I’m a white Anglo-Saxon Protestant but I don’t care one bit about the race, religion, or ethnicity of my doctor when my life is on the line. I just want the most qualified physician making life and death decisions for me. I think most people feel the same.

When I was in medical school, we had minority students from every racial background imaginable, but some of them never made the grade. About 25% of all medical students in the first-year class never graduate – and many of them come from these minorities. Perhaps they were disadvantaged in their earlier educational experience, but they just couldn’t keep up with the extreme demands of medical school.

The Wall Street Journal editorial board tells us the Supreme Court banned racial preferences in university admissions, but finding ways to maintain them has become a cottage industry in higher education. Medical schools are among the frequent offenders, and a new report shows how schools have maintained different standards for applicants depending on their race.

Do No Harm, a group that studies preferences in medicine, submitted a Freedom of Information Act request to 93 public medical schools for 2024 admissions data on race, undergraduate GPA, Medical College Admission Test (MCAT) scores, and whether or not the applicant was admitted. Twenty-three schools have responded so far, and the data suggests racial preferences are still going strong.

At the responding schools, admitted black applicants had lower MCAT scores than admitted white and Asian applicants at 22 out of 23 schools. Admitted Asian students had a mean MCAT score of 514, approximately the 88th percentile. Admitted black students had a mean score of 508.3, approximately the 73rd percentile. The delta also existed for comparative GPAs among the groups.

After the Justices ended racial preferences in Students for Fair Admissions (SFFA) v. Harvard in June 2023, the Association of American Medical Colleges said it was “deeply disappointed” in the Court’s decision and that “racial and ethnic diversity in educational settings” provided “critical benefits” and a way to address health inequities. Schools have been looking for ways around the Court ever since.

In the admissions cycles since 2023, little has changed. At many universities, demographic data of admitted students has held steady and in some cases the share of “underrepresented” minorities has increased. Data from 34 schools shows that the racial composition of medical schools hasn’t changed much since the Supreme Court’s decision.

The report by Ian Kingsbury and Naomi Risch concedes that “qualities like empathy and strong interpersonal skills matter when it comes to excellence in medicine,” but they don’t substitute for medical and scientific aptitude. Preferences that elevate less qualified doctors won’t reduce inequities in public health, but they will stigmatize successful minority applicants who excel. Oh, and to remind, racial preferences are against the law.

Medical schools are not doing these students, or their potential future patients, any favors by promoting unqualified applicants. Either the students will experience failure in their medical school experience or their future patients will experience less than adequate medical expertise from their underqualified doctors. Neither situation should be allowed to happen.

Imagine wondering if your doctor only got into medical school because of racial preferences! Furthermore, these racial preference practices undermine the credibility and reputations of highly qualified minority physicians. They deserve better.

When you bake a cake, it’s good to follow the recipe. But as any good cook knows, there are times when it’s best to modify the recipe in certain situations. If you’re at high altitude you may have to adjust the temperature of the oven or how long you bake. If your family or friends eating the cake have medical conditions like diabetes, or high blood pressure, you may want to reduce the amount of sugar or salt you use. You can’t just blindly follow the recipe in all situations.

But doctors are now being trained to treat patients like following a recipe – one that doesn’t allow for any deviations. It’s called protocol-driven medicine, or evidence-based treatment.

David Mansdoerfer, professor of healthy policy at Pepperdine University, writes in The Epoch Times, “Medical education once trained doctors to think like detectives, piecing together clues from a patient’s story, symptoms, and unique circumstances. It taught them to sit with uncertainty, ask tough questions, and see the person behind the illness. Today, it’s at risk of churning out technicians who follow checklists instead of their instincts. The culprit? A growing obsession with standardized protocols that’s turning medicine into a paint-by-numbers exercise.”

He calls this the quiet corruption of medical education: the slow erosion of the physician as healer. Protocols—those step-by-step guidelines for everything from prescribing antibiotics to managing heart disease—were meant to make care safer and more consistent. They can help, especially in a crisis. But somewhere along the way, they went from being tools to being the boss. A push for standardization, kickstarted by efforts to improve healthcare quality in the late 1990s, has made protocols the backbone of medical practice. Hospitals, insurers, and government agencies now lean on them to measure performance, decide payments, and enforce rules.

Medical schools have followed suit. Instead of teaching students to wrestle with complex cases or challenge assumptions, many curricula now drill them on following algorithms. Students learn to tick boxes for conditions like diabetes or infections but aren’t always encouraged to ask, “Does this make sense for this patient?” The classroom, once a place for debate and discovery, feels more like a training ground for compliance.

