My guest this week will no doubt be familiar to many of you. Heather Mac Donald is a fellow at the Manhattan Institute and the author of many books, including the recently published When Race Trumps Merit: How the Pursuit of Equity Sacrifices Excellence, Destroys Beauty, and Threatens Lives
I won’t comment on the anecdotal nature or originality of the suppositions of the cause(s) of the difference of performance. That’s fine. I thought the completely unfounded and subjective nature of assigning weighted causal variables by percentage a bit too presumptive and risible.
One can be supportive of the good intentioned effort but I think that aspect should have been pointed out. I was a bit surprised you didn’t since I’ve found your other comments to be rigorously astute.
Finally got around to this one. Wow. That was an avalanche. A lot to chew on. Could have devoted an hour to each topic, but they just kept going.
I feel like a coach at the end of a football game after the Gatorade has been dumped on me. I know it's all a show of brotherhood and respect, but now I'm wet and cold af.
The most disturbing part for me were those stats on high school academics. The most fundamental solution there is to never lessen standards for any reason. I have zero fear that these standards can be met and exceeded, even if it took another generation. More importantly, *so* many of these issues begin and end in the home, not the school.
But all of these topics carry a certain amount of nuance that's hard to get to with two interlocutors so closely aligned--like Glenn and Heather. While I appreciate his attempts to steelman arguments from the left, I think Glenn (inadvertently) conflates the most obstreperous people on the far left with relatively serious people who simply lean left, and they are not one and the same any more than Heather MacDonald and Amy Wax.
And fwiw, violent crime is a lot more complicated than it seems. For instance, most people, including most Black people, aren't experiencing violent crime on any sort of regular basis. But it's so easy to paint a picture of a living hell with statistics. I am reminded of a Thomas Sowell interview when he alluded to a rather overused talking point about murder rates in Honduras. According to him--if I recall accurately--a shockingly high percentage of those murders occur on three streets, which is a fact that would almost certainly alter the stereotypical image of Honduran crime.
Much of the world looks at America's gun laws and our mass shootings and wonders, "What the ****?"
Fair question. But how many Americans can (personally) relate to a mass shooting? It's a pretty thin slice. We're a nation of 330mm.
"How bad is X?" Very often that depends on what we're comparing X *to*. The capacity for a people to accept/condone various ill behaviors in their midst is staggering in many ways, but so is the capacity for people to ignore situations that don't directly affect them (like crime in another person's neighborhood).
I would love to hear someone like Will Saletan chime in on this video. But I would not want to hear from a progressive troll. Big difference.
Time 47: MacDonald explores “Black doctors for Black patients” concept. Patient’s doctor preference (for any demographic category including race and other) varies between in-group and out-group depending on patient and medical condition, especially if in-group expectation and stigma. In 2011, I spoke to a woman In Istanbul who visited a OB/GYN MD at a government hospital, seeking STD-testing. The female MD (Muslim) told patient, “You have never married which means you are a virgin and therefore cannot have STD. Patient responded- “I am 53 years old and not a virgin.” In USA, that patient would seek an out-group MD for ob/gyn.
Regarding education achievement gap for Black Americans; I speculate the following factors
(1): Effect of culture on learning. One of my parents attended school to 8th grade and the other had attended university level- but in another country. I developed learning skills alone by trial and error. Today at age 56, I am aggressive and analytical with regard to new information- which makes learning easier. But, at age 19 - I was clueless. I had to work harder to learn a complex topic. Culture adds a dimension to one’s information seeking and processing skills.
(2): Haidt - coddled kids. 30 years ago, while teaching high school geometry- a girl interrupted my class instruction to complain that I was teaching the students something that she already knows and therefore I should teach another aspect of Geometry, instead. And I should “take her word” that she actually knows the concept. A guy interrupted the same geometry class on a different day to complain that I wasn’t teaching what he needed, (He needed to learn non-Geometry, measuring wood with a ruler for his after-school job.)
