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Racism at Harvard
by Larry Miller, Herb Schreier, & Jon Beckwith
Larry Miller, Herb Schreier, and Jon Beckwith are all active in both the Genetics Group and the Sociobiology Group of Science for the People. Larry is a medical student at Harvard. Jon teaches in the Microbiology Department at Harvard Medical School and was instrumental in getting the minority student program established there in 1968. Herb is a child psychiatrist at Mass General Hospital and at the East Boston Health Clinic.
“Professor contends medical schools’ standards have dropped because of rise in minority students.”
— NY Times, May 13,1976
“Professor assails Blacks’ performance.”
— Harvard Crimson, May 14, 1976
In the middle of May, as students at Harvard Medical School were preparing for their exams, as many medical schools around the country were completing their admissions decisions, as President Ford spoke of “alternatives to busing,” Bernard D. Davis, a Professor at Harvard Medical School, stirred up a storm the impact of which is far from over. On May 13, 1976, Davis published an article on the opinion pages of the New England Journal of Medicine, which was a thinly-veiled attack on minority admissions programs at medical schools. The article was picked up immediately by the New York Times and then much of the media; Davis appeared on several Boston TV stations. Davis was quoted in the Times as warning against the “temptation to award medical diplomas on a charitable basis” and suggesting that some medical diplomas might be awarded to “a person who might leave a swath of unnecessary deaths behind him.” The clearcut insinuation was that an increase in minority doctors could cost patient’s lives.
There have been immediate and tragic effects of this publicity. First, several incidents have occurred in Boston area hospitals in which white patients have refused to be seen by black doctors — a direct result of Davis’ statements. Secondly, Medical School admissions offices around the country have since contacted Harvard Medical School to learn of the “failure” of its minority admissions programs. Such programs, which were under attack already (minority admissions to medical schools declined for the first time in 1975) may have been dealt a severe blow. This is not to speak of the contribution of this slander to heating up the racist situation in Boston over the busing issue; nor of the contribution to strengthening attempts to reverse affirmative action programs1,2
What did Davis base his statements on? There were no data of any sort in his article. There was a reference to a single student who had been unable to pass his Medical Boards, part I, in five tries, but still received a medical degree. Among the numerous responses (see below) to Davis’ claims were some strongly worded statements from Robert Ebert, Dean of Harvard Medical School, which totally refuted Davis’ innuendos. What follows is a letter written by Ebert to the Deans of all medical schools in the United States:
Such wide publicity has been given to the article written by Dr. Bernard Davis and appearing in the New England Journal of Medicine (Vol. 294, No. 20, May 13, 1976, p.118), that I feel compelled to write you in the hope that you and your admissions committee will not be misled by what I can only term irresponsible statements made by Dr. Davis. The article, entitled “Academic Standards in Medical Schools,” purports to be a general commentary on the subject, but in fact is a thinly veiled criticism of the Harvard Medical School. He implies that academic standards at Harvard have fallen (unproven) and that some degrees have been granted on a charitable basis. He uses a single example for the latter charge, the case of a student who had failed Part I of the National Boards five times but was ultimately granted the M.D. by vote of the Faculty. What he neglected to state, because he had not bothered to inform himself of the facts, was that the student in question was granted a degree only after a year of highly satisfactory clinical performance on the wards of a distinguished hospital, documented by letters from all the chiefs of service under whom he served. Nor did Dr. Davis mention that the student had passed Part II of the National Boards. There is nothing to suggest that this man will be anything but a fine physician. To consider that he might be a danger to patients is ludicrous.
The facts are these: All Harvard medical students are judged by precisely the same academic standards in both the preclinical and clinical years. Some minority students have had academic difficulties along the way, and so have some white students. The faculty has never granted a degree to anyone on a “charitable basis.” Dr. Ewalt, Senior Associate Dean for Clinical Affairs, and internship advisor, reviewed in its entirety every record of every medical student graduating in the Class of 1976, and he interviewed all fourth-year students. Not only did he judge that all were well qualified, but he was unable to distinguish between minority and majority students on the basis of their records.
