The University of Pennsylvania’s Division of Renal-Electrolyte and Hypertension recently made a quiet update to its history web page: it removed all references to its former co-chief, Dr. Stanley Goldfarb.
For several years, Goldfarb has been a vocal critic of considering social determinants of health, racism, and anything else he considers too “woke” in medical education or health care at large. In 2019, he penned a Wall Street Journal editorial entitled, “Take Two Aspirin and Call Me by My Pronouns,” which gave rise to the social media hashtag #GoldfarbChallenge. It makes fun of his criticism that medical students are taught about social issues and don’t spend enough time concentrating on biochemistry and physiology. These tweets share stories of how physicians heroically procured therapies for their patients but, instead of celebrating their successes, sarcastically lament their inability to remember the biochemistry of those medications or the disease processes.
One can argue — up to a point — that physicians have unique skills and knowledge, and that their efforts are best spent on traditional “medical” concerns. One can also engage in civil debate about how social determinants of health affect people. But there’s a problem when hateful stereotyping and inflammatory rhetoric enter the conversation.
This year, Goldfarb published a book by the same title as his Wall Street Journal piece and, for his virtual book tour, he twisted the findings of a study published in the journal Academic Medicine to argue on Twitter that medical residents from groups considered to be underrepresented in medicine might be “less good at being residents” compared with their non-underrepresented counterparts, a claim he echoed in similar terms in an essay for Newsweek. Michael Parmacek, the chair of Penn’s Department of Medicine, called his statements “racist.” The editor-in-chief of the journal Health Affairs later said essentially the same thing about Goldfarb’s organization, Do No Harm.
Now retired from Penn, Goldfarb retains a position of influence as a nephrology editor-in-chief for publisher Wolters Kluwer’s UpToDate, the leading point-of-care medical reference for millions of clinicians. That’s 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 promoting values of respect and collegiality in medicine.
Goldfarb’s position at UpToDate is an impediment to all three.
Nephrology — which was the focus of my work as a medical fellow — has been a focal point in 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 minimizing the perceived severity of kidney disease and need for treatment and perpetuating unfair stereotypes of Black people. There are also historical and ongoing concerns about fair access to donated kidneys and disparities in outcomes of therapies such as dialysis and kidney transplantation.
UpToDate also has a stated goal, in line with the policy of the American Medical Association, of ensuring that race is framed as a social construct and not as 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 derides efforts to advance health equity and is unlikely to help bring UpToDate’s content in line with its own policies and those of the AMA, or even to discuss 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 institutions that eliminate it as giving in to the “woke crowd.” I question whether Goldfarb is pursuing a philosophy on the use of race, or is rather just demonstrating a reflexive opposition to any change made in the name of fairness or equity, or worse: objecting to changes that might deprioritize white people.
Since its founding in 1992, UpToDate has become a primary point-of-care resource for clinicians in the U.S. and around the world. It is essential that the company retains its reputation as a trustworthy and evidence-based source of clinical information. Goldfarb’s numerous public statements in the media and through his organization make it difficult to trust that the patient care recommendations he curates are objective and free of bias. This is not an academic exercise — the information in UpToDate affects patients’ lives.
It is especially concerning that, in recent months, Goldfarb has provided misleading accounts of multiple studies to further his ideological goals. In the Academic Medicine article I mentioned earlier, he ignored the fact that the researchers controlled for exam rankings as a way to argue that lower evaluations were evidence of “less good” performance rather than bias on the part of evaluators. In a subsequent blog post, he inaccurately conflated people who were “non-underrepresented in medicine” with those who were white (in the study, non-underrepresented residents were both white and non-white) to argue for the superiority of white doctors.
Similarly, in his criticism of a 2019 study conducted 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 service for heart failure, he ignored all control variables to cast doubt on the integrity of the analysis. The reasons these are problems for a medical reference editor require no further explanation, and the fact that he does this to advance a racist narrative is inexcusable.
Respect for others, which is a mainstay of the medical profession, is something else Goldfarb has cast aside. He repeatedly fails to treat other physicians with respect. For example, in a report his organization released attacking a specific medical school’s diversity, equity, and inclusion initiatives (I am not citing it here to protect the school’s participants), he gratuitously included an appendix with the names, email addresses, and salaries of the committee members, including medical residents, unnecessarily exposing them to risks of harassment.
In May 2022, his organization sent a mobile billboard to disrupt Harvard Medical School’s commencement. He and his organization have also used inflammatory language to deride institutions such as Boston Children’s Hospital, which subsequently became a target of unrelated violent threats over its transgender care. While the threats were not directly precipitated by Goldfarb’s rhetoric, his claim that one of the most renowned children’s hospitals in the world has given up on its mission of caring for children to become a radical political institution is eerily similar to claims made by those railing against Boston Children’s Hospital. Even if Goldfarb truly believes this, it should disqualify him from having influence over medical guidelines.
Simply stated, Goldfarb does not demonstrate the behavior expected of a physician, much less one in a position of influence. There are many nephrologists who are qualified to curate science and guidelines while also advancing health equity and treating others with respect. Goldfarb is not one of them, and he should not have a position at UpToDate.
Let’s make replacing him 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 views expressed here are his own and do not necessarily reflect those of the organizations he is affiliated with.
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