Social Justice in Medicine

[YeOleBoneWiz]

Some groups of people just have cultures that are less malleable to modern society than others. Its not a color of the skin things more ancestry. IE Irish southern culture is a bit less malleable than other European cultures more prevalent in the north east or midwest. Many asian cultures fall into the latter. If we want to have legit discussion of ethnical differences in outcomes we can't ignore the above.

There are studies showing this if anyone is interested. Some groups of people come from areas that required a more aggressive type of persona and more athletic build to survive. Usually the studies measure reaction to controlled stress situations and hormone levels before/after the stressor is provided.

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[detritus]

The issue with this is that not everyone agrees about how to get there. Do you force equality of outcome or strive to provide equality of opportunity? Some people don't even agree that diversity as measured by the color of your skin should be the goal, but rather diversity of experience or opinion. Do we start telling schools to accept X% Hispanic, Y% African-American, Z% Asian?

I'm of the opinion that equality of opportunity should be the goal and that begins at the grassroots level, not top-down via government mandates.

I never argued for government mandates or telling schools what to do. I want equality of opportunity too, but surely we are not there. I’m sure black kids would love to have the opportunity to become doctors just like white kids but many of their lives just make that a very difficult task. This is why I said it’s not all about medical schools. It starts earlier on in the pipeline. We need more black science teachers, more educational initiatives targeted at black neighborhoods, scholarships, that sort of thing. By the time someone is applying to med school so much had to have gone right for them. It’s great to champion those who work their asses of to break out and kill the MCAT, get into Harvard or whatever but we need to look into the number of black kids that never even have that as a realistic aspiration. No one should be given a medical school acceptance for nothing, but we gotta understand that the lack of black doctors, although not our faults, is a big public health problem. In the meantime I only ask that we try and train the outstanding physicians we do have of all backgrounds to be more competent in treating all types of people.

 

[Steve_Zissou]

I never argued for government mandates or telling schools what to do. I want equality of opportunity too, but surely we are not there. I’m sure black kids would love to have the opportunity to become doctors just like white kids but many of their lives just make that a very difficult task. This is why I said it’s not all about medical schools. It starts earlier on in the pipeline. We need more black science teachers, more educational initiatives targeted at black neighborhoods, scholarships, that sort of thing. By the time someone is applying to med school so much had to have gone right for them. It’s great to champion those who work their asses of to break out and kill the MCAT, get into Harvard or whatever but we need to look into the number of black kids that never even have that as a realistic aspiration. No one should be given a medical school acceptance for nothing, but we gotta understand that the lack of black doctors, although not our faults, is a big public health problem. In the meantime I only ask that we try and train the outstanding physicians we do have of all backgrounds to be more competent in treating all types of people.

I agree with you, for the most part. Hell, I’m Hispanic and the number of Hispanic medical students relative to the population is just as bad.

It seems I assumed that you were for direct government intervention to solve those ills (as in forcing schools to meet quotas). I apologize.

As for what I’m doing, I’m mentoring underprivileged Hispanic kids. I plan to continue to do the same with shadowing for students once I’m a physician. I plan to donate to groups that advocate/provide education to underprivileged groups (can’t take credit for that because I haven’t done it, just a plan).

 

[operaman]

I read the study @detritus linked above and I see 2 major drivers for the infant mortality difference:

1) bias. Yes, I’m sure that this plays some role, likely from both patient and physician. I think the data are compelling enough on this front to suggest some role for implicit biases. I don’t think they are the major contributor though.


2) physician quality. Here is what I think is the major driver and neither discussed nor controlled for in the study.

What kind of white physician elects to practice in mostly black hospitals serving underserved populations with far higher rates of Medicaid and self pay? Spoiler alert: it’s not the best trained ones! Those docs are practicing in nice Wealthy suburban areas with largely white commercially insured patients. So which white docs go to the poor underserved black areas? Probably a combo of the altruistic alongside those who can’t get hired elsewhere. The study notes the mortality differential between physician races increases in hospitals that deliver more black babies. The effect also increased in babies with more comorbidities, which suggests to me that the white physicians working in black hospitals may not be as good as their black counterparts.

