Our apolitical science-driven physicians

From the New England Journal of Medicine, i.e., the folks whom we can trust to give us science-informed advice on masks and vaccines, untainted by a political point of view… “Failed Assignments — Rethinking Sex Designations on Birth Certificates” (December 17, 2020):

We believe that it is now time to update the practice of designating sex on birth certificates, given the particularly harmful effects of such designations on intersex and transgender people.

Recognizing that the birth certificate has been an evolving document, with revisions reflecting social change, public interest, and privacy requirements, we believe it is time for another update: sex designations should move below the line of demarcation.

Designating sex as male or female on birth certificates suggests that sex is simple and binary when, biologically, it is not. Sex is a function of multiple biologic processes with many resultant combinations. About 1 in 5000 people have intersex variations.

Assigning sex at birth also doesn’t capture the diversity of people’s experiences. About 6 in 1000 people identify as transgender, meaning that their gender identity doesn’t match the sex they were assigned at birth. Others are nonbinary, meaning they don’t exclusively identify as a man or a woman, or gender nonconforming, meaning their behavior or appearance doesn’t align with social expectations for their assigned sex.

Moving sex designations below the line of demarcation wouldn’t imperil programs that support women or gender minorities, it would simply require that programs define sex in ways that are tailored to their goals.

Moving sex designations below the line of demarcation may not solve many of the problems that transgender and intersex people face. Controversies regarding bathrooms, locker rooms, and sports participation will continue, regardless of legal sex designations.

Today, the medical community has a duty to ensure that policymakers don’t misinterpret the science regarding sex and that medical evaluations aren’t being misused in legal contexts.

Also, “A Test of Diversity — What USMLE Pass/Fail Scoring Means for Medicine” (June 18, 2020):

The stakes are high for all students taking this first Step examination of the three required for medical licensure. But students from racial and ethnic groups that are underrepresented in medicine experience great angst.

Recently, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) decided to change score reporting from a three-digit numerical score for the Step 1 exam (the mean score for first-time takers was 230 in 2018) to a pass-or-fail outcome. … Although the effect on trainees from underrepresented groups remains uncertain, we believe that the change is a critical step toward diversifying the medical profession — particularly the most competitive, and simultaneously least diverse, medical specialties — opening a world of possibilities for physicians and patients alike.

The odds are stacked against students from underrepresented minority groups starting early in their scholastic journeys. Beginning in grade school, they may be subject to teachers’ racial and ethnic biases that can hinder their achievement. Socioeconomic factors such as neighborhood poverty and parental educational attainment may limit their access to high-quality schools, test-preparation resources, and supportive mentorship, widening the achievement chasm.

The medical examination system poses challenges that are especially burdensome to students of color and those with lower socioeconomic status. Step 1, much like the Medical College Admission Test (MCAT), places a financial burden on students that includes the cost of the exam ($645 in 2020) and the study materials required to prepare for it.

As with the MCAT, scores on Step 1 are lower among black, Hispanic, Asian-American, and female students than among their white male counterparts. Although this disparity has multiple causes, historically disadvantageous early education in minority communities probably plays an important role for members of underrepresented minority groups.

… we believe that holistic review will be a tide that raises all ships equitably.

The last sentence is my favorite. There are a limited number of slots for training the most lucrative and cushiest specialties, but everyone will have a better chance of obtaining a slot after this change.