In the wake of voters’ clear rebuke of Democratic governance in states as varied as Virginia and New Jersey, critics of the racially essentialist and illiberal ideas that fall under the umbrella of “critical race theory” are taking a well-deserved victory lap.
But the debate over the power of what John McWhorter and others call “an elect” to rewrite school curricula along CRT lines is only one battle in a larger war.
The war rages on in many of the nation’s elite institutions and associations. In the past week, two of the nation’s major professional medical organizations signaled their capitulation to the language and practices of our new religion of race: The American Medical Association (AMA) and the American Psychological Association (APA).
The APA issued a statement outlining its new role in “dismantling systemic racism against people of color in the U.S.” It reads like the proposal of an anti-racist lobbying organization, which is evidently what the APA has reimagined itself to be. On K-12 education, for example, the APA states: “Racism at every level permeates the landscape of education in the United States (U.S.), from housing and policies that determine where children are zoned to attend school in prekindergarten through postsecondary and lifelong learning, to the detriment of the academic achievement, self-concept, persistence, and success of students of color.”
Also suspect: Merit and testing. “The use of standardized test scores in the admissions process are viewed inappropriately by some as a barometer of applicants’ academic merit,” the APA resolution states. Scientific research is also not spared. “The boundaries of psychological science have often been controlled to define ‘good’ psychological science as that which centers ‘objectivity’,” the APA states (note the use of scare quotes for the word objectivity).
No more! The APA now embraces, “constructivist, critical-ideological, and other critical paradigms” for research and resolves that “no one methodological approach is ‘better,’ but rather, each may be conducted with or without appropriate scientific rigor and with or without appropriate applicability to the research question(s).” (Emphasis added).
Even this is too weak a commitment for the American Medical Association, an organization that has been a fan of CRT and intersectionality for some time, and earlier in 2021 released a multi-year strategic plan to “embed racial justice and advance health equity.”
The AMA’s new guide, Advancing Health Equity: A Guide to Language, Narrative, and Concepts, is 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. “The field of equity, like all other scholarly domains, has developed specific norms that convey authenticity, precision and meaning,” a preamble states. “Just as the general structure of a business document varies from that of a physics document, so too is the case with an equity document.” (Not surprisingly, the preamble includes the now-ubiquitous “Land and Labor Acknowledgement” of the indigenous peoples displaced by AMA headquarters in Chicago, as well as “explicit recognition and reconciliation of our country’s twin, fundamental injustices of genocide and forced labor”).
The AMA claims this new guide is intended to provide “physicians, health care workers and others a valuable foundational toolkit for health equity.”
What tools are in this toolkit?
First and foremost, the tools of the medical profession are to be turned not to better health care, but to social justice: “Physicians and other health care workers, who first and foremost care for patients and their medical needs, must develop a critical consciousness of the root causes and structural drivers of health inequities.”
To that end, language and narratives must be rewritten to suit this new ideological framework: “As we explore in this guide, dominant narratives (also called malignant narratives), particularly those about ‘race,’ individualism and meritocracy, as well as narratives surrounding medicine itself, limit our understanding of the root causes of health inequities. Dominant narratives create harm, undermining public health and the advancement of health equity; they must be named, disrupted and corrected.”
Among the things that must be “disrupted?” Merit. “Narratives that uncritically center meritocracy and individualism render invisible the very real constraints generated and reinforced by poverty, discrimination and ultimately exclusion,” the guide states. Instead, they cite “critical race theory. . . gender studies, disability studies, as well as scholarship from social medicine” as the means for creating “an alternative narrative, one that challenges the status quo, one that moves health care towards justice.”
If followed, the guidance offered by the AMA seems more likely to burden medical professionals with the task of constantly signaling their allegiance to this new ideology rather than simply being good doctors. The guide suggests never referring to someone as “a diabetic,” for example, but rather, as “a person living with diabetes.” The “equity-focused alternative” to the term “the obese” is now “people experiencing obesity.” Instead of “individuals” who have a certain condition, it is “survivors” of said condition. As well, any phrase or word that might seem violent is verboten: “Avoid saying target, tackle, combat or other terms with violent connotation when referring to people, groups or communities.”
The lists of appropriate and inappropriate words and phrases goes on for pages. “Disadvantaged” communities must now be referred to as “historically and intentionally excluded” communities. “Minority” should be replaced with “historically marginalized.” So, too, with biological sex: “sex” and “gender” are to be replaced with “sex assigned at birth” and “gender identity.” And previously “vulnerable” communities are to be declared simply “oppressed.”
