How ‘structural racism’ came to dominate medical research



President Trump's recent push to send federal health care dollars directly to individuals, rather than insurers, reflects a broader demand for transparency and effectiveness in how public funds are used. Government-funded medical research, which forms the foundation of much clinical care, also requires such scrutiny.

In recent years, academic medicine has advanced a nebulous theory of “structural racism” that echoes the 19th century “miasma” theory, which blamed disease on “bad air.” Despite scant evidence, studies attempting to validate this vague framework have multiplied, often funded by largely unaware taxpayers. Refocusing federal research dollars on rigorous science and evidence-based care is essential to correcting this trajectory.

The incentives were clear: Few researchers — early-career or established — would decline funding in an area where the NIH was investing heavily.

How did this happen? The construct of “structural racism” was virtually absent from medical literature until a decade ago. Since then, it has become the default explanation in academic medicine for differences in health outcomes across racial and ethnic groups. Its rise accelerated during the 2020 anti-racism craze, which swept through corporate boardrooms and university administrations while also becoming a core ideological pillar of Black Lives Matter and other political movements.

Academic medicine was no exception. This philosophy quickly gained favor in medical education, academic health centers, elite journals, and professional associations, eventually influencing federal agencies that distribute research funding.

The result: a surge of grant-funded studies built on the premise that racism causes health disparities. Of the nearly 2,300 articles indexed under the term “structural racism” in PubMed, the U.S. National Library of Medicine’s database of leading biomedical and health journals, 95% were published after Jan. 1, 2020. In 2025 alone, PubMed lists 400 such papers — nearly four times the total published before 2020.

This proliferation has been supported by a tsunami of federal taxpayer dollars coming from the National Institutes of Health. From 2020 to 2025, an NIH database search found nearly 750 projects mentioning “structural racism” in their abstracts, totaling almost $533 million in funding. More than 70 of those projects were funded in 2025 at just under $40 million — significantly down from more than 220 projects in 2024 totaling $150 million, but still far above 2020, when only 12 projects received a little over $12 million in the aggregate. Before 2020, the NIH had funded just 10 such projects at a combined cost of $4 million.

Funding patterns across NIH’s 27 Institutes and Centers from 2020 to 2025 make clear that ideology, not medical science, drove much of this growth. The largest investments came from the National Institute on Drug Abuse ($147 million in total funding), National Institute on Minority Health and Health Disparities ($70 million), and National Institute on Aging ($57 million), each pouring substantial resources into “structural racism” research.

In 2025, for example, NIDA supported a project under the Healthy Brain and Child Development National Consortium that identified “structural racism” as a risk to babies before and after birth, alongside more recognizable factors like maternal health, toxic exposures, and child abuse — thereby conflating an abstract, ill-defined, and ideological social theory with measurable, scientific variables as a threat to child development.

Also in 2025, NIMHD funded the Clinical Research Scholars Training program, a “health-equity focused” initiative created in part due to NIH calls for research on “the impact of structural racism and discrimination on health disparities.” Eligibility for this program was limited to those deemed “underrepresented in biomedical research.” All others need not apply.

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And just last year, a NIA-funded project invoked “interrelated systems of structural racism” and “race-specific stress” as risk factors for Alzheimer’s disease and cognitive decline, diverting attention and resources away from well-established contributors such as genetics, medical conditions, lifestyle and environmental factors, and core biological mechanisms like amyloid plaques and tau tangles.

Unfortunately, a commitment to science gave way to ideology years ago. Under Francis Collins, the NIH “acknowledged and committed to ending structural racism,” without even defining the concept itself. “Structural racism” was accepted despite its questionable validity and lack of explanatory power.

With vague boundaries and mechanisms difficult to measure, claims of “structural racism” far exceeded the empirical evidence. Nevertheless, the idea was accepted wholesale and used to justify a wave of DEI initiatives, effectively recasting the NIH as an “anti-racist” institution in the Ibram X. Kendi mold. Objective science was no longer sufficient; the agency was expected to take an activist stance.

Proponents embraced this shift, seeing an opportunity to move health research from “individual-level risk, health behavior, and functioning” to “structural level concepts” with “structural racism” named specifically. Research dollars supported tools like the Structural Racism Effect Index to “guide policies and investments to advance health equity.”

The incentives were clear: Few researchers — early-career or established — would decline funding in an area where the NIH was investing heavily, especially when that support could provide a path to publication in top journals.

Yet the instruments used to quantify “structural racism” expose a basic flaw: They don’t measure racism.

The SREI’s nine dimensions, for example, largely track socioeconomic conditions — wealth, income, housing, employment. In practice, a high score identifies communities facing poverty. Even researchers linking SREI scores to hypertension, obesity, smoking, and low physical activity concede they “cannot make causal inferences.”

