Readers of this website will need no reminding that in the aftermath of George Floyd’s death the dogma of “anti-racism” swept through Anglophone high society, and the University of Oxford was no exception. This ideology, though laudable in its aims, is unscientific, obscurant and racist in implementation.

In July, an open letter was circulated among the Oxford medical students with a list of “required actions”.  There were demands to engineer the diversity of faculty and actors used in practical examinations. In response to this and other student interventions, the Clinical Tutor Group (CTG) decolonised the curricula and committed the medical school to unconscious bias training.

The medical school’s commitment to unconscious bias training was particularly baffling because it has been shown empirically not to work. For example, see the systematic review and meta-analysis by Forscher (2019). This is perhaps not surprising. Such training is based on the Implicit Association Test (IAT), the validity and reliability of which as a psychometric test has been called into question.

Academic institutions should make appointments on merit alone

This is not to say that implicit biases do not exist. Rather, no reliable tool has been developed to measure implicit bias, there is very poor evidence that IAT scores correlate with real-world behaviour or play a significant role in perpetuating racial inequality. Some studies have even suggested that bias training actually serves to reinforce stereotypes. Apparently, concerns were raised at the CTG, but they proceeded regardless, essentially on the basis of the “something must be done” mentality and the fact that such training is already commonplace. Usually, in medicine, a high evidentiary bar prevents the implementation of pointless or damaging interventions. It was disheartening to see the medical school discard this principle for political expediency. Doctors should know that just going along with things is a dangerous attitude. Imagine if Dr Frances Kelsey, who almost singlehandedly prevented the approval of thalidomide by the FDA, had shared the CTG’s feebleness in the face of a prevailing orthodoxy. She would not have saved thousands of American newborns from permanent disability.

I was also troubled by the commitment to ensure racial diversity in faculty. Academic institutions should make appointments on merit alone. To include race as a hiring criterion would be racist. The open letter claimed that: “The importance of Black Students being interviewed, taught and mentored by Black Faculty cannot be overstated, and the impact it has on confidence and attainment to only see White people in positions of power throughout a Black student’s entire Medical School training is hugely damaging.”

I am not aware of any evidence supporting such patronising assertions and it has certainly not been my experience as an ethnic minority student. The “you can’t be what you can’t see” mindset ought to be challenged, rather than indulged. Unfortunately, this lazy thinking is frequently encountered, with even the British Medical Journal (BMJ) printing a (paywalled) testimonial from a doctor who felt that she could not become an anaesthetist because she had never met one of her own race. Our reaction to such reasoning ought to be to encourage the holder to modify their beliefs and pursue their dreams regardless. The inspirational words of surgeon and Olympic figure skater Debi Thomas represent a better attitude: “I didn’t think I had to see a black woman do this to believe it’s possible.”

I wonder whether the new “anti-racists” regard their aims as overriding all other considerations. For example, does a pledge to diversify faculty override a commitment to meritocracy? The real world forces a choice between considerations you may wish to hold simultaneously paramount. For example, a “non-diverse” individual may be best qualified for a position you hoped to fill with a “diverse” person. Choosing meritocracy makes your commitment to diversity meaningless. Choosing diversity undermines your institution’s excellence. With such thinking, Oxford would likely not remain the world’s finest medical school, if not for the proliferation of this same ideology amongst the competition. You cannot fulfil these two contradictory aims. If you value the essential functions of a medical school, you should hope that meritocracy triumphs over diversity every single time.

‘Anti-racists’ do have a peculiar tendency to make sweeping generalisations about racial groups

In October the promised training was delivered, beginning with a lecture from Margot Turner, a senior lecturer in “Diversity and Medical Education” from St George’s University, London. Early on, she reminded us of the lifelong nature of effective anti-racism—rather convenient for someone in her line of work you might think. In general, this was a rather pedestrian talk by “social justice” standards, sticking mostly to the well-rehearsed clichés: unconscious bias, intersectionality, white privilege, white fragility etc. (For effective debunking of such pseudo-intellectualism, I would recommend New Discourses.) There were a few perplexing moments, including: “Often white people have a problem understanding culture in its broadest sense”. “Anti-racists” do have a peculiar tendency to make nonchalant, sweeping and evidence-free generalisations about racial groups. Then followed some “lived experiences”—what normal people call anecdotes—and a supremely awkward group discussion of which I will say no more as I kept no notes.

The written materials on our online learning site were worse than I had anticipated. Remarkably, in what is a major departure from standard practice in developing teaching materials, the medical school appears, to the best of my knowledge, to have given its blessing for each page to be written by a single student, without oversight or moderation. The race page, in particular, was a political opinion piece, which should not have been presented as authoritative. The page was replete with unsubstantiated claims, such as “Racism is rampant within society at large,” and riddled with what Thomas Sowell has called the “Invincible Fallacy”, whereby discrimination is unjustifiably considered the null hypothesis in explaining disparities.

