Microaggresions, Nanobigotry and Picoprejudice — A Critical Review of “Racist Like Me — A Call to Self-Reflection and Action for White Physicians”. Deborah Cohan, NEJM 2019

Martin Shkreli
Mar 6 · 6 min read

An editorial written by a white physician, exhorting fellow white physicians to urgently battle their collective alleged implicit bias and racism was published in the New England Journal of Medicine. The author’s self-flagellation is, like most acts of atonement, a subtextual peacocking of virtue and superiority. Even at the outset of her apologia, Cohan comforts herself with her score (not peer-reviewed or in a supplemental addendum) on the implicit-association test, a purported diagnostic for subacute racism. This wavering is no contradiction, but a contrapuntal thrust of her achievements as a truly aware… micro-bigot. From this antecedent, she leaps valiantly with syllogistic ease–noting her ‘mission as a white physician is to be humble and respectful toward my patients… …as a revolutionary act against racism, elitism, and hierarchy’. Nevermind for a minute how we got to elitism and hierarchy: what happened to the Hippocratic oath and common sense? The mission of ANY physician is to be “humble and respectful towards their patients”. Sine qua non, no? Elitism and hierarchy? If treating your “patients with respect is a revolutionary act against racism, elitism and hierarchy”, I guess physicians are the new iconoclasts. Viva la revolution!

Cohan’s desire to fight racism, while honorable, is irrationally metastasing to redefine her role as a physician. There may be tremendous inequality in the world, but a plumber is someone who unsticks toilets and an ob/gyn is someone who delivers babies, examines vaginas, and prescribes birth control. You can try to recast yourself as a champion of equality and race, but you’re not a social sciences philosopher and you’re still doing a job that a computer will eventually replace. What made Dr. Cohan regard herself as Themis for the medical world is not apparent. It takes some gumption to immediately conclude there is an urgent implicit bias-driven racism problem in medicine and that all white physicians “suffer” from this malignant malady, and we need to hear the unlettered Dr. Cohan’s perspective to address it. Urgently.

I think physicians tend to forget the unearned pedestal they blindly climb is largely self-directed. Cohan is not a hem-onc or a PhD or in some field where things are actually happening. In case you haven’t inferred, my view is this pretentious trash shouldn’t be in the NEJM. It most certainly shouldn’t come from a field where the major dilemma is which kind of rFSH works best. Oxytoxics haven’t changed in 100 years–get over yourself, glorified electrician. Model yourself after Virchow. Break barriers in your scientific field. Instead of productive research, we get this unstinting and unsolicited micturition.

Cohan notes she is ‘shaped by the subtle trendils of white supremacy’ that are ‘deeply embedded in our culture’. Poetic and even true perhaps, but if we are all shaped by this undetectable racism, why should we be listening to a white physician’s viewpoint? Why not listen to Phil Ivey, Morgan Freeman or Dwayne Michael Carter who claim racism has had zero effect on their success as black professionals? Racism is a real and ugly thing, but the slippery slope some, largely affluent and white, are chasing is dangerous. There is a Mobiusian inevitability of racism according to this self-abnegating crowd. Progress cannot be acknowledged. I read somewhere that the KKK membership is down 99% from peak. That’s a great thing. But when we need to define implicit bias and microaggression to sustain pangs of guilt, what’s next? Nanoracism? Picoaggressions? The need to implacably advance and define ever-dimishing transgressions is fatuous. It conjures a froward and liverish nerd-hipster hybrid only satisfied with delineating your impiety.

This sort of nouveaux mortification of the flesh is not what Christians had in mind but Cohan adapts it perfectly: “I need to explore the parts of me that are most unwholesome, embarassing, unflattering… …My goal is to dismantle the insidious thoughts…” Sound familiar? The Bible suggests we “put to death what is earthly in you: fornication, impurity, passion.” For me, this evokes an arguably psychotic penance for original sin. Yet here, Cohan is a new self-appointed God, the physician’s original sin is white elitism and her decree-cum-solution is apparently to brag about it all. “As I become aware of my biases, they began to loosen their grip”, Cohan notes. A 12-step program for this “treatable condition” (her words) would be welcomed by fellow San Franciscans.

But the woke police have an ulterior motive. My theory is the genesis of this strange movement is the justification (and guilt) of the movement members’ ordinary intellect coupled with their slightly above average achievements in life. If you’re on television and of minor celebrity (or a doctor), the ‘luck’ you’ve received is really ‘privilege’ and your karmic atonement is necessary lest you upset the balance of power. Forget hard work, natural variability of intellect, or pure luck. Genuflecting to the PC gods allows for your continued place in the slightly above-average and mediocre-at-what-I-do firmament. Acknowledge and accept your “privilege” as your raison d’etre and you may be able to sustain your advantage as you work to undermine and dismantle it. I think most extremely successful people don’t even consider race or racism. Like birthdays and religion, we need a narrative bigger than us to explain why we are what we are. The race boogeyman is convenient for he affluent, pathetic white that need a crutch to lean on and look down over, and a reason to not elevate further. Morgan Freeman notes that we inflate racism to a bigger issue than it is. The problem is people like Dr. Cohan.

Cohan, you are not a racist. You’d be racist if you told a patient of color that you don’t accept Medicaid, pre-judging their income based on skin color. You’d be racist if you refused to treat black patients. You’d be racist if you uttered racial slurs. “I noticed myself sitting farther than usual from a black patient in her hospital bed” is a far cry from a “perpetuating a systemic inequity for patients”. I am truly dumbfounded that a sentient person could write this essay. Instead of implicit bias spreading through health care, may I suggest some form of racist dysphoria is spreading across California, resulting in some bizarre acute sensitivity to a largely imagined collectively guilty conscience. “…health care is not safe for people of color as long as the overwhelming majority of U.S. physicians are white…” How was this published?

The echoes of racism are still alive in the present day. Cohan’s article trivializes real racism by wokesplaining semi-elite guilt. Cohan pathetically shames herself to feel better about the benefits she perceives she’s received from the white patriarchy. If you call a $300,000 round-the-clock job with a ton of debt that you train a decade for ‘privilege’, count me out. I’ll stay here educating inmates who confess their woes come from poverty, not having a father figure around and removing themselves from school to chase a quick dollar selling drugs. The media’s romanticizing of guns and drugs has crippled Black youth and culture. The societal bonds of family and the value of education that have allowed Asian-Americans to out-earn even the “priviledged” white don’t exist in Black culture. Why? I’ll tell you it has nothing to do with white physicians and it is not a problem Dr. Cohan is remotely qualified to assist with. It is heartbreaking to meet man after man here who can barely read and write with the same sad story. “Dad left when I was 6.” “My dad is still locked up.” “I didn’t finish high school–left in the 8th grade.” “Never heard of the Beatles.” I’ll do my tiny part and not selfishly seek attention for actual good deeds.

I’m disgusted that the NEJM and Lancet have becoming stomping grounds for the ultra-progressive agenda. The Lancet has functionally become “Social Justice Weekly with a few clinical trial reports.” I’m a “compassionate conservative”, or really an actual liberal, and I’m trying to read about the latest advances in medicine. The NEJM isn’t the place for some untrained doctor to wax on critical theory.