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These health risks may result from poverty, contribute to it, or arise from entirely different causes. Labeling them as products of “structural racism” adds no explanatory value, miscasts economic hardship as race-based, and downplays individual responsibility. It overshadows far more consequential drivers of outcome disparities, including access to care, personal choice, medical comorbidities, and genetics.

Nonetheless, no alternative explanation for health disparities has received anywhere near the same attention in leading medical journals — such as the New England Journal of Medicine, Lancet, and JAMA — as “structural racism.” This concept has been treated as settled fact, with disparities alone offered as proof: If disparities exist, racism must be the cause. Likewise, many medical organizations have reinforced this view through policies and position papers that embed an anti-racism framework into scientific inquiry.

But change is in the air. The NIH’s recent miasma-like fixation on “structural racism” is finally clearing. Under Director Jay Bhattacharya, the agency is refocusing on its core mission of funding rigorous, evidence-based science rather than ideology-driven research. This shift will direct scarce taxpayer dollars toward work grounded in medical science and its practical application — research that can genuinely improve health rather than feed political currents.

This course correction is timely, and while sustained effort in 2026 will be needed to fully restore the NIH to its rightful mission, taxpayers can take comfort: America’s leading biomedical and medical science research institute will once again prioritize their dollars and their health.

Editor's note: This article was originally published by RealClearPolitics and made available via RealClearWire.

Horowitz: New studies shows robust immunity among health care workers from COVID reinfection six months after infection



Nearly a year into this virus, it has become clear that, after up to a third of the people in this country already contracted it, according to some estimates, there is nothing we can do to stop it through non-pharmaceutical interventions. Yet, while the government and media continue to push the vaccine (and masks, of course) with religious fervor, they act as if natural infection itself confers little or no immunity. In reality, as with any virus, it likely confers more immunity than a vaccine.

A new study published in the New England Journal of Medicine by U.K. scientists tracked antibody levels of 12,541 health care workers in Oxford University hospitals for six months. A total of 1,265 tested positive for antibodies at some point during the study period, of which 68% recall having had symptoms associated with SARS-CoV-2. They specifically observed the period of the second wave of infection to see if health care workers, who are disproportionately exposed to the virus relative to other people, would be re-infected.

The result? Not a single symptomatic reinfection and just two people who had previously tested positive for antibodies wound up testing positive via PCR testing for a presumed asymptomatic reinfection.

The important fact to remember is that immunity does not necessarily mean one cannot have the presence of the virus detected in his body thereafter. What it usually means is that one who is infected, particularly if one had at least a moderate case of it, will not suffer meaningful or serious symptoms from a reinfection. This is likely true of most viruses – whether immunity was conveyed through infection or a vaccine – but we don't test 1 million people per day for other viruses. Were we to do so, we would likely discover rare but measurable instances of asymptomatic "reinfection."

Earlier this week, Texas Congresswoman Kay Granger tested positive for the virus despite having had the first round of the Pfizer vaccine. She experienced no symptoms. It's true that she had not been given the second shot yet, however, the same way such findings shouldn't be alarming with regard to a vaccine, they shouldn't be alarming with regard to natural immunity. If anything, this study shows a higher rate of immunity conveyed upon people with natural infection than what has been proven so far from the vaccine. But the government refuses to even entertain the idea of natural immunity from what has anyway become a near-unavoidable transmission of the virus.

These results jive with another recent British study from Newcastle University researchers published last week in the Journal of Infection. They detected 1,038 confirmed infections (through a mix of antibody and PCR tests) among a pool of 11,103 health care workers during the first wave of the virus from March 10-July 6.

During the second wave in the fall, they retested 128 of the health care workers who had previous confirmed SARS-CoV-2 infection and 2,115 who had not. While the sample size of this study is smaller, they found zero new infections among those previously infected. At the same time, they observed a 13.7% infection rate among the group of people who were not previously infected.

None of the 1,038 health care workers who had confirmed prior infections experienced symptoms during the second wave. In those previously infected, there was a median of 173 days from the date of first confirmed positive result to the end-point of the analysis period confirmed with a negative test, which would again show roughly six months of immunity and counting.

Obviously, it's going to take more time to study the question of immunity in the long-term, especially for those who only got the virus asymptomatically or who get it again asymptomatically, but the notion that someone could get a serious case twice is unfounded at this point and is very unlikely.

Until now the assumption is that because antibodies seem to wane after three months and are non-existent for others who have been infected that there is no immunity. However, there is strong evidence that the body produces memory T-cells that convey long-term immunity long after the antibodies wane. Yes, it will take longer to definitively prove that fact, but why do our political leaders continue to make negative assumptions that always seem to defy known precedents of immunobiology while promoting draconian and devastating policies based on those unproven and increasingly unlikely assumptions?

"Oh, asymptomatic individuals are driving the spread, even though they never typically do, so we must assume everyone is sick and quarantine the world."

"Oh, this virus doesn't convey immunity, so we must do this forever."