The views expressed by Dr. Davis are his own and do not reflect those of the Faculty or the administration. Enclosed are copies of statements by the Faculty Council and the chairmen of all the preclinical science departments. Both take issue with the conclusions implied in Dr. Davis’s article. The effort of the Harvard Medical School to recruit minority students has been a success, and the Faculty vouches for the competence of all its graduates. It is my profound hope that Dr. Davis’ statements are not misconstrued by members of your faculty or by your admissions committee and are not interpreted to mean that Harvard is drawing back from its commitment to minorities or that our minority graduates are any less competent than any others. Such is not the case. I also hope that you will continue your own efforts on behalf of minority students and will not permit the pronouncements by Dr. Davis to alter your present admission policies.
Davis and Biological Determinism
Since Davis obviously had no evidence to back up his allegations, where did they come from? The views he has put forth in this incident are quite consistent with his writings and talks given in the past few years which reflect a biological determinist perspective. This perspective has led him to publicly support such areas of research as genetics and intelligence studies, genetic engineering3, XYY research4, and, most recently, sociobiology5.
A thread that runs throughout his recent statements is that most members of disadvantaged groups are disadvantaged because they were born that way. Thus, we can only go so far in correcting discrimination, since the basis for discrimination is the inherent lack of ability in certain groups. While he equivocates, the following excerpts from a speech presented at the Cambridge Forum on April 10, 1976, illustrated this perspective:
But while evolution must [sic] predict the existence of behavioral genetic differences between groups, it does not predict for any two groups the size of those differences or even their direction… We do not know that any two separated groups will have significant differences in their pool of behavioral genes, but we certainly cannot assume they will not have such differences…. One might argue that it would be better not to focus on such matters in an era when racial justice is an immediate crucial issue for our society. And the dangers are obvious. But there are also dangers if we ignore reality.
If we refuse to take into account the existence of wide genetic diversity among individuals, then what we mean by social equality will be vague and it will lead us to have foolish and unrealistic expectations. Similarly, for many liberals the assumption of an equal distribution of potentials between groups has led to support of quotas under the illusion that this is simply a concrete way to enforce equality of opportunity. Now within a limited range this approach actually has a sound biological basis. For all the identifiable groups in our society do overlap extensively in their distribution of potentials… However, for jobs that demand above average capacities, whether for abstract thought, artistic creativity or motor coordination, we cannot predict how the chips might fall with equal opportunity. Hence for such competitive jobs, the elimination of discrimination is unlikely to result in complete parity, even though it will surely markedly increase the representation of many groups that have been held down in the past. In other words, if an effort is made to provide equal opportunity, and, by this, I would include efforts to correct the effects of early disadvantages, and if a residual numerical disparity is still seen, its presence does not prove that the effort has failed and that the opportunities are still unequal. Under those conditions, persistence of quotas would mean society’s giving up the obvious valuable goal of trying to match responsibilities with abilities… Some would regard unequal ethnic representation in high status jobs as inherently unfair, regardless of the reasons….
Thus, science tells us that we sow confusion, if we will fail to distinguish social equality, which is a normative matter, from biological equality, which is an empirical matter, for we can manipulate our social structure, but we cannot manipulate our genes. Science also tells us that environmental measures can compensate to some degree for various genetic defects, but only within limits. Hence social justice must be built around the reality of our genetic diversity.”
What Davis has done in this passage is to begin with a not unreasonable hypothesis that there may be a broad genetic diversity for behavioral traits (this may or may not be true — there is no evidence). Initially, he is very careful to point out in this talk that evolution does not “predict… the size or direction” of these differences between groups. And, in fact, nowhere does he tell us: 1) how we are to measure the genetic component of group differences (that is, separate genetic and environmental factors) and 2) determine the direction (that is, which group is better endowed for the trait). Yet, incredibly, he goes on to imply that quota systems will never totally reverse the “unequal ethnic representation in high status jobs”, that “elimination of discrimination is unlikely to result in complete parity.” What Davis has assumed here is that those groups which are now under-represented in such high status jobs are less well-endowed overall in the qualities that lead to those jobs. In other words, those groups which are excluded now are excluded due to lack of the requisite innate abilities. Perhaps a few group members can achieve “high status jobs” but most are simply genetically unable. The crucial step in Davis’ argument is simply left out — he never even considers the possibility that the disadvantaged groups may be genetically equal or even superior to the current dominant groups. Further, he simply assumes that the abilities required to attain “high status jobs” are genetic. Both assumptions can only come from Davis’ own beliefs about the source of differences between groups, and both are obviously consistent with racist proclamations of genetic inferiority. Thus, even if we accept Davis’ premise concerning genetic diversity, his conclusions are groundless.