(3): “Achievement gap caused by racism” idea has been around since mid-1980’s. That causes some students to speculate “racism” when instruction is challenging.
(4): Limited opportunity for social intimacy at university. Social intimacy requires transparency, but non-Black professors and students probably fear “You are racist” accusation- so remain guarded, which inhibits intimacy.
Time 33.00; Glenn mentions “First five years” of child’s life as opportunity for cognitive development, instead of waiting until medical school. By age 3 - vocabulary difference of up to 100% for rich vs. poor. I have seen the difference up-close in observations of family and friends.
But, beware the 60-page PDF- “SF Department of Early Childhood Strategic Plan 2023-2027” from SF DPH. Every page - literally has race-equity wording. This is the same Equity program that tried to remove standardized test admissions at SF’s famed Lowell High School and is currently trying to remove Algebra from 8th grade curriculum, (I signed petition).
Plan prioritizes Black, Latino, Pacific Islander* and Indigenous race groups; due to historic oppression. I fear that cognitive skills will be characterized as “Whiteness”, and after all the indoctrination activities, there will be little time for development.
*Population = 2,500 for all age groups. Population of SF group is at a 30-year low. I am so grateful that SF-Gov is acting to protect the city residents from the harm caused by the morally inferior race (sarcasm). I predict better outcomes for groups that Equity program excludes.
In recognition of my first cousin Dr. Harold Martin, Chancellor at an HBCU, North Carolina A&T, who's doing a fabulous job in improving the performance of Black college students.
Black students have options besides attending white Ivy League colleges. As black ppl, we need to invest and support our own institutions. Improve our sense of community. Social integration led to unattended consequences.---loss of Black owned farms, buisneeses, teachers, and community.
Blacks shopping exclusively at non Black owned buisneeses for goods and services is not empowerment. Our kids need a healthy environment with Black role models affirming them.
Glenn, the newly elected "progressive" DAs don't have any trouble hiring. They either fire or force out career prosecutors, then hire replacements aligned with their views. They can be ignorant but at least they are aligned. It's true that some career prosecutors resign but the first thought is whether the good work can be continued or it can't. Some try to stay on and work to hold it together.
But after the guillotine falls, there's plenty of space to hire replacements. These are largely defense attorneys and public defenders. Boudin mostly hired his colleagues from the public defender's office in San Francisco. After his recall, some of these are going to Alameda County, across the Bay and where Oakland and Berkeley are located. Alameda County used to have an excellent DA's office. It is now experiencing the hostile takeover you suggest. But to your point about hiring, there will be no trouble at all.
Voters did indeed elect them. And the voters will experience the folly of having done so. The results on the street led to Boudin's recall. Enough was enough. But it is no small task to put a DA's office back together again.
But we expect that sort of thing in San Francisco, right? Why are these tropes-based fantasies selling elsewhere? Voters are pretty bad at prescience. Predicting the future is not a strength. But sensing something is not right presently is possible and I think we would all agree many things are not right. What is sad and disturbing to me personally is when fallacious conclusions are reached and courses adopted which will not work and indeed will make matters worse.
Around 1:17 Heather MacDonald makes a point that’s something I’ve been noticing for a while. Regarding basic standards of achievement for basically anything, the backwards thinking goes like this: the standard is a, b and c; but there are some people who cannot reach that standard (for whatever reason); therefore the standard is faulty (exclusive, biased, etc); therefore to be perfectly democratic we must eliminate all those standards. And then what?
The transatlantic slave trade mal-distributed massive generational wealth and power to Europeans. Europe wouldn't be what it is today without practicing genocide, Black chattel slavery, and colonization. America is founded on racialization. Other racial groups weren't transported thousands of miles from home while living and dying in their excrement. This was massive!
Just listened and enjoyed the conversation enormously. It helped unravel some very troublesome knots we have been struggling with in woke America - and make sense of these issues with a discussion based on facts. There is too much magical thinking and cancelling of real conversations that could lead to solutions.....