"Oh, masks stop the spread of respiratory viruses, despite universal belief they did not and despite 9 months of them failing to stop the spread."

Why is it that the onus is upon us to conclude with certainty that these premises are wrong, instead of them having to prove that their premises are correct? Whatever happened to innocent until proven guilty? They are relying on the social conditioning ensuring that a lie repeated enough times becomes true regardless of the science.

New England Journal Of Wokeness Erases Its Medical Credentials With False Article About Gender Identity

The charge that sex designations on a birth certificate is medically ill-advised stands contrary to even the most basic understanding of science.

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What we are seeing is an effort to deprioritize the facts of biological sex to accommodate an incredibly tiny and unrepresentative number of transgender activists.

No more sex identification on birth certificates, New England Journal of Medicine article declares



A New England Journal of Medicine article published last week states that birth certificates no longer should include sex identification "given the particularly harmful effects of such designations on intersex and transgender people."

What are the details?

The article said birth certificates in 1949 underwent a revision that "created a line of demarcation. The legally identifying fields above the line appear on certified copies of birth certificates, whereas information in the fields below the line, which is used for statistical purposes, is deidentified and reported in the aggregate. Race and parents' marital status, for example, were moved below the line of demarcation to permit self-identification and to avoid stigma, respectively."

Simply put, the authors said it's time to move sex designation below the line.

More from the article:

Designating sex as male or female on birth certificates suggests that sex is simple and binary when, biologically, it is not. Sex is a function of multiple biologic processes with many resultant combinations. About 1 in 5000 people have intersex variations. As many as 1 in 100 people exhibit chimerism, mosaicism, or micromosaicism, conditions in which a person's cells may contain varying sex chromosomes, often unbeknownst to them.2 The biologic processes responsible for sex are incompletely defined, and there is no universally accepted test for determining sex.

Assigning sex at birth also doesn't capture the diversity of people's experiences. About 6 in 1000 people identify as transgender, meaning that their gender identity doesn't match the sex they were assigned at birth. Others are nonbinary, meaning they don't exclusively identify as a man or a woman, or gender nonconforming, meaning their behavior or appearance doesn't align with social expectations for their assigned sex.

Sex designations on birth certificates offer no clinical utility; they serve only legal — not medical — goals. Certainly, knowing a patient's sex is useful in many contexts, when it is appropriately interpreted. Sex modifies the clinical suspicion of a heart attack in the absence of classic symptoms and is a proxy for many undefined social, environmental, and biologic factors in research, for example. But, in each of these applications, sex is merely a stand-in for other variables and is not generally ascertained from a birth certificate.

'Keeping sex designations above the line causes harm'

The piece emphasizes that "keeping sex designations above the line causes harm."

More from the article:

For people with intersex variations, the birth certificate's public sex designation invites scrutiny, shame, and pressure to undergo unnecessary and unwanted surgical and medical interventions.1Sex assignments at birth may be used to exclude transgender people from serving in appropriate military units, serving sentences in appropriate prisons, enrolling in health insurance, and, in states with strict identification laws, voting. Less visibly, assigning sex at birth perpetuates a view that sex as defined by a binary variable is natural, essential, and immutable. Participation by the medical profession and the government in assigning sex is often used as evidence supporting this view. Imposing such a categorization system risks stifling self-expression and self-identification.

People with intersex variations may undergo surgeries before they are old enough to consent, often losing reproductive capacity and sexual sensation as a result. Transgender people receive worse health care and have worse outcomes than cisgender people.3 Health care professionals have a particular duty to support vulnerable populations who have historically been harmed by clinicians and by the medical system in general.

The bathroom thing

The authors of the article go further and address safety concerns related to transgender individuals using locker rooms and restrooms of their choice. "But fears about privacy and safety violations in public accommodations aren't supported by evidence. A study examining the effects of a Massachusetts law protecting transgender people in public accommodations revealed no increase in violations. Meanwhile, many intersex and transgender people avoid public spaces, including restrooms, for fear of mistreatment."

Passports and other documents

The authors also say that if sex designations are removed from birth certificates, it would allow applicants for passports and other government-issued documents "to identify their gender without medical verification."

Pushback

A number of article commenters questioned the authors' conclusions:

  • "I consider myself a left of center thinking person but this goes a little too far down a rabbit hole I don't want to step into," one reader noted.
  • "If a person who is male wants to pretend they are female, does that mean I legally have to pretend with them?" another reader asked.
  • "Tinkering with birth certificates will not alter the fact that humans are either men OR women, as little as the Flat Earth Society can make the earth flat," another reader commented. "There are tiny flat patches on earth and a tiny number of humans have ambiguous sex but this does not change the fundamental principles."
  • "This kind of thinking is just another example of how far we are wandering from truth," another reader said.

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The NEJM has forgotten that original intention of not eradicating the disease from public life, but giving Americans the best chance of living with it.