Equity Agenda Response

Equity Agenda Response


We must speak up when something seems unethical and offensive to our moral intuitions. We must speak up when new initiatives that restrict and dictate how we provide medical care are forced upon us. The future of our healthcare and the well-being of our patients depend on it.

Response to Equity Agendas of Medical Professional Societies

Introduction

Since the murder of George Floyd, many medical professional societies have advocated for radical institutional change.  We are bombarded with information about how to remedy our complicity in racism, misogyny, and oppression with things like Diversity, Equity, and Inclusion (DEI) committees, anti-racism training, and implicit bias seminars. In January of 2021, the American Academy of Pediatrics (AAP) released the AAP Equity Agenda, which cites Intersectionality as a core principle.  The American Medical Association (AMA) released The AMA's strategic plan to embed racial justice and advance health equity, which cites Critical Race Theory (CRT) as a framework for policy. The American College of Surgeons (ACS) has hired new DEI officers that will implement institutional changes, as well.

Many items in these Equity Agendas are not only antithetical to the core mission of physicians but also will harm our patients and their families.

Definition of Equity and the Origin of Structural Determinism

Let us start with definitions.  What is “equity?”  The Milken Institute School of Public Health at George Washington University defines equity as “recognizing that each person has different circumstances and allocating the exact resources and opportunities needed to reach an equal outcome.”  It’s unclear who would be chosen to do the measuring of outcome and the allocating. It is clear though, that equal opportunity is not the goal. Implied in this specific definition of “equity” is the idea that disparate outcomes are caused by disparate distribution of resources, and that perpetually unjust power structures of society determine outcomes.  

The name of this concept is “structural determinism.” Structural determinism hinges on the assumption that any social system is organized such that one group is positioned to oppress another in a zero-sum game.  This is a core belief of Karl Marx and his future acolytes, the Critical Theorists of the Frankfurt School. These people, along with French postmodernists, provided the basis of the current social philosophies of Critical Race Theory, Intersectionality, Queer and Gender Theory and Radical Feminism.  Based on the common threads of power and oppression that weave these Critical Social Justice (CSJ) philosophies together, the only way to achieve “equity” is to identify and dismantle “the systems of oppression.”  For example, according to the AMA, they plan to “empower physicians and health systems to dismantle structural racism and intersecting systems of oppression.” (AMA p. 48) “The system,” in CSJ jargon, encompasses the entire liberal society.  Critical Race Theorists Richard Delgado and Jean Stefancic explain it best: " Unlike traditional civil rights, which embraces incrementalism and step-by-step progress, critical race theory questions the very foundations of the liberal order, including equality theory, legal reasoning, Enlightenment rationalism, and neutral principles of constitutional law.” (Delgado and Stefancic, 2001)

 

Track Record of Equity Policies

We cannot accept the assumptions of Critical Social Justice on faith. Given how complex it is to measure health and economic outcomes, accounting for all the causal factors that impact them, it is impossible to distill a multivariate equation down to a single variable.  Also, if equal outcome is the goal, then what fundamental ethical values will be sacrificed to achieve it?  We have already experienced how this ideology impacts our education system.  Achieving “Equity”, at least through this lens, means eliminating standardized tests, lowering academic standards (Soave, 2021), and even overtly discriminating against some racial groups in favor of others (Gardey, 2021) (Breuninger, 2020).  In the workplace, DEI policies tend also to be counterproductive.  Peter Bregman, writing for the Harvard Business Review, cites a study reviewing identity-based diversity training in 829 companies over 31 years.  It finds that such trainings provide no benefit in the workplace (Bregman, 2012). In many situations, DEI actively creates more division and animus. It forces people to look at each other by group identities, not individual characteristics, solidifying stereotypes about race and gender.

Furthermore, to achieve “equity” under the “equal outcome” definition, we abandon the principle that people who achieve excellence should occupy leadership positions.   We sign up to the harmful idea that merit and excellence cannot be objectively measured.  We usher in a powerful new aristocracy which forces our institutions to allocate opportunities unfairly and unequally, in order to achieve its vision of “leveling the playing field.” 

Deeper Examination of One Medical Equity Agenda

There are certain objectives that are especially alarming in the AAP Equity Agenda. Section III, Objective 3.2 states that the AAP will “require consideration by the Board of racial and ethnic diversity in appointing committee members and selecting nominees for other leadership positions, including editorial boards.” Does this mean that race and gender will be prioritized over other qualities when choosing among candidates?  The language of this objective implies that one’s immutable characteristics will be prioritized over clinical, research, or educational excellence.  It implies that these unchangeable attributes create a perspective and competence that cannot be achieved through experience and hard work, but only through living in a state of marginalized oppression in a liberal society.  It may also violate the Civil Rights Act. 