Glenn, these discussions are so rich, it's easy to forget an early point while moving on to listen to the remainder. I have a comment on your point on the general question of doubt and rumors of inferiority.
I wonder if some of the most accurate answers can be found in the behavioral sciences, as well as the field of epigenetics. We're beginning to understand that it isn't so much our genes which influence everything from behavior to medical outcomes, but the expression of those genes. Twins studies have been very instructive. For example, to the question of whether depression "is genetic", there does seem to be a gene which a population prone to depression share in common. But having it doesn't mean a person will suffer depression. It needs to be activated, as it were. The triggering factor is stress. (see Robert Sapolsky's lecture on stress and anxiety to what looks like a room, heavily weighted to parents, at Stanford a few years ago.) This is epigenetics.
We know that certain stressors can be passed on to our offspring. An example comes from the area of domestic violence. I think it's evident that being in the minority, and indeed being alone, in a population is also inherently stressful. Bonobos who have violated norms can be ostracized from the group. In isolation, their blood chemistry shows heightened cortisol and adrenaline. Where survival depends on being in the group, being isolated appears to feel like a very real existential emergency. How opposite it must feel to being a bonobo in good standing, being groomed and grooming others in the group. It's the difference between low stress and high stress.
Are humans different? Isolation, stress and fear evidently are associated with depression in humans. What about as a population instead of an individual? (Sapolsky also talks about functional MRI studies showing subjects photos of faces and measuring amygdala activity depending on the faces shown. It seems more about "others" vs. "us" than about race. So what if someone else is different? It's all about the consequences of being an "us" or an "other".)
But my point is that perhaps we would all benefit by understanding the effects across generations of negative experiences and whether such shared experiences in a population could be evident in a variety of social measures, including standardized tests. Isn't this something to pursue in trying to understand the gaps Dr. Mac Donald points to? It's about understanding and fixing an evident problem, not killing the instrument which revealed it.
The more I listen to 'meritocracy' debates the more I suspect you are addressing the wrong issues. For example: Fifty years ago Bobby Fisher became world chess champion and he was praised for his achievement. In fact, in those days, being chess champion was widely lauded as a pinnacle of human intelligence. It has been more than twenty years since the best human player has be able to beat a chess engine (computer program) Ding Liren is the new world chess champion. I could never hope to beat him 'over the board' but with a chess engine I would beat him every time. In fact, against a chess engine a grandmaster is like John Henry, the pile-driving man. No professional chess player can train adequately without the assistance of a chess engine.
As to medicine: If not today, but in a year or two at most, with the assistance of AI, a lowly PA (physician assistant) will be able to deliver a more accurate medical diagnosis than the most experienced (and expensive) physician. Say goodbye to the "my son, the doctor" meme.
I don't have answers, but your discussion with Ms Mac Donald is past its expiration date.
As much as I see her case, and I see all the madness around me, I think she left a lot on the table. Medical school is four years of one's career, when one isn't actually treating patients. It isn't everything.
So here are some more problems: physicians train in residency programs, which are accredited by one national body, the ACGME (there used to be more but this is the consolidated authority now). That body is captured, so now everyone trains on required milestones that can include some DEI talking points. You have to do what they say to have a career in medicine. It would be very, very difficult to litigate around that, and who would try with their career on the line?
But again, residency is 3-7 years and then you're done. What's really important is all the regulation that comes thereafter. There are states that require implicit bias training to maintain a medical license. You need a license to practice medicine. Roland Fryer can start his evidence-based DEI company when he's suspended from Harvard. Colin Wright can start a substack when he gets blacklisted from academia. These are not great options, but it's better than what I face. I need a license, or I'm not a doctor.
