Medical Education and Research continued: DEI or Science?

Good care for all requires first being able to give good care at all. That in turn requires the best possible science training, first and foremost.

A distinguished scientist at a major US medical school sent me an email recently, after my last piece:

“I went to a prestigious national medical meeting a few months ago. Half the cutting-edge science was replaced by DEI talks. Although these were of interest, there were no talks about potential effects of Covid vaccines on the immune system or prevalence of side effects. 

The after-dinner speech at the final banquet, ordinarily given by a Nobel Laureate or major journal editor in chief, was this time given by an Assistant Clinical Professor on her experience as a Latina facing structural racism in peer review.”

I replied and asked him to comment more on this:

“a key point is that we are in the middle of a replication crisis in Alzheimer's disease research (see Science last week), in cancer research, in diabetes research and in biological psychiatry. Part of this may be fraud, which is impossible to eliminate entirely in any human activity where ambition exceeds attainments -- but a larger fraction is probably error by researchers and physicians who do not understand statistics and proper experimental design, what "bias" means and what are suitable controls. 

The bottom line is that society needs, more than ever, rigorous science in medicine; and medical education needs rigor. Yet, part I of the national medical boards have just been made P/F, and so it might happen that students do not pay as much attention in Years 1 and 2. This when both scientific knowledge and its misuse (or misrepresentation) are exploding.

This is more than a philosophical issue. Proper medical care and optimal public health policy depend on both scientific rigor and an awareness of what we do not know. Doctors, medical scientists and policy makers need to be particularly aware of the possible unknown unknowns.”

Just to make it clear, in a later email he made it clear that equity was an important issue for him, which needed to be addressed in medicine, but just not at the expense of science.

“Re-accreditation of medical schools will include DEI standards, which I support but not to the exclusion or reduction of rigorous science. DEI aspects of medicine are especially important in XXX (omitted by me to protect anonymity) where minorities have worse health-care outcomes and shorter lives. Black women are much more likely to die in childbirth in XXX (omitted by me to protect anonymity) than white women.”

So the issue here is not being blind to inequities in society, or not searching for ways to improve medical care for all. The issue is training researchers and practitioners to be the best doctors, and that involves first and foremost an understanding of the fundamental science necessary to provide the best health care possible and to push the frontiers of medical research forward. Only then can one providing training to help improve concern for all patients, and an awareness of existing inequities that doctors or researchers can then apply, when appropriate, in their own work.

The latter should be a part of a broad training in being a good caregiver. But unless students are trained to become the best possible medical practitioners, then the central goal of improving health care in our society for all cannot be achieved.

Oh, and in case you wonder why I protected my colleague’s anonymity, I had asked him if he might pen a piece elaborating on his emails.

His answer: He wanted to remain anonymous..  

Sadly, understandable, and now the norm, rather than the exception now for faculty in higher education.