UpToDate has a racism problem: Dr. Stanley Goldfarb


Jhe Division of Renal Electrolyte and Hypertension at the University of Pennsylvania recently made a quiet update to its history web page: it removed all references to its former co-chief, Dr. Goldfarb.

For several years, Goldfarb has been a strong critic of the consideration of social determinants of health, racism, and anything he considers too “woke” in medical education or health care in general. In 2019, he wrote a Wall Street Journal op-ed titled “Take Two Aspirin and Call Me by My Pronoms”, which spawned the social media hashtag #GoldfarbChallenge. He mocks her criticism that medical students learn about social issues and don’t spend enough time focusing on biochemistry and physiology. These tweets recount how doctors heroically delivered therapies to their patients but, instead of celebrating their successes, sarcastically lamented their inability to remember the biochemistry of those drugs or disease processes.

It can be argued – to a point – that physicians have unique skills and knowledge and that their efforts are best directed to traditional “medical” concerns. One can also engage in a civil debate about how the social determinants of health affect people. But there’s a problem when hateful stereotypes and inflammatory rhetoric enter the conversation.

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This year, Goldfarb published a book with the same title as his Wall Street Journal article, and for his virtual tour of the book, he misrepresented the findings of a study published in the journal Academic Medicine to argue on Twitter that resident physicians from groups considered underrepresented in medicine might be “worse at being residents” compared to their non-underrepresented counterparts, a claim he echoed in similar terms in an essay for Newsweek. Michael Parmacek, chairman of Penn’s Department of Medicine, called his statements “racist.” Later, the editor of the journal Health Affairs said essentially the same thing about Goldfarb’s organization, Do No Harm.

Now retired from Penn, Goldfarb retains an influential position as nephrology editor for publisher Wolters Kluwer’s UpToDate, the leading point-of-care medical reference for millions of clinicians. This is problematic for several reasons, including the importance of ensuring an appropriate discussion of race in nephrology (the branch of medicine that focuses on the kidneys), accurately and dispassionately interpreting scientific data, and promote the values ​​of respect and collegiality in medicine.

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Goldfarb’s position at UpToDate is an obstacle for all three.

Nephrology – which was central to my work as a medical researcher – has been at the center of the debate over the use of race in medical decision-making, because the equation that was used until recently to estimate kidney function included a controversial adjustment for Black race, potentially downplaying the perceived severity of kidney disease and the need for treatment and perpetuating unfair black stereotypes. There are also historical and current concerns about equitable access to donated kidneys and disparities in the outcomes of therapies such as dialysis and kidney transplantation.

UpToDate also has the stated goal, in accordance with American Medical Association policy, to ensure that race is defined as a social construct and not a biological variable.

Yet many nephrology articles in UpToDate continue to discuss race as a biological risk factor. In Goldfarb, UpToDate has an editor who scoffs at efforts to advance health equity and is unlikely to help align UpToDate’s content with its own and WADA policies, or even that he discusses these issues in a meaningful way.

Goldfarb’s inflammatory criticism of health equity is not only counterproductive, but also inconsistent. While saying he opposes the use of race in any medical decision-making or to ensure equal access to care, he supports the use of the kidney function race multiplier and attacks the institutions that eliminate it as yielding to the “awake crowd.” I wonder if Goldfarb is pursuing a philosophy on the use of race, or rather merely demonstrating reflexive opposition to any changes made in the name of justice or fairness, or worse: opposing changes that might deprioritize Whites.

Since its inception in 1992, UpToDate has become a premier resource for clinicians in the United States and around the world. It is critical that the company maintain its reputation as a trusted, evidence-based source of clinical information. Goldfarb’s numerous public statements in the media and through his organization make it hard to believe that the patient care recommendations he organizes are objective and unbiased. This is not an academic exercise – the information in UpToDate affects the lives of patients.

Of particular concern is that in recent months Goldfarb has provided misleading accounts of multiple studies to further its ideological goals. In the Academic medicine In the article I mentioned earlier, he ignored the fact that researchers were monitoring review rankings to argue that lower ratings were evidence of “worse” performance rather than bias of from the evaluators. In a subsequent blog post, he inaccurately confused people “not underrepresented in medicine” with those who were white (in the study, non-underrepresented residents were both white and non-white) for argue for the superiority of white doctors.

Similarly, in his critique of a 2019 study by researchers at Brigham and Women’s Hospital in Boston showing that black and Hispanic patients were less likely than white patients to be admitted to a cardiology ward for heart failure, he ignored all control variables to cast doubt. on the integrity of the analysis. Why these are problems for a medical reference editor requires no further explanation, and the fact that he is doing this to advance a racist narrative is inexcusable.

Respect for others, which is a pillar of the medical profession, is something else that Goldfarb has set aside. He repeatedly fails to treat other doctors with respect. For example, in a report published by his organization attacking a specific medical school’s diversity, equity, and inclusion initiatives (I’m not quoting it here to protect school participants), he included for free an appendix with the names, email addresses and salaries of committee members, including medical residents, putting them at unnecessary risk of harassment.

In May 2022, his organization sent a mobile billboard to disrupt the start of Harvard Medical School. He and his organization have also used inflammatory language to deride institutions such as Boston Children’s Hospital, which later became the target of violent threats unrelated to its transgender care. While the threats weren’t directly precipitated by Goldfarb’s rhetoric, his claim that one of the world’s most renowned children’s hospitals has given up on its mission of caring for children to become a radical political institution is eerily similar to the claims of those speaking out against Boston Children’s Hospital. Even if Goldfarb truly believes this, that should prevent him from influencing medical guidelines.

Simply put, Goldfarb does not demonstrate the behavior expected of a doctor, let alone a doctor in a position of influence. Many nephrologists are skilled in organizing science and guidelines while advancing health equity and treating others with respect. Goldfarb is not one of them, nor should he hold a position at UpToDate.

Let’s make his replacement the next #GoldfarbChallenge.

Eric R. Gottlieb is an internal medicine physician in the Boston area and an instructor in medicine at Harvard Medical School. The opinions expressed here are his own and do not necessarily reflect those of the organizations with which he is affiliated.

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