While he makes no evidence or logical basis, Davis makes these irrational claims under the guise of objective science (“Science tells us… “). This misuse of his status as a scientist to promote his own opinions as scientific fact is inexcusable. It is bad enough that he claims a scientific basis for illogical theories which are immediately useful to those promoting racism; but he now has extended this unfounded perspective into the sphere of social policy by his attack on minority programs at Harvard Medical School.
Davis’ pseudoscientific theories and their supposed practical implications have not been limited to criticism of efforts to eliminate discrimination. His apparent ability to perceive which groups have higher levels of which traits has also led him to make suggestions for eugenics programs:
… I wonder whether such a eugenic program is not likely to emerge, aimed primarily at reducing the production of indiViduals whose genetic endowment would limit their ability to cope with a technologically complex environment. Would not such a program then seem simply like a preventive approach, supplementing the curative approach, to the humanitarian goal of minimizing human misery?6
We further wonder, considering his perspective on “genetic endowment,” whether the implications of the following statements are not an indication of which classes should be subject to such eugenics programs. Academic performance is strongly correlated with socioeconomic status in our society, whatever be the reasons; and however painful that fact, no conscientious educator can ignore performance in assessing ability.7
For years, we in Science for the People and others have been exposing the dangers and the fallacies of contemporary biological determinist theories8,9. These theories usually begin with racist, sexist or class-based assumptions, are marked by shoddy or fraudulent research and logic, and serve to provide ideological support for the continued functioning of oppressive social institutions. In fact, the questions upon which most of this research is based are only of interest to those promoting the status quo. This is not neutral research which is being misused. Davis’ extension of his own brand of biological determinism into directly harmful public statements and the rapidity with which they are picked up and publicized illustrates the seriousness with which these ideas should be taken and the need to confront them. This case also illustrates how prestigious scientific journals (Science and the New England Journal of Medicine) are quite open to promoting reactionary social policy in the name of science and health care.
Medical Schools and Health Care
THE RESPONSE AT HARVARD
The major initial response to Davis’ statements came from the Third World Caucus of medical students. They demanded that “the President of the University reprimand Professor Bernard Davis by entirely relieving him of the responsibility of student evaluation… ” A rally was held at Harvard Medical School to protest “racism in medicine” following a press conference. (These demands will presumably be pursued through official channels.) The rally was attended by over 100 students, employees, and faculty. Subsequently the President of Harvard, the Dean of the Medical School and the chairpeople of the basic science departments all publicly rejected Davis’ allegations in a relatively strongly worded fashion.
The major issue raised in this controversy is equal opportunity for medical education for blacks, Chicanos, Boricuas10, Native Americans, and other minorities, and also those from lower socioeconomic classes. These groups form a definite minority of physicians. But the issue of equal opportunity in tum has important implications for health, in terms of the distribution of physicians and influences on a community’s health. The maldistribution of physicians and other health care workers by geographical area and income has been widely demonstrated; central urban areas, some rural areas, and many working-class areas have an inadequate supply of physicians, and even then many residents cannot afford high-priced health care. The past several decades have demonstrated that, for both financial and personal reasons, medical students recruited from the white middle and upper classes do not practice in these areas, where physicians are most needed.
While recruiting efforts have slowly begun to address the inadequate supply of black and women physicians, the percentage from working-class backgrounds has not changed in 50 years11. The result of the selection of white male middle class students to attend medical schools is not only unequal access to health care for a large part of the population, but also that physicians have little experience in their own backgrounds with the health needs of a large part of the population.
|% medical students, 1920||12||1||4|
|% medical students, 1961||12||2||6|
|% medical students, 1973||12||6||16|
|% U.S. population, 1973||49||12||51|
This class domination of medicine is certainly a contributing factor to the crisis in medical care that exists in this country. Infant mortality rates, which are twice as high for non-whites as for whites in some areas, reach the levels of some underdeveloped countries12. Longevity statistics are the worst in the industrialized world13. Five thousand communities are without a single primary care physician, yet more surgeons than needed are produced (which may account for the thousands of needless operations performed each year14), while a meager 1.4% of current interns and residents are training in general practice programs15.
