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Last month, the Journal of the American Medical Association published an episode of its podcast, JAMA Clinical Reviews, which is hosted by Ed Livingston, a UCLA surgeon and JAMA editor. The episode was titled “Structural Racism for Doctors—What Is It?,” and in it Livingston interviewed Mitchell Katz, President and Chief Executive Officer of NYC Health + Hospitals.
For reasons that will soon become clear, the podcast episode was yanked offline and replaced with a brief statement from Howard Bauchner, the editor-in-chief of JAMA, apologizing for its existence. You can listen to the original here. If you do, you’ll hear that Livingston [edit: I originally said ‘Katz’ here] is a bit skeptical of the concept of structural racism — a view he expresses two or three times, depending on how you interpret his introduction. At the end, he basically says that because the problem is not that poor black and brown people literally aren’t allowed to buy a house in a nicer neighborhood or get a higher-paying job by dint of their race, he doesn’t find the structural-racism framing to be all that useful. This could launch a whole other newsletter but I think that Livingston is A) oversimplifying a bit and B) expressing a viewpoint that is widely held among Americans, as well as a likely common reaction when people first encounter the idea of “racism without racists.”
Either way, the vast majority of the podcast’s runtime is given over to allowing Katz to explain why structural racism is a useful concept for understanding health disparities, and why racism can persist in healthcare (and other areas) even in the absence of legally sanctioned racism or individually held racist beliefs. Whatever one thinks of the merits of Katz’s claims, if you’re familiar with the subject matter, the episode comes across as a pretty basic Structural Racism 101 primer. Were we in possession of a machine that could chew up a podcast’s content and spit out a number placing it from 1 (far-right) to 100 (far-left) on an oversimplified political spectrum, I bet this podcast episode would garner an 80 or so. After all, only 51 percent of Americans believe “Blacks are treated less fairly than whites in their interactions with police,” so there’s obviously widespread disagreement over even straightforward questions about racism in public life.
The podcast episode’s troubles started with a tweet, now deleted, from JAMA that linked to the episode.
It read, “No physician is racist, so how can there be structural racism in health care? An explanation of the idea by doctors for doctors in this user-friendly podcast from the great [Mitchell Katz] and [Ed Livingston].”
People took umbrage at “no physician is racist.” On the one hand, I understand — it’s a weird thing to say. On the other, it seems impossible to me that JAMA was arguing there is literally not a racist physician in the country. Who believes this? Rather, I think the tweet was an attempt to get at the distinction between individual-level and structural-racism — as in, again, There can still be racism in medicine even in the absence of individually racist doctors.
Anyway, ‘reasonable’ and ‘Twitter’ do not mix, so people within medicine started freaking out at how horribly offensive the tweet was. Then some of them listened to the podcast episode itself and decided that it was basically a war crime. The low point came when a tweet calling the podcast episode potentially ‘violent’ got hundreds of retweets. (If you do a Twitter search for “JAMA racism” you’ll see a mix of over-the-top stuff and reasonable critiques too — I’m not trying to claim this was entirely frothing madness, and of course people are allowed to disagree with a podcast and to point out its flaws.)
The genuine trouble began when Administrators from the UCLA health system got involved. If you are not familiar with this species, Administrators are a group whose job is to sweep in and respond to perceived controversy, in theory to protect an institution’s good standing but in practice always making things much, much worse. And much more ridiculous. This group, Administrators, has been busy lately — they were most recently spotted inside The New York Times, insisting Donald McNeil, Jr. not give The Daily Beast the full, highly exculpatory account of his actions in Peru — that he instead cede to that publication’s overblown charges of racism and ‘apologize’ for them, which he refused to do in that manner.
In this case, Administrators published a statement expressing just how horrifically outraged they were by what happened. You can read it here, and it is festooned with the names of some of the most important people in the UCLA health system: John Mazziotta (Vice Chancellor, UCLA Health Sciences), Kelsey Martin (Dean, David Geffen School of Medicine at UCLA) Johnese Spisso (President, UCLA Health), Clarence H. Braddock III (Vice Dean for Education and Executive Director of the Anti-racism Roadmap, Geffen School), Medell Briggs (Interim Chief, Health Equity, Diversity and Inclusion at UCLA Health), and Lynn K. Gordon (Emeritus Senior Associate Dean, Office of Equity and Diversity Inclusion, Geffen School).
