RUTHFULLY YOURS

No matter election outcomes, presidential executive orders, and the ebbing support for the “woke” agenda among the general public, the medical establishment — epitomized by the New England Journal of Medicine — continues to push DEI ideology in medical school admissions policies.

A recent advocacy article in the NEJM pledges fervid fealty to DEI, primarily focusing on gender ideology. From, “Facing Political Attacks on Medical Education — The Future of Diversity, Equity, and Inclusion in Medicine” (citations omitted):

In recent years, the United States has seen an onslaught of legislation aimed at dismantling diversity, equity, and inclusion (DEI) initiatives in higher education, including medical education. Although these legislative actions are often construed as focusing only on race, they also explicitly or implicitly target members of sexual and gender minority (SGM) groups. The deluge of legislative and policy attacks, including a slew of executive orders in the current administration, is a component of a larger political movement that seeks to exclude people who have been historically underrepresented and marginalized in many sectors of society, including medicine.

Baloney. Opposing the invidious DEI agenda isn’t about excluding anybody from a fair shot at personal achievement. It’s about ensuring that the doctors of tomorrow are the most excellent practitioners we can license, and so students’ acceptance into medical school should be based on merit. In other words, capability should matter most. Identity should be irrelevant.

The authors believe otherwise:

The goal of DEI in health care and public health is to ensure that leaders of health care systems value all people equally and that all people can obtain the power, knowledge, resources, conditions, and opportunities that enable them to achieve optimal health. In medical education, this goal requires addressing disparities in recruitment and retention of people who have historically been excluded from the profession, as well as directly addressing inequities in patient outcomes. In health care, a diverse workforce including people with a range of racial, ethnic, sexual, and gender identities can serve patients better than a workforce that is far more homogeneous than the population itself.

Indeed, under a DEI admissions regime, I suspect that students would be less representative of the population since the focus would be on admitting individuals with relatively rare personal characteristics who check the equity boxes established by the diversity commissars.

The authors seem to believe that people can be good doctors only for patients who look like them or are members of the same “SGM”s (sexual and gender minorities) as they are and have sexual or identity preferences akin to those of their patients.

Certainly, all physicians should be able to provide high-quality care to all patients regardless of their identity. But research has shown that patient–provider concordance is correlated with stronger communication, increased trust, and greater patient satisfaction, especially in communities that have been, and often continue to be, mistreated by the health care system. These benefits translate into measurable improvements in patient and population outcomes; Black adults, for example, live longer in U.S. counties that have more Black physicians. But for members of communities that have been largely excluded from the physician workforce, there is often no option to see a health care provider with a concordant identity.

It’s ridiculous. It reminds me of Hollywood woke types who insist that only gay actors can play gay characters.

And, of course, the authors wield the usual ad hominem slurs against opponents of DEI:

These actions and statements by anti-DEI health professionals incite fear among their potential supporters who may feel their position of power is threatened by growing efforts to recruit people who have been historically underrepresented within, excluded from, and marginalized in medicine. Such responses aim to uphold a status quo in medicine that reflects a broader culture of White supremacy, homophobia, and patriarchy. They attempt to ensure that prospective physicians from historically and intentionally excluded racial and ethnic groups continue to face disproportionate difficulty in pursuing a career in medicine, and they create a hostile environment for SGM students as well as those from marginalized racial and ethnic groups.

This really gets my blood boiling:

Such attacks [legislation prohibiting so-called “gender-affirming care] on SGM patients parallel anti-DEI trends in medical education; they are part of larger efforts both to politicize patients’ freedom to access evidence-based care and to exclude health care workers from minoritized groups. Politicians use inflammatory language in framing these initiatives in order to provoke emotional responses and mislead the public. They often absurdly and outrageously describe gender-affirming care as “child abuse,” “experimentation,” or “mutilation” in order to ignite fear among their constituents. Bills banning or restricting gender-affirming care, such as the Missouri Save Adolescents from Experimentation (SAFE) Act and the Alabama Vulnerable Child Compassion and Protection Act, are framed as “protecting” children, when in fact they prevent transgender young people from accessing potentially lifesaving health care.

The authors are the real obfuscators. The evidence against subjecting children to gender-transition interventions is increasing almost daily — a fact that articles about gender in establishment medical journals rarely even mention. A study published just the other day demonstrates that gender-dysphoric patients who undergo transition surgeries are “at significantly higher risk for depression, anxiety, suicidal ideation, and substance use disorders than those without surgery.”

How can we trust a medical establishment that is bent on dismantling excellence as the primary goal of medical education and refuses to even acknowledge that its ideological beliefs have, at minimum, been significantly challenged by contrary scientific data?

The sad fact is that we can’t. I don’t know how it can be managed, but we sorely need a new medical establishment.