This has not been a good couple of years for white folks in America. If you start the count at the beginning of the anti-police protests in Ferguson, Missouri, an unlikely Ground Zero for revolution one must say, or even two years earlier a thousand miles south in Seminole County, Florida where Treyvon Martin met his untimely and unlikely end, some of the most cherished fictions underpinning our society have been shown to be lies. You can blame technology, blame bad karma or just see pigeons coming home to roost but one thing is sure: Since whites have historically insisted on running the shop, the dishonesty must be laid at their doorstep. And if you had any doubts, then came Missouri again, at the University of Missouri, and later Hollywood with the uncovering of more self-serving falsehoods. Austin looks to be next on the calling-out-Caucasians list.
That conservative whites often but not limited to members of the Republican Party, and liberals—almost exclusively members of the Democratic Party—chose to believe a skewed version of reality doesn’t matter so much now because the truth has not only been publicized, it’s been posted on YouTube. In rapid succession we’ve been rocked by revelations about criminal justice, higher education and culture—the last represented by the OscarsSoWhite protests which were a mere opening of the discussion of white privilege in the arts. Now, to mix metaphors, to view what’s happening in a different way, a fourth horseman is riding into town, this town, the Texas capital. For those not schooled in the Good Book—a group that includes me—in Revelations the Four Horsemen of the Apocalypse represent calamities: conquest, war, famine and death. In modern America the four are actually goods that have been apportioned unfairly, denying minorities anything like a fair share—or a fair shake. The fourth horseman in this instance is healthcare and what is about to happen in Texas will make Ferguson and Seminole County pale by comparison. Healthcare is the next front in the race wars in this country and like bad policing, it’s going to be deadly. We know that because it already is.
We’re already familiar with past discrimination in the provision of medical care in this country. In the case of blacks the “none” of slavery was succeeded by the “little” of Jim Crow that was followed by the substandard that continues today. You don’t have to cite acts of omission like the contamination of the Flint, Michigan water supply; acts of commission are much more compelling. Most famously there were the Tuskegee syphilis experiments in which black men were intentionally misled and left untreated by the U.S. Public Health Service in order to track the progress of the disease, and the Henrietta Lacks case in which Johns Hopkins University stole a valuable cell line from a black woman with cancer. It’s no coincidence that both of these cases involve medical research because that’s where we’re going today in Austin. The city is preparing to greet the first class of the newest medical school in the country, part of the nation’s first brand new medical faculty in half a century, and when it comes to the health of minorities which—per the city and the county, already trails far behind whites—“new” will not be synonymous with “better.”
One is reluctant to raise personalities in a discussion of anything as widespread and endemic as poor minority healthcare in America. It would be like claiming that Donald Trump represents everything wrong with this country, no matter how good an argument he makes on the campaign trail. But to a significant degree the new dean of the new University of Texas Dell Medical School serves the same role in healthcare. He represents most of what’s wrong with the system today, especially as regards minorities, and even giving the dean the benefit of the doubt in a new position, and time to do his job, his tenure thus far in Austin only reinforces that impression. Which is precisely where the Trump comparison ends.
Because on a personal level Dr. R. Clairborne “Clay” Johnston is everything that The Donald is not: this Colorado-born, Harvard-educated, San Francisco-transplant neurologist is charming, thoughtful and circumspect. He has a smile that isn’t snarky and he listens, as opposed to Trump who blusters. Regarding Dr. Johnston’s prior career and his beginnings in Austin, however, one is nonetheless reminded of any number of observations by the great German-born Jewish philosopher Hannah Arendt who made famous “banality of evil” when referring to wrongdoing. An apt Arendt quote that translates well in regards Dr. Johnston: “The sad truth is that most evil is done by people who never make up their minds to be good or evil.” And a personal favorite: “Only crime and the criminal, it is true, confront us with the perplexity of radical evil; but only the hypocrite is really rotten to the core.” Much of what is known regarding the kind of medicine Dean Johnston practices has already been published elsewhere: the background for example of the role played by black DNA in modern healthcare, in a seminal interview by Ta-Nehisi Coates in The Atlantic three years ago (a piece actually about genetics and intelligence) that can be said to have started the ball rolling; and the specifics on the dean himself in this blog two years ago. But both bear repeating. As to the dean himself—and his personality—there does seem to be a certain liberal banality present. You get the feeling after listening to Dr. Johnston’s interviews that here’s a man who says the right thing, who has the talk down, but not the walk—but talk’s all that really counts here, and he’ll fit right in, in well-meaning Austin. This is a community after all that has gentrified blacks and Hispanics out of their homes and neighborhoods, where the police have shot an average of one unarmed black man every year or so as far back as anyone can remember; where the school district has regularly disciplined black kids at a rate far beyond that of whites and where the aforementioned healthcare system is statistically worse for minorities, all while the majority population pats itself on the back for enlightenment. Dean Johnston, who is still relatively new to the city, should feel right at home.