But licenses are at the state level, so maybe you can pick a state that you like. Okay. But to be hired and to get reimbursed, you probably need to be board certified (this is the thing that makes you a pediatrician or a neurosurgeon or whatever other specialist you are). There is one national board for each specialty, which is a non-governmental agency. They set requirements. They can take your certification away if they don't like you. Being board certified is not a constitutional right, so you have no due process. You cannot practice in a specialty if the board doesn't want you to. Rand Paul once tried to create a separate ophthalmology board in recognition of this monopoly problem, but it didn't go anywhere. The specialty boards can impose ideological commitments nationwide if they want to. This hasn't really happened yet, not in the way it could. You think defunding the police is bad, wait until the American Board of Psychiatry and Neurology tells psychiatrists you can't involuntarily commit a black person, for any reason. Wait until the surgeons aren't allowed to give Sally Satel another kidney because she hold the wrong views; how's that for cancel culture? What if keeping one's political opponents alive through medical treatment becomes construed as causing "harm" using the prevailing rhetoric? These are real possibilities.
And this is to say nothing of the decline of independent private practice medicine, subjecting physicians to being employed by places with HR departments. The CMS regulations. The Joint Commission. The clinical guideline committees. The regulatory agencies. Every one of these systems is an opportunity for capture. Non-meritocracy med school admissions is bad, but when whatever integrity all of these other bodies have completely collapses, it will dwarf anything we've seen so far in the Woke Era.
I asked for it, I got it. Good conversation, but I want to pull a Glenn Loury and offer some pushback, specifically on Step 1.
This refers to Step 1 of the U.S. Medical *Licensing* exam. The stated purpose of the test is to qualify one for a license to practice medicine. A license is a binary thing. You either have one or you don't; every physician practicing in a state has the same license (with some marginal exceptions). So pass/fail makes perfect sense for the USMLE.
Residency applications are not the stated purpose of the USMLE; the exam was appropriated for that because it was standardized nationwide. Residency training is specialized; it is not a binary all or nothing. So it's actually quite strange to think that someone applying to be a psychiatrist is judged on the same USMLE score as someone applying for radiation oncology or urological surgery. Yes, medicine is about the whole person, but these training programs are very different. I would argue there ought to be residency entrance exams separate from the USMLE (as much as it would be expensive and miserable) which would be more specialized.
It was also a point of contention that Step 1 specifically was so important. There are 3 steps. The third is taken during residency (and thus is irrelevant to the competitive process of applying for residency training). However, Step 1 was often encouraged to be taken after year 2 of med school, before a medical student starts seeing patients in the traditional curriculum of two years of classroom science content followed by two years of clinical clerkships, and often before they've picked which residency they'll apply to. Step 1 is more of a basic science exam. Step 2 is taken later and is more applied.
For reasons unbeknownst to me, Step 1 scores were king in the residency application process; often a minimum score was set for consideration for a position. I would much rather be judged on the more clinical exam taken when I'm more mature and have had experience using my knowledge in actual clinical scenarios, and Step 2 is still scored, so presumably that's now the benchmark. (I'm speaking against interest; my own Step 2 score was not good for personal reasons).
It also used to be the case that Step 2 was divided into a multiple choice exam and a clinical exam (CS) on practice patients. In practice, CS had over a 95% pass rate and was failed mostly by immigrants who didn't speak fluent English, but it cost thousands of dollars to take and was a burden. I'm glad they got rid of it, and I think English language skills can be assessed in a less burdensome way.
There was a lot of criticism of medical schools "teaching to the test" for the basic science of Step 1. It disincentivized curricular innovation to get students more clinical skills earlier on. Many medical students (yours truly included) almost completely ignored their medical school curriculum and instead focused on test prep videos and question banks for Step 1. Classrooms were empty. University of Vermont removed lectures from their program completely, presumably because everyone was out studying for Step 1. There are a lot of problems with med school that have nothing to do with DEI.
Thus, I see clear arguments for making Step 1 pass/fail that do not undermine meritocracy (because we still have Step 2) and which could be argued to serve many other goals that aren't explicitly part of the diversity agenda.
