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On Seeing Long Shadows: Is Academic Medicine at its Core a Practice of Racial Oppression?

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Abstract

Suggestions that academic medicine is systemically racist are increasingly common in the medical literature. Such suggestions often rely upon expansive notions of systemic racism that are deeply controversial. The author argues for an empirical concept of systemic racism and offers a counter argument to a recent suggestion that academic medicine is systemically racist in its treatment of medical trainees: Anderson et al.’s (Academic Medicine, 98(8S), S28–S36, 2023) “The Long Shadow: a Historical Perspective on Racism in Medical Education.” Contra the authors of “The Long Shadow,” the author argues that racial performance disparities in medical education cannot be validly attributed to racism without careful empirical confirmation; he further argues that standards of assessment in medical education cannot be properly deemed racist merely because minority trainees are disproportionately disadvantaged by them. Furthermore, the history of medicine and society in the Anglo-European West is not, as argued by the authors of “The Long Shadow,” best viewed as one long tale of racial oppression culminating in the present day pervasive racism of academic medicine in the United States. Racism is a deplorable stain on our history and our present but it is not the historical essence of Christianity, European civilization, Western medicine, or contemporary academic medical institutions.

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Notes

  1. The Merriam-Webster definition given prior to the 2020 revision is quoted in Preston(2020).

  2. I have offered an account of and argument against critical theory in the form of critical race theory in Huddle (2022). In the present paper “critical theory” is the critical theory of the Frankfurt School. For present purposes, the important tenets of critical theory are: (1) Suspicion of usual methods of academic inquiry in history and the social sciences on the grounds that such methods are contaminated by ideology and in fact serve the interests of a dominant societal group. (2) A presumption that hierarchy or social stratification in society inevitably reflects oppression: domination by upper-situated groups through subordination of lower-situated groups. (3) Conviction that scholarship can and must identify and serve the interests of the oppressed, often by exposing the routine forms of thought and practice of oppressor groups as enabling of oppression. See, Celikates & Flynn (2023) for a discussion of Frankfurt School Critical Theory.

  3. Such debunking in the case of race-centrism takes the form of an accusation that scholarship presuming the importance of objectivity is “white sociology,” as in Brunsma and Wyse’s definition (references omitted): “White sociology is a paradigmatic approach that holds as central (1) that sociological knowledge creation is an objective process, embedded with objectivity; (2) the practice of a “value-free” approach to doing sociology; and (3) the privileging of the positivist methodological approach to doing sociology. However, in practice, white sociology’s objectivity centers on Eurocentric experiences that produce ethnocentric research and the objectification of racialized Others (Brunsma & Wyse, 2019, 3).” In a similar vein, Slatton and Feagin contend that mainstream scholars “provided mid-twentieth century theories on race that privileged a white male lens” (Slatton & Feagin, 2019, 175); and Bonilla-Silva and Zuberi contend that “the dominant perspective in sociology has been defined by a view of reality that privileges Whites in the United States and Europe” (Zuberi & Bonilla-Silva, 2008, 15–16).

  4. A particularly useful articulation of the theoretical orientation of a race-centrist is offered by Howard Winant in his response to Andreas Wimmer’s book Ethnic Boundary Making: Institutions, Power, Networks (Winant, 2015, 2181-218;, Wimmer, 2013). Winant suggests that Wimmer’s conclusions about race are mistaken on account of his “scientism” and nomothetic commitments”—that is, a determination to seek causal mechanisms using the investigative tools of sociology. For Winant, this leads to an unfortunate “depoliticizing” of sociological work and a devaluing both of the voice of “ordinary people” in understanding racial oppression and of idiographic methods more generally as means of understanding social reality.

  5. Cf. Bonilla-Silva: “Omi and Winant, Feagin, and I have made mostly macrolevel claims about race in America” (Bonilla-Silva, 2015, 82).

  6. Cf. Winant’s suggestion that sociology aspiring to objectivity must give way to idiography in understanding race: “I call for a political sociology much more attentive to the variety and profundity of popular struggles…I argue against the claims of the nomothetic, deductive approach that Wimmer proposes for the comprehensive study of REN (race, ethnicity and nation) and appeal to an alternative, idiographic and radical pragmatist orientation in tackling these themes (Winant, 2015, 2177).

