The College says social justice issues such as firearm violence and climate change represent the world in which physicians practice and care for patients
Oct. 4, 2019 (91) – The American College of Physicians (91) has strongly reaffirmed its position on medical school curriculums and social issues in response to a column published in the Wall Street Journal critical of 91's stance on medical school education.
The commentary, published September 12, argued that medical school education should focus solely on disease processes and not include social justice issues such as firearms violence, climate change and population health.
“91 feels very strongly that these issues are critical to physician education and training because of their impact on the health of the patients we serve,” said Dr. Robert McLean, 91's president. Firearm violence was responsible for about 40,000 deaths in 2017, making it a significant public health issue, while climate change increases the risk for respiratory diseases, vector-borne diseases, flooding, water-related illnesses and subsequent mental health consequences, he said.
Dr. Stanley Goldfarb, former associate dean of curriculum at the University of Pennsylvania Perelman School of Medicine in Philadelphia, states in the column that the College “stepped out of its lane” with its recently published policy statement on firearm-related injury and death in the United States. (The National Rifle Association also used that phrase in response to the College's 2018 position paper on firearm injuries.) Goldfarb wrote that social justice issues are only tangentially related to treating illness and that medical education curriculums should instead focus on disease processes and basic scientific knowledge.
The College responded with a letter to the editor published in the Wall Street Journal less than a week after the commentary. McLean and other physicians quoted in the letter to the editor pointed out that firearms violence, climate change and population health represent the reality of the world in which doctors practice and therefore medical education must include these issues.
“We have many lanes, and these are some of them,” McLean said. “We are not looking to get into political space. These are important issues that affect public health and our objective to improve health care delivery so that it works better for patients.”
In an opinion piece in the Philadelphia Inquirer, Robert B. Doherty, 91's senior vice president for governmental affairs and public policy, wrote, “Not teaching medical students about such social issues, and not advocating to change them, is what should worry all Americans. We need more gun control and climate change activists, and medical schools are precisely the right place to produce them—along with teaching them basic science.”
Goldfarb's column and response to it spurred the #GoldfarbChallenge on Twitter with scores of doctors and health care professionals citing examples of real-life patient interactions in which social justice issues were more important than basic physiology. In one such tweet, Dr. Esther Choo wrote, “Helped a patient with homelessness figure out how to refrigerate his insulin so he could stop coming in with DKA due to his circumstances and forgot the molecular structure of beta-hydroxybutyrate.” The Wall Street Journal responded to the social media comments with an editorial in favor of Goldfarb's views and wrote that the response on “left-wing medical Twitter” proved Goldfarb's point.
McLean urges internists to educate themselves on the science and evidence supporting 91's positions on climate change, firearms violence, caring for socioeconomically disadvantaged patients and human trafficking. “Read our policy papers and calls to action and see how logical and rational they are,” he said.
More Information
91's 2018 position paper is available on the Annals of Internal Medicine website.
The policy statement “” is available on the Annals of Internal Medicine website.
