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Medical associations promote diversity over meritocracy in new guide

The Association of American Medical Colleges
The Association of American Medical Colleges, which co-authored the guidance with the American Medical Association | Shutterstock

December 6, 2021 6:57pm

Updated: December 7, 2021 9:39pm

The two associations responsible for accrediting American medical schools have stated that meritocracy is a “malignant” narrative and race has “no genetic or scientific basis,” which doctors worry will lower standards of care.

The American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) Center for Health Justice made these points in a guidance they issued Nov. 30 titled “Advancing Health Equity,” which looked to address inequality in medical care through better “language, narrative, and concepts.”

Included are the ideas that “individualism and meritocracy” are “malignant narratives” that “create harm” and that that medical vulnerability is “the result of socially created processes” over biology or genetics.

The AMA and AAMC cosponsor the Liaison Committee on Medical Education, which accredits all US medical schools.

The Washington Free Beacon interviewed several doctors who expressed concern the guidelines would lead to “underqualified doctors, missed diagnoses, and unscientific medical school curricula.” Most spoke anonymously, out of fear of retaliation.

"Some vulnerability isn't about economic or social marginalization," said Jeff Singer, a general surgeon in Arizona and the only doctor who chose to be identified. "A lot of conditions" — such as Tay-Sachs, which disproportionately impacts Ashkenazi Jews, and triple-negative breast cancer, which disproportionately affects black women — "vary based on genetics. We’re talking about matters of life and death here."

A group of five black genetics researchers made a similar argument in The New England Journal of Medicine in March, saying that ignoring race is “a form of naïve 'color-blindness' that is more likely to perpetuate and potentially exacerbate disparities.”

They argued that race has “both a genetic and a social component,” so discouraging language that brings attention to race may lead doctors to overlook how “genetic differences between populations defined by ancestry” have medical needs.

“Although ignoring race could improve equality (by leading to identical medical treatment for everyone), we believe that equity is necessary to address disparities,” they wrote. “We urge our colleagues in medicine and science to refrain from haphazardly removing race from clinical algorithms and treatment guidelines in response to recent initiatives attempting to combat anti-Black racism.”

The five black researchers also highlighted how considering race led to positive outcomes, even outside their field of genetics. Examples cited include how Black-owned barbershops could help connect their Black male clientele to help for hypertension – which is higher in that demographic – and how Black dermatology patients are more satisfied by service at skin-of-color clinics.

Some doctors have turned their concerns to how the guide’s stance against meritocracy will lower the standards of medical school admissions, leading to less qualified doctors in the future.

Medical error is the third leading cause of death in the United States, according to a 2018 study by Johns Hopkins medical school.