To say that Dr. Johnston has a questionable past is an understatement. He comes to us from the University of California San Francisco, UC’s exclusive and exclusively-healthcare campus where he was in charge of translational science which means commercialization of medical discoveries. At UCSF he once wrote a research paper justifying the charging of up to a million dollars for a single stroke medication given in an ER if the med extends the patient’s life by 20 years. When the UCSF chancellor, a cancer specialist and former pharmaceutical executive, got in trouble with the New York Times for the hypocrisy of having Marlboro stock in her multi-million dollar private portfolio, Johnston teamed with her to write another paper extolling industry-university ties and downplaying conflicts of interest in academia. In the context of the Ta-Nehisi Coates interview with one of the country’s foremost geneticists—UCSF’s own Dr. Neil Risch—in which Risch explained that black DNA is more valuable for research purposes because of wider variability in African-origin genes, Dr. Johnston, whose duties at UCSF included recruitment of medical study participants, received a proposal from the head of pediatrics at Oakland Children’s Hospital: skip the appeal to San Francisco’s mostly white parents, who don’t have many children in the first place and don’t want the kids they do have in clinical trials, and instead increase the “catchment” of black kids in the East Bay for experiments. “Recruitment in San Francisco can be especially challenging,” the proposal addressed to Dr. Johnston’s office read. “In particular, there is simply a limited pool of children living in San Francisco for pediatric studies, as well as a limited pool of African Americans of all ages. Fortunately there is a population of more than 2 million individuals in the East Bay which, for the most part, has not been tapped for UCSF-based clinical trials.” No one knows what Dr. Johnston’s immediate reply was but UCSF did not content itself with a mere contract with the East Bay hospital, it took over the whole of Oakland Children’s which is now UCSF Benioff Children’s Hospital Oakland.
Coming to Texas, Dr. Johnston’s first hire in Austin was an assistant dean “for partnerships,” which means industry ties. Johnston is a businessman as much as a physician. He’s here to make money for the university, for the university’s donors and for investors in the city and state. The pharmaceutical industry alone is estimated by Motley Fool to be worth $19 trillion. Even in Texas, where everything is already bigger, that’s a whole lot of money even if you can just get a small slice. In that context, the future Dell Medical School has become one of the few bipartisan projects in the capital, both parties see a cash cow in the making and no one much cares who gets squeezed or how hard to get the milk. A study recently produced by a UT System working group, led by Regents bad boy Wallace Hall, proposed pulling out all stops to increase UT-industry cooperation, which will mean bio-medicine in Austin. Meanwhile, across the country, in a different context, a recent Emory University study found that white physicians consistently underestimate pain levels in black patients, while a UCSF scientific study on healthcare disparities recently found that black heart attack victims are much more likely to be diverted to a secondary emergency room, less likely to be seen by the appropriate specialist and more likely to die sooner as a result. To translate that to English, that means for example (and this is purely an example) if Brackenridge Hospital is on diversion because the ER is getting slammed, the paramedics or whoever decides what patients need to be sent “elsewhere,” most often choose blacks to go to the secondary facility, which is not an unlikely scenario here since Austin-Travis County EMS, with the exception of its leadership, is four-fifths white (2015 stats), the healthcare equivalent of all white police officers patrolling black neighborhoods. It’s a good bet that although bad policing gets more attention, more minorities are being killed by hospitals than by police-issue nine-millimeters but no one notices because, as an Irish wit once said, “doctors bury their mistakes.” Dr. Johnston is the man chosen to bridge treatment divides like this in Austin and so far, speaking as a black person, it doesn’t look particularly reassuring.
