Bad Medicine

PC, M.D.: How Political Correctness Is Corrupting Medicine, by Sally Satel, Basic Books, 2000. 285 pp.

“For several decades the universities, the law profession and the workplace have been under assault by people claiming oppression of one sort or another,” writes Sally Satel in the introduction to PC, M.D. “It’s almost surprising that medicine has been immune for so long.” Dr. Satel, a psychiatrist and American Enterprise Institute fellow, warns that the immunity is over. Nuttiness about race and sex has begun to turn everything from public health to psychiatry into a leftist rant against the white man. “Indoctrinologists,” as Dr. Satel calls them, have not yet hijacked the entire health profession but their mission is to put ideology before all else-before science, commonsense, and even patients.

‘Schools of Justice’

Public health has improved our lives tremendously. Sanitation measures and the discovery of how germs cause disease have saved millions of lives. Today, though, schools of public health take a different approach to disease. Having noticed that the rich are healthier than the poor, and that whites are healthier than blacks, they have decided racism and poverty are what really cause disease, and that people therefore have little responsibility for their own health. The next step in public health is to stamp out inequality, and Dr. Satel has compiled an eye-opening set of quotations that show how far the rot has gone.

Harvey Fineberg, former dean of Harvard School of Public Health, says that “a school of public health is like a school of justice.” Lawrence Wallack of Portland State University and Lori Dorfman of the School of Public Health at UC, Berkeley say, “The practice of public health is, to a large degree, the process of redesigning society.” William Foege of Emory University School of Public Health says, “Every problem is a public health problem.” David G. Whites of Indiana-Purdue University says any public health policy that ignores “social justice is unworthy of the name.” He wants official designation of “poverty as a medical pathogen.” One common theory is that since capitalism produces differences in income it may have to be eradicated in order to improve health.

The resolutions of the American Public Health Association reflect this kind of thinking. APHA has officially condemned aid to the Nicaraguan contras, called for a “nuclear-weapon-free world,” and demanded campaign finance reform. These are “public health” concerns because APHA members have a mission to “redesign society,” a mission that once again betrays the left’s unlimited lust for power.

The theory that injustice makes people sick is called “the social production of disease,” and Dr. Satel reports that it often goes so far as to posit that “the good health of the well-off somehow depends on the poor being sick.” It’s not hard to imagine the policies that follow. Sally Zierler of Brown University’s Department of Community Health offers the following plan to combat AIDS: Limit the power of corporations, cap the salaries of CEOs, eliminate corporate subsidies, stop corporate contributions to political candidates, and strengthen labor unions. This will work because she says AIDS is “a biological expression of social inequality.” Take away the inequality and AIDS will disappear.

Dr. Satel points out that public health activists are selective about the social conditions that will have to change. Church-going and marriage are associated with good health, but the activists are too busy smashing racism and capitalism to encourage anything like that.

Since it is society that makes people sick it is wrong to expect them to look after themselves. Writing with Nancy Krieger of the Harvard School of Public Health, Brown’s Dr. Zierler explains why black women take drugs and get AIDS: “In response to daily assaults of racial prejudice and denial of dignity, women may turn to readily available mind altering substances for relief. . . . Seeking sanctuary from racial hatred through sexual connection as a way to enhance self-esteem . . . may offer rewards so compelling that condom use becomes less of a priority.” Rodney Clark of the Psychology department at Wayne State University would agree. He says emphasizing personal responsibility for avoiding disease is “a subtler form of racism.”

In Dr. Satel’s view, “the notion that social forces are major determinants of health-that they are so overwhelming in fact that personal responsibility and self-care are reduced to quaint notions and middle-class values-is one of the most pernicious themes in PC medicine.”

Dr. Satel doesn’t think giving poor people money will make them much healthier, since they often don’t make good use of doctors even when they are free. Slum-dwellers often show no interest in free drug treatment, HIV screening, or vaccinations. She also cites a UCLA study in which nearly all whites went back for more visits when a free cancer screening showed an abnormality but only 75 percent of blacks and Hispanics did.

A crucial point Dr. Satel cannot bring herself to make is that good health correlates with intelligence. Entirely aside from whether they have medical insurance, smart people take better care of themselves. They read warning labels, they think about diet, they are more likely to exercise, and less likely to get fat or take drugs. IQ differences alone explain most of the class and race differences that upset public health activists.

About the closest Dr. Satel gets to this obvious but forbidden point is to say: “Social inequalities . . . do not literally produce the sedentary lifestyle, obesity and risky behavior that typically underlie many of the differences in health status between the less wealthy and the better-off.” True, being poor doesn’t make you smoke and watch day-time television, but it would have been nice to hear some thoughts on what does.

Not surprisingly, the mental health field is even more riddled with “social justice” than public health. Plenty of people who might not swallow the idea that “sexism” can give you breast cancer seem to think it can drive you crazy. Dr. Satel explains “feminist therapy:”

[S]ociety is dysfunctional, not the patient. And because a woman’s mental state is believed to reflect the position of women in society, any symptoms of depression or anxiety are seen largely as the product of a society that is hostile to women. Thus, a feminist therapist is often reluctant to suggest to a woman that she might bear some responsibility for her problems.

“Multicultural therapy” shifts the ground from sex to race:

Multicultural counselors presume that nonwhite patients’ personal difficulties largely stem from their efforts to adjust to a racist society. By urging patients to find only external sources for their discontent, multicultural counseling makes a mockery of self-exploration-the true purpose of therapy-and self-determination.

