{"id":74872,"date":"2021-11-29T15:26:39","date_gmt":"2021-11-29T21:26:39","guid":{"rendered":"https:\/\/milesfortis.com\/?p=74872"},"modified":"2021-11-29T15:27:11","modified_gmt":"2021-11-29T21:27:11","slug":"74872","status":"publish","type":"post","link":"https:\/\/milesfortis.com\/?p=74872","title":{"rendered":""},"content":{"rendered":"

BLUF:
\nThe co-opting of medicine by woke progressives could turbo-charge all that is dangerous about public health. AHE should worry any patient whose life, health and ease of mind depend on a doctor now focused on concerns other than the patient at hand.<\/strong><\/em><\/p>\n

The Pall of Politics Descends Upon American Medicine.<\/a><\/p>\n

A new guidance document for medical professionals emphasizes critical race theory and social justice at the expense of patient care<\/em><\/p>\n

Under new AMA guidelines, doctors\u2019 bedside manner is to be replaced with an air of accusation<\/p>\n

Politics, and in particular hard-left \u201cwokeness,\u201d is infecting American medicine\u2019s bloodstream. The danger cannot be overstated. It threatens medical professionals, patients, medical science and America\u2019s civic life. Like so many societal pathologies, this one seems to have turned septic during the COVID-19 pandemic. The most prominent symptom is a newly released document that is at once laughable and terrifying.<\/p>\n

New Language for a New Orthodoxy<\/strong><\/h3>\n

In October, two of the most powerful medical organizations in America\u2014the American Medical Association (AMA) and the American Association of Medical Colleges\u2014released \u201cAdvancing Health Equity: A Guide to Language, Narrative and Concepts<\/a>,\u201d or AHE. Its 54 densely packed pages admonish American physicians to regiment their speech to conform with woke terminology. The document implores doctors to abandon ordinary expressions in favor of politically charged, politically correct circumlocutions.<\/p>\n

Medical professionals are now expected to traverse a linguistic minefield, abandoning hundreds of familiar expressions and replacing them with tortured academic cadences. Failure to conform, the document implies, is a severe moral failing.<\/p>\n

This is not merely replacing the simple with the sesquipedalian. The doctor\u2019s every utterance must contain an air of accusation. When someone is ill, it is because someone else is to blame. Previously, a caring doctor might have told an African American patient that his lineage makes him especially vulnerable to diabetes. No more. In woke-speak, the word \u201cvulnerable\u201d is verboten. Now, the doctor must refer to the patient as \u201coppressed,\u201d \u201cmade vulnerable\u201d or \u201cdisenfranchised.\u201d Someone, or some grotesque societal failing, is to blame for the patient\u2019s higher-than-average risk of diabetes. The explanation for this particular lexical shift is representative of AHE\u2019s tone and worldview:<\/p>\n

Vulnerable is a term often used to describe groups that have increased susceptibility to adverse health outcomes. We even describe individual people as vulnerable or not, often based on socioeconomic status.<\/p>\n

If we pause to examine our taken-for-granted narrative, we see that vulnerability can be understood in very different ways. In this case, as a characteristic of people or groups. But what if we shift the narrative from an individualistic lens to an equity lens?<\/p>\n

In doing so, we begin to ask questions about the structural origins of vulnerability. Vulnerability is the result of socially created processes that determine what resources and power groups have to avoid, resist, cope with, or recover from threats to their well-being.<\/p>\n

Instead of stigmatizing individuals and communities for being vulnerable or labeling them as poor, we begin to name and question the power relations that create vulnerability and poverty. People are not vulnerable; they are made vulnerable.<\/p><\/blockquote>\n

The entire document reads like final exam essays written by a student who forgot to study\u2014endless strings of half-remembered vocabulary words assembled randomly in hopes that the professor will count the words but not read them. Every med student, every doctor in America must endure hundreds of such homilies and conform or be weighed in the balance and found wanting. Doctors must abandon the notion that a patient bears some individual responsibility for his or her health status. Whatever ails you, somebody out there did it to you. In the search for scapegoats, AHE taps into the fashionable academic catechisms of critical race theory and intersectionality and swears fealty to both.<\/p>\n

<\/p>\n

Recent Criticism<\/strong><\/h3>\n

Three recent essays from Commentary magazine express concern about the negative effects of woke ideology on American discourse. Two concern medicine, and one of those focuses on AHE.<\/p>\n