What’s sad is that offering such an opinion in most medical schools would probably land me in front of some associate dean. The SJWs in MedEd seem to be more interested in pushing their agenda than truly discussing and debating the underlying issues. There are major issues in the world, but the SJW and “anti-racist” framework simply doesn’t allow for reasonable debate, electing instead for good old fashioned indoctrination.

 

[Damson]

I read the study @detritus linked above and I see 2 major drivers for the infant mortality difference:

1) bias. Yes, I’m sure that this plays some role, likely from both patient and physician. I think the data are compelling enough on this front to suggest some role for implicit biases. I don’t think they are the major contributor though.


2) physician quality. Here is what I think is the major driver and neither discussed nor controlled for in the study.

What kind of white physician elects to practice in mostly black hospitals serving underserved populations with far higher rates of Medicaid and self pay? Spoiler alert: it’s not the best trained ones! Those docs are practicing in nice Wealthy suburban areas with largely white commercially insured patients. So which white docs go to the poor underserved black areas? Probably a combo of the altruistic alongside those who can’t get hired elsewhere. The study notes the mortality differential between physician races increases in hospitals that deliver more black babies. The effect also increased in babies with more comorbidities, which suggests to me that the white physicians working in black hospitals may not be as good as their black counterparts.

What’s sad is that offering such an opinion in most medical schools would probably land me in front of some associate dean. The SJWs in MedEd seem to be more interested in pushing their agenda than truly discussing and debating the underlying issues. There are major issues in the world, but the SJW and “anti-racist” framework simply doesn’t allow for reasonable debate, electing instead for good old fashioned indoctrination.

Based off @detritus 's study I thought perhaps it is just implicit bias affecting treatment outcome. Thanks for noting the other potential driver

In the meantime I only ask that we try and train the outstanding physicians we do have of all backgrounds to be more competent in treating all types of people.

How do we do that?

 

[Mass Effect]

I didn't imply anything of the sort. I explicitly stated that medical schools should only be teaching us medicine, not a political worldview. Stop putting words in my mouth.

And I'm saying that understanding political worldviews IS part of medicine. If you don't see that, you're an example of why it's necessary.

 

[Steve_Zissou]

And I'm saying that understanding political worldviews IS part of medicine. If you don't see that, you're an example of why it's necessary.

Agree to disagree then, I suppose.

 

[detritus]

I read the study @detritus linked above and I see 2 major drivers for the infant mortality difference:

1) bias. Yes, I’m sure that this plays some role, likely from both patient and physician. I think the data are compelling enough on this front to suggest some role for implicit biases. I don’t think they are the major contributor though.


2) physician quality. Here is what I think is the major driver and neither discussed nor controlled for in the study.

What kind of white physician elects to practice in mostly black hospitals serving underserved populations with far higher rates of Medicaid and self pay? Spoiler alert: it’s not the best trained ones! Those docs are practicing in nice Wealthy suburban areas with largely white commercially insured patients. So which white docs go to the poor underserved black areas? Probably a combo of the altruistic alongside those who can’t get hired elsewhere. The study notes the mortality differential between physician races increases in hospitals that deliver more black babies. The effect also increased in babies with more comorbidities, which suggests to me that the white physicians working in black hospitals may not be as good as their black counterparts.

What’s sad is that offering such an opinion in most medical schools would probably land me in front of some associate dean. The SJWs in MedEd seem to be more interested in pushing their agenda than truly discussing and debating the underlying issues. There are major issues in the world, but the SJW and “anti-racist” framework simply doesn’t allow for reasonable debate, electing instead for good old fashioned indoctrination.

Shout out to you and @Steve_Zissou for thinking about this paper and actually listening to my replies, it’s a breath of fresh air. Thanks for the insight I never even thought of the types of physicians that may work in these different settings. I agree with you, sometimes academic culture can stifle real discussion. Personally, your post made me think about other contributing factors and it’s not a bad suggestion to be honest. This stuff can be nuanced and thoughtful, doesn’t have to be only one right answer.

edit: some of us “SJW” types might surprise you. Some of us are off the deep end but most of us just want to see meaningful progress and discussion on how to get there.

