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Vinay Prasad's avatar

A number of commenters have raised concerns that social determinants of health are important, and that poor, black and hispanic people do worse in America. I agree! And I wish to make 5 points

1. Most lectures in medical education merely restate the obvious. Poor people do worse, and minorities do worse, in so far as they are poor. At some point, this message has been conveyed. What are we going to do about it? Another 10 or 20 or 100 lectures won't help anyone.

2. There is no evidence that raising awareness has done anything to reduce disparities, just as not a single indigenous person has benefit from hundreds of people listening to land acknowledgement. This is also true for some medical disease awareness campaigns (see my JAMA paper)

3. The solutions to socioeconomic disparities largely precede medicine. These disparities begin in early life. Advocate for better elementary school education. Better nutrition for kids. Roland Frier has other good ideas (see Econ talk). But little of this has to do with medicine. (One irony is that so much of this DEI curriculum was silent about school closures during COVID-19, which did more damage to poor or minority kids than any other action in the last quarter century)

4. One of the videos I watched from UWashington discusses how doctors should advocate for (a higher) minimum wage, and stronger tenant laws. But It is entirely unclear if those policies will help poor and minority patients. Minimum wage increases have spillover effects-- some low wage jobs get replaced with robot kiosks-- and strong tenant laws often lead to fraud, as apartments are passed along in families or to friends, or kept empty. Moreover, these topics are better covered by economists rather than doctors

5. Finally, there is only so much time in medicine. Graduating students are often unable to calculate post test probabilities of basic diagnostic tests. Few can tell you what a p value means. Nearly none can dissect a NEJM paper. Not all know how to care for DKA, or COPD or HF. Medicine must prioritize these things.

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Christine's avatar

There should be no tolerance for politics and baseless ideologies in medicine or medical education.

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