  7. As Daniel Little puts the point: “…the very notion of a comprehensive social science that lays the basis for systematizing and predicting social change is radically ill-conceived…. Instead of looking for a few general and comprehensive theories of social change, we should be looking for a much larger set of quasi-empirical theories of concrete social mechanisms. And, the generalizations that we will be able to reach will be modest ones having to do with the discovery of some similar processes that recur in a variety of circumstances and historical settings” (Little, 2016, xvi). Thus academic traditionalists hold totalizing “grand narrative” accounts of society to be suspect, not because truth in any universal sense is unattainable, as postmodernists would contend, but because such accounts overlay their totalizing lenses (reified social forces such as class conflict, patriarchy, capitalism, imperialism, or racism) on a complex social reality without the epistemic warrant that granular sociological or historical investigation would provide.

  8. As observed by Andrew Sullivan in his review of Kendi’s How to be an Antiracist (Sullivan, 2019). Kendi envisions a governmental “Department of Anti-racism” which would target public or private “antiracist policies” which could include “racist ideas” as determined by “formally trained experts on racism” (Kendi, 2019b).

  9. Investigations of racial group differences in performance on the MCAT have not found evidence of test bias as might be indicated by test failure to correlate with student subsequent performance in medical school (Davis et al., 2013). There is no doubt that tests such as the SAT were once culturally biased but that is no longer the case (Zwick, 2019, 137). Recent fault-finding with objective testing in the undergraduate medical setting has concerned not the intrinsic fairness of the tests but their relevance to clinical expertise or competence (Teherani et al., 2018; Lucey et al., 2020).

References

  • Anderson, N., Mytien, N., Marcotte, K., Ramos, M., Gruppen, L., & Boatright, D. (2023). The long shadow: A historical perspective on racism in Medical Education. Academic Medicine, 98(8S), S28–S36. https://doi.org/10.1097/ACM.0000000000005253

    Article  Google Scholar 

  • Banaji, M. R., Fiske, S. T., & Massey, D. S. (2021). Systemic racism: Individuals and interactions, institutions and society. Cognitive Research: Principles and Implications, 6(82), 1–21.

    Google Scholar 

  • Blum, L. (2002). Racism: What it is and what it isn’t. Studies in Philosophy and Education, 21, 203–218.

    Article  Google Scholar 

  • Blumenberg, H. (1985). The legitimacy of the modern age. MIT Press.

  • Boatright, D., Ross, D., O’Connor, P., Moore, E., & Nunez-Smith, M. (2017). Racial disparities in medical student membership in the Alpha Omega Alpha Honor Society. JAMA Internal Medicine, 177(5), 659–665.

    Article  Google Scholar 

  • Bonilla-Silva, E. (2015). More than prejudice: Restatement, reflections, and new directions in critical race theory. Sociology of Race and Ethnicity, 1(1), 73–87.

    Article  Google Scholar 

  • Bonilla-Silva, E. (2021). What makes systemic racism systemic? Sociological Inquiry, 91(3), 513–533.

    Article  Google Scholar 

  • Brunsma, D. L., & Wyse, J. P. (2019). The possessive investment in white sociology. Sociology of Race and Ethnicity, 5(1), 1–10. https://doi.org/10.1177/2332649218809968

    Article  Google Scholar 

  • Buell, D. K. (2005). Why this new race: Ethnic reasoning in early Christianity. Columbia University.

  • Buell, D. K. (2009). Early Christian universalism and modern forms of racism. In M. Eliav-Feldon, B. Isaac, & J. Ziegler (Eds.), The origins of racism in the west (pp. 109–131). Cambridge University Press.

  • Butterfield, H. (1931). The Whig interpretation of history. WW Norton and Company.

  • Canay, I. A., Mogstad, M., & Mountjoy, J. (2023). On the use of outcome tests for detecting bias in decision-making. National Bureau of Economic Research. Retrieved April 23, 2024, from http://www.nber.org/papers/w27802

  • Celikates, R., & Flynn, J. (2023). Critical theory (Frankfurt School). In E.N. Zalta, and U. Nodelman (Eds.), The Stanford Encyclopedia of Philosophy Retrieved February 24, 2024, from https://plato.stanford.edu/archives/win2023/entries/critical-theory/

  • Daniels, A. (2019). False positive: A year of error, omission and political correctness in the New England Journal of Medicine. Encounter Books.

  • Davis, D., Dorsey, J. K., Franks, R. D., Sackett, P. R., Searcy, C. A., & Zhao, X. (2013). Do racial and ethnic group differences in performance on the MCAT exam reflect test bias? Academic Medicine, 88(5), 593–602. https://doi.org/10.1097/ACM.0b013e318286803a

    Article  Google Scholar 

  • Editorial Board (2020). The New England Journal of Politics, Part II. The Wall Street Journal. October 9, 2020. Retrieved June 20, 2023, from https://www.wsj.com/articles/the-new-england-journal-of-politics-part-ii-11602283219

  • Eva, K. W., Bordage, G., Campbell, C., Galbraith, R., Ginsburg, S., Holmboe, E., & Regehr, G. (2016). Towards a program of assessment for health professionals: From training to practice. Advances in Health Sciences Education, 21(4), 897–913.