SPECIAL BICENTENNIAL FEATURE: HOW DID WE GET THIS WAY?
The bias in medical school admissions toward the white middle class male is a creation only of the last 70 years. In the early years of this century, there were so many “doctors” that it was difficult for them to make a living. Powerful pressures from within the American Medical Association, a white middle-class male group, began to urge and often to succeed in closing the medical schools which trained blacks, women, and students from the working class. This process was accelerated and ultimately completed by the famous Flexner report, sponsored in tum by the Carnegie Foundation. In order to create the scientific and highly selective medical schools we know today, Flexner recommended such measures as:
To be sure, many of the “medical schools” closed after the Flexner Report were providing inadequate training. However, the result of these actions was to establish the restricted access to medical education that we have today, and also to stifle the indigenous health care traditions which have never systematically been proven inferior to scientific medicine.
These same problems were recognized over 40 years ago. The 1932 Committee on the Costs of Medical Care pointed out “The problem of providing satisfactory medical service to all people of the U.S…. is a pressing one. At the present time many persons do not receive service which is adequate either in quantity or quality, and the costs… are inequitably distributed. The result is a tremendous amount of preventable pain… anguish… needless death… largely unnecessary.”16. By that time, the American Medical Association, with the aid of private foundations, had tightened its grip on the selection, supply, and education of new doctors (see box on Flexner report), and dictated the form that the market place of medicine would take. When the reactionary stands of the AMA in the face of pressing social needs, caused it to lose some of its influence over the course of medicine in the U.S., a new decision-making establishment began to emerge. Helped by an infusion of Federal research funds during World War II and the publicity of impressive technological advances, the scientists and administrators of large medical centers, who also had a direct hand in the admission and molding of new physicians, ascended as the new directors of the path medicine would take.
The establishment of the large university medical center as the new leader of American medicine has been welcomed by some as “perhaps the most profound and promising development in the evolution of medical care.”17 The centers became important forces in advancing the treatment of specific diseases, but they have, in effect, retarded the development of an equitable, effective and efficient system of health care for most people. Competition for prestige and funds, a desire to do “important” work, and a willingness to carry out certain research because there was money available to do so, caused human priorities to suffer. Things have changed little for the majority of Americans. Despite remarkable technological advances, a 1971 Citizens Board of Inquiry into Health Services for Americans reported that:
The United States has failed to provide adequate health services to the vast majority of its citizens. The system is in disarray… Consumers have few meaningful options in health care today… 18
Because of the relative autonomy these centers enjoy in determining the selection of future physicians and the direction of medical education, they have contributed to what has been called the “obsolescence of the American physician… his inappropriate orientation to disease and to people, the economic (fee for service) and societal (one to one) framework of the physician-patient relationship, the traditional notion of a patient-centered rather than a community-centered responsibility… “19 Students are chosen mainly by criteria that select for those with scientific research interests and those who will go into specialties. The criteria work against people who, for example, would find satisfaction giving primary care in a small community.20.
One of the major criteria for choosing medical students is the scores on the Medical School Admission Test (MCAT). While this test has very limited usefulness in predicting who will graduate, it does predict career choice. In all of the major medical specialties, the higher the average grade of students on MCATs, “the larger the proportion designating an interest in research or teaching.”21 One educator suggested that “available evidence indicates that if medical schools continue to admit students primarily on the basis of academic aptitude, we can predict with certainty a continued decrease in the number of graduates who will choose to provide primary care.”22 This continued emphasis on research as opposed to primary health care in medical schools is reflected in the statement of the dean of a newly built and needed medical school at San Diego. He saw his school as reaching”… heights beyond (that) already achieved at major academic medical centers such as Stanford, Hopkins, Harvard and Chicago … ” “Large patient care programs,” he continued, “are not necessary and divert attention from other teaching and research activities.”23 Already selected for “intellect,” this homogeneous group of students who will do well by certain narrow definitions of success (no known admissions criteria, nor medical school grades are useful.in predicting who will become a good physician) cannot be expected to change a system which suits them well, treats them comfortably (median income of doctors is currently well above $40,000) and with respect (doctors still stand next to Supreme Court Justices in the eyes of the public).
