Politics, and in particular hard-left “wokeness,” is infecting American medicine’s bloodstream. The danger cannot be overstated. It threatens medical professionals, patients, medical science and America’s 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.
New Language for a New Orthodoxy
In October, two of the most powerful medical organizations in America—the American Medical Association (AMA) and the American Association of Medical Colleges—released “Advancing Health Equity: A Guide to Language, Narrative and Concepts,” 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.
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.
This is not merely replacing the simple with the sesquipedalian. The doctor’s 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 “vulnerable” is verboten. Now, the doctor must refer to the patient as “oppressed,” “made vulnerable” or “disenfranchised.” Someone, or some grotesque societal failing, is to blame for the patient’s higher-than-average risk of diabetes. The explanation for this particular lexical shift is representative of AHE’s tone and worldview:
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. 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? 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. 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.
The entire document reads like final exam essays written by a student who forgot to study—endless 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.
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.
In “We Got Here Because of Cowardice. We Get Out With Courage: Say No to the Woke Revolution,” 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 “begins 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.”
Weiss writes, “Those 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.” Neutrality is forbidden, and skeptics are heretics. Any disparity is conclusive proof of racism, according to Ibram X. Kendi, whom Weiss describes as “the high priest of this ideology” and whose words underlie AHE.
AHE is laden with villains defined as Weiss describes. AHE finds the following sentence unacceptable: “Low-income people have the highest level of coronary artery disease in the United States.” Instead, the doctor should say: “People 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.”
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’t speak of an “underserved community.” Rather, the community is “historically and intentionally excluded” from proper care. There are no sins of omission; someone wanted those outcomes and actively sought them.
In “Wokeness M.D.: The Threat to Medicine,” Tevi Troy wonders “whether wokeness is directing doctors to treat patients unequally,” citing anecdotal evidence that such notions are enveloping medicine. Troy describes a psychiatrist speaking at Yale School of Medicine on “The Psychopathic Problem of the White Mind.” Among her words, “White 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.” Yale offered tepid concerns about the talk, but, as Troy says, “Such a lecture and the lukewarm response highlights a problem that could spread—a world in which a credentialed medical practitioner could feel confident in publicly expressing such murderous views without paying any sort of professional price.”
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 “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.” According to Troy, “The 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.”
In “Critical Race Theory Is Coming for Your Doctor,” Christine Rosen takes direct aim at AHE. She calls the document “an effort to wrap these ideologically-suspect ideas and jargon in the cloak of science—all while forcing physicians to start talking like good social-justice soldiers.” Per AHE, she says, “the tools of the medical profession are to be turned not to better health care, but to social justice,” which is philosophically based on “critical race theory . . . gender studies, disability studies, as well as scholarship from social medicine.”
The likely result is “to burden medical professionals with the task of constantly signaling their allegiance to this new ideology rather than simply being good doctors.” The AMA, she says, “wants its members’ primary focus to be social justice, not medical care.” Doctors must “shift the narrative,” in the words of AHE, “from 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.”
AHE’s 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. “Marginalized communities” become “groups that have been historically marginalized or made vulnerable.” An “ex-con” or a “felon” is now “formerly incarcerated,” “a returning citizen” or a “person with a history of incarceration.” A minority is now “historically marginalized” or “minoritized” or “BIPOC” (Black, Indigenous and people of color). The obese are now “people with obesity.” One cannot be a “COVID-19 case”; rather, one is a “person with COVID-19.” “The homeless” become “persons experiencing homelessness,” as if linguistic terpsichore provides the person with a warm bed and a square meal.
One can no longer “tackle issues within the community” because “tackle” is a word connoting violence and, hence, offensive. Doctors must no longer speak of the war against cancer or combating cancer because “war” and “combat” are also violent terms. Instead, doctors must “eliminate” cancer. One hopes that AHE’s authors don’t learn that Google’s definition of “eliminate” includes “murder (a rival or political opponent).” The last sentence hints at endless future lexical revisions—thus turning the English language into a continual game of three-card monte.
These linguistic contortions may even harm the very people they are trying to serve. AHE advises against the use of the term “free clinic” because the word “free” is demeaning. But Conor Friedersdorf notes that an advantage of the term “free clinic” is that it informs people of the price (zero) charged by the clinic. Without that simple name, Friedersdorf says, “few poor people will know that they can get care there without having to pay.”
Throughout AHE, there are overt suggestions and subtle hints that one’s own health is not one’s responsibility. “People who do not seek healthcare” are now “workers under-resourced with” something. As noted earlier, the implication is that the person who did not receive care is blameless. Someone else is, by implication, always to blame. “Disparities” and “inequalities” should be dropped in favor of “inequities,” because if John is less healthy than Joe, then someone other than John is explicitly to blame for John’s unfortunate lot.
AHE repeatedly uses passive verbs. “Vulnerable groups” become “groups that have been economically/socially marginalized.” This verb structure implies that the unfortunate conditions just happened to the person and implicitly blames some outsider.
“Equality” is replaced by “equity.” AHE’s 168-word explanation for this substitution includes:
Seeking to treat everyone the “same” . . . 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.
Who’s To Blame?
Scapegoats—corporeal and conceptual—emerge throughout the document. AHE wants to “expose the political roots underlying apparently ‘natural’ economic arrangements, such as property rights, market conditions, gentrification, oligopolies and low wage rates.” 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 “free market” is also to blame, based on a specious, caricatured, ignorant definition provided in AHE.
“Free” 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.
Another recurring theme in AHE is “whiteness,” which doesn’t necessarily have anything to do with a person’s skin tone (or maybe it does; depends when you ask):
Whiteness . . . is both cultural and socioeconomic power and privilege. Whiteness, according to sociologist Ruth Frankenberg, is “dominant 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 ‘white’ culture works, because ‘white’ culture is the dominant culture that sets the norms. Everybody else is then compared to that norm.”
Some weeks ago, I wrote about the progressive political monoculture that 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:
As of 2021, the public health sector—which, by Pollack’s description, is incompetent to communicate with half the American population about its core expertise (the spread of infectious disease)—has sought to claim manifest destiny over climate change, property law, racism, wages, voting laws, transportation, terrorism, crime, policing, juvenile justice, higher education, employment, incarceration, financial lending, identity theft, bullying, gentrification, human trafficking, online poker and who knows what else.
I’ll add here that public health’s imperial aspirations pose grave risks to America’s 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 U.S. Supreme Court eventually curtailed the CDC’s presumed authority.)
Throughout the 20th century, on similar grounds, America’s 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.
Over this period, the American medical community was not guiltless. Doctors were complicit in public health’s 20th-century abuses. In criticizing AHE, Matthew Yglesias, Robby Soave and Alex Tabarrok all note that even today, the AMA plays an outsized role in limiting the supply of healthcare resources to the very “oppressed” communities that AHE purportedly favors. But still, the doctor’s devotion to the individual patient has historically offered something of a counterweight to public health’s collectivist impulses.
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’ involvement in this enterprise signals that medical schools will be forums for political indoctrination—at the expense of technical skills and scientific inquiry.
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.