 

[deleted859689]

https://scholar.harvard.edu/files/dobbin/files/an2018.pdf

Here is an interesting paper on it.

Read it and I generally agree with what is said. I used to have this same train of thought that actively bringing up biases can form them in itself. This was my main stance in my media in society elective in undergrad where we examined a lot of commercials and the teacher told us some of them were racially biased. However, I would counter-argue that I personally didn't see any racial bias, but now you put the idea in my head.

My current mind set is that some people have biases they don't know about, and perhaps discussing it is more beneficial than trying to ignore it. However, a part of me still wonders if everyone in the world just dropped the race card and we all just stopped talking about it, would we be better off? Good read, but not a medical journal citation. FYI I used to work at starbucks and went through those dumb "3rd place" training modules and agree it really didn't do anything. but hey, they're doing pretty well as a company and offer awesome benefits.

 

[raiderette]

Grew up poor from rural areas. I also have been working in women's health since I started volunteering at age 14. Social justice to me is real life. First generation college students are less than 5% of med school graduates.
Regardless of color, poor kids like me rarely make it to graduation. I will continue to fight anyone feeling oppressed because they have a curriculum that tries to teach empathy.

 

[Steve_Zissou]

Grew up poor from rural areas. I also have been working in women's health since I started volunteering at age 14. Social justice to me is real life. First generation college students are less than 5% of med school graduates.
Regardless of color, poor kids like me rarely make it to graduation. I will continue to fight anyone feeling oppressed because they have a curriculum that tries to teach empathy.

That’s all good and fine, but two issues.

1) Teaching a certain political stance =/= teaching empathy

2) Is empathy something you can teach? Can you greatly improve your empathy via a 2 hour lecture?

 

[dr_kateb]

That’s all good and fine, but two issues.

1) Teaching a certain political stance =/= teaching empathy

2) Is empathy something you can teach? Can you greatly improve your empathy via a 2 hour lecture?

Cognitive empathy possibly. Emotional probably not. Teaching how to express compassion is probably more productive, which is independent of empathy.

 

[deleted480308]

Grew up poor from rural areas. I also have been working in women's health since I started volunteering at age 14. Social justice to me is real life. First generation college students are less than 5% of med school graduates.
Regardless of color, poor kids like me rarely make it to graduation. I will continue to fight anyone feeling oppressed because they have a curriculum that tries to teach empathy.

I don’t think anyone here was arguing against empathy

 

[YeOleBoneWiz]

Grew up poor from rural areas. I also have been working in women's health since I started volunteering at age 14. Social justice to me is real life. First generation college students are less than 5% of med school graduates.
Regardless of color, poor kids like me rarely make it to graduation. I will continue to fight anyone feeling oppressed because they have a curriculum that tries to teach empathy.

The med school I went to promoted rural primary care. We had a lot of white first time college grads as classmates. The school used to 'promote' scholarships all the time for us. Unfortunately none of them qualified since they were not minority status. Most, if not all scholarships at my school went to people of color who came from families who were already very well off and did not need the money.
****ness like that is why we are not so lighthanded when it comes to SJW garbage.... as if you are poor and white it is your fault but be of color and wait, its still the white guys fault.

 

[deleted480308]

The med school I went to promoted rural primary care. We had a lot of white first time college grads as classmates. The school used to 'promote' scholarships all the time for us. Unfortunately none of them qualified since they were not minority status. Most, if not all scholarships at my school went to people of color who came from families who were already very well off and did not need the money.
****ness like that is why we are not so lighthanded when it comes to SJW garbage.... as if you are poor and white it is your fault but be of color and wait, its still the white guys fault.

Forgive my ignorance here but, what the hell is “****ness”?

 

[YeOleBoneWiz]

Forgive my ignorance here but, what the hell is “****ness”?

According to urban dictionary it comes in around 50 different flavors of badness

 

[Angus Avagadro]

Shout out to you and @Steve_Zissou for thinking about this paper and actually listening to my replies, it’s a breath of fresh air. Thanks for the insight I never even thought of the types of physicians that may work in these different settings. I agree with you, sometimes academic culture can stifle real discussion. Personally, your post made me think about other contributing factors and it’s not a bad suggestion to be honest. This stuff can be nuanced and thoughtful, doesn’t have to be only one right answer.

edit: some of us “SJW” types might surprise you. Some of us are off the deep end but most of us just want to see meaningful progress and discussion on how to get there.

