The Moral Imperative of Countering Antisemitism in US Medicine – A Way Forward
Hedy S. Wald, PhD¹, and Steven Roth², MD FARVO

1 Clinical Professor of Family Medicine, Warren Alpert Medical School of Brown University,
Department of Family Medicine, Providence, Rhode Island 02913, [email protected]

2 Michael Reese Professor of Anesthesiology and Vice Head for Research and Faculty Affairs,
University of Illinois College of Medicine, Chicago, Illinois 60612, [email protected]

Corresponding Author: Steven Roth MD FARVO, Department of Anesthesiology, University of
Illinois College of Medicine at Chicago, 835 South Wolcott, Room E714, Chicago, Illinois 60612

Email: [email protected], telephone: 312-996-0052.

Word Count: 1497, including references
Tables: None
Figures: None

Conflict of Interest Disclosures: Dr. Wald is Commissioner, Lancet Commission on Medicine,
Nazism, and the Holocaust. The views presented in this article do not necessarily represent the
other members of the Lancet Commission on medicine, Nazism, and the Holocaust, but rather
the views of the authors only. Dr. Wald has received honoraria from educational institutions for

presentations on the legacy of medicine during the Holocaust and professional identity for-
mation. Dr. Roth has nothing to disclose.

Funding: None
Author contributions: Wald: Conceptualization; Data curation; Project administration; Writing

• original draft; and Writing – review & editing. Roth: Conceptualization; Data curation; Project
  administration; Writing – original draft; and Writing – review & editing.

Commentary: The Moral Imperative of Countering Antisemitism in US Medicine – A Way
Forward
Background
Antisemitism, the world‟s oldest form of hatred,

1 was endemic in American medicine in the
early to mid-20th century, with quotas on Jewish students and residency trainees until the 1960s.2
Antisemitism did not fully dissipate even as a greater number of physicians emerged from the
American Jewish community.

3 Antisemitism has dramatically increased in the United States in
2023, with 8,873 antisemitic incidents in 2023, a 140% increase from 2022 and the highest since
data collection began (1979). Much of this increase appears related to the October 7, 2023 terror
attack on Israel, with the 5,326 incidents recorded in the US from October to end December 2023
exceeding that in any single year.
4 Presently, 74% of Americans consider antisemitism a serious
problem.5 Examples of its impact upon medicine include medical students‟ social media postings
claiming that Jews wield disproportionate power,
6 antisemitic slogans at UCLA Geffen School of

Medicine,
7 antisemitic graffiti at the UCSF Cancer Center,
8 Jewish medical students‟ exposure to demonization of Israel diatribes and rationalizing terrorism,
9 and faculty, including a professor of
medicine at UCSF, posting antisemitic tropes and derogatory comments about Jewish healthcare
professionals.10 Jewish medical students‟ fears of retribution should they speak out have been
reported.

9 Our recent unpublished survey of Jewish physicians and trainees demonstrated a two-
fold increase from 40 to 88% for those who experienced antisemitism before vs after October 7.

Antisemitism and all forms of hate and discrimination must be rejected. A first step is defin-
ing antisemitism; the International Holocaust Remembrance Alliance definition is the official

definition within the Antisemitism Awareness Act of 2023, of the US Department of State, and

30 other nations. Included are distinct aspects of antisemitism such as stating that Jews wield in-
ordinate influence, incitement of violence against Jews, applying double standards to, demoniz-
ing and/or delegitimizing Israel, and Holocaust denial.

We offer a framework of Education, Engagement, Empathy, and Enforcement (4 E‟s) as key
elements to counter the growing antisemitism in medicine, also serving as a program to eradicate
all forms of hate, to foster civil discourse, and to provide progress toward the ever present goal
of fostering a diverse and inclusive environment.
Antisemitism and the Learning Environment
A prominent manifestation of antisemitism in educational institutions is the presence of a
hostile learning environment, an ethical failure and violation of Civil Rights Code Title VI. Over

140 Title VI investigations have been brought against American universities, many since Octo-
ber 7, 2023 and some already implicating or likely to extend to include medical schools. Hostile

learning environments have striking relevance for contemporary medicine given that the learning
environment plays a central role in wellbeing, academic performance, and professional identity
formation, including qualities and conduct in medical practice.