In \u201cWe Got Here Because of Cowardice. We Get Out With Courage: Say\u00a0No<\/em>\u00a0to the Woke Revolution<\/a>,\u201d Bari Weiss masterfully describes the wokeness phenomenon. While she does not specifically address AHE, her descriptions provide a valuable lens on the document. Woke ideology \u201cbegins by stipulating that the forces of justice and progress are in a war against backwardness and tyranny. . . . [P]ersuasion . . . is replaced with public shaming. Moral complexity is replaced with moral certainty. Facts are replaced with feelings. . . . Ideas are replaced with identity. Forgiveness is replaced with punishment. Debate is replaced with de-platforming. Diversity is replaced with homogeneity of thought. Inclusion, with exclusion.\u201d<\/p>\n

Weiss writes, \u201cThose who do not abide by every single aspect of its creed are tarnished as bigots, subjected to boycotts and their work to political litmus tests.\u201d Neutrality is forbidden, and skeptics are heretics. Any disparity is conclusive proof of racism, according to Ibram X. Kendi, whom Weiss describes as \u201cthe high priest of this ideology\u201d and whose words underlie AHE.<\/p>\n

AHE is laden with villains defined as Weiss describes. AHE finds the following sentence unacceptable: \u201cLow-income people have the highest level of coronary artery disease in the United States.\u201d Instead, the doctor should say: \u201cPeople underpaid and forced into poverty as a result of banking policies, real estate developers gentrifying neighborhoods, and corporations weakening the power of labor movements, among others, have the highest level of coronary artery disease in the United States.\u201d<\/p>\n

Now we can point fingers at whoever is responsible for whatever ills befall people in a low-income neighborhood. If that neighborhood lacks doctors or hospitals, the doctor mustn\u2019t speak of an \u201cunderserved community.\u201d Rather, the community is \u201chistorically and intentionally excluded\u201d from proper care. There are no sins of omission; someone wanted those outcomes and actively sought them.<\/p>\n

In \u201cWokeness M.D.: The Threat to Medicine<\/a>,\u201d Tevi Troy wonders \u201cwhether wokeness is directing doctors to treat patients unequally,\u201d citing anecdotal evidence that such notions are enveloping medicine. Troy describes a psychiatrist speaking at Yale School of Medicine on \u201cThe Psychopathic Problem of the White Mind.\u201d Among her words, \u201cWhite people make my blood boil. . . . I had fantasies of unloading a revolver into the head of any white person that got in my way, burying their body and wiping my bloody hands as I walked away relatively guiltless with a bounce in my step, like I did the world a favor.\u201d Yale offered tepid concerns about the talk, but, as Troy says, \u201cSuch a lecture and the lukewarm response highlights a problem that could spread\u2014a world in which a credentialed medical practitioner could feel confident in publicly expressing such murderous views without paying any sort of professional price.\u201d<\/p>\n

Troy says wokeness is already interfering with scientific research. He cites the case of Norman Wang, an associate professor at the University of Pittsburgh Medical Center. In a peer-reviewed paper, Wang asserted that \u201call who aspire to a profession in medicine and cardiology must be assessed as individuals on the basis of their personal merits, not their racial and ethnic identities.\u201d According to Troy, \u201cThe journal retracted it [the paper], his medical center renounced it, and Dr. Wang was removed from his position and demoted by the university. His data were not at issue, but his conclusions were deemed unacceptable.\u201d<\/p>\n

In \u201cCritical Race Theory Is Coming for Your Doctor<\/a>,\u201d Christine Rosen takes direct aim at AHE. She calls the document \u201can effort to wrap these ideologically-suspect ideas and jargon in the cloak of science\u2014all while forcing physicians to start talking like good social-justice soldiers.\u201d Per AHE, she says, \u201cthe tools of the medical profession are to be turned not to better health care, but to social justice,\u201d which is philosophically based on \u201ccritical race theory . . . gender studies, disability studies, as well as scholarship from social medicine.\u201d<\/p>\n

The likely result is \u201cto burden medical professionals with the task of constantly signaling their allegiance to this new ideology rather than simply being good doctors.\u201d The AMA, she says, \u201cwants its members\u2019 primary focus to be social justice, not medical care.\u201d Doctors must \u201cshift the narrative,\u201d in the words of AHE, \u201cfrom the traditional biomedical focus on the individual and their behavior to a health equity focus on the well-being of communities, as shaped by social and structural drivers.\u201d<\/p>\n

Unacceptable Terms<\/strong><\/h3>\n

AHE\u2019s authors seek to avoid offending a long list of groups who (they presume) are displeased by terse phrases but, it seems, not by longer, imprecise, meandering euphemisms. \u201cMarginalized communities\u201d become \u201cgroups that have been historically marginalized or made vulnerable.\u201d An \u201cex-con\u201d or a \u201cfelon\u201d is now \u201cformerly incarcerated,\u201d \u201ca returning citizen\u201d or a \u201cperson with a history of incarceration.\u201d A minority is now \u201chistorically marginalized\u201d or \u201cminoritized\u201d or \u201cBIPOC\u201d (Black, Indigenous and people of color). The obese are now \u201cpeople with obesity.\u201d One cannot be a \u201cCOVID-19 case\u201d; rather, one is a \u201cperson with COVID-19.\u201d \u201cThe homeless\u201d become \u201cpersons experiencing homelessness,\u201d as if linguistic terpsichore provides the person with a warm bed and a square meal.<\/p>\n