First, a description of UCSF, whence Dr. Johnston came, is helpful in understanding the man himself. The UC campus in San Francisco is designed like UT’s own Medical Branch on Galveston Island, to be devoted solely to the healing arts and in the case of UCSF, with no undergraduates. But while UTMB has struggled in recent years, with efforts made to close the campus, UCSF has become one of the pre-eminent healthcare universities in the world, even though many people don’t know it exists. It has been the largest public recipient of federal healthcare research dollars during much of the Obama tenure, due in no small part to the university’s Congressional representative, Nancy Pelosi. The father of senior U.S. Senator from California Dianne Feinstein was one of the first Jewish surgeons at UCSF, and Facebook owner Mark Zuckerberg’s wife graduated medical school and did her pediatric residency there. A few months ago, Vice President Joe Biden went to UCSF not Harvard to plead for work on a “magic bullet” against cancer. Political, connected, wealthy, elite and elitist, UCSF has influence it hasn’t even used yet. It has produced great advances in science (synthesis of human growth hormone, for one, as well as a Hepatitis B vaccine that all healthcare workers in the country are said to take, to avoid accidental infection.) But the university also has had a reputation as the least racially-diverse campus among UC’s ten universities, which is saying a lot since blacks are only 3 percent of students in UC System overall. Texas Republicans may berate libs Pelosi and Feinstein but their hope is to create another UCSF in tech-rich Austin. What they don’t recognize is who’ll be paying the hidden costs. Dr. Johnston is not coming from an environment where he was steeped in diversity. Whatever he was hired to do in Austin, whatever he brings to the table, it has nothing to do with any expertise in minority health. He’s not here for us, even though we’re the majority in the state, he’s here for you if you’re Anglo.
In an interview last year, Dr. Johnston walked back a little of his history in San Francisco. “It’s not the intent [in Austin] to do a bunch of pharmaceutical trials,” he said. “It’s not really even about trials.” That’s great. But in a prior interview he placed himself firmly in the hypocrites’ camp. “I’m certainly not going to defend UCSF and its track record; we both know it needs to be better,” he said speaking of his former employer’s record on race. The unstated assertion here is that he could do better. But if you consider Johnston’s first eight appointments of department chairs in the new Dell School of Medicine (medical education, women’s health, pediatrics, surgery, psychiatry, internal medicine, population health and neurology) he has filled all eight positions with Caucasians in a state that is majority black, Hispanic and Asian. We’re not talking here about a missing “vice-dean of diversity” or “v.p. for inclusion” or “director of community engagement,” either. UT Austin has had a vice president for diversity, Dr. Gregory Vincent, for a decade now but when the powers-that-be sit down at UT, Dr. Vincent is still the only Negro in the room. (And it’s also important to note that even having blacks in the mix is no insurance against wrongdoing: the Tuskegee experiments were facilitated by the all-black Tuskegee Institute, and by black doctors, and run by a black nurse. One can only hope that having minorities present will protect against abuse.) In any case, that this missing component is damaging minority health has already been proven and Dean Johnston knows it. Healthcare is all about “best practices,” what the literature says in other words, and the literature in this case is all up in Dean Johnston’s face.