11 Aspects of anti-Jewish hostile
learning environments we have personally observed in medical schools include tearing down
posters of Jewish hostages including children, demonization of Jews, accusing Jewish students of
complicity with genocide, wearing banned graduation regalia portraying Israel‟s destruction, and
Holocaust distortion or inversion.
Fostering critically reflective, morally resilient lifelong professional identity formation in

medical education is an essential component to help trainees and professionals fulfill their par-
ticular responsibility to fight antisemitism and all forms of hate.

12 Education, Engagement, Empathy, and Enforcement – A Way Forward

1) Education: Moral responsibility and agency are essential for trainees, faculty, and clini-
cians. Education is a well-documented central tenet toward attenuating all hate and antisemitism

in particular. Interest is increasing in implementing The Lancet Commission on Medicine, Na-
zism, and the Holocaust report calling for this history and its implications to be required in medi-
cal education to support history-informed professional identity formation including fighting anti-
semitism and other forms of hate.

12 Medical education must include moral education, thus, criti-
cally reflecting on pervasive complicity of physicians during the Nazi regime and the extent to

which anti-Jewish hate can extend, can foster empathy and support combating antisemitism and

all discrimination. Within an antisemitism education program, modules including the contempo-
rary relevance of this history can be combined with teaching history of Judaism, the Jewish peo-
ple‟s over 3,000 year old connection to the land of Israel, and achieving understanding of the

reasons for persistence of antisemitism including denying the Jewish people‟s right to self-
determination within the land of their origin, Israel. We recommend integrating this education on

Jewish history and the Holocaust into existing diversity, equity, and inclusion (DEI)/sexual har-
assment/anti-bias programs aiming to improve the learning environment and patient care. The

Diversity Matters Program of the Accreditation Council for Graduate Medical Education‟s (AC-
GME) includes teaching modules cultivating cultural and religious sensitivity to Jewish patients,

staff, and trainees which can be readily incorporated into existing DEI programs in medical
schools. DEI “competencies” of the American Association of Medical Colleges (AAMC) should
be broadened to include antisemitism and religious discrimination as called for in President
Biden‟s National Strategy to Counter Antisemitism.

2) Engagement is fostering and maintaining civil discourse in medical learning and practice en-
vironments through reflective dialogue and actions, including critical reflection for perspective-

taking. The AAMC recommended key elements for training in civil discourse including: 1) al-
lowing one‟s convictions to be challenged, 2) developing humility that one could be mistaken,

and 3) respecting the humanity of those who disagree.

13 Widespread incorporation of such prin-
ciples within a structured paradigm for medical education, however, has yet to be achieved.

Functioning within an often polarized political atmosphere, teaching these elements is essential
toward achieving understanding despite individual differences.
3) Empathy should be fostered and sustained in peer-to-peer and faculty-student relationships,

as well as within patient care, although the former tends to be underemphasized in medical edu-
cation. Education about the history of medicine during Nazism and the Holocaust can foster crit-
ical reflection which includes perspective taking, empathy, and humility.12 A ripple effect for

humanistic, non-biased care as well as preventing ethical erosion is an expected outcome.
4) Enforcement: With the strong interest that medical schools have to ensure that all groups are

treated fairly with no real or perceived double standards, academic leadership should provide un-
equivocal definitions and behavior policies regarding hate speech in any form of media,

and actions that could constitute harassment. There should be consistent enforcement of discipli-
nary consequences as in place, e.g., with racial slurs. Microaggressions cannot be tolerated, nei-
ther can macro-aggressions.

These 4 E‟s align with and embody AMA guidelines for healthcare organizations and
systems, including academic medical centers, to establish policies and organizational culture to
prevent and address systemic racism, explicit and implicit bias, and microaggressions in the

practice of medicine (civil and human rights) as well as a code of behavior as a guide in develop-
ing standards for teachers and learners in their own institutions.

Conclusions
We suggest implementing a 4 E‟s framework as a way forward during this challenging time
for our trainees, faculties, healthcare practitioners, and our patients. Given rising hostile learning
environments, we urge a prospective approach by medical schools. Intervention programs for
countering antisemitism (“toward equity, diversity, and inclusion”) and evaluating efficacy of

such interventions are needed.14 Existing excellent resources are available to support recogniz-
ing, studying, and teaching about antisemitism and fostering Jewish inclusion to the better-
ment of all trainees, faculty, and practitioners. These include the Lancet Commission on

medicine, Nazism, and the Holocaust,

12 ACGME‟s Diversity Matters, AMA guidelines, and
AAMC‟s suggestions on fostering civil discourse. Such efforts can help ensure a medical

education and practice free from antisemitism and with true commitment to diversity and in-
clusion ideals.

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