    Article  Google Scholar 

  • Fredrickson, G. M. (2002). Racism: A short history. Princeton University Press.

  • Goldman, L. (2023). Whig history or woke history: Can you spot the difference? History Reclaimed. Retrieved June 30, 2023, from https://historyreclaimed.co.uk/whig-history-or-woke-history-can-you-spot-the-difference/

  • Gordon, P. E. (2019). Secularization, genealogy, and the legitimacy of the modern age: Remarks on the Löwith-Blumenberg debate. Journal of the History of Ideas, 80(1), 147–170.

    Article  Google Scholar 

  • Govaerts, M. J. B., van der Vleuten, C. P. M., & Holmboe, E. S. (2019). Managing tensions in assessment: Moving beyond either-or thinking. Medical Education, 53(1), 64–75.

    Article  Google Scholar 

  • Gruen, E. S. (2020). Ethnicity in the ancient world—did it matter? Berlin: Walter de Gruyter.

  • Hamm, E. (2019). Christian thought, race, Blumenbach, and historicizing. Zygon, 54(1), 240.

    Article  Google Scholar 

  • Haskell, T. (1990). Objectivity is not neutrality: Rhetoric vs. practice in Peter Novick’s That noble dream: History and theory, 29(2), 129–157.

    Article  Google Scholar 

  • Heng, G. (2018). The invention of race in the European Middle ages. Cambridge, UK: Cambridge University Press.

  • Hodges, B. D. (2010). A tea-steeping or i-doc model for medical education? Academic Medicine, 85(9), s34–s44.

    Article  Google Scholar 

  • Huddle, T. S. (2023). Against the turn to critical race theory and anti-racism in Academic Medicine. HEC Forum, 35(4), 337–356. https://doi.org/10.1007/s10730-022-09471-1

    Article  Google Scholar 

  • Huddle, T. S., & Heudebert, G. R. (2007). Taking apart the art: The risk of anatomizing clinical competence. Academic Medicine, 82(6), 536–541.

    Article  Google Scholar 

  • Jordan, W. C. (2001). Why race? Journal of Medieval and Early Modern Studies, 31(1), 170.

    Article  Google Scholar 

  • Junker, T. (2019). Blumenbach’s theory of human races and the natural unity of humankind. In N. Rupke, & G. Lauer (Eds.), Johann Friedrich Blumenbach: Race and Natural History 1750–1850, (pp. 96–112). Routledge.

  • Keel, T. (2018). Divine variations: How christian thought became racial science. Stanford, Stanford University Press.

  • Kendi, I. X. (2019a). How to be an antiracist. Penguin Random House LLC.

  • Kendi, I. X. (2019b). Pass an anti-racist constitutional amendment. Politico Magazine Retrieved February 22, 2024 from https://www.politico.com/interactives/2019/how-to-fix-politics-in-america/inequality/pass-an-anti-racist-constitutional-amendment/

  • Kennedy, R. (1989). Racial critiques of legal academia. Harvard Law Review, 102(8), 1745–1819.

    Article  Google Scholar 

  • Kilminster, R. (2013). Critique and overcritique in sociology. Human Figurations, 2(2). Retrieved February 23,2024, from http://hdl.handle.net/2027/spo.11217607.0002.205

  • Kleshinski, J., Khuder, S. A., Shapiro, J. I., & Gold, J. P. (2009). Impact of preadmission variables on USMLE step 1 and step 2 performance. Advances in Health Sciences Education, 14(4), 69–78. https://doi.org/10.1007/s10459-007-9087-x

    Article  Google Scholar 

  • La Du Toit, G. P (2020). Ethnic reasoning and early Christian identity: A Pauline theological perspective. HTS Teologiese Studies/Theological Studies, 76(1), a5800. https://doi.org/10.4102/hts.v76i1.5800

    Article  Google Scholar 

  • Lewis, L., Fabersunne, C. C., Iacopetti, C. L., Negussie-Retta, G., McBride, D., Irving, P., & Marbin, J. (2023). Racial affinity group caucusing in medical education—A key supplement to antiracism curricula. New England Journal of Medicine, 388(17), 1542–1545.

    Article  Google Scholar 

  • Little, D. (2016). New directions in the philosophy of social science. Lanham, MD: Rowman & Littlefield International.

  • Lucey, C. R., Hauer, K. E., Boatright, D., & Fernandez, A. (2020). Medical education’s wicked problem: Achieving equity in assessment for medical learners. Academic Medicine, 95(12S), S98–S108.

