It seems that no American institution is immune to the phenomenon. You have some organization out there that for all you know is just a regular and sensible group of professionals. You don’t pay much attention to what they are up to because, after all, you have your own life to lead. Then one day, for whatever reason, you have occasion to take a look at their latest utterances. And immediately it hits you — Holy Shit!, the Body Snatchers have gotten them too. The people involved seem by their physical appearance to be nearly unchanged, but they have developed a glassy-eyed stare, and out of their mouths come nothing but mindless catchphrases about “systemic racism,” “oppression,” “marginalized peoples,” and “white privilege.” Their words and actions are now centrally directed by some weird mind-control system that makes them incapable of doing anything except parroting the latest progressive neo-racist dogma.
I’ll be the first to admit that I haven’t much been following what the American Medical Association has been up to for a few decades. Then I ran across the November 3 piece by Christine Rosen in Commentary titled “Critical Race Theory Is Coming for Your Doctor.” Rosen’s article dissects a new document just out (October 28) from the AMA, with the title “Advancing Health Equity: A Guide To Language, Narrative, and Concepts.” I should also mention that something called the Center for Health Justice of the Association of American Medical Colleges (the trade association of medical schools) also participated in preparing and uttering this document.
A fair summary of “Advancing Health Equity” would be that if you just stumbled across it at random, you would be sure that it is a parody. But I have cross-checked not only to Rosen’s article, but also to the AMA’s own website, and I can assure you that the document is not a parody. It is very real. If you were thinking “they must be kidding,” disabuse yourself of that idea. They are not.
Before getting into the substance of “AHE,” let me give some background on the current state of the AMA. If you’re my age or anything close, you may remember the AMA as having almost if not a majority of U.S. medical doctors as members, and of being the main voice of the medical profession. But the more recent story is that the AMA has been in a decades-long decline, and lately more like a death spiral. Somewhere along the way, it got captured by political activists, and the sane people have gradually abandoned it.
In the AMA’s own publicity, they tout statistics that seem to show healthy and even growing membership. For example, there’s this from a speech in June 2021 by AMA Executive Vice President James Medara:
“This year the AMA celebrates 10 years of steady growth among dues-paying members, as shown on this slide. In terms of raw numbers, AMA membership has grown by more than one third since 2011.”
But plenty of analysts have looked more closely at the AMA’s numbers and discerned that the organization is rapidly hollowing out. For example, a June 2019 article in MedPage by Dr. Kevin Campbell has the title “Don't Believe AMA's Hype, Membership Still Declining,” and offers some insightful numbers. It appears that the AMA provides deeply discounted and/or free memberships to categories including medical students, residents, and retirees. Take those out of the AMA’s membership numbers, and here’s what you get:
[I]f you remove [students and residents] from the AMA's published numbers, you get 1,093,472 physicians, and . . . only 132,133 practicing physicians who are AMA members. That's 12.1%.
In short, it’s a tiny minority, basically consisting of those few doctors who spend their time on political activism rather than actually tending to patients.
So what’s in this “Advancing Health Equity” thing? Let’s start at the beginning. The beginning here means the Preamble, which comes even before the Introduction. And the Preamble in a document such as this of course means the obligatory “Land and Labor Acknowledgement”:
The American Medical Association’s headquarters is located in the Chicago area on taken ancestral lands of indigenous tribes, such as the Council of the Three Fires, composed of the Ojibwe, Odawa and Potawatomi Nations, as well as the Miami, Ho-Chunk, Menominee, Sac, Fox, Kickapoo and Illinois Nations. . . . We acknowledge their ancestors were forced out by colonization, genocide, disease and war. The AAMC and AMA also acknowledge the extraction of brilliance, energy and life for labor forced upon millions of people of African descent for more than 400 years.
Now we must turn to the substance of the document. What are the means these people propose using to advance “health equity.” This being the American Medical Association, you might have the idea that their best shot at making a contribution to “health equity” would be through improvements in the practice of medicine. That would be entirely wrong. According to this document, the big problem causing health inequity is not deficient medical care, but rather — you guessed it — the use of the wrong “narratives.” And the solution, of course, is to force the use of the correct narratives.
Please start your journey by carefully studying this graphic:
Having reviewed that, you now understand that great harm has been done by use of the “dominant narratives,” also known as “malignant narratives,” that “undermine public health and the advancement of health equity.” These “dominant” and “malignant” narratives are the ones that contain such evil concepts as “meritocracy,” “individualism,” and “medicine itself”:
Central to this work is a consideration of our language, and the narratives that shape our thinking. 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.
Clearly, the fundamental imperative here is to “move healthcare toward justice.” And, as couldn’t be more obvious, the way to accomplish that goal is simply to replace “narratives grounded in white supremacy and sustaining structural racism” with morally superior narratives of “critical race theory . . ., gender studies, disability studies, as well as scholarship from social medicine”:
Narratives grounded in white supremacy and sustaining structural racism, for example, perpetuate cumulative disadvantage for some populations and cumulative advantage for white people, and especially white men. Patriarchal narratives enforce rigidly defined traditional norms, and reinforce inequities based on gender. Narratives that uncritically center meritocracy and individualism render invisible the very real constraints generated and reinforced by poverty, discrimination and ultimately exclusion. Yet a rich tradition of work in health equity and related fields, including critical race theory (defined in the glossary), gender studies, disability studies, as well as scholarship from social medicine, gives us a foundation for an alternative narrative, one that challenges the status quo, one that moves health care towards justice.
You can go on and on from there if you want. There are about 50 pages of this drivel. At around page 8 we start in on the latest in permissible and impermissible terminology. You quickly learn that most of the brand new vocabulary that you just learned last week has already been superseded and replaced among the super-woke. Example:
Avoid use of adjectives such as vulnerable, marginalized and high-risk.
These terms can be stigmatizing. These terms are vague and imply that the condition is inherent to the group rather than the actual causal factors. Try to use terms and language that explain why and/or how some groups are more affected than others. Also try to use language that explains the effect (i.e., words such as impact and burden are also vague and should be explained).
And that’s only the beginning of pages and pages of this stuff. Other terms that seemed to be fashionable just a few days ago and now are suddenly verboten include such things as “cultural competence,” “disadvantaged,” “under-resourced,” “under-served,” “disparities,” “fairness,” “vulnerable,” and many, many more. Check out the document to learn the latest trendy alternatives to each of these formerly-fashionable terms. Or better yet, don’t, because the new alternatives are likely themselves to be declared to be racist or white supremacist within a matter of days or weeks at most. Your chance of keeping ahead of this whirlwind is about zero.
At page 49 we find a list of names of people who have reviewed and approved this document. Some 29 of them are from the AMA. There are also seven from the AAMC. And then there are the fourteen from the CDC. Yes, the big government “public health” bureaucracy was heavily involved and has its fingerprints all over this.Well, I’m about ready for my annual round of medical checkups from the internist, the eye doctor, the skin doctor, and so forth. The new item on my agenda is I will ask each of them if they are members of the AMA. Any one of them who is will promptly be replaced.