After Donald Trump took office in 2017, there was a surge of interest among the intellectual left in “1984,” George Orwell’s classic novel about statist repression.
The latest entry in this category comes from the American Medical Association and the Association of American Medical Colleges, which last week issued a manifesto titled “Advancing Health Equity: A Guide to Language, Narrative and Concepts.”
It’s quite something.
Let’s leave aside for the moment the obvious question of why it’s the AMA’s business to lecture anyone about what counts as acceptable language. As far as I know, the folks at Fowler’s Modern English Usage have never issued a guide to performing thyroid surgery.
Be that as it may, the country’s most powerful medical associations have decided that the “dominant narratives” of inequality in health care must be “named, disrupted and corrected,” according to an introduction that reads like it came from Mao’s “Little Red Book.”
The long list of words and phrases the AMA now proscribes includes “marginalized communities,” “morbidly obese,” “the homeless,” “inmates,” “individuals,” “ethnic groups” and “racial groups,” and anything that could be related to violent imagery, such as “target communities” or “tackle issues.”
In their place, doctors are now advised to use terms such as “groups that are struggling against economic marginalization,” “people with severe obesity,” “people who are experiencing homelessness” and so on.
Also expunged are the words “Caucasian,” “minority,” “vulnerable,” “white paper,” “blackmail,” “blackball” and “slave.” (Public service: If your doctor feels the need to use any of those last ones in the course of an exam, maybe find another doctor.)
Because change can be confusing, the AMA helpfully offers some sample “well-intentioned” sentences that might be problematic, along with alternatives using “equity-focused language.”
For instance, you might be tempted to say something like: “For too many, prospects for good health are limited by where people live, how much money they make, or discrimination they face.”
What you should say is: “Decisions by landowners and large corporations, increasingly centralizing political and financial power wielded by a few, limit prospects for good health and well-being for many groups.” I swear I’m not making this up.
Let me offer a few serious observations.
First, part of what we learned in the 20th century, during a series of long wars against tyrannical governments and ideologies, is that all repressive movements start by mandating versions of history and their own lists of acceptable terminology.
These medical groups — and, more to the point, the elite academic movement they’re kowtowing to — may believe they’re bringing history and language more in line with the goal of social justice. What they’re actually doing is trying to control what their members are allowed to think and say.
Second, keep in mind that the AMA is one of the most powerful lobbies in Washington and has long fought a litany of progressive reforms to the health-care system. Only recently did the organization drop its blanket opposition to some very limited kind of “public option,” and only then in an effort to head off proposals such as Medicare-for-all.
So if the medical profession really wants to get on the side of social justice, there are things it can do that would be more meaningful than banning a bunch of words that have nothing to do with medicine.
Third, in sheer political terms, with midterm elections looming and a potential presidential rematch after that, it’s hard to think of anything the left could do that would be more self-defeating than continuing to propagate a cultural war over language.
If you want to set the stage for a triumphant Trump return, keep issuing edicts that make it immoral to use terms such as “colorblind” and “tough on crime.”
Finally, while the AMA’s new guidebook may seem trivial compared with pressing issues like climate change or immigration, I’d argue that it’s actually a powerful testament to where we are at the moment — and it should frighten you as much as it does me, even if we’re sympathetic to the underlying cause.
When one of the most elite and powerful industry groups in the society senses so much external pressure that it feels compelled to banish words and institute new, tortured phraseologies, it tells you that no group is immune to what Orwell, in his famous essay on politics and language, called “the worst follies of orthodoxy.”
Then again, in that same essay, Orwell used the term “white paper.” So I guess he’s part of the problem, too.