Davis’ foray .into the public arena with his attack on minority admissions programs raises several issues.
First, this incident shows the direct links between the resurgent “academic” biological determinist theories and racist, sexist, and anti-poor and working-class social policy. While Davis has limited himself mainly to attacks on minority programs, others have used essentially the same arguments against women and lower socioeconomic classes.24 These arguments are used to support admissions policies which contribute to the continuation of a costly, class-biased, archaic medical system and the consequent neglect of the health needs of most people in our society. In addition, the domination of medicine and medical research by white middle and upper class men further distorts research objectives and practices. For instance, it is male medical researchers who have favored directing contraceptive development towards the female reproductive physiology, thus leaving the burden of contraception on women, and the dangers of contraceptive testing on mainly Third World women.25
The education of more minority, women and working class students to be physicians is a highly desirable goal, and some inequities and oppressive features of medicine may be ameliorated. Some of the doctors from these groups may even help to begin the process whereby communities can gain control over their own health care. However, it is unlikely by itself to produce meaningful and lasting change in medical care in this country. As long as medical school admissions and training are oriented towards producing academicians, researchers and high-priced specialists, there will still be only a small proportion of doctors committed to improving community health.
But further, what has to be recognized here is that providing health care is not the same as promoting health. Amidst all the concern about health care providers, it must be recalled that the major influences on a community’s health are income, job situation housing, environment, community self-reliance, etc. — factors generally determined outside the community by those who control the sources of capital, such as corporations and landlords.26 And it is the same group of large corporations who dominate the health care industry. Thus, in both generating and helping to maintain a community’s health, control comes from without. Only by organized community involvement in and control of health care and living conditions can true health be achieved.
- See, for example, editorials in Science magazine—Oct. 17, 1975, Dec. 19, 1975, and Feb. 13, 1976.
- N. Glazer. Affirmative Discrimination. Basic Books 1976.
- B.D. Davis. Editorial in Science, Oct. 25, 1974.
- B.D. Davis. Editorial in Science, Sept. 26, 1975.
- B.D. Davis. New England Journal of Medicine. 293, 1375, 1976.
- B.D. Davis. Harvard Medical Area Newsletter, 2, #4, May, 1970.
- B.D. Davis. Letter to the Editor. NY Times. April 16, 1976.
- See articles on IQ, XYY and Sociobiology in IQ: Scientific or Social Controversy. edited by Genetics and Social Policy Group of Science for the People. Available from SESPA, 16 Union Square, Somerville, MA 02143 for $1.25.
- N. Block and G. Dworkin. The IQ Controversy. Pantheon paperback, 1976. (An excellent collection of articles.)
- People from the U.S. colony, Puerto Rico.
- V. Navarro. Int. J. Health Services 5, 74 (1975).
- H.A. Schreier. Pharos. vol. 38 #3, July 1975.
- B. and J. Ehrenreich. Social Policy May/June, 1974.
- N.Y. Times, January 27, 1976, p. 1.
- R.H. Ebert. Scientific American. vol. 229, #3, Sept. 1973.
- Report of the Committee on the Costs of Medical Care for American People. Chicago, Univ. of Chicago, 1932.
- J. Knowles. Scient. Amer. 229, 128, 1973.
- Heal Yourself. Report of the Citizens Board of Inquiry into Health Services for Americans. Washington D.C., 1971.
- M. Michaelson. N.Y. Rev. 32, July 1, 1971.
- E.L. Kelly. J. Med. Educ. Supplement, 32, 185, 1957.
- P.J. Sonazarro. Educational Self Study by Schools of Medicine New York 1967.
- R.G. Page, Littlemeyer, eds., Preparation for the Study of Medicine. University Press of Chicago, p. 147, 1967.
- Grobstein, Clifford. University of California, San Diego, in Lippard and Purcell, Case Histories of Ten New Medical Schools. Josiah Macy Jr. Foundation. N.Y. 1972.
- R. Herrnstein, “I.Q.” The Atlantic Monthly, Sept. 1971; E.O. Wilson, N.Y. Times Sunday Magazine, Oct. 12, 1975. p.38.
- R. Arditti, this issue, and Science for the People 6, #5, Sept. 197 4, p. 8.
- J. Kosa et al. Poverty and Health. Harvard University Press, 1975.