    Article  Google Scholar 

  • Merriam-Webster. n.d. Racism. In Merriam-Webster.com dictionary. Retrieved February 22 (2024), from https://www.merriam-webster.com/dictionary/racism

  • Merriam Company. (1967). Racism. In Webster’s seventh new collegiate dictionary, 704. Springfield, Merriam Webster Inc.

  • Niemonen, J. (2010). Public Sociology or Partisan Sociology? The curious case of whiteness studies. The American Sociologist, 41(1), 48–81. https://doi.org/10.1007/s12108-010-9086-x

    Article  Google Scholar 

  • Paradies, Y. C. (2006). Defining, conceptualizing and characterizing racism in health research. Critical Public Health, 16(2), 143–157.

    Article  Google Scholar 

  • Preston, A. (2020). Redefining racism: Against activist lexicography. New Discourses Retrieved February 22, 2024, from https://newdiscourses.com/2020/08/redefining-racism-against-activist-lexicography/

  • Reed Jr., A. (2016). The post-1965 trajectory of race, class, and urban politics in the United States reconsidered. Labor Studies Journal, 41(3), 260–291.

    Article  Google Scholar 

  • Rothoff, T., Kadmon, M., & Harendza, S. (2021). It does not have to be either or! Assessing competence in medicine should be a continuum between an analytic and a holistic approach. Advances in Health Science Education, 26(5), 1659–1673.

    Article  Google Scholar 

  • Rubiés, J. P. (2017). Were early modern Europeans racist? In A. Morris-Reich, & D. Rupnow (Eds.), Ideas of ‘race’ in the history of the humanities (pp. 33–55). Palgrave MacMillan.

  • Schuwirth, W. T., & van der Vleuten, C. P. M. (2020). A history of assessment in medical education. Advances in Health Sciences Education, 25(5), 1045–1056.

    Article  Google Scholar 

  • Shelby, T. (2014). Racism, moralism, and social criticism. Du Bois Review, 11(1), 57–74.

    Article  Google Scholar 

  • Slatton, B. C., & Feagin, J. R. (2019). Racial and ethnic issues: Critical race approaches in the United States. In G. Ritzer, & W. Murphy (Wds.), The Wiley Blackwell companion to sociology (2nd Edn). Wiley Blackwell.

  • Slavin, S. (2022). Is medical education systemically racist? Journal of the National Medical Association, 114(5), 498–503.

    Article  Google Scholar 

  • Sullivan, A. (2019). A glimpse at the intersectional left’s political endgame. New York Intelligencer. Retrieved February 22, 2024, from https://nymag.com/intelligencer/2019/11/andrew-sullivan-the-intersectional-lefts-political-endgame.html

  • Teherani, A., Hauer, K. E., Fernandez, A., KingJr., T. E., & Lucey, C. (2018). How small differences in assessed clinical performance amplify to large differences in grades and awards: A cascade with serious consequences for students underrepresented in Medicine. Academic Medicine, 93(9), 1286–1292. https://doi.org/10.1097/ACM.0000000000002323

    Article  Google Scholar 

  • ten Cate, O., & Regehr, G. (2019). The power of subjectivity in the assessment of medical trainees. Academic Medicine, 94(3), 333–337.

    Article  Google Scholar 

  • Urquidez, A. G. (2021). Reply to my critics: (Re-)defining racism: A philosophical analysis. Ethical Theory and Moral Practice, 24(3), 679–698.

    Article  Google Scholar 

  • Wimmer, A. (2013). Ethnic boundary making: Institutions, power, networks. Oxford University Press.

  • Wimmer, A. (2015). Race-centrism: A critique and a research agenda. Ethnic and Racial Studies, 38(13), 2186–2205.

    Article  Google Scholar 

  • Winant, H. (2015). Race, ethnicity and social science. Ethnic and Racial Studies, 38(13), 2176–2185.

    Article  Google Scholar 

  • Zuberi, T., & Bonilla-Silva, E. (2008). White logic, white methods: Racism and methodology. Lanham, MD: Rowman & Littlefield, Publishers.

  • Zwick, R. (2019). Assessment in American higher education: The role of admissions tests. The Annals of the American Academy of Political and Social Science, 683(1), 130–148. https://doi.org/10.1177/0002716219843469

    Article  Google Scholar 

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  1. Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, 1534 3rd Avenue South, Birmingham, AL, 35294, US

    Thomas S. Huddle

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Huddle, T.S. On Seeing Long Shadows: Is Academic Medicine at its Core a Practice of Racial Oppression?. HEC Forum (2024). https://doi.org/10.1007/s10730-024-09529-2

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