Just as the mantra “correlation does not imply causation” is ingrained in the scientific psyche, so too should “disparity does not imply discrimination”. Once you are aware of it, you realise that the Invincible Fallacy is commonplace—the BMJ’s special edition on racism is overflowing with it. Racism may very well contribute to some disparities, but extraordinary claims require extraordinary evidence. Unfortunately, anecdotal evidence of racism, however horrendous, does not suffice. When hearing such stories, it is natural to be moved, horrified or angry on someone else’s behalf. However, in the same way that we value systematic reviews above case reports, we should value rigorous inquiry over anecdote in informing our general perceptions.

The prominence of microaggressions in our teaching materials is also of concern. Lawyer Greg Lukianoff and psychologist Jonathan Haidt pointed out in their book, The Coddling of the American Mind, that such a focus acts as “a reverse cognitive behavioural therapy”, reducing resilience and encouraging people to read racism into everything. It is certainly true that hurtful things can be said unintentionally. However, the current trend to problematise innocuous comments is troubling, especially when combined with absolute faith in the perceived victim.

Microaggressions again raise the question of what the “anti-racists” are willing to sacrifice. If a comment-receiver is the sole authority on what is racist, then there is no freedom of speech. If guilt is presumed, then there is no due process. I encourage the opposite approach, which avoids using your emotions to divine someone else’s supposed racism. By considering the comment-maker’s presumed intention, alongside their tone of voice and the context, you can avoid making such premature emotional judgements.

I share the desire to see the world rid of racism and admire my colleagues’ intentions

It brings me no joy to publicly criticise my medical school, to which I am otherwise fiercely loyal. I share the desire to see the world rid of racism with those colleagues and faculty who have designed our diversity training. I admire their industriousness and trust in their noble intentions. There is much to commend in what they have said and done. I am glad, for example, that they have made the reporting of race-based bullying and harassment easier and that the medical school has encouraged us to consider dermatological presentations in non-white skin. I welcome the undertaking to collect more data; this could be incredibly enlightening. Sadly, I have little faith that the data will be faithfully and impartially interpreted.

When considering the issues of disparities and discrimination, doctors should avoid political ideologies and unhelpful neologisms.  For example, “lived experiences” and “microaggressions” can cut in as many directions as you please. Does a black man’s experience of racism prove the theory of white privilege any more than Dr Ella Hill’s race-based victimisation at the hand of a grooming gang disproves it? Is a Brexit-supporting student’s “lived experience” of a consultant outrageously insulting Brexit voters evidence of systemic Remainer-ism? Is a prominent local GP Helen Salisbury’s jibe (“One of the privileges I have is to work in a remain voting city… I rarely see overt racism”), ironically presented as part of an article designed to extol her own open-mindedness, a microaggression against Brexiteers?

Doctors, of all people, should avoid univariate analysis. Ending racism is not the only important thing in the world. Is expunging sometimes imaginary “microaggressions” more important than freedom of speech and due process? Is diversity more important than meritocracy? More broadly, is social justice (equal outcomes for groups) more important than individual justice (people get what they deserve)?

I have no idea how many medical students are troubled by the latest incarnation of “anti-racism”—presumably more than would publicly admit it. I hope this article encourages them to think critically about the ideology presented in in our diversity training. It is depressing to see a great university and faculty undermine its own principles, either through thoughtlessness or cowardice. Oxford’s current approach, by elevating feelings over facts, is unbecoming of a supposedly scientific institution.

In British universities, it appears that the commitment to diversity does not apply to ideas

In British universities, it appears that the commitment to diversity does not apply to ideas and I suspect that the situation will continue to worsen. However, I do believe that we are seeing the first signs of rationality reassert itself. I was impressed by the admirable stand against Critical Race Theory in schools made by the Equalities Minister, Kemi Badenoch and the courage shown by abandoning unconscious bias training in the civil service, on the basis of the overwhelming evidence against it. If this article ever comes to her notice, I encourage her to extend her attention to Britain’s universities.

Finally, I wish reassure readers that I do not oppose diversity, which is very often the benign product of meritocracy, but that I oppose the engineering of diversity, which would undermine more important principles. Fundamentally, I care as much about disparate outcomes in medicine as much as the next doctor. I believe they should be thoroughly and scientifically investigated, to establish their cause, so that we can identify those interventions that have the best chance of saving our patients’ life years. On a practical level, I believe in combating racism whenever it rears its ugly head. But I refuse to racialize every aspect of my work life.

We should show kindness towards patients and support those who face discrimination. This does not require commitment to any particular social commentary or political ideology. Withholding judgment pending further high-quality evidence is not bigoted: it is your duty as a scientifically minded person. When we reject science and embrace simplistic and ill-founded catch-all explanations (such as “systemic racism”), we make understanding and dealing with health outcome disparities much harder.

Activist medicine risks taking a dangerous turn away from science and reason

Practicing medicine is somewhat more than the simple application of research findings to the patient in front of you. Doctors are rightly expected to consider extra-scientific issues, such as consent and privacy, but also the social consequences of medical interventions. In Britain, medical professionals command a high level of public trust, which those more inclined to activism would wield to foster social change. Oftentimes, the benefits are clear, such as when doctors warn of the myriad consequences of smoking. However, in adopting “social justice” ideology, activist medicine risks taking a dangerous turn away from science and reason, thereby neglecting to do our best by our patients.

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The author is a medical student at the University of Oxford, UK and can be contacted at [email protected].