Why is this happening?

You might wonder how things got this way. When I was a medical student, fifty years ago, we were taught to think. In fact, we were taught that our medical education was not a four-year experience but a life-long pursuit of medical knowledge; not the mindless use of pre-determined protocols to obviate our need for thinking!

As in most situations like this, the change is much more about money than the pursuit of medical excellence. The author tells us, “Healthcare systems and insurers love protocols because they’re predictable and easy to measure. Payment systems reward doctors for sticking to guidelines, even when bending the rules might better serve a patient. Medical schools, too, are caught in this web. Many rely on funding tied to “quality” metrics, which often mean protocol adherence. Professors, pressed to meet these expectations, teach students to play by the book rather than think outside it.”

Why should we be concerned?

First, it’s eroding the art of medicine. Doctors trained to follow protocols may hesitate to trust their gut when a patient doesn’t fit the mold. A rigid guideline might push antibiotics for an infection that needs a different approach or limit pain relief for someone in agony. Patients stop feeling like individuals and start feeling like data points.

Empathy takes a hit, too. Listening to a patient’s fears or hopes doesn’t fit neatly into a flowchart, so it gets sidelined. Yet we all know a doctor’s compassion can make as much difference as their prescription pad. When medicine becomes mechanical, that human connection fades, and patients notice.

Worst of all, this approach stifles the curiosity that drives medical progress. If doctors are trained to follow protocols without question, who will challenge outdated practices or dream up new treatments? A 2014 editorial in The British Medical Journal warned that rigid guidelines can hold back the kind of creative thinking medicine needs to evolve.

Recipes are useful as a starting point and protocols have their place as a foundation of our medical treatment. But skilled chefs and physicians alike must be able to adapt to the particular needs of their customers to produce the best meals and treatment they deserve. We must be able to think sometimes “outside the box” if we want our treatment to fit the particular needs of the individual we are treating – and to advance our knowledge of medicine beyond today’s understandings.

If you or your child have a rare disease, the chances of getting newly developed medicine to treat it just got better. This is one of the less-discussed benefits of the Big Beautiful Bill (BBB) just passed by Congress and signed into law by President Trump.

The BBB reverses the damage done by President Biden’s Inflation Reduction Act (IRA) that was woefully misnamed. The Editorial Board of The Wall Street Journal tells us the IRA was a woeful bill in countless ways, but the worst is its Medicare drug price controls. The early damage has been less investment in so-called orphan drugs for rare diseases. Because the pool of patients is small, manufacturers have to set higher prices to recoup their investment. This makes them an attractive target for Medicare bureaucrats.

The IRA price controls exempted orphan drugs, but only if they are approved for a single indication. They lose their exemption if they are used to treat more than one rare disease, though many diseases share an underlying pathology such as a gene mutation. Of the 280 orphan drugs approved between 2003 and 2022, 63 were approved later for another indication.

The law has discouraged companies from studying orphan drugs for multiple rare diseases. Some face a Hobson’s choice. If an experimental medicine works for two rare diseases, companies might have to jettison one use lest their drug become subject to price controls and return on its investment collapse.

Several orphan drug makers have canceled studies for follow-on indications since the IRA controls took effect. A recent analysis by the National Pharmaceutical Council found that the share of orphan drugs that received a second orphan drug designation fell by nearly half after the law passed—to 6.3% from 12.1% pre-IRA. This is a disincentive to finding new uses for existing drugs.

Republicans addressed this problem in the BBB by adding a provision to their tax bill that would ensure orphan drugs remain exempt from the price controls even if they are repurposed for other rare diseases. Many Democrats have signed onto similar legislation, though it’s telling that the left’s price-control crowd is now screaming about the provision’s $5 billion budget cost.

Progressives say expanding the orphan drug exemption will encourage Congress to make more tweaks that erode the price controls. Let us hope so. The orphan drug is a microcosm of the IRA’s disincentives to innovate. America has always been the leading country for new drug innovations and should remain so. Patients with rare diseases were an important voice in helping rouse political support for the orphan drug fix. Their success will improve and lengthen countless lives.

Most of the talk about the BBB will focus on the tax law changes and who benefits most. Democrats will try to convince you that only the rich will benefit although I doubt the rich care about no taxes on tips, no taxes on overtime, and reduced taxes on social security – all provisions of the new law which will benefit low income Americans. But you won’t hear about removing disincentives to new drug innovations – which will benefit everyone since disease is no respecter of incomes.