Dr. Satel reports that the majority of therapy training programs now have a multi-culti element that reinforces the mush students have been learning since high school:

[T]he trainees walk into grad school on the first day of classes already believing that the dominant culture is the root of psychpathology. By the time they graduate as therapists, these multiculturalists will be so thoroughly schooled in the oppressive ways of society that they’ll be able to read bias into virtually anything patients tell them.

Manual Ramirez, author of Multicultural Therapy, calls the problems non-whites have in a white society “mismatch shock.” Dr. Satel writes, “I suspect that no matter what a patient tells Ramirez, he will manage to diagnose ‘mismatch shock.'”

For whites, multicultural training is supposed to open their eyes to their role in oppressing non-whites, and to help them “unlearn racism.” In extreme cases, it produces treatment programs in which white men have no official place at all. Dr. Satel writes that at San Francisco General Hospital all patients are assigned to treatment teams, and every team specializes in one of six areas: blacks, Asians, Hispanics, homo- and bisexuals, AIDS carriers, or women. The only people without specialists are white men, who presumably end up with whatever team has an opening.

Many ethnic treatment programs are merely goofy. Dr. Satel writes about one drug treatment program in which “somehow the [black] patients were supposed to absorb self-esteem by participating in Afrocentric exercises, not from achieving anything in particular.” But in the long run, steeping non-white nutters in tales of white racism does harm, not good: “[O]ppression-based therapies are enormously seductive because they tend to absolve the sufferer of responsibility This is precisely why therapists should not practice them” since the point of therapy is to take “a person from thinking of himself as a victim to one who is an agent of his own destiny.” What good does it do a patient, Dr. Satel asks, to tell him he has no hope of recovery until “racism” and “sexism” are eradicated?

Therapy for victims also has the effect of swelling their ranks, because of the glamorous light it shines on them. Many unbalanced people have noticed the fashionable flutter around anyone who claims he was molested as a child, and Dr. Satel thinks this explains why so many people dredge up “repressed memories” of being raped or buggered by Daddy.

Disparate Treatment

What about the endless complaints that a white male medical establishment mistreats or fails to treat anyone not white and male? Dr. Satel dissects the studies that make this claim, showing that with comparisons of patients with genuinely similar conditions and circumstances the “race” or “sex” effect dwindles to the vanishing point. Many researchers are so eager to unmask discrimination they publish shoddy work that fails to hold other variables constant. Dr. Satel also points out that doctors get paid when they treat people; they’re not likely to turn down a fee just because the patient looks different.

Some claims about discrimination are simply false. Luminaries from Hillary Clinton on down complain that medical research “excludes” women, but Dr. Satel reports that in 1997, for example, of the 6 million subjects in NIH-funded research 62 percent were women. Government studies in 1983 and 1988 found that clinical trials used men and women in much the same proportions as the sexes get the diseases being studied. There are not very many single-sex studies but there are now more that are all-female than all-male. Few medicines have a significantly different effect in men and women anyway.

There has likewise been much whooping about a male establishment that doesn’t bother to study women’s diseases. In fact, breast cancer gets more research funding than any other kind of cancer — and has since 1985. It gets three to five times as much as prostate cancer even though more men are diagnosed with it than women with breast cancer, and the death rates are nearly identical. The one justification is that breast cancer usually kills at a younger age than prostate cancer. In any case there is certainly no sexist plot to leave breast cancer incurable.

Feminist bombast about breast cancer distracts women from worse killers. In 1997, 70,000 American women died of lung cancer while (only) 42,000 died of breast cancer. Heart disease kills more women than all cancers combined, but there is far more outrage about alleged flaws in the medical system than about women who are fat and won’t exercise.

As it always does, the evil, all-powerful patriarchy has collapsed at the merest touch. Dr. Satel says there are now at least 3,600 medical programs that call themselves women’s health centers. It would be hard to find anything specially for men.

PC, M.D. also attacks claims that the medical establishment mistreats non-whites. Although the book is a little light in this area, it does touch on outright racial differences in disease and mortality rates that suggest different outcomes have biological causes. For example, Dr. Satel cites the usual charge that black infants die more frequently than white infants because black mothers don’t get the pre-natal care they deserve. Some black mothers just don’t bother with pre-natal care even if it’s free, but Dr. Satel notes that Hispanics, who get even less pre-natal care than blacks, have lower infant mortality than whites. She hints there may be biological reasons for this, but also talks about “Mexican heritage.” All the evidence suggests Asians are just healthier and live longer than whites, who are healthier and live longer than blacks. Just as intelligence differences cause racial gaps in academic achievement, biological differences cause health differences. Perhaps it is asking too much of the good doctor to make this point, but until she does, her opponents can always argue that “racism” makes blacks sicker than whites.

PC, M.D. covers a number of other areas less central to the concerns of AR. There is a chapter about a loony movement among psychiatric patients who claim they have the right to be insane, and that not even the wildest psychotics should be forced into treatment. Activists like to quote Andrew Weil, an alternative medicine guru, who said, “Every psychotic is a potential sage or healer.” They also like Herbert Marcuse, who said mental patients are revolutionaries and that psychiatry is “one of the most effective engines of suppression.”

Dr. Satel also writes about the New Age mumbo-jumbo that women, mostly, have smuggled into medicine. There are, she reports, 50,000 practitioners of “Therapeutic Touch” (TT) on