Section 5 Objective 5.3 states that the AAP plans to “use the Academy’s advocacy resources to promote federal, state, and community-level advocacy that addresses health inequities, advances racial equity, and promotes social justice.” How does the AAP define “social justice”?  Does it mean justice based on liberal principles, as most people would expect it to mean, or Critical Social Justice?  The language seems intentionally vague, which leaves room for ad hoc political activism in a document that ought to be promoting patient well-being.  The public can see that putting this philosophy to practice in public health leads to such situations as when New York City decides to distribute Covid monoclonal antibodies based on patients’ race.  (FAIR vs. NYC)

There are some positive things, to be sure, in the AAP Equity Agenda. The AAP advocates for the establishment of a primary care provider for all patients.  We know that patients have better health outcomes when they have established “medical homes,” and rural patients tend to be underserved in this area. It is a worthy goal to establish primary care for all patients, regardless of their location or resources. The AAP also advocates for delivering sensitive medical care that addresses the needs of patients who don’t speak English, or who have traditional beliefs about health.  Lastly, the AAP advocates for providing minority medical students with meaningful opportunities for exposure to pediatrics.  These are all worthy endeavors.

Consequence of CSJ-based DEI and Equity Agendas

Nonetheless, at the heart of these Equity Agendas, based in Critical Social Justice, is a Trojan Horse attempt to reshape how we view each other into the classic Marxian power struggle. Many people, unfamiliar with the Critical Social Justice literature, jump on board because of the nice language and motte-and-bailey (bait and switch) linguistic manipulation tactics.  Once we get past the deliberate and methodical redefinition of common words, we see that these Equity Agendas call for the resurgence of an ancient, illiberal worldview, in which we view others primarily by their identity groups based in immutable characteristics. We are being asked to no longer treat every patient individually and fairly, knowing they each have unique circumstances and challenges.

Additionally, our medical societies are now prioritizing identity politics over merit when creating the future healthcare workforce.  Given that the AMA has called merit a “malignant narrative” rooted in White Supremacy (AMA 2021), they are signaling they will work within the framework of an intolerant orthodoxy to lower standards of medical care and medical education in the name of Equity.  The predictable result will be a massive loss of trust in medical institutions by the public, leading to unnecessary and preventable death and suffering.  

A Call for Action

We, the undersigned, reject the core of any medical association’s Equity Agenda based in Critical Social Justice.  Instead, we state our support for efforts based in Merit, Fairness, and Equality (MFE).   We call for treating colleagues and patients as individuals.  We strive for a common humanity and a color-blind society that upholds meritocracy.  We do not deny that our country has struggled with grotesque racism in the past, and that we still deal with echoes of that past.  However, we believe that tremendous progress has been made by affirming humanistic values.  We call for a renewal of the legacy that emerged from the Civil Rights movement: to judge people based on the content of their character, not the color of their skin.   Some people insist that this vision over-simplifies the entire body of Martin Luther King’s work.  They even cynically insist that this vision is a trick, a mirage created by White supremacists to maintain White power.  (Derrick Bell, 1992) No!  This vision of Martin Luther King, reflected on the signs of Black men who marched during the Memphis Sanitation Strike--signs that read “I am a man!”—is what convinced swaths of ordinary Americans to condemn racism and embrace the universal humanity in all people.  Appealing to this moral intuition in Americans is what moved our country forward in fulfilling the Constitutional promise of ensuring equality and freedom for all. 

We must have courage.  We must speak up when something seems unethical and offensive to our moral intuitions.  We must speak up when new initiatives that restrict and dictate how we provide medical care are forced upon us. The future of our healthcare and the well-being of our patients depend on it.

 

Authors:

Erica Li, MD, pediatrician

J. Lee Pace, MD, orthopedic surgeon

Lindly Theroux, DO, pediatrician

Signees:

Diana Blum, MD, neurologist

Richard T. Bosshardt, MD, FACS, plastic surgeon

Marilyn M. Singleton, MD, anesthesiologist

Nancey Trevanian Tsai, MD, FABPMR, rehabilitation medicine

 

Get in touch with us at criticalmedtheory@gmail.com

 

Works Cited

American Medical Association. (2021, May). The AMA's strategic plan to embed racial justice and advance health equity. Retrieved from AMA: https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity

 

Bell, Derrick, A Jr. "Racial Realism," Connecticut Law Review 24, no 2 (1992)

 

Bregman, P. (2012, March 12). Diversity Training Doesn't Work. Retrieved from Harvard Business Review: https://hbr.org/2012/03/diversity-training-doesnt-work

 

Breuninger, K. (2020, August 13). Yale 'illegally discriminates' against White and Asian students, Justice Department says. CNBC.com.

 

Delgado, Richard and Jean Stefancic.  Critical Race Theory: An Introduction.  First edition (2001).” p. 7

 

FAIR vs. NYC

 

Gardey, E. (2021, March 28). Asian Discrimination: Colleges Move to Eliminate the SAT. Retrieved from American Spectator:  https://spectator.org/asian-discrimination-sat-requirements/

 

Soave, R. (2021, May 4). In the Name of Equity, California Will Discourage Students Who are Gifted at Math. Retrieved from Reason.com:  https://reason.com/2021/05/04/california-math-framework-woke-equity-calculus/

 

 

 

 

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