The note apologizes for the tweet and goes on to explain that “While the podcast itself set out to illustrate ‘how structural racism worsens health outcomes,’ it has unintentionally served as an important lesson on implicit bias and ‘white fragility,’ and has demonstrated the harm we can cause when we fail to acknowledge the life-threatening realities of structural and interpersonal racism in medicine.” Interestingly, the Administrators link to a glowing essay about the book White Fragility written by a white woman on staff at the New Yorker who loved it, not the withering critique written by a brown man who found it condescending. (No evidence is provided to explain why the podcast constituted white fragility or implicit bias, though on the other hand DiAngelo’s definition of white fragility honestly boils down to “a reaction to a conversation about race by a white person that someone claims is white fragility,” since denial of white fragility is evidence of white fragility, so I guess the claim is prima facie true. Guilty as charged, Ed Livingston!)
Having asserted that this 15-minute podcast caused harm, the Administrators promise to address it. Because while on the one hand, “we respect each individual’s right to express his or her own opinions,” on the other hand, this was just too terrible an event to leave unmolested by a UCLA bureaucracy with an insatiable appetite for justice-doing:
On behalf of DGSOM and UCLA Health leadership, we write to acknowledge the harms inflicted, and to help begin to repair them, at a minimum through solidarity. We have also spoken with Dr. Livingston and will be facilitating a Restorative Justice session with his department and the DGSOM Office of Equity and Diversity Inclusion.
Presumably, this Restorative Justice session is not optional.
Because, again, what happened here — a 15-minute podcast episode which risked exposing students, faculty, or staff to measured skepticism of the concept of structural racism — was so potentially traumatic, the note closes by reminding everyone that there are Resources Available: “As we look ahead, we remain committed to recognizing and addressing all forms of bias and racism and to fostering dialogue that pushes us to transcend our discomfort in service of becoming an anti-racist organization. We encourage those seeking support to utilize the mental health and well-being resources available to you.”
***
My first move in situations like this is always to blame Administrators. Seriously. Whenever there’s a blowup like this that garners attention, it was usually the result, at least in part, of Administrators making key decisions that seem almost designed to exacerbate everything, even if from their perspective they are broadcasting firm allyship and understanding. I think this is a pretty embarrassing display from UCLA Health.
On the other hand, we have to contend with the fact that a small but loud — and potentially growing, and certainly emboldened-of-late — subset of progressives in elite institutions do not think their colleagues should be allowed to disagree with them. I am not overstating this. They believe political disagreement on mainstream issues that divide Americans is a matter for not only social sanction, but also HR and professional punishment.
Some of them at least have the decency to say so out loud. “Facing widespread criticism on Twitter, undergoing an internal workplace review, or having one’s bookpanned does not, in fact, erode one’s constitutional rights or endanger a liberal society,” wrote Hannah Giorgis in her response to the Harper’s Letter (which, side-note, I found to be pretty dishonest and distortionary as a signatory). As Michelle Goldberg subsequently pointed out, one of these things is not like the other. Of course “undergoing an internal workplace review” over one’s political views — which inherently entails a threat to one’s employment — impinges on the rights we expect people to enjoy in a truly liberal society.
Giorgis clearly supports the idea of an internal workplace review over political disagreement, but I don’t want to single her out. This is a commonly held view among a subset of the most aggressively righteous progressives in many institutions. When they don’t say so, they express it with their actions. After the young progressive data analyst David Shor tweeted a link to a study suggesting nonviolent protest works better than its violent counterpart, the activist Ari Trujillo decided that Shor’s stance constituted “anti-blackness” and tweeted at his then-employer, Civis Analytics, “come get your boy.” After Matt Yglesias signed the Harper’s letter, his then-colleague at Vox Emily VanDerWerff publicly tweeted a note she had sent to their bosses explaining that Yglesias’s signature on the letter made her feel unsafe (while in the same breath arguing — disingenuously — she wasn’t really trying to get him in trouble). One hundreds and fifty staffers at The New York Times signed a letter demanding their colleague McNeil be re-investigated not only for mentioning the N-word, but also for allegedly expressing his belief that “white supremacy doesn’t exist” (though the claim that he said this was always based on thin reporting and I think that in light of his own account of the trip — not to mention his background reporting from places like South Africa — it’s unlikely he ever said anything nearly so pat or ignorant, anyway).