I wasn't able to access the entire paper, only the abstract. @operaman is correct, there are many variables not controlled in these kinds of studies. To name a few. What about prenatal care? Comorbidities? Weight gain which increases incidence of c section? Smoking? Alcohol and drug use? Please correct me if the study controlled these variables as I wasnt able to access the entire paper. I'm always a little skeptical when studies on physician race and outcome are compared

 

[GoSpursGo]

Let's please try to move away from name-calling, and anything involving the letters c-u-c-k in that order.

 

[dr_kateb]

Forgive my ignorance here but, what the hell is “****ness”?

Your wife is unfaithful. Some guys are fine with it and wear it as a badge of honor (male feminist types).

 

[Goro]

I find it hilarious you think cancel culture is a liberal phenomena. Nowadays conservatives adhere to it just as much. I mean, is there even a difference between cancel culture and identity politics?

I agree with you, but my own perception is that it's worse on the far left (and I'm a Yellow Dog Democrat). I'm reminded of how the Berkeleyites reacted to Ann Coulter giving a talk at UCB. They didn't just object, they rioted.

 

[TwoHighways]

I don’t see right wingers shouting people down/protesting/rioting when a when a leftist shows up to give a lecture on campus. Can anyone name a prominent left wing intellectual that has been a victim of cancel culture at the hands of right wingers? If anything, I’ve seen a lot of the radical left turning on center left for not toting the identity politics/victimhood card.

If you want to find “racism”, your own confirmation bias will uncover it. I mean, I could talk about “black privilege” when it comes to affirmative action and admissions, and if the US was such a racist country, how did such a policy ever even get implemented? Last time I checked, it was mostly white people that died to end slavery (yes, the counter of which is that it was mostly white people responsible for the slave trade). How did we strike down Jim Crow laws? How did civil rights legislation get passed? It seems like so many people discount the progress we’ve made. Yeah, we have a tarnished legacy, but what country or civilization doesn’t? And that’s not an attempt to discredit the struggle that black Americans have historically faced. I just think so many problems in the black community today aren’t the fault of anyone else. Yeah, there’s legitimate discussions to be had about the war on drugs, policing (on behalf of all Americans, not just black Americans), and poverty. All I’m suggesting is that we look within prior to subscribing to a bitter mindset that I’m being oppressed by some other group of people. Is your life right now not better than your parent’s lives? Do you not have more opportunities than they did to be successful? Let’s not throw the baby out with the bath water. And we ought to exhaust any and all possible explanations for racial differences in outcome prior to assuming it’s “systemic racism”.

 

[Goro]

14 pages and we're still going good! Hats off to all of you for still keeping this (mostly) civil.

For those of you new to SDN, the typical SPF dumpster fire thread would go on for the same amount of time, on the usual subject topics, and to save your time, I summarize them for you (to keep things still civil, the debate is on the merits of Floon vs Zool)

SDNer A: Floon bad!
B: Floon good Zool bad
C: cites ten studies where Floon is good and Zool is bad
D: cites ten studies where Zool is good and Floon is bad
E: Gives strawman argument why Floon is bad
F: Gives strawman argument why Zool is bad
A: Floon bad!
B: Floon good Zool bad
E-J: give whataboutism arguments for why Floon/Zool are bad
A, D, G, I: F you!
B, E, H J: No, F you!!
Random Red Sox fan: F the Astros!
Thoracic Guy [posts "bruh" meme...gets most likes in the thread]
K: makes some obscure reference to an even more obscure topic
Everybody else on SDN: ???????
A: I forgot where I was...
B: I think it i was your turn?
C: No, I think it was B's turn
A: I'm a little tired. B, can you go first?
B: Sure thing! Floon good Zool bad!!!
Rinse and repeat for 10 more pages.

