If it seems remarkably reminiscent of the American Bar Association, that’s because it is. Much as the ABA became captive to progressive lawyers and academics at the expense of the rest of the bar, the American Medical Association has apparently succumbed to the same influence. Capturing institutions has become a primary goal, the purpose of which is to reform their evil ways and train future generations to be woke.
In a document called Advancing Health Equity: A Guide to Language, Narrative and Concepts, the AMA and AAMC urge physicians and other health-care workers to replace many “commonly used” words, such as vulnerable, with “equity-focused” alternatives, such as oppressed.
The document is a classic example of how administrative bureaucracies of all sorts are thinking about social justice in 2021. Substantive disparities exist in health-care outcomes in the United States—across a variety of demographic and socioeconomic lines––alongside ongoing debates about their causes and how best to eliminate them. But in response, two leading medical organizations are proposing a lot of language policing that presumes far-left answers to a host of thorny questions.
Conor Friedersdorf doesn’t dismiss health care disparities by race. They exist. Why they exist and what to do about them to eliminate such disparities is a tough, but critical, question. Are physicians dismissive of black patients’ complaints about pain? Do they not give black patients the time and attention they need and deserve? Do black people lack access to medical care for lack of health insurance? Are black people making health choices that are counterprodutive, from the food they eat to the prenatal care sought by pregnant black women to drug use?
What gives rise to this issue is not that the medical profession doesn’t care about finding answers to these problems, but that the AMA has simultaneously put its efforts into turning the language of physicians left.
In this instance, the guide explains:
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.
Is there a problem to be solved here? Is it “stigmatizing” to say that black people are at greater risk of heart disease and obesity? Perhaps, but so what?
But that would be misleading. Medical vulnerability is not synonymous with oppression. Men are more vulnerable to COVID-19 than women, but not because men are more oppressed. My grandmother is far more vulnerable to the disease than a wrongfully incarcerated teenager, yet she is far less oppressed. Meanwhile, a warehouse worker whose boss fails to update workplace-safety protocols might indeed be vulnerable to COVID-19 because of lopsided power relations. But if exposed to a public-health message urging vaccination for “the most oppressed,” he might think, That’s not me, whereas a message informing him that “indoor workers are among the most vulnerable” is far more explicit about whom the advice is for.
It has become an article of faith over the past few years that language plays an indisputable role in oppression, dehumanizing people and thus creating an atmosphere where they are treated as lesser people. Is it dehumanizing to refer to a diabetic as a diabetic or a person with diabetes? If using more words rather than fewer to say the same thing makes someone feel less “dehumanizing,” there’s no harm in it, even if it seems silly and pointless. But will the physician who chooses fewer words be criticized, perhaps reprimanded or shunned, for dehumanizing her patients? That could be a problem.
But the bigger, and more substantive problem, is the creation of a medical language that flies in the face of reality and makes medical communication less clear and more imprecise.
On page 8 of the report, the AMA explains what it means by this. Here’s an example of what not to say and what to replace it with.
Is it society’s fault that people choose not to wear masks or seek healthcare? Perhaps for some, but for those who make healthcare choices that are harmful, in what way does it advance their care by removing the “blame” from those who need to be told to stop making bad choices? The same is true for co-morbidities like obesity, which can be blamed on an array of politically correct rationalizations, but won’t stop a person from eating McDonald’s for dinner daily until they die.
And more to the point, will physicians’ assumption of social justice rhetoric endear them to their patients?
The guide is also politically naive. The AMA and AAMC imagine that if doctors and other health-care professionals adopt the suggested language, they will bring about progressive change by way of the credibility that their words carry. More likely, they will squander that credibility. The medical profession won’t remain more broadly trusted than left-wing activists if the two become indistinguishable. And that’s what will happen if doctors follow the guide’s advice. Instead of saying, “Low-income people have the highest level of coronary artery disease,” it urges health professionals to substitute this doctrinaire sentence: “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 a section attacking “the narrative of individualism,” the guide posits that health promotion “typically means educating people as individuals,” and urges “shifting this narrative, from the individual to the structural, in order to more fully understand the root causes of health inequities in our society.” It’s already hard enough to get my conservative grandfather to heed his doctors about how best to care for a bad back worn down from decades in construction. A new narrative meant to problematize real-estate developers or individualism would not improve his medical condition, but it would inflame his temper. One wonders if the AMA and the AAMC grasp how many patients of all races and socioeconomic groups (never mind doctors) strongly disagree with the agenda that the two organizations are pushing. Either way, patients will feel put off by doctors who sound like ideologues from a different political tribe.
If the purpose of medicine is to teach patients who to hate for their health, then this shift makes some sense, even though it’s more likely that patients will instead assume their docs are left-wing nuts. But if the purpose of medical care is to improve people’s health, and maybe even eliminate the health disparities between black and white patients, obscuring medical reality behind political rhetoric isn’t going to do the job.
AMA President Gerald Harmon explicitly endorses the new guidance too. Dominant narratives can be “wielded as a weapon to oppress others,” he wrote as part of an article extolling its release. “That is the case, for example, with the use of adjectives that dehumanize individuals by reducing them to their diagnosis—simply referring to a patient living with diabetes as a ‘diabetic’—or that unfairly labels groups of people as ‘vulnerable’ to chronic disease while ignoring the entrenched power structures, such as racism, that have put them at higher risk.”
Whether the AMA will go the way of the ABA remains to be seen, but blaming racism rather than Big Macs isn’t likely to save anyone. If they have a pain, they go do a doctor. They don’t want to be asked where they’re oppressed, but where it hurts, so the doc can make them better.