Sometimes these attempts to get people in trouble for political disagreement work and sometimes they don’t. David Shor was fired, Matt Yglesias left on his own terms to likely make significantly more money writing Slow Boring (with VanDerWerff’s letter having certainly influenced his decision, according to this interview with Conor Friedersdorf), and Donald McNeil Jr. was for all intents and purposes forced out by his bosses but did technically ‘resign.’ The point is less the outcome of an individual case — though of course to an individual employee, being ‘investigated’ for one’s political beliefs is a humiliating and potentially jarring experience — and more how quickly this norm has descended upon so many liberal institutions. It is now considered normal to seek an investigation into a colleague over disagreement that would pass by completely unremarked upon if expressed in a newspaper column or drive-time radio. (If you disagree with me, explain why so many high-profile people within journalism and academia and activism publicly disseminated VanDerWerff’s note to her bosses, enthusiastically tweeted Giorgis’s rejoinder to the Harper’s letter, and so on. When people tell you who they are, believe them!)
These examples are just the tip of the iceberg — others have yet to come out (I’m working on a story about a particularly crazy one that I hope will be published soon — UPDATE: it’s out!), or won’t come out at all (people do not want to burn their professional bridges). And these events may just be the stars in a galaxy dominated by invisible dark matter: Think of the chilling effect this climate has on anyone who dissents. This is a horribly corrosive thing to happen to any institution. If you can’t criticize your school or company’s approach to antiracism, or disagree with colleagues, that’s a recipe for institutional and intellectual rot, for groupthink, for toxic workplaces and classrooms in which the most self-assured and authoritarian-minded employees and administrators get to make the implicit ‘rules’ about what can and cannot be said. Self-critique is oxygen to an institution — without it, its vital organs die and decay, and if the problem is left unaddressed long enough the entire institution can curdle into something unrecognizable. (I don’t know if the American Civil Liberties Union is quite at that stage yet, but it’s close.)
To be clear, the deeply unpleasant people I’m talking about and referencing here would surely deny the claim that they are seeking for disagreement with them to be disallowed in some meaningful sense. They would likely microwave some bone-cold line about free speech really just being about the Constitution, or say something like “It’s completely inappropriate for a medical researcher in a gatekeeping role to not believe in structural racism.” These responses tend to involve a slew of highly questionable assumptions and liberal (or perhaps ‘illiberal,’ to make an obvious dad-joke) spoonfuls of question-begging. Who decides what level of belief in structural racism ‘qualifies’ someone for a given perch? Is there a committee? Who is assigned to it? Is it formed via a free and fair election? If 95% of people within an institution believe in structural racism, is it good or wise to punish the 5% who don’t? Moreover, if free speech is really just about the government and the Constitution, how can anyone be opposed to the private, informal blacklists that caused so much harm during the height of Cold-War anti-communist hysteria? “No one’s free-speech rights are being violated! Companies can do what they want — you can always make a film elsewhere, outside Hollywood.” That’s the hill you want to die on? You, the ardently pro-labor progressive? As the kids on the internet say: Oof. Yikes.
Look: I do not really enjoy any of this. I do not like how much of my brainspace and, sometimes, writing output is dominated by these increasingly vicious intraleft disputes. But it is unavoidable: What happens in these institutions goes a long way toward determining which ideas spread and which thinkers are allowed to have a platform. I wrote an entire, non-culture-war-oriented book about the cultural and institutional forces that help half-baked behavioral-science ideas to flourish, and the harms that ensue as a result (well, one chapter deals with some culture-war stuff). How can I ignore it when so many important liberal institutions, from media outlets to medical schools, seem headed down a fairly authoritarian, anti-intellectual path? It would be great if we on the left could all get on the same page about the minimal requirements of a liberal society run by useful and intelligent people rather than Administrators, which would allow us to then turn our attention more fully to substantive disagreements about, you know, welfare policy and stuff.
But instead, we’re gripped by all of the ugliness of a roaring moral panic. Make no mistake: That’s what this is. Yes, there’s a longstanding, deeply righteous effort to make the United States a better, more racially just place. This effort is led by policy makers and activists and academics and others who mostly do their work quietly, without much fanfare or tweeting. There is, however, also a moral panic descending on most liberal institutions, and it is causing real harm, and it does not deserve our respect or deference. It is giving rise to conformist, panicky, dysfunctional institutions that are diverting resources away from improving the world out there and toward pointless, performative internal struggle sessions.
Questions? Comments? Misinterpreted snippets of this newsletter you’re going to send to my head of HR, Jesse Singal? I’m at singalminded@gmail.com or on Twitter at @jessesingal. The image of a bunch of torch-wielding Simpsons characters taking part in an angry mob is from here.