In almost every instance, each change to the language insists that the old terms, which were often quite suitable, albeit more neutral in tone, be replaced with ones that forcefully embed and elevate victimization. Saying you’re someone from a minority group signals nothing about your likely success or failure in life. Saying “I’m from a historically marginalized group” is preferable because it signals one’s place in the new hierarchy of victimization.
It also opens the door for semantic excuse-making for unhealthy behavior. When a patient refuses to follow a doctor’s treatment plan and suffers the inevitable physical consequences, the AMA has decreed that you may no longer call that person non-compliant: “Compliance describes purely passive behavior in which patients follow instructions. Non-compliance places blame for treatment failure solely on patients.” The preferred term is now “non-adherence,” which supposedly recognizes all of the “structural barriers” that excuse Jimmy for refusing to take his antibiotics and landing him back in the E.R.
Even advertising free medical services is now suspect: “The use of ‘free clinic’ puts a pejorative narrative that undermines equity and exposes the reality of a two-tier, segregated health care system.”
The guide insists on replacing the word “equality” with “equity” (which “refers to fairness and justice and is distinguished from equality”) and “fairness” with “social justice” because “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 AMA is not recommending these changes as merely a matter of semantics. They signal a shift in worldview. The country’s largest professional medical organization wants its members’ primary focus to be social justice, not medical care.
Consider the following scenario offered by the AMA guide:
“A 44-year-old Puerto Rican man comes to a free clinic with acute exacerbation of back pain. He has diabetes and hypertension. He is hesitant to seek health care. He expresses a mistrust of institutions because of negative experiences with the criminal justice system.”
Their recommendation is no longer to treat the patient’s acute and long-term health issues. It is to tackle the “structural violence associated with hyperincarceration.” (The AMA offers no definition for what, exactly “hyperincarceration” is). Later, they note how the case “called for a much deeper and nuanced analysis to fully understand the dynamics of structural violence at play.”
Rather than the “conventional” medical observation that “low-income people have the highest level of coronary artery disease in the United States,” the AMA would have doctors shift their focus from individual patients to “structural” forces. They recommend reimagining the problem of heart disease as follows: “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.”
The AMA isn’t merely asking doctors to use more sensitive language; they want them to do so in service of broader social justice—not medical—goals: The “opportunity to “shift the narrative”—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” is the end game.
In other words, physicians should become advocates: “Physicians and health care workers will also need to ensure behavior and practice change, establish meaningful collaboration with and advocacy for communities that have been historically marginalized, and participate in multi-sector partnerships to address societal systems of oppression,” the guide states (emphasis added).
Instead of asking “What interventions can address health inequities?” the AMA now wants medical professionals to ask, “What types of social change is [sic] necessary to confront health inequity?” Instead of asking “How can we promote healthy behavior?” The AMA wants doctors to ask, “How can we democratize land use policies through greater public participation to ensure healthy living conditions?”
Not surprisingly, the guide cites anti-racism profiteer Ibram X. Kendi as an inspiration.
This isn’t just bad social theory; it’s bad medicine. The reimagining of narratives leaves little room for medical realities: “It is past time to shift the narrative from race to racism—recognizing, as critical race scholarship teaches us, that race is a socially-constructed system for producing and reinforcing power,” the report states, quoting social-justice advocate Dorothy Roberts (whom, it should be noted, has a law degree, not a medical degree): “[R]ace is not a biological category that naturally produces these health disparities because of genetic difference. Race is a social category that has staggering biological consequences.”
As for those in the medical profession who might question this ideological reimagining of physicians’ work? They will likely be dismissed as perpetuating those “malignant narratives.” The AMA argues, “Dominant narratives use coded racial language to feed on insecurities of the white majority; they stoke resentment and distract from threats that might otherwise unite people across racialized groups, such as concentrated wealth and the destruction of the environment.” Among the words considered “coded racial language” by the AMA? “Colorblind” and “states’ rights.”
The dictionary definition of justice is the process whereby one’s action are fairly and impartially judged. This is not the justice being pursued in practices like the APA and AMA guidelines. Indeed, the AMA defines “justice” in its glossary as “a future state where the root causes (e.g., racism, sexism, class oppression) of inequity have been dismantled and barriers have been removed.”
Opponents of this sort of racially essentialist, quasi-religious thinking should learn from the example of parents who are successfully fighting these efforts in schools: Speak out against unscientific and ideologically suspect claims. Build alternative institutions that promote objective research and merit. Hold those in power accountable for their actions. Our nation’s medical professionals have spent the past two years helping Americans survive a deadly pandemic. Now they must fight despicable and divisive ideologies that threaten to undermine the integrity of their work.