The go-to resource regarding the education of healthcare professionals in this country is a 2004 document called Missing Persons: Minorities in the Health Professions, A Report of the Sullivan Commission on Diversity in the Healthcare Workforce.” Louis Sullivan is an interesting figure, a black Republican who is a distinguished physician in the mode of Ben Carson, but unlike Carson, Dr. Sullivan has common sense, and administrative skills, having served as Secretary of Health and Human Services during the George H.W. Bush administration. Later, during W’s tenure in the White House, despite Sullivan’s strong conservative bent, and despite having equally-conservative former GOP senator Bob Dole as co-chair of his commission, Sullivan came to the unsurprising conclusion that a lack of minorities in the healthcare professions was hurting minority health. The Sullivan report is now the standard on American university campuses that teach the health professions, the guiding document regarding improving minority outcomes, the idea being that to make minority healthcare better you have to empower blacks, Hispanics and other “missing persons” in the health professions, which is nowhere more important than in medicine and nursing. But this is Austin and what people say is distinguishable from what people do. Just last year, new U.T. Chancellor William McRaven promised change in selecting UT component institution leadership but as Texas Monthly’s African-American blogger (and first regular black writer after over 40 years of TM’s publication, speaking of diversity) Doyin Oyeniyi pointed out almost immediately, UT has reduced its white student body population under 50%, which is a good thing, but three-quarters of faculty members are still white. The leadership of UT System is also all-white. This isn’t brain surgery and even if it were, these are pretty smart people. They know what they’re doing. It’s a new enterprise, the medical school, but it’s still business as usual.
For example, to counter the objections regarding a lack of diversity the university now claims that the new medical school has established a formal relationship with Austin’s historically-black college, Huston-Tillotson. But UT has fought in front of the attorney general to keep the actual Huston-Tillotson contract secret. The primary contractor for the new medical school is Seton, which already runs University Medical Center Brackenridge and is also a partner with Travis County Central Health, but both Travis County and Seton are now fighting to keep confidential their contractual agreements, according to a recent Seton letter to the AG, because the contract “lays out the specific duties and responsibilities [of] Seton . . . . as well as a schedule of fees agreed to by Seton and Travis County.” Exactly. Patients need to know what’s going on and how much it’s going to cost. Sleights of hands like these, and overt corruption, or covert conflicts of interest, hit minorities hardest because we live closest to the edge financially. This isn’t really an argument about healthcare. It’s a fight about money, and in a fight over money the one with the most money usually wins.
There’s a thread on the Internet that President Fenves is Latino. He’s not. His antecedents were in the Holocaust, as were Hannah Arendt’s. But societal conscience is missing in the new president’s resume. In short order as president, Fenves’ chosen acting number two, Provost Judith Langlois, as well as the new Vice President of Research, the new Dean of Communications and the new Dean of the LBJ School of Public Affairs that Dr. Fenves has chosen are all white, also. The new permanent provost, who will be the university’s #2 when she arrives this summer, coming from the University of Virginia, is Caucasian too. (To talk some pre-emptive smack, to be a little rude now in order to be less confrontational later, the fact that the new provost’s field of research is American slavery will get her absolutely zero additional credibility if BlackLivesMatter decides to pressure for closing down the plantation at UT.) Of all the deans and vice presidents at the University of Texas Austin, two dozen in number, one is Latino or Spanish-surnamed—and there’s the previously-mentioned black vice president for diversity as well, of course. Everyone else is white. The new chancellor lied when he said things were going to be different: yes, women are being empowered on campus but as the Oscars dispute showed us when Meryl Streep offered her lame excuse that she is somehow Everywoman, white women in power are not the same as women of color or minority men. Consider this: Who are the best students and some of the most formidable scientists and engineers in this country? Asians and Asian-Americans. They have no power at UT. Or consider: On whose future does Texas rely, because of demographic trends? Latinos. They have no power at UT. Whites are still running everything at the university and not doing a very good job for the rest of us. The sideshow of what long-dead Confederate general’s statue is on what UT quad is just that, a sideshow meant to divert attention from issues of black, brown and Asian empowerment in a state where we are the majority. Dr. Fenves shows no concern for empowering minorities or improving minority health in a state and on a campus where we are decidedly out of the loop. He doesn’t need a Supreme Court decision to do it either. In the interview last year Dean Johnston made the claim, in light of UT Austin’s recent history allowing unjustified admissions to the wealthy and connected, that there is a “firewall” between himself and the admissions process for the first students in the medical school. The claim seems unconvincing. Much more convincing is that UT is constructing another bastion of white privilege on campus. And in the long run it’ll kill more black people than all the police forces in Texas on their worst days.