What Happens When Doctors Can't Tell the Truth?

S E E D E D   C O N T E N T

They meet once a month on Zoom: a dozen doctors from around the country with distinguished careers in different specialities. They vary in ethnicity, age and sexual orientation. Some work for the best hospitals in the U.S. or teach at top medical schools. Others are dedicated to serving the most vulnerable populations in their communities. 

The meetings are largely a support group. The members share their concerns about what’s going on in their hospitals and universities, and strategize about what to do. What is happening, they say, is the rapid spread of a deeply illiberal ideology in the country’s most important medical institutions. 

This dogma goes by many imperfect names — wokeness, social justice, critical race theory, anti-racism — but whatever it’s called, the doctors say this ideology is stifling critical thinking and dissent in the name of progress. They say that it’s turning students against their teachers and patients and racializing even the smallest interpersonal interactions. Most concerning, they insist that it is threatening the foundations of patient care, of research, and of medicine itself.

These aren’t secret bigots who long for the “good old days” that were bad for so many. They are largely politically progressive, and they are the first to say that there are inequities in medicine that must be addressed. Sometimes it’s overt racism from colleagues or patients, but more often the problem is deeper, baked into the very systems clinicians use to determine treatment.

“There’s a calculator that people have used for decades that predicts the likelihood of having a successful vaginal delivery after you've had a cesarean,” one obstetrician in the Northeast told me. “You put in the age of the person, how much they weigh, and their race. And if they’re black, it calculates that they are less likely to have successful vaginal delivery. That means clinicians are more likely to counsel black patients to get c-sections, a surgery they might not actually need.” 

There’s no biological reason for race to be a factor here, which is why the   calculator   just changed this year. But this is an example of how system-wide bias can harm black mothers, who are two to three times more likely to die in childbirth than white women even when you control for factors like income and education, which often make racial disparities disappear.

But while this obstetrician and others see the problems endemic in their field, they’re also alarmed by the dogma currently spreading throughout medical schools and hospitals. 

I’ve heard from doctors who’ve been reported to their departments for criticizing residents for being late. (It was seen by their trainees as an act of racism.) I’ve heard from doctors who’ve stopped giving trainees honest feedback for fear of retaliation. I’ve spoken to those who have seen clinicians and residents refuse to treat patients based on their race or their perceived conservative politics.

Some of these doctors say that there is a “purge” underway in the world of American medicine: question the current orthodoxy and you will be pushed out. They are so worried about the dangers of speaking out about their concerns that they will not let me identify them except by the region of the country where they work. 

“People are afraid to speak honestly,” said a doctor who immigrated to the U.S. from the Soviet Union. “It’s like back to the USSR, where you could only speak to the ones you trust.” If the authorities found out, you could lose your job, your status, you could go to jail or worse. The fear here is not dissimilar. 

When doctors do speak out, shared another, “the reaction is savage. And you better be tenured and you better have very thick skin.”

“We’re afraid of what's happening to other people happening to us,” a doctor on the West Coast told me. “We are seeing people being fired. We are seeing people's reputations being sullied. There are members of our group who say, ‘I will be asked to leave a board. I will endanger the work of the nonprofit that I lead if this comes out.’ People are at risk of being totally marginalized and having to leave their institutions.” 

While the hyper focus on identity is seen by many proponents of social justice ideology as a necessary corrective to America’s past sins, some people working in medicine are deeply concerned by what “justice” and “equity” actually look like in practice.

“The intellectual foundation for this movement is the Marxist view of the world, but stripped of economics and replaced with race determinism,” one psychologist explained. “Because you have a huge group of people, mostly people of color, who have been underserved, it was inevitable that this model was going to be applied to the world of medicine. And it has been.”  

“Wokeness feels like an existential threat,” a doctor from the Northwest said. “In health care, innovation depends on open, objective inquiry into complex problems, but that’s now undermined by this simplistic and racialized worldview where racism is seen as the cause of all disparities, despite robust data showing it’s not that simple.”

“Whole research areas are off-limits,” he said, adding that some of what is being published in the nation’s top journals is “shoddy as hell.” 

Here, he was referring in part to a   study   published last year in the Proceedings Of The National Academy Of Sciences. The study was covered all over the news, with headlines like “Black Newborns More Likely to Die When Looked After by White Doctors” (CNN), “The Lack of Black Doctors is Killing Black Babies” (Fortune), and “Black Babies More Likely to Survive when Cared for by Black Doctors” (The Guardian).

