Woke Medicine: A Prescription for Disaster

REVIEW: 'Take Two Aspirin and Call Me By My Pronouns' by Stanley Goldfarb, M.D.

'Take Two Aspirin and Call Me By My Pronouns' by Stanley Goldfarb, M.D. /
May 22, 2022

It is a popular sport among those on the progressive left to dismiss conservatives' concerns about the spread of "woke" ideology (such as Critical Race Theory and "antiracism" training) in public education and corporate culture. Parents are scolded for suggesting that seeing the world through the "lens of CRT" or the factually challenged posturing of the 1619 Project might be harmful to their children's education, and employees are chastised for questioning the effectiveness of new mandates on Diversity, Equity, and Inclusion. The implication is that only a racist would resist the new "antiracism."

And yet, there is one arena in which woke thinking is not merely politically polarizing, but deadly. As Dr. Stanley Goldfarb, a nephrologist and associate dean for curriculum at the Perelman School of Medicine at the University of Pennsylvania, writes in Take Two Aspirin and Call Me By My Pronouns, the "quiet woke revolution" that had been going on in medicine for some time "erupted in spring 2020 into a full-blown revolution"—one with ongoing negative consequences.

That year, in the wake of the killing of George Floyd in Minneapolis and the ensuing protests, and amid a global pandemic, doctors and medical students began going well beyond their remit as physicians to embrace the role of social justice activists. "Led by a cadre of woke administrators who embraced the tenets of critical race theory, the medical establishment was committing itself to a misguided focus on anti-racism and equity in all aspects of the health-care system," Goldfarb writes.

Groups of physicians organized under names such as White Coats for Black Lives, and issued manifestos that were little more than crypto-Marxist argle bargle: A June 2021 statement outlined the group's mission of "dismantling dominant, exploitative systems in the United States, which are largely reliant on anti-Black racism, colonialism, cisheteropatriarchy, white supremacy, and capitalism," for example. When "just what the doctor ordered" means a lecture on the harms of the cisheteropatriarchy, it is clear medicine has strayed far from its professional purpose.

Goldfarb makes short work of many of the faulty "antiracism" medical studies that take as their starting point the new popular assumption that medicine is racist. One frequently cited study about pain treatment in black and white patients claimed white doctors do not adequately treat black patients for pain; in fact, as Goldfarb describes, that study's conclusions relied on other studies that were themselves seriously flawed and often not replicable, but which nevertheless received a great deal of attention, citation, and publication in prestigious medical journals eager to demonstrate their "antiracism" bona fides.

Likewise, studies of maternal and infant care of black women versus white women have yielded poorer outcomes for black women. If you ask a woke believer why this is the case, they will tell you something akin to the word salad offered by Vice President Kamala Harris: "Systemic racial inequities and implicit bias." But, Goldfarb notes, to come to such alarmist conclusions one must ignore, as many of these studies do, many confounding factors such as the fact that black women "tend to have more underlying 'comorbid' conditions such as obesity, diabetes, and hypertension. They tend not to seek prenatal care as often as White women despite government programs to support such visits." In fact, "Were obstetricians to take classes in unconscious bias every year of medical school, their attendance would not do a thing to alter the factors that contribute to the greater risk of childbirth in the Black community."

Although "antiracism" studies are built on sand, they serve a professional and practical purpose for woke physicians by creating an easy villain. "The new religion of 'wokism' demanded the acceptance of a crippling mythology that racism—or even White supremacy—was the cause of the very real disparities in health-care outcomes for Black communities," Goldfarb writes. Far easier to cite "racism" than to delve into the complicating factors that impact individual health.

Goldfarb is at his best when he tackles two disturbing trends in medicine: the dumbing down of standards for entrance into medical schools and the capitulation of medical school curricula to woke posturing at the expense of rigorous clinical training. He sees how even the American Medical Association has engaged in an institutional effort to appear more equitable by attacking the very idea of merit. The AMA's recent master plan, for example, decries the "myth of meritocracy and other malignant narratives."

Goldfarb notes the irony of claims that medical schools and hospitals are awash in white supremacy; these are the same institutions that for decades have pursued affirmative action policies that hold minority applicants to lower standards than their white peers. "The inarguable reality is that Blacks are preferentially admitted to medical school. Once admitted, they are virtually guaranteed to graduate. And once graduated, they are likely to find training programs more than eager to accept them in the name of diversity," he writes. "Black students with a middling GPA in college and a 50ish percentile rank on the MCAT had a ninefold greater chance than White students. In other words, while only 20 percent of White applications with such mediocre grades and scores were admitted to medical school, 85 percent of comparable Black applicants were."