I won’t comment on the anecdotal nature or originality of the suppositions of the cause(s) of the difference of performance. That’s fine. I thought the completely unfounded and subjective nature of assigning weighted causal variables by percentage a bit too presumptive and risible.
One can be supportive of the good intentioned effort but I think that aspect should have been pointed out. I was a bit surprised you didn’t since I’ve found your other comments to be rigorously astute.
Finally got around to this one. Wow. That was an avalanche. A lot to chew on. Could have devoted an hour to each topic, but they just kept going.
I feel like a coach at the end of a football game after the Gatorade has been dumped on me. I know it's all a show of brotherhood and respect, but now I'm wet and cold af.
The most disturbing part for me were those stats on high school academics. The most fundamental solution there is to never lessen standards for any reason. I have zero fear that these standards can be met and exceeded, even if it took another generation. More importantly, *so* many of these issues begin and end in the home, not the school.
But all of these topics carry a certain amount of nuance that's hard to get to with two interlocutors so closely aligned--like Glenn and Heather. While I appreciate his attempts to steelman arguments from the left, I think Glenn (inadvertently) conflates the most obstreperous people on the far left with relatively serious people who simply lean left, and they are not one and the same any more than Heather MacDonald and Amy Wax.
And fwiw, violent crime is a lot more complicated than it seems. For instance, most people, including most Black people, aren't experiencing violent crime on any sort of regular basis. But it's so easy to paint a picture of a living hell with statistics. I am reminded of a Thomas Sowell interview when he alluded to a rather overused talking point about murder rates in Honduras. According to him--if I recall accurately--a shockingly high percentage of those murders occur on three streets, which is a fact that would almost certainly alter the stereotypical image of Honduran crime.
Much of the world looks at America's gun laws and our mass shootings and wonders, "What the ****?"
Fair question. But how many Americans can (personally) relate to a mass shooting? It's a pretty thin slice. We're a nation of 330mm.
"How bad is X?" Very often that depends on what we're comparing X *to*. The capacity for a people to accept/condone various ill behaviors in their midst is staggering in many ways, but so is the capacity for people to ignore situations that don't directly affect them (like crime in another person's neighborhood).
I would love to hear someone like Will Saletan chime in on this video. But I would not want to hear from a progressive troll. Big difference.
Time 47: MacDonald explores “Black doctors for Black patients” concept. Patient’s doctor preference (for any demographic category including race and other) varies between in-group and out-group depending on patient and medical condition, especially if in-group expectation and stigma. In 2011, I spoke to a woman In Istanbul who visited a OB/GYN MD at a government hospital, seeking STD-testing. The female MD (Muslim) told patient, “You have never married which means you are a virgin and therefore cannot have STD. Patient responded- “I am 53 years old and not a virgin.” In USA, that patient would seek an out-group MD for ob/gyn.
Regarding education achievement gap for Black Americans; I speculate the following factors
(1): Effect of culture on learning. One of my parents attended school to 8th grade and the other had attended university level- but in another country. I developed learning skills alone by trial and error. Today at age 56, I am aggressive and analytical with regard to new information- which makes learning easier. But, at age 19 - I was clueless. I had to work harder to learn a complex topic. Culture adds a dimension to one’s information seeking and processing skills.
(2): Haidt - coddled kids. 30 years ago, while teaching high school geometry- a girl interrupted my class instruction to complain that I was teaching the students something that she already knows and therefore I should teach another aspect of Geometry, instead. And I should “take her word” that she actually knows the concept. A guy interrupted the same geometry class on a different day to complain that I wasn’t teaching what he needed, (He needed to learn non-Geometry, measuring wood with a ruler for his after-school job.)
(3): “Achievement gap caused by racism” idea has been around since mid-1980’s. That causes some students to speculate “racism” when instruction is challenging.
(4): Limited opportunity for social intimacy at university. Social intimacy requires transparency, but non-Black professors and students probably fear “You are racist” accusation- so remain guarded, which inhibits intimacy.