Despite these breathless headlines, the study was so   methodologically flawed   that, according to several of the doctors I spoke with, it’s impossible to extrapolate any conclusions about how the race of the treating doctor impacts patient outcomes at all. And yet very few people were willing to publicly criticize it. As Vinay Prasad, a clinician and a professor at the University of California San Francisco,   put it   on Twitter: “I am aware of dozens of people who agree with my assessment of this paper and are scared to comment.” 

“It’s some of the most shoddy, methodologically flawed research we’ve ever seen published in these journals,” the doctor in the Zoom meeting said, “with sensational conclusions that seem totally unjustified from the results of the study.”

“It’s frustrating because we all know how hard it is to get good, sound research published,” he added. “So do those rules and quality standards no longer apply to this topic, or to these authors, or for a certain time period?”

At the same time that the bar appears to be lower for articles and studies that push an anti-racist agenda, the consequences for questioning or criticizing that agenda can be high. 

Just ask Norman Wang. Last year, the University of Pittsburgh cardiologist was demoted by his department after he published a   paper   in the Journal of the American Heart Association (JAHA) analyzing and criticizing diversity initiatives in cardiology. Looking at 50 years of data, Wang argued that affirmative action and other diversity initiatives have failed to both meaningfully increase the percentage of black and Hispanic clinicians in his field or to improve patient outcomes. Rather than admitting, hiring and promoting clinicians based on their race, he argued for race-neutral policies in medicine. 

“Long-term academic solutions and excellence should not be sacrificed for short-term demographic optics,” Wang wrote. “Ultimately, all 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.”

At first, there was little response. But four months after it was published, screenshots of the paper began circulating on Twitter and others in the field began accusing Wang of racism. Sharonne Hayes, a cardiologist at the Mayo Clinic,   implored   colleagues to “rise up.” “The fact that this is published in ‘our’ journal should both enrage & activate all of us,” she wrote, adding the hashtag #RetractRacists.

Soon after, Barry London, the editor in chief of JAHA, issued an   apology   and the journal retracted the work over Wang’s objection. London cited no specific errors in Wang’s paper in his statement, just that publishing it was antithetical to his and the journal’s values. Retraction, in a case like this, is exceedingly rare: When papers are retracted, it’s generally because of the data or the study has been discredited. A search of the journal’s website and the   Retraction Database   found records of just two retractions in JAHA: Wang’s paper and a 2019 paper that erroneously linked heart attacks to vaping.

After the outcry, the American Heart Association (AHA), which publishes the journal, issued a   statement   denouncing Wang’s paper and promising an investigation. In a   tweet , the organization said it “does NOT represent AHA values. JAHA is editorially independent but that’s no excuse. We’ll investigate. We’ll do better. We’re invested in helping to build a diverse health care and research community.” 

As the criticism mounted, Wang was removed from his position as the director of a fellowship program in clinical cardiac electrophysiology at University of Pittsburgh Medical Center and was prohibited from making any contact with students. His boss   reportedly   told him that his classroom was “inherently unsafe” due to the views he expressed.

Wang is now   suing   both the AHA and the University of Pittsburgh for defamation and violating his First Amendment rights. To the doctors on the Zoom call, his case was a stark warning of what can happen when one questions policies like affirmative action, which, according to   recent polling , is opposed by nearly two-thirds of Americans, including majorities of blacks, Hispanics, and Asians. 

“I’m into efforts to make medicine more diverse,” a doctor from the Zoom group said. “But what’s gone off the rails here is that there is an intolerance of people that have another point of view. And that's going to hurt us all.”

JAHA isn’t the only journal issuing apologies. In February, the Journal of the American Medical Association (JAMA)   released a podcast   hosted by surgeon and then-deputy journal editor Edward Livingston, who questioned the value of the hyper focus on race in medicine as well as the idea that medicine is systemically racist. 

“Personally, I think taking racism out of the conversation will help,” Livingston said at one point. “Many of us are offended by the concept that we are racist.”

It’s possible Livingston’s comments would have gone unnoticed but JAMA promoted the podcast on Twitter with the tone-deaf text: “No physician is racist, so how can there be structural racism in health care?” 

Even more than in the case of Norman Wang, this tweet, and the podcast it promoted, led to a massive uproar. A number of researchers vowed to boycott the journal, and a petition condemning JAMA has received over 9,000 signatures. In response to the backlash, JAMA quickly deleted the episode, promised to investigate, and asked Livingston to resign from his job. He did....