When minority students fail to achieve at levels considered "equitable" to students of other races, the standards are simply changed or dropped to achieve the desired outcome. When black medical students failed to qualify for Alpha Omega Alpha (the medical school society equivalent of Phi Beta Kappa, which inducts entrants based on academic achievement), woke scholars like Dr. Catherine Lucey at UCSF attacked the standards, claiming the "systems we use [for student evaluation] fail to take into account the extra work minorities are doing." What extra work is this? She cited, without evidence, "stressors" such as "low levels of racism that exist in our patients." As Goldfarb puts it, "If extra work and stressors were the criteria, young women who give birth during medical school would be automatic inductees."

Once accepted into medical school, students encounter far less rigorous training than in previous eras. Citing equity goals, many medical schools have moved from issuing grades to pass/fail assessments. A longtime educator himself, Goldfarb is concerned that "the science content of student education has been dramatically reduced. So has the range of clinical experience," which has "diminished the practical value of medical education." What are they learning instead? As Goldfarb describes, "Researchers at the University of Oregon, writing in the journal Academic Medicine in 2021, surveyed the curricula of 122 medical schools and found that more than half had a required course that covered elements of advocacy." The goal of such classes is "clearly political, not medical."

Woke medicine thus creates its own feedback loop:

Many young physicians and medical students see poverty, housing, police policies, incarceration rates, climate, and gun control as legitimate concerns of the medical profession. This expanded role for physicians is the rationale for the proposed transformation in medical education. Medical students are not being educated in the complexities of social policy. They are being indoctrinated. Once programmed, they can leverage the trust placed in physicians to advocate for a variety of progressive policies that have never worked anywhere.

Goldfarb is blunt in his assessment of the consequences—not the woke utopia imagined by its practitioners, but degraded health care for all: "By abandoning the traditional values such as treating all patients equally and recruiting the best and the brightest students, too many health educators have adopted a racialist agenda that will, if anything, aggravate health disparities and undermine the trust of patients of all races."

Humanities majors might wince when Goldfarb says, "It is one thing for the Princeton classics department to abandon its Latin requirement for classics majors. It is quite another for Harvard Med to cut training time in biochemistry and pharmacology for future doctors. After all, no one dies if the classics major cannot conjugate morior." But he is right to point out the real-world stakes. Commenting on the AMA's "Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity," Goldfarb notes, correctly, and chillingly, "Unlike other social justice programs, this program is lethal. It will tangibly reduce the quality of medical care, and almost every American will suffer its side effects."

Throughout the book, Goldfarb makes a convincing case that woke medicine is both a distraction and a danger. It's a distraction because it exacts serious opportunity costs. Training doctors to be activists rather than to better treat individual patients does little to improve health care; physicians should be eliminating suffering, not engaging in social engineering. Likewise, it is dangerous because by lowering standards and rigor in the name of "equity," it undermines the quality of medical care.

It also justifies racist practices in the name of righting past injustices. A badly designed study that purported to show that white cardiac patients received better care than black patients concluded by noting proudly that the hospital where the researchers worked now practiced "a preferential admission option for Black and Latinx heart failure patients to our specialty cardiology service." As Goldfarb writes, "this is probably illegal but certainly immoral and an abrogation of the authors' medical oath to care for the best interests of the patient." Unfortunately, there are many more examples of physicians sacrificing patient care on the altar of political correctness.

Oddly for revolutionaries, today's woke physicians and medical students are surprisingly sensitive. Harvard Medical School's Brigham and Women’s Hospital recently caved to the complaints of woke medical students who said that the hospital’s main auditorium made them "uncomfortable" because it contained portraits of past leaders in the profession, who happened to be white men. "These giants of American medicine did not own slaves, treat Indians poorly, experiment on Black patients, or help the American military in any way," Goldfarb notes. "Their sin was to be White, all of them, and, even worse, male. Their very existence was a microaggression." For a profession that requires rigor, intelligence, and resilience, such coddling does not bode well.

And yet, Goldfarb is not despairing; rather, he calls for a "neo-traditional counterrevolution" in medicine that will revive higher standards for medical education and practice—standards uncorrupted by ideological crusades. He has spearheaded the formation of a nonprofit organization, Do No Harm, to eliminate identity politics in medicine.

It is a mark of his good sense that Goldfarb manages to maintain a wittily combative tone throughout his book—a commendable quality given the concerted efforts by some of his colleagues to cancel him. The book grew out of an opinion piece he published in the Wall Street Journal and for which he was pilloried by his woke colleagues and attacked on social media as an "asshole." Goldfarb writes, "My goal is to inspire my fellow assholes to go full Howard Beale and shout from the rooftops, 'I'm as mad as hell and I’m not going to take this anymore.'"

After reading this book, every American who has ever set foot in a hospital or a doctor's office should be mad as hell too.

Take Two Aspirin and Call Me By My Pronouns: Why Turning Doctors into Social Justice Warriors is Destroying American Medicine
by Stanley Goldfarb, M.D.
Bombardier Books, 216 pp., $17

Christine Rosen is senior writer at Commentary magazine and a fellow at the Institute for Advanced Studies in Culture at the University of Virginia.

Published under: Book reviews , Health Care