Time 33.00; Glenn mentions “First five years” of child’s life as opportunity for cognitive development, instead of waiting until medical school. By age 3 - vocabulary difference of up to 100% for rich vs. poor. I have seen the difference up-close in observations of family and friends.
But, beware the 60-page PDF- “SF Department of Early Childhood Strategic Plan 2023-2027” from SF DPH. Every page - literally has race-equity wording. This is the same Equity program that tried to remove standardized test admissions at SF’s famed Lowell High School and is currently trying to remove Algebra from 8th grade curriculum, (I signed petition).
Plan prioritizes Black, Latino, Pacific Islander* and Indigenous race groups; due to historic oppression. I fear that cognitive skills will be characterized as “Whiteness”, and after all the indoctrination activities, there will be little time for development.
*Population = 2,500 for all age groups. Population of SF group is at a 30-year low. I am so grateful that SF-Gov is acting to protect the city residents from the harm caused by the morally inferior race (sarcasm). I predict better outcomes for groups that Equity program excludes.
https://en.m.wikipedia.org/wiki/Harold_L._Martin
In recognition of my first cousin Dr. Harold Martin, Chancellor at an HBCU, North Carolina A&T, who's doing a fabulous job in improving the performance of Black college students.
Black students have options besides attending white Ivy League colleges. As black ppl, we need to invest and support our own institutions. Improve our sense of community. Social integration led to unattended consequences.---loss of Black owned farms, buisneeses, teachers, and community.
Blacks shopping exclusively at non Black owned buisneeses for goods and services is not empowerment. Our kids need a healthy environment with Black role models affirming them.
Glenn, the newly elected "progressive" DAs don't have any trouble hiring. They either fire or force out career prosecutors, then hire replacements aligned with their views. They can be ignorant but at least they are aligned. It's true that some career prosecutors resign but the first thought is whether the good work can be continued or it can't. Some try to stay on and work to hold it together.
But after the guillotine falls, there's plenty of space to hire replacements. These are largely defense attorneys and public defenders. Boudin mostly hired his colleagues from the public defender's office in San Francisco. After his recall, some of these are going to Alameda County, across the Bay and where Oakland and Berkeley are located. Alameda County used to have an excellent DA's office. It is now experiencing the hostile takeover you suggest. But to your point about hiring, there will be no trouble at all.
Voters did indeed elect them. And the voters will experience the folly of having done so. The results on the street led to Boudin's recall. Enough was enough. But it is no small task to put a DA's office back together again.
But we expect that sort of thing in San Francisco, right? Why are these tropes-based fantasies selling elsewhere? Voters are pretty bad at prescience. Predicting the future is not a strength. But sensing something is not right presently is possible and I think we would all agree many things are not right. What is sad and disturbing to me personally is when fallacious conclusions are reached and courses adopted which will not work and indeed will make matters worse.
Around 1:17 Heather MacDonald makes a point that’s something I’ve been noticing for a while. Regarding basic standards of achievement for basically anything, the backwards thinking goes like this: the standard is a, b and c; but there are some people who cannot reach that standard (for whatever reason); therefore the standard is faulty (exclusive, biased, etc); therefore to be perfectly democratic we must eliminate all those standards. And then what?
The transatlantic slave trade mal-distributed massive generational wealth and power to Europeans. Europe wouldn't be what it is today without practicing genocide, Black chattel slavery, and colonization. America is founded on racialization. Other racial groups weren't transported thousands of miles from home while living and dying in their excrement. This was massive!
Just listened and enjoyed the conversation enormously. It helped unravel some very troublesome knots we have been struggling with in woke America - and make sense of these issues with a discussion based on facts. There is too much magical thinking and cancelling of real conversations that could lead to solutions.....
Word.
There can be no excuse for protecting criminals for the sake of veiling disparate impact.
In fact the State should clamp down even harder on lawbreakers regardless of race, gender, religion, sexuality, etc.
The law must be applied equally to all without regard for history, ancestry, etc.
