Lerner and Rothman [1] present a pollyannaish view in their editorial on the attack on Jewish staff at the Medical Faculty of Vienna [2]. They state that "the record of the U.S. medical profession is, on the whole, commendable" [1]. I believe that the U.S. medical profession has been permeated by racism and that the education of U.S. physicians as we know it could not continue in the absence of this racism.

The number of minority medical students has remained far below their percentage of the U.S. population, especially if the two predominantly black medical schools are excluded. The patients on whom physicians train are "captive" and disproportionately composed of minorities or poor persons. Caldwell and Popenoe [3] suggest that the bias in our attitudes toward minority patients is reflected in the emphasis on skin color in case presentations. Medical care is multitiered and segregated by race and class. Minorities are disproportionately represented among the uninsured and underinsured.

Lerner and Rothman remind us that racist attitudes in Central Europe toward minorities began long before the "final solution." They point out the role eugenics played in the policies that led to mass murder, but they do not discuss the extent to which the Germans borrowed their ideas and policies from the U.S. eugenics movement [4]. The Bell Curve, a rehash of eugenicist arguments [5], has created a stir because of the persistence of racist and eugenicist thinking.

The current emphasis on molecular biology and the genetic basis of disease supports the notion that the person with disease is at fault and downplays the social and environmental conditions that are the main cause of most disease. This emphasis thereby subtly reinforces racism.

It is easy to see the manifestations of racism when they are as egregious as the Holocaust. Racism is so institutionalized in the way we "do business" in the United States that it has become part of the scenery. Affirmative action coupled with intensive education is necessary to rid ourselves of this murderous scourge.