One can no longer \u201ctackle issues within the community\u201d because \u201ctackle\u201d is a word connoting violence and, hence, offensive. Doctors must no longer speak of the war against cancer or combating cancer because \u201cwar\u201d and \u201ccombat\u201d are also violent terms. Instead, doctors must \u201celiminate\u201d cancer. One hopes that AHE\u2019s authors don\u2019t learn that Google\u2019s definition of \u201celiminate\u201d includes \u201cmurder (a rival or political opponent).\u201d The last sentence hints at endless future lexical revisions\u2014thus turning the English language into a continual game of three-card monte.<\/p>\n

These linguistic contortions may even harm the very people they are trying to serve. AHE advises against the use of the term \u201cfree clinic\u201d because the word \u201cfree\u201d is demeaning. But\u00a0Conor Friedersdorf notes<\/a>\u00a0that an advantage of the term \u201cfree clinic\u201d is that it informs people of the price (zero) charged by the clinic. Without that simple name, Friedersdorf says, \u201cfew poor people will know that they can get care there without having to pay.\u201d<\/p>\n

Throughout AHE, there are overt suggestions and subtle hints that one\u2019s own health is not one\u2019s responsibility. \u201cPeople who do not seek healthcare\u201d are now \u201cworkers under-resourced with\u201d something. As noted earlier, the implication is that the person who did not receive care is blameless. Someone else is, by implication,\u00a0always<\/em>\u00a0to blame. \u201cDisparities\u201d and \u201cinequalities\u201d should be dropped in favor of \u201cinequities,\u201d because if John is less healthy than Joe, then someone other than John is explicitly to blame for John\u2019s unfortunate lot.<\/p>\n

AHE repeatedly uses passive verbs. \u201cVulnerable groups\u201d become \u201cgroups that have been economically\/socially marginalized.\u201d This verb structure implies that the unfortunate conditions just happened to the person and implicitly blames some outsider.<\/p>\n

\u201cEquality\u201d is replaced by \u201cequity.\u201d AHE\u2019s 168-word explanation for this substitution includes:<\/p>\n

Seeking to treat everyone the \u201csame\u201d . . . ignores the historical legacy of disinvestment and deprivation through policy of historically marginalized and minoritized communities as well as contemporary forms of discrimination that limit opportunities. . . . Through systematic oppression and deprivation from ethnocide, genocide, forced removal from land and slavery, Indigenous and Black people have been relegated to the lowest socioeconomic ranks of this country. The ongoing xenophobic treatment of undocumented brown people and immigrants (including Indigenous people disposed of their land in other countries) is another example. Intergenerational wealth has mainly benefited and exists for white families.<\/p><\/blockquote>\n

Who\u2019s To Blame?<\/strong><\/h3>\n

Scapegoats\u2014corporeal and conceptual\u2014emerge throughout the document. AHE wants to \u201cexpose the political roots underlying apparently \u2018natural\u2019 economic arrangements, such as property rights, market conditions, gentrification, oligopolies and low wage rates.\u201d So, owners of property, constitutional and legal protections of property, businesses, and those who move into previously decrepit neighborhoods are all poised for blame. Other scapegoats include bankers, real estate developers and corporations weakening the power of the labor movement. The \u201cfree market\u201d is also to blame, based on a specious, caricatured, ignorant definition provided in AHE.<\/p>\n

\u201cFree\u201d refers specifically to the absence of public regulations and state intervention to defend workers safety as well as consumer and environmental protection. This concept cannot be found on a large scale in practice since modern markets rely on rules, regulations, property rights and enforceable laws, including those governing corporations, partnerships, foreign exchange, trade, etc.<\/p><\/blockquote>\n

Another recurring theme in AHE is \u201cwhiteness,\u201d which\u00a0doesn\u2019t necessarily have anything to do with a person\u2019s skin tone<\/a>\u00a0(or maybe it does; depends when you ask):<\/p>\n

Whiteness . . . is both cultural and socioeconomic power and privilege. Whiteness, according to sociologist Ruth Frankenberg, is \u201cdominant cultural space with enormous political significance, with the purpose to keep others on the margin. . . . white people are not required to explain to others how \u2018white\u2019 culture works, because \u2018white\u2019 culture is the dominant culture that sets the norms. Everybody else is then compared to that norm.\u201d<\/p><\/blockquote>\n