Glenn, these discussions are so rich, it's easy to forget an early point while moving on to listen to the remainder. I have a comment on your point on the general question of doubt and rumors of inferiority.
I wonder if some of the most accurate answers can be found in the behavioral sciences, as well as the field of epigenetics. We're beginning to understand that it isn't so much our genes which influence everything from behavior to medical outcomes, but the expression of those genes. Twins studies have been very instructive. For example, to the question of whether depression "is genetic", there does seem to be a gene which a population prone to depression share in common. But having it doesn't mean a person will suffer depression. It needs to be activated, as it were. The triggering factor is stress. (see Robert Sapolsky's lecture on stress and anxiety to what looks like a room, heavily weighted to parents, at Stanford a few years ago.) This is epigenetics.
We know that certain stressors can be passed on to our offspring. An example comes from the area of domestic violence. I think it's evident that being in the minority, and indeed being alone, in a population is also inherently stressful. Bonobos who have violated norms can be ostracized from the group. In isolation, their blood chemistry shows heightened cortisol and adrenaline. Where survival depends on being in the group, being isolated appears to feel like a very real existential emergency. How opposite it must feel to being a bonobo in good standing, being groomed and grooming others in the group. It's the difference between low stress and high stress.
Are humans different? Isolation, stress and fear evidently are associated with depression in humans. What about as a population instead of an individual? (Sapolsky also talks about functional MRI studies showing subjects photos of faces and measuring amygdala activity depending on the faces shown. It seems more about "others" vs. "us" than about race. So what if someone else is different? It's all about the consequences of being an "us" or an "other".)
But my point is that perhaps we would all benefit by understanding the effects across generations of negative experiences and whether such shared experiences in a population could be evident in a variety of social measures, including standardized tests. Isn't this something to pursue in trying to understand the gaps Dr. Mac Donald points to? It's about understanding and fixing an evident problem, not killing the instrument which revealed it.
The more I listen to 'meritocracy' debates the more I suspect you are addressing the wrong issues. For example: Fifty years ago Bobby Fisher became world chess champion and he was praised for his achievement. In fact, in those days, being chess champion was widely lauded as a pinnacle of human intelligence. It has been more than twenty years since the best human player has be able to beat a chess engine (computer program) Ding Liren is the new world chess champion. I could never hope to beat him 'over the board' but with a chess engine I would beat him every time. In fact, against a chess engine a grandmaster is like John Henry, the pile-driving man. No professional chess player can train adequately without the assistance of a chess engine.
As to medicine: If not today, but in a year or two at most, with the assistance of AI, a lowly PA (physician assistant) will be able to deliver a more accurate medical diagnosis than the most experienced (and expensive) physician. Say goodbye to the "my son, the doctor" meme.
I don't have answers, but your discussion with Ms Mac Donald is past its expiration date.
The one thing that can never happen is the responsibilitizing of the marginalized. It endows them with agency which cancels their essence as victims.
As much as I see her case, and I see all the madness around me, I think she left a lot on the table. Medical school is four years of one's career, when one isn't actually treating patients. It isn't everything.
So here are some more problems: physicians train in residency programs, which are accredited by one national body, the ACGME (there used to be more but this is the consolidated authority now). That body is captured, so now everyone trains on required milestones that can include some DEI talking points. You have to do what they say to have a career in medicine. It would be very, very difficult to litigate around that, and who would try with their career on the line?
But again, residency is 3-7 years and then you're done. What's really important is all the regulation that comes thereafter. There are states that require implicit bias training to maintain a medical license. You need a license to practice medicine. Roland Fryer can start his evidence-based DEI company when he's suspended from Harvard. Colin Wright can start a substack when he gets blacklisted from academia. These are not great options, but it's better than what I face. I need a license, or I'm not a doctor.
