RUTHFULLY YOURS

Heather Mac Donald of the Manhattan Institute has a much-linked article in the current (Summer 2022) issue of the City Journal with the title “The Corruption of Medicine.” The subject matter has substantial overlap with a Manhattan Contrarian post from last November with the title “The Progressive Neo-Racist Cancer Has Completely Destroyed The AMA.”

Mac Donald’s piece goes deeply into what she calls “two related hypotheses” that have recently come to dominate the medical profession:

Medical education, medical research, and standards of competence have been upended by two related hypotheses: that systemic racism is responsible both for [1] racial disparities in the demographics of the medical profession and for [2] racial disparities in health outcomes.

For today, I’m going to focus on the second hypothesis, that “systemic racism” in the U.S. medical system is responsible for “racial disparities in health outcomes.” Is this hypothesis remotely plausible?

According to Mac Donald’s piece, not only is this second hypothesis deemed plausible, but among the elites of the medical profession it is seen as so clearly true that it is required to be accepted a priori, and no questioning of the hypothesis is allowed.

For a statement of the official views of the AMA, Mac Donald refers us to a truly bizarre document issued by that group last October with the title “Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.” (OSP) Mac Donald describes the document as “indistinguishable from a black studies department’s mission statement,” and “a thicket of social-justice maxims.” Here are a few choice quotes that Mac Donald takes from the document to give you an idea what it is about:

[P]hysicians must “confront inequities and dismantle white supremacy, racism, and other forms of exclusion and structured oppression, as well as embed racial justice and advance equity within and across all aspects of health systems.” The country needs to pivot “from euphemisms to explicit conversations about power, racism, gender and class oppression, forms of discrimination and exclusion.”

The rest of the document (it is 86 pages long) is more and more and yet more of same. Here is an excerpt from the OSP giving the official explanation of the reasons for different health outcomes between and among groups (found on page 12 of the document):

Through systematic oppression and deprivation from 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 is another example. Thus, intergenerational wealth has mainly benefited and exists for white families. . . . The resulting differences in outcomes among historically marginalized and minoritized populations have been explained away through the myth of meritocracy. It is a narrative that attributes success or failure to individual abilities and merits. It does not address the centuries of unequal treatment that have intentionally robbed entire communities of the vital resources needed to thrive. . . . Health inequities are “unjust, avoidable, unnecessary and unfair” gaps that are neither natural nor inevitable. Rather, they are produced and sustained by deeply entrenched systems that intentionally and unintentionally silence, cause stress and prevent people from reaching their full potential.

For an example of what happens to someone who expresses any doubt about the hypothesis that “health inequities” result exclusively from systemic racism, Mac Donald cites the case of one Ed Livingston, former deputy editor for clinical reviews and education for the Journal of the American Medical Association (JAMA). Livingston did a podcast on February 24, 2021, where he was asked by the host about the issue of “impoverished neighborhoods with poor quality of life and little opportunity.” In response, per Mac Donald:

Livingston expressed the view that “the current emphasis on ‘racism,’ . . . ‘might be hurting’ the cause of racial equality. . . . The focus, as Livingston saw it, should be on socioeconomic disparities, not alleged racial animus.

You undoubtedly can see what’s coming:

[T]he podcast became an instant totem of white supremacy. JAMA disappeared it from the web. Livingston himself was disappeared from JAMA shortly thereafter. . . . JAMA’s editor-in-chief Howard Bauchner, [declared that] the disappeared podcast . . . was “inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA.”

Etc., etc., etc.

So in light of the current obsession at the AMA of “systemic racism” and “white supremacy” as being the only acceptable explanations for any disparities in health outcomes between racial groups, it occurred to me to look up some relevant statistics that might bear on the question. Here is a 2021 chart from the CDC giving life expectancy statistics by race and sex as of 2020:

There are many interesting things in this chart. I’m going to focus on the top line, which deals with life expectancy at age 0, that is, at birth. The life expectancy at birth for “Non-Hispanic white” is given as 78.0 years, and for “Non-Hispanic black” as 72.0 years. That’s a difference of 6.0 years, and would seem like something quite substantial that could call for an explanation.

But then, check out the difference in the “All origins” category between Male and Female life expectancy. It’s 75.1 years for Male and 80.5 years for Female, a difference of 5.4 years. That’s almost as much as the 6.0 year black/white differential. I tried Googling to find out about the systemic discrimination against men that must be causing this big disparity, and I can find literally nothing. That’s weird.

And check out this: the life expectancy at birth of Non-Hispanic black Females is given as 75.8 years, compared to 75.5 years for Non-Hispanic white Males. The black women live longer than the white men. And I had somehow thought that the white men were “supremacists” and “oppressors,” while black women were afflicted by the “intersectionality” of being both black and women. But nothing about these compounded disadvantages turns up in life expectancy statistics.

And how about those Hispanics? Their life expectancy at birth is given as 79.9 years, compared to only 78.0 for Non-Hispanic whites and 72.0 for Non-Hispanic blacks. I had thought that Hispanics were a “marginalized” and “oppressed” community. Again, not in any way that turns up in life expectancy statistics.

Based on just those contradictions, there is very good reason to doubt the hypothesis that “systemic racism” and “oppression” are the exclusive, or even significant, causes of disparities in health outcomes between and among the races. And then, there are numerous other plausible hypotheses that could explain parts of the disparities. For example, blacks have higher rates of obesity than members of other races, higher rates of hypertension, and higher rates of diabetes. All of these things are areas where assistance from trained medical professionals could be helpful in improving the health outcomes.