 

[NontradCA]

I don’t see right wingers shouting people down/protesting/rioting when a when a leftist shows up to give a lecture on campus. Can anyone name a prominent left wing intellectual that has been a victim of cancel culture at the hands of right wingers? If anything, I’ve seen a lot of the radical left turning on center left for not toting the identity politics/victimhood card.

If you want to find “racism”, your own confirmation bias will uncover it. I mean, I could talk about “black privilege” when it comes to affirmative action and admissions, and if the US was such a racist country, how did such a policy ever even get implemented? Last time I checked, it was mostly white people that died to end slavery. How did we strike down Jim Crow laws? How did civil rights legislation get passed? It seems like so many people discount the progress we’ve made. Yeah, we have a tarnished legacy, but what country or civilization doesn’t? And that’s not an attempt to discredit the struggle that black Americans have historically faced. I just think so many problems in the black community today are self inflicted. Yeah, there’s legitimate discussions to be had about the war on drugs. All I’m suggesting is that we look within prior to subscribing to a bitter mindset that I’m being oppressed by some other group of people. Let’s not throw the baby out with the bath water. And we ought to exhaust any and all possible explanations for racial differences in outcome prior to assuming it’s “systemic racism”.

@GoSpursGo

I’m sposed to be civil to this thing? Smh.

 

[TwoHighways]

@GoSpursGo

I’m sposed to be civil to this thing? Smh.

Make your counterpoint. Look, we can disagree and even be “offended” and still put forth a good faith effort to understand a viewpoint that runs counter to our own.

 

[Damson]

@GoSpursGo

I’m sposed to be civil to this thing? Smh.

Yes. I would be, because in anything we believe in with certainty, we can certainly be wrong about it.

Veiled ad hominems and dismissive remarks aren't real arguments.

 

[TwoHighways]

Oh, the hysterics. So making the point that it was largely white people that died fighting for the Union is equivalent to holocaust denial? Really?

 

[NontradCA]

Yes. I would be, because in anything we believe in with certainty, we can certainly be wrong about it.

Veiled ad hominems and dismissive remarks aren't real arguments.

I wasn’t making an argument.

 

[Damson]

The issue is, we weren’t initially talking about whether it’s what’s most popular, we’re talking about whether it’s right.

Really trying to resist invoking Godwin’s law to make my point here.

Is it time to invoke Godwin's law yet

 

[Steve_Zissou]

This is the equivalent of holocaust denial. So Millions of slaves that died, suffered cruelty didn’t end slavery but white savior did?

While this may be cathartic for you in some way, this accomplishes nothing and makes no point. Why not make a reasoned argument and pick his argument apart?

I promise you, if someone were in here denying the holocaust, they would get torn apart pretty easily.

 

[TwoHighways]

Look, slavery and the mindset of those that condoned it based on the “inferiority” of a person with more melanin content in their skin was atrocious. But I’m not about to discredit the efforts of those “white saviors” (this is everything that’s wrong with radical SJW/critical race theorists, the rhetoric is divisive trash), the efforts of which played a large role in correcting the wrongs of this country. Not will I be held accountable for the sins of the past that I had no involvement in.

It’s like, go out and do amazing things that would have been impossible for previous generations to go out and do. If you’re passionate about improving the lives of the dispossessed, use your gifts (I presume anyone posting here is on the right side of the intelligence bell curve) to go out there and seek out bright kids in ****ty situations to mentor. Empower them through giving them a mindset that they can achieve great things for themselves as well.

If we spent a fraction of the time doing something of value as we did virtue signalling on social media and/or complaining, how much better would the world be as a result of such action?

 

[NontradCA]

I wasn’t looking for anyone to clean up what I said and I stand by it and they can ban me for it. I know it violates the TOS. I’ll take the licks for it gladly. I only wish a ..... would

 

[TwoHighways]

I wasn’t looking for anyone to clean up what I said and I stand by it and they can ban me for it. I know it violates the TOS. I’ll take the licks for it gladly. I only wish a ..... would

If it was up to me, I wouldn’t have you banned. That being said, I’ve been put in timeout for much less.

 

[gyngyn]

Sadly, it appears we cannot have a civil discussion on this topic.
Closing (again).