Some weeks ago, I wrote about the\u00a0progressive political monoculture<\/a>\u00a0that rules the field of public health. That article responded to an essay by Harold Pollack, a left-of-center professor of public health and of social work who worries aloud that his field is ideologically uniform and intolerant of dissenting opinions. I responded:<\/p>\n

As of 2021, the public health sector\u2014which, by Pollack\u2019s description, is incompetent to communicate with half the American population about its core expertise (the spread of infectious disease)\u2014has sought to claim manifest destiny over\u00a0climate change<\/a>,\u00a0property law<\/a>,\u00a0racism<\/a>,\u00a0wages<\/a>,\u00a0voting laws<\/a>,\u00a0transportation<\/a>,\u00a0terrorism<\/a>,\u00a0crime<\/a>,\u00a0policing<\/a>,\u00a0juvenile justice<\/a>,\u00a0higher education<\/a>,\u00a0employment<\/a>,\u00a0incarceration<\/a>,\u00a0financial lending<\/a>,\u00a0identity theft<\/a>,\u00a0bullying<\/a>,\u00a0gentrification<\/a>,\u00a0human trafficking<\/a>,\u00a0online poker<\/a>\u00a0and who knows what else.<\/p><\/blockquote>\n

I\u2019ll add here that public health\u2019s imperial aspirations pose grave risks to America\u2019s constitutional stability. Public health exhibits a recurring pattern: (1) Declare that X is now a public health issue. (2) Declare that X is in crisis. (3) Flout legal and constitutional norms to quell said crisis. During the pandemic, the Centers for Disease Control and Prevention (CDC) declared that housing evictions were within the realm of public health and that evictions in high-infection areas constituted a crisis. The CDC therefore assumed authority to ban residential evictions, nullifying state property laws nationwide. (The\u00a0U.S. Supreme Court<\/a>\u00a0eventually curtailed the CDC\u2019s presumed authority.)<\/p>\n

Throughout the 20th century, on similar grounds, America\u2019s public health sector played a powerful role in forced sterilizations of tens of thousands of Americans, bans on interracial marriage, bans on marriage of disabled Americans, deportations of immigrants on spurious grounds and monstrous experiments on African American men.<\/p>\n

Over this period, the American medical community was not guiltless. Doctors were complicit in public health\u2019s 20th-century abuses. In criticizing AHE,\u00a0Matthew Yglesias<\/a>,\u00a0Robby Soave<\/a>\u00a0and\u00a0Alex Tabarrok<\/a>\u00a0all note that even today, the AMA plays an outsized role in limiting the supply of healthcare resources to the very \u201coppressed\u201d communities that AHE purportedly favors. But still, the doctor\u2019s devotion to the individual patient has historically offered something of a counterweight to public health\u2019s collectivist impulses.<\/p>\n

But AHE and its underlying ideology seek to turn doctors away from individual patients toward broad social issues. Effectively, AHE demotes American medicine to a subordinate branch of public health. The American Association of Medical Colleges\u2019 involvement in this enterprise signals that medical schools will be forums for political indoctrination\u2014at the expense of technical skills and scientific inquiry.<\/p>\n

The co-opting of medicine by woke progressives could turbo-charge all that is dangerous about public health. AHE should worry any patient whose life, health and ease of mind depend on a doctor now focused on concerns other than the patient at hand.<\/p>\n","protected":false},"excerpt":{"rendered":"

BLUF: The co-opting of medicine by woke progressives could turbo-charge all that is dangerous about public health. AHE should worry any patient whose life, health and ease of mind depend on a doctor now focused on concerns other than the patient at hand. The Pall of Politics Descends Upon American Medicine. A new guidance document … Continue reading “”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,41],"tags":[],"class_list":["post-74872","post","type-post","status-publish","format-standard","hentry","category-crap-for-brains","category-health-medicine"],"_links":{"self":[{"href":"https:\/\/milesfortis.com\/index.php?rest_route=\/wp\/v2\/posts\/74872","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/milesfortis.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/milesfortis.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/milesfortis.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/milesfortis.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=74872"}],"version-history":[{"count":2,"href":"https:\/\/milesfortis.com\/index.php?rest_route=\/wp\/v2\/posts\/74872\/revisions"}],"predecessor-version":[{"id":74874,"href":"https:\/\/milesfortis.com\/index.php?rest_route=\/wp\/v2\/posts\/74872\/revisions\/74874"}],"wp:attachment":[{"href":"https:\/\/milesfortis.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=74872"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/milesfortis.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=74872"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/milesfortis.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=74872"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}