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AAMC Reporter: February 2008Viewpoint:
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When National Institutes of Health Director Elias Zerhouni, M.D., announced the 2007 Pioneer and New Innovator awards last fall, he said the awards were for researchers "positioned to make…potentially transformative discoveries." I was pleased to note that nine of the 41 awards went to Harvard faculty, but my pleasure became exultation when I recognized three of our nine awardees were African American M.D./Ph.D. graduates. Almost 40 years after affirmative action was initiated at Harvard Medical School, our minority graduates continue to demonstrate again and again that, on a reasonably even playing field, they perform at the highest level. With Black History Month in full swing, it is fitting to reflect on the progress this country has made—and the threats to that progress.
How did it all begin?
In the 1968-69 academic year, 266, or 2.7 percent, of 9,863 first-year medical students in the United States were black Americans. Half of these attended Howard or Meharry, two fine historically black medical schools. Black enrollment in all other U.S. medical schools totaled 133. In March of 1968, President Lyndon Johnson's National Advisory Commission on Civil Disorders concluded that "our nation is moving toward two societies, one black, one white—separate and unequal....What white Americans have never fully understood—but what the Negro can never forget—is that white society is deeply implicated in the ghetto. White institutions created it, white institutions maintain it, and white society condones it."
This report was barely in print before the nation was stunned by the assassination of the Reverend Martin Luther King on April 4 of that year. Black Americans felt betrayed by the wanton murder of a man who epitomized America's hope for nonviolent change. Within three days, an ad hoc faculty group at Harvard Medical School began work on a proposal for the next faculty meeting. As drafted by its nine members (of which I was one), the resolution called for affirmative action in admissions. It read in part that "we propose an immediate goal of admitting 15 Negro students per year." (In 1968, the word "black" had not yet replaced "negro.")
Given the historical moment, there was little open opposition. The challenges to our proposal were more subtle: skepticism about its feasibility and objections in principle to "quotas." A number of speakers extolled the lofty aim of the resolution but expressed doubt that the school could find 15 "qualified" Negro students in the United States. Others opposed numerical benchmarks, instead urging that the goal of 15 be replaced by the phrase "a substantial number." We insisted that stipulating a numerical "target" (not a "quota") was crucial to ensure an all-out effort. After all, six might be considered a substantial number in a school that never had admitted more than three. What finally led to its adoption was a brokered agreement to increase class size from 125 to 140; thus, there would be no threat of reduction in places for "usual" applicants. In the summer of '68, volunteer faculty, students, and staff visited colleges seeking black students to announce the new policy and encourage them to apply. Minority applications increased six fold. In addition to the conventional academic indicia, Harvard Medical School's admissions committee examined the black students' record of community service, the effort they had expended to overcome adversity, their sheer capacity for hard work, and their personal commitment to medicine and to bettering the lives of others.
We met our target of 15 for the class of 1973. And we have continued to this day to build on that early success. Whereas underrepresented minority graduates in the 34 years before 1973 numbered less than 30, there have been more than a thousand in the years since. Diversity in students (and then later faculty) has led to a broadened understanding of medicine as a helping profession, and has sent some research foci in new directions. Nationwide, as more underrepresented minority students were admitted, more applied. But the tide began to recede in the '90s after ballot initiatives in California and Washington and court decisions in Texas, Mississippi, and Louisiana banned "race conscious" admissions. In Grutter v Bollinger (2006), the U.S. Supreme Court seemed to recognize the legitimacy of affirmative action to maintain diversity because of its benefits to the university as a whole. Writing for the majority, now-retired Supreme Court Justice Sandra Day O'Connor optimistically suggested that "we expect that 25 years from now the use of racial preferences will no longer be necessary."
She did not anticipate that her successor, Justice Samuel Alito, a year later would help forge a new Supreme Court majority that would prohibit public schools from using race to promote integration, thereby jeopardizing the pipeline into college. In his dissent to that decision, Justice Stephen Breyer characterized the 5-4 decision as one "the Court and the nation will come to regret."
These legal actions make the educational challenge more difficult. The limited diversity thus far achieved makes it even more urgent to increase recruitment of underrepresented minority students. Medical schools are unique in enjoying legal authorization to educate physicians. In return for that monopoly, society expects us to produce doctors in the numbers and of the quality, kinds, and diversity needed to respond to the nation's health care needs. It won't be easy, but then, it never has been. During Black History Month, we will do well to heed the words of Frederick Douglass: "Without struggle, there is no progress."
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