairs and division chiefs are more likely to be white, according to Li.

“It’s garbage data in, garbage conclusion out … but what the public takes away is that white doctors are killing black babies. How is that going to create trust among our African American patients? I worry they will stop going to the hospital if they get sick,” Li said.

Dr. Norman Wang, a program director at the University of Pittsburgh medical school, was removed from his position after publishing a paper which questioned the efficacy of race-based affirmative action.

Dr. Edward Livingston, an editor of the Journal of the American Medical Association (JAMA), argued on a podcast that socioeconomic factors, not structural racism, held back communities of color. Livingston and the top editor at JAMA both resigned after public outcry, with the latter being suspended for three months before his resignation.

The Association of American Medical Colleges wrote that leaders in academic medicine “are weaving content and experiences throughout their curricula to significantly boost awareness of social inequities and structural drivers of health” and argued that equity-related “social drivers need to be woven into the very fiber of medical education.”

Li told the DCNF she is concerned that practices based in “race Marxism” could negatively affect medical education and ultimately patient care by detracting from the limited time medical students have to learn critical scientific information.

Doctors are noticing a decline in newly-graduated medical interns, Li explained.

Li also worries that doctors may be asked in the future to pledge allegiance to “race Marxism” ideology in the maintenance of license process, meaning that doctors who do not comply would risk losing their medical licenses or board certifications. The American Board of Medical Specialties (ABMS), which controls medical licensing in the U.S., already incorporates diversity, equity and inclusion (DEI) content into its continuing certification programs.

ABMS member boards, which license doctors in specific fields, such as family medicine or pediatrics, collect racial data on candidates and physicians to evaluate certification exams and incorporate the data into “ongoing improvement efforts,” according to the ABMS website. Most of these boards also provide implicit bias training for item writers and examiners and plan to expand these trainings further, the website states.

ABMS did not respond to the Daily Caller’s requests for comment.

INCENTIVES

Dr. Carrie Mendoza, a Chicago-based emergency medicine physician and Fellow of the American College of Emergency Physicians, spoke with the DCNF about how new ideas travel from academia into patient care and medical administration using the example of the opioid crisis.

Doctors use CPT codes, which are owned by the American Medical Association (AMA), to bill insurance and government  programs such as Medicare. Since the AMA derives income through doctors’ use of CPT codes, there is an incentive to create more codes, Mendoza explained.

In the early 2000s, widespread concern that patients’ pain was not being adequately addressed led regulators to require doctors and hospitals to measure pain, introducing the pain scale as the “fifth vital sign,” Mendoza said. Doctors’ improvement of their patients’ pain scores was used to determine whether doctors were “meeting goals,” and it even impacted doctors’ bonuses, according to Mendoza. Doctors were incentivized to prescribe more pain medication, and the AMA’s CPT codes for pain treatment were the structure through which those financial incentives were fulfilled.

“In emergency medicine we quickly saw that people were getting inappropriate prescriptions for things like ankle sprains and then becoming addicts, then there were diversions and overdoses,” Mendoza explained. 

Mendoza sees a link between the early stages of the opioid crisis and the current popularity of racial essentialism in the medical field. By creating CPT codes for Social Determinants of Health (SDH), a new umbrella term adopted by the medical industry to focus on patients’ education and their experiences with discrimination, poverty and incarceration, among many other factors, the AMA is incentivizing a bureaucracy to focus on issues outside the doctor’s control, Mendoza argued.

“There’s a parallel here where admission requirements for medical schools and residency are being loosened. When these factors converge, you get into an environment where there can be patient harm,” Mendoza said.

Mendoza speculated that the government could use data collected through SDH codes to justify its priorities in healthcare. For example, the University of Illinois, citing data on homelessness as a social determinant of health, partnered with the Center for Housing and Health to provide housing for homeless patients.

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The AMA, which develops CPT codes, released a 2021-2023 “strategic plan to embed racial justice and advance health equity” which aims to “understand and operationalize anti-racism equity strategies … develop structures and processes to consistently center the experiences and ideas of historically marginalized … and minoritized (Black, Indigenous, Latinx, Asian and other people of color) physicians” and “amplify and integrate often ‘invisible-ized’ narratives of historically marginalized physicians and patients in all that AMA does.”

The American Medical Association did not respond to DCNF’s requests for comment.