As Race ‘Equity’ Advances in Health Care, Signs of a Chilling Effect on Dissent

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This article is part two of a two-part series. Read part one here.

The national movement to eradicate what activists call systemic racism and white privilege from medicine and health care has few public critics in the medical profession. A possible reason: Skeptics who have questioned these efforts have been subject to harsh Twitter campaigns, professional demotions and other blowback.

A podcast of the Journal of the American Medical Association caused a furor this year when one of its editors suggested that discussion of systemic racism is an unfortunate distraction that should be taken off the table. In response to a protest petition, the AMA launched an internal investigation into the creation of the podcast (and a since deleted Tweet that promoted it). Eventually, the Journal’s top two editors, who are both white, resigned—the editor-in-chief’s departure coming after he issued a public apology in which he affirmed the existence of structural racism in the United States and in the health care field.

In Minneapolis, Hennepin Healthcare System removed gynecologist Tara Gustilo, of Filipino descent, from her position as chair of the OB/GYN department after members of her department questioned her “ability to lead.” The demotion followed her series of Facebook posts criticizing critical race theory, Black Lives Matter and “How to Be an Antiracist” author Ibram X. Kendi, and her insistence that her department must strictly adhere to race-neutral policies with regard to patient care.

Colleagues and other doctors on Twitter denounced as racist University of Pittsburgh cardiologist and professor Norman Wang, who is ethnically Chinese, after his peer-reviewed paper last year critiqued affirmative action as illegal and discriminatory. The Journal of the American Heart Association, which published the paper, soon retracted it, alleging “deliberate misinformation or misrepresentation.” Wang’s employer demoted him from his role as director of a fellowship program for physicians, barred him from contact with fellows and residents, and temporarily prohibited Wang from contact with med students. Kathryn Berlacher, director of the cardiology fellowship program, reprimanded him in an email: “It is clear to us that any educational environment in which you partake is inherently unsafe, increasing our learners’ risk for undue bias and harm.”

In each case, the dissenting doctors broadcast opinions counter to the official positions and policies of their organizations. The American Heart Association and Pitt officials, on Twitter and in public announcements, said Wang’s critique of affirmative action was inconsistent with their institutional values of diversity and inclusion.

Such incidents are noteworthy because of their eerily scripted language of moral outrage and public denunciation, coming from the nation’s highest levels of professional achievement, often on internal issues that would typically be handled with sensitivity and discretion as personnel matters.

“Rise up, colleagues!” Mayo Clinic cardiologist and diversity director Sharonne Hayes tweeted in August in response to Wang’s article. “The fact that this is published in ‘our’ journal should both enrage & activate all of us.”

Berlacher announced Wang’s demotion in a Tweet. “We stand united for diversity, equity and inclusion,” she proclaimed. “And denounce this individual’s racist beliefs and paper.”

The American Heart Association chimed in: “JAHA is editorially independent but that’s no excuse. We’ll investigate. We’ll do better.”

Those who are concerned by the social justice fervor sweeping through the medical profession say that such examples are evidence of the movement’s chilling effect on open debate of complex social issues.

“Most in academic medicine who are troubled by this are keeping their heads down and keeping their mouths shut,” said Thomas Huddle, who retired this year as professor at the medical school at the University of Alabama at Birmingham. “They’re deeply afraid of social media mobs and of academic administrative superiors who’ve taken this stuff on.”

People hold placards with paintings of George Floyd, Daunte Wright and Philando Castile after the verdict in the trial of former Minneapolis police officer Derek Chauvin, found guilty of the death of George Floyd, in front of Hennepin County Government Center, in Minneapolis, Minn., on April 20, 2021. Carlos Barria/Reuters

In the wake of George Floyd’s killing last year, the social justice movement has generated tremendous support. Brittani James and Stella Safo, both African American doctors, drew more than 10,000 signatures for their petition to review and restructure JAMA in the aftermath of the February podcast.

They say the underrepresentation of people of color and the erasure of their perspectives on racism is typical of many elite institutions in medicine.

“Racism was created with intention and must therefore be undone with intention,” the petition states. “Structural racism has deeply permeated the field of medicine and must be actively dissolved through proper antiracist education and purposeful equitable policy creation.”

James, a Chicago-based physician and assistant professor in the College of Medicine at the University of Illinois, said she has little patience with accusations that social justice fosters cancel culture.

“I have to chuckle,” James said. “As a black woman, I absolutely cannot express my opinion, ever.

“I have to consistently think whom I’m in the room with. And I will be fired quickly without fanfare, without anyone advocating for me,” James said. “This idea that they’re uniquely persecuted is totally divorced from reality. My entire life has been a tightrope of being careful what I say, because there’ll be retribution against me.”

Wang has filed a federal lawsuit, alleging retaliation, defamation, discrimination and First Amendment violations, against the University of Pittsburgh and related entities; the American Heart Association; Wiley Periodicals, and Pitt med school leaders and professors. They have denied the allegations, saying this is a professional dispute between academics, not a question for the courts. JAHA accused Wang of “inaccuracies, misstatements, and selective misreading of source materials,” and cites two examples of alleged misquotes.

Gustilo has filed a discrimination complaint with the Equal Employment Opportunity Commission, in which she describes critical race theory as “a race essentialist ideology that presupposes zero sum racial conflict and seeks to remedy that by discriminating against individuals, so as to make group outcomes more equal.”

A Hennepin spokeswoman said the organization can’t comment during pending legal actions but said by email that the “allegations are inaccurate.”

Gustilo is receiving support from the Foundation Against Intolerance and Racism, or FAIR, an advocacy organization created to provide resources and support to parents who oppose critical race theory in K-12 schools. The nonprofit group is now planning to establish a medicine chapter to advise and support doctors who are troubled by the injection of CRT into medical training and medical ethics.

Erica Li, a West Coast pediatrician and FAIR volunteer active in the development of the medicine chapter, agrees that racism exists in some situations, but said that racial disparities could have multiple causes. She opposes using affirmative action and other race-based standards to achieve equity, a term that refers to mandating equal outcomes by race.

Li said she is not fearful of retaliation, but asked that her precise location not be disclosed in this article. She said she “has taken great lengths to take my photos and contact information off the Internet” after a colleague received death threats over an issue not related to critical race theory.

A growing frustration with racial disparities in American society is motivating the push for what activists call structural or systemic changes. On the JAMA podcast, however, the deputy editor, Edward Livingston, expressed skepticism that this was the wisest approach.

“Structural racism is an unfortunate term to describe a very real problem,” Livingston said, acknowledging that poverty and economic inequality can lead to racial disparities. “But we strive to have a society that’s more equal, where everybody has the same opportunities.”

“Personally, I think taking racism out of the conversation would help. Many people like myself are offended by the implication that we are somehow racist,” Livingston said, according to published reports. “The focus must be on equal opportunity and making sure that that exists.”

Safo, an assistant clinical professor at the Icahn School of Medicine at Mount Sinai in New York, said the podcast struck a raw nerve. “I think there’s a real discomfort with our country’s reckoning around race. And there’s a real desire by individuals in power to feel like, ‘Well, not me, I’m not one of them.’”

When asked about the implications for open debate and free expression, James, the Chicago physician and self-described activist, black feminist and anti-racism scholar, reframed the issue.

“They call it cancel culture, but it’s actually accountability.”