But licenses are at the state level, so maybe you can pick a state that you like. Okay. But to be hired and to get reimbursed, you probably need to be board certified (this is the thing that makes you a pediatrician or a neurosurgeon or whatever other specialist you are). There is one national board for each specialty, which is a non-governmental agency. They set requirements. They can take your certification away if they don't like you. Being board certified is not a constitutional right, so you have no due process. You cannot practice in a specialty if the board doesn't want you to. Rand Paul once tried to create a separate ophthalmology board in recognition of this monopoly problem, but it didn't go anywhere. The specialty boards can impose ideological commitments nationwide if they want to. This hasn't really happened yet, not in the way it could. You think defunding the police is bad, wait until the American Board of Psychiatry and Neurology tells psychiatrists you can't involuntarily commit a black person, for any reason. Wait until the surgeons aren't allowed to give Sally Satel another kidney because she hold the wrong views; how's that for cancel culture? What if keeping one's political opponents alive through medical treatment becomes construed as causing "harm" using the prevailing rhetoric? These are real possibilities.
And this is to say nothing of the decline of independent private practice medicine, subjecting physicians to being employed by places with HR departments. The CMS regulations. The Joint Commission. The clinical guideline committees. The regulatory agencies. Every one of these systems is an opportunity for capture. Non-meritocracy med school admissions is bad, but when whatever integrity all of these other bodies have completely collapses, it will dwarf anything we've seen so far in the Woke Era.
I asked for it, I got it. Good conversation, but I want to pull a Glenn Loury and offer some pushback, specifically on Step 1.
This refers to Step 1 of the U.S. Medical *Licensing* exam. The stated purpose of the test is to qualify one for a license to practice medicine. A license is a binary thing. You either have one or you don't; every physician practicing in a state has the same license (with some marginal exceptions). So pass/fail makes perfect sense for the USMLE.
Residency applications are not the stated purpose of the USMLE; the exam was appropriated for that because it was standardized nationwide. Residency training is specialized; it is not a binary all or nothing. So it's actually quite strange to think that someone applying to be a psychiatrist is judged on the same USMLE score as someone applying for radiation oncology or urological surgery. Yes, medicine is about the whole person, but these training programs are very different. I would argue there ought to be residency entrance exams separate from the USMLE (as much as it would be expensive and miserable) which would be more specialized.
It was also a point of contention that Step 1 specifically was so important. There are 3 steps. The third is taken during residency (and thus is irrelevant to the competitive process of applying for residency training). However, Step 1 was often encouraged to be taken after year 2 of med school, before a medical student starts seeing patients in the traditional curriculum of two years of classroom science content followed by two years of clinical clerkships, and often before they've picked which residency they'll apply to. Step 1 is more of a basic science exam. Step 2 is taken later and is more applied.
For reasons unbeknownst to me, Step 1 scores were king in the residency application process; often a minimum score was set for consideration for a position. I would much rather be judged on the more clinical exam taken when I'm more mature and have had experience using my knowledge in actual clinical scenarios, and Step 2 is still scored, so presumably that's now the benchmark. (I'm speaking against interest; my own Step 2 score was not good for personal reasons).
It also used to be the case that Step 2 was divided into a multiple choice exam and a clinical exam (CS) on practice patients. In practice, CS had over a 95% pass rate and was failed mostly by immigrants who didn't speak fluent English, but it cost thousands of dollars to take and was a burden. I'm glad they got rid of it, and I think English language skills can be assessed in a less burdensome way.
There was a lot of criticism of medical schools "teaching to the test" for the basic science of Step 1. It disincentivized curricular innovation to get students more clinical skills earlier on. Many medical students (yours truly included) almost completely ignored their medical school curriculum and instead focused on test prep videos and question banks for Step 1. Classrooms were empty. University of Vermont removed lectures from their program completely, presumably because everyone was out studying for Step 1. There are a lot of problems with med school that have nothing to do with DEI.
Thus, I see clear arguments for making Step 1 pass/fail that do not undermine meritocracy (because we still have Step 2) and which could be argued to serve many other goals that aren't explicitly part of the diversity agenda.