America’s Racialized Medical Schools

 Earlier this month, the White House announced a five-year plan for redressing racial inequality. It is essentially the Biden administration’s version of a diversity, equity, and inclusion (DEI) plan, like those issued by nearly every major university, only at a vastly larger scale. The policy aims to “advance an ambitious, whole-of-government approach to racial equity and support for underserved communities” by embedding equity goals in every aspect of the government.

From the highest offices of the state down to the smallest local bureaucracies, DEI now pervades almost all levels of American society. And while it was once thought that the fringe racial theories that animate the DEI agenda could be confined to small liberal arts campuses, it is clear that is no longer the case.

Increasingly, medical schools and schools of public health are enthusiastically embracing the values of DEI and instituting far-reaching policies to demonstrate their commitments to the cause. To many in the universities and perhaps in the country at large, these values sound benign—merely an invitation to treat everyone fairly. In practice, however, DEI policies often promote a narrow set of ideological views that elevate race and gender to matters of supreme importance.

That ideology is exemplified by a research methodology called “public health critical race praxis” (PHCRP)—designed, as the name suggests, to apply critical race theory to the field of public health—which asserts that “the ubiquity of racism, not its absence, characterizes society’s normal state.” In practice, PHCRP involves embracing sweeping claims about the primacy of racialization, guided by statements like “socially constructed racial categories are the bases for ordering society.”

These race-first imperatives have now come to influence the research priorities of major institutions. Perhaps no better case study exists than that of the University of California, San Francisco (UCSF), an institution devoted exclusively to the medical sciences, and one of the top recipients of federal grants from the National Institutes of Health. Last May, UCSF took the unprecedented step of creating a separate Task Force on Equity and Anti-Racism in Research, which proceeded to make dozens of recommendations.

That task force builds on layers of prior DEI bureaucratic expansion, spanning nearly a decade. This programming includes the “UCSF Anti-Racism Initiative,” started after the summer of 2020, which established dozens of new institutional policies throughout the university, such as “evaluating contributions to diversity statements in faculty advancement portfolios.” The School of Medicine, meanwhile, has published its own Timeline of DEI and Anti-Racism Efforts, which documents such steps as adding a “social justice pillar” to the school’s curriculum and creating an anti-racist curriculum advisory committee.

The policies often promote an idiosyncratic and controversial understanding of concepts like diversity and racism. Through its Difference Matters initiative, the medical school created a document titled “Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators”—which is filled with eyebrow-raising assertions. Racism, the guide asserts, “refers to the prioritization of the people who are considered white and the devaluation, exploitation, and exclusion of people racialized as non-white.” Anti-racism, meanwhile, involves directly shifting power from those who are white to those who are Black. “Anti-racism examines and disrupts the power imbalances between racialized and non-racialized people (white people), to shift power away from those who have been historically over-advantaged and towards people of color, especially Black people.” Of course, when applied to the allocation of lifesaving medical care, these ideals can carry weighty consequences. During the height of the COVID pandemic, New York, Minnesota, and Utah issued guidance for allocating monoclonal antibodies that heavily prioritized racial and ethnic minorities.\

While this hyper-racialized approach has long been the norm in humanities departments, it now appears to have fully crossed over into the hard sciences as well, with medical schools leading the charge. Med schools across the country have aggressively embraced DEI programming, often instituting policies that promote a narrow vision of social justice. In 2021, the University of Michigan Medical School created its Anti-Racism Oversight Committee Action Plan, making a set of new policy recommendations that had won the endorsement of the medical school’s leadership. That action plan called for a new curriculum to help inculcate a “demonstrated increase in understandings of DEI, antiracism, and intersectionality concepts in medical students and residents.” For medical residents, the plan stipulated that the curriculum should be based on Ibram X. Kendi’s book Stamped from the Beginning.

Some of these initiatives create obvious issues of academic freedom. In 2020, the UNC School of Medicine created a “Task Force for Integrating Social Justice Into the Curriculum,” issuing a report with dozens of recommendations. One called for faculty to adhere to “core concepts of anti-racism,” listing several of these required “concepts,” including “race is not a set biological category” and “specific organs and cells do not belong to specific genders.” The task force also called for students to “be trained in core advocacy skills”—even listing a number of political causes that it deemed important for students to embrace. These causes, which the report labeled “health realms,” included “restoring U.S. leadership to reverse climate change,” and “achieving radical reform of the US criminal justice system.” The school initially listed every recommendation as “On Time” on an online implementation tracker, though it eventually walked back some of the more controversial requirements.

All of this comes under the broad umbrella of “diversity, equity, and inclusion,” illustrating how the term is both far more radical and more deeply entrenched than its defenders often claim.\\

Shorn of any context, the principles of diversity and inclusion strike many people as unobjectionable, and even laudable. But in practice they are used as a shorthand for a set of divisive ideological dogmas and bureaucratic power grabs. Under the banner of DEI, medical institutions that are supposed to focus on protecting human life are being sacrificed on the altar of the racialist ideology.

Because of the ideological project associated with DEI initiatives, critics often highlight their effect on curriculum and teaching. But the more potent effect, in the long run, could end up being on scientific research and scholarship.

For the UCSF Task Force on Equity and Anti-Racism in Research, the stated goal is to transform the university’s research enterprise. “To truly rectify the entrenched, structural harms from racism in research,” the task force report notes, “we must start from its foundations in the way that we privilege knowledge, methods, and people. The overarching changes required to mitigate racism in research is a philosophical shift in the mindset of those in power and those who produce research.”

Although the policies listed in the report are only recommendations, some have already been implemented, and many are likely to be in the future. The report’s first recommendation, for example, calls for a new vice chancellor for DEI in research. In September, UCSF announced the role was given to Tung Nguyen, co-chair of the task force. The report—referred to by Nguyen as a “labor of love and trauma”—states that the recommended policies will show that “anti-racism” is “centered in all aspects of the way we work and function as a research enterprise.” That includes emphasizing diversity statements even more strongly in the promotion and tenure process, and evaluating university leadership along such lines as their “record of hiring women and members of historically excluded populations.” Not necessarily the qualities that people suffering from serious illnesses would look for in their medical care providers.

The task force calls for inserting similar DEI requirements into its research enterprise and adding “scoring criteria on equity and anti-racism” to UCSF’s internal grant programs. It recommends expanding UCSF’s existing anti-racism research grant program—something Nguyen has emphasized since taking his new role. The report itself links to UCSF’s “Pilot for Anti-Racism Research” program, which funds small research projects within the university. That program provides perhaps the clearest articulation of what UCSF means by “anti-racism research.” It borrows the language of UCSF’s “Anti-Racism and Race Literacy” guide, noting: “Anti-racism examines and disrupts the power imbalances between racialized and non-racialized people, to shift power away from those who have been historically over-advantaged and towards people of color.” It later adds, “Anti-racism research uses approaches such as the Public Health Critical Race Praxis for applying Critical Race Theory to empirical research.”

In other words, under the new ideological regime that has taken power both inside the federal bureaucracy and in institutions like UCSF, even medical research has become yet another front in a larger ideological battle. Tomorrow’s doctors and medical experts are being selected and trained on the basis of their willingness to “disrupt power imbalances between racialized and non-racialized people.”

Much of the report raises obvious concerns. Some, for instance, might reject the task force’s assertion that racism pervades all areas of the university—especially in such a progressive bastion as UC San Francisco. It is telling that the university seems to actively encourage this assumption in research, but also unsurprising—after all, the “ordinariness of racism” is one of the tenets of public health critical race praxis, which is now being pushed by Nguyen under the guise of anti-racism research.

More broadly, many of these measures could pose a threat to academic freedom. Organizations such as the Academic Freedom Alliance and the Foundation for Individual Rights and Expression have argued against mandatory diversity statements. After all, given that DEI is often associated with a narrow set of social and political views, it’s not hard to see how evaluating a professor’s commitment to DEI invites viewpoint discrimination. An “anti-racism” advisory board that reviews grants would only extend that policy further.

By the time it published the report, the UCSF task force was aware of all of these issues. Each had been brought up by UCSF employees during the comment period. The comments were published in the report’s appendixes, which make up perhaps the most telling part of the whole publication.

One commenter repeated the same line in every answer: “I fundamentally do not feel or have ever felt that UCSF is a racist place. These are grossly misdirected funds and efforts.” Several cautioned against embracing discriminatory policies in the name of anti-racism. “All of the above sounds to me like trying to fight racism with more racism,” one noted. Still others urge the task force not to distract from UCSF’s focus on scientific research. As one commenter put it, “UCSF is a medical and life science campus. Its strength lies in its objective data-driven experimental approach. Qualitative and sociological research has no place at UCSF and no place in scientific medical research and will undermine UCSF’s reputation.”

Yet rather than addressing the concerns of the school’s employees, the report attacks them while presenting its authors as the real victims.

It is important to note that while many of the comments received were constructive and helpful, task force members were traumatized by a striking number of comments that denied the existence of inequities and racism, and others that minimized the burden that racism has imposed, particularly on Black Americans at UCSF.

The forward to the report quotes one of the task force co-chairs, Sun Yu Cotter, who adds:

It is extremely important to acknowledge the magnitude of the emotional labor and trauma that many of the Task Force members endured in doing this work, particularly during the public comment period. Not only are many of the Task Force members, especially our Black colleagues, encountering and navigating racism on a daily basis at work and outside of work, we are also volunteering our very limited time to dive into grueling work (the minority tax is real!). Then to be gaslit by some members of our very own UCSF community was very painful.

Take note. This is the future of American medicine.

John Sailer is a fellow at the National Association of Scholars.

https://www.tabletmag.com/sections/news/articles/americas-racialized-medical-schools