In May of 2021, the Duke Health System sent a draft “pledge” to the employee community, affirming that the organization “stands against racism, bias, and hate.” This pledge, since published on the Duke Health website, was signed by four medical doctors and one Ph.D. and included the assurance that the drafters were “guided by science.” Their fundamental reason for writing the pledge, and its fundamental claim, was that “racism is a public health crisis.” That had not been my experience, nor did it fit my observations, so I asked to see the clinical data the authors had used to form this conclusion. After much back and forth, I received the following reply from a Duke Health senior administrator: “I concede that I cannot find a [clinical] trial that proves implicit bias is the cause of worse health outcomes for African Americans. Believe me. I have looked.”
While the reply acknowledged that Duke could have worded the pledge better, the official with whom I corresponded nevertheless felt that “social-science” data supported the pledge’s assertion. My response was that Duke Health was a medical institution and was supposed to rely on “evidence-based” clinical medicine. Social-science data are inherently political and a source of disagreement between political parties. Thus, Duke was presuming to make a political assertion on behalf of its employees, who were in no position to push back. They were acting politically under the guise of medical science.
The official with whom I corresponded felt that “social” science supported the pledge.Because the draft pledge had been accompanied by a letter soliciting “concerns” and contrary perspectives, I felt that my silence would represent tacit approval. As Duke was not moved to correct itself following my initial query, I proceeded to ask a second, more substantial question regarding the pledge’s commitment to “equitable healthcare.”
Was Duke “promoting equal outcomes for groups, or the equal treatment of individuals?” In my new letter, I explained that society works best when we try to treat each individual as having equal worth, dignity, and protection under the law. A collectivist system, on the other hand, is concerned with the worth, dignity, and protection of groups. These two systems are mutually exclusive.
The pledge states, “We must ensure equitable access to treatments and care” and asserts that “excellent … health care cannot happen without equity.” Yet the underlying assumption in those claims is that equitable access and equity are revealed by equal outcomes. As the left-leaning Aspen Institute has written, “racial equity” is “what a genuinely non-racist society would look like. […] This is in contrast to the current state of affairs in which a person of color is more likely to … experience poor health outcomes.”
Now contrast that with the Declaration of Independence, which affirms that people are endowed by their creator with equal rights as individuals, not a guarantee of equal outcomes for groups. The latter is a collectivist mindset.
These are two different visions for society: “equal rights and opportunity” on the one hand and “equal outcomes” on the other. The former is free and based on individual merit, while the latter is forced and based on group performance. Both systems have been tried, with the results unequivocally favoring individual freedom over group equality. Individuals were created in the image of God; groups were not. Individuals are equal; groups are not.
My concern remains that a real public-health crisis will result from favoring a race-based ideology over evidence-based care.Duke gave me no answer to my follow-up query. Its website reads, “We encourage questions and challenges.” Therefore, I repeated my question: “Why is Duke pursuing a social/political structure based on the equality of outcomes for groups [collectivism], rather than promoting an organization based on the equal treatment of each person [individualism]?”
After two months without a response, I wrote a third time with the same question and stated, “If Duke remains silent, I will assume Duke has declined to address this matter privately and that I may make my concern public. Equality of individuals, or equality of groups? It cannot be both.” My concern was and remains that a real public-health crisis will result from favoring a race-based ideology over evidence-based care.
We cannot govern for the equal treatment of individuals (which will lead to unequal prosperity) and simultaneously for equal outcomes for groups (which will lead to equal poverty). Nevertheless, Duke seems committed to influencing group outcomes rather than individual ones. Most recently, I directed my inquiries to Human Resources and received no response. The decision to ignore a legitimate concern is one I cannot understand. Duke must not persist in making politicized, unscientific assertions on behalf of its employees.
Kendall Conger, M.D., is a practicing emergency medicine physician and an adjunct associate in the Department of Family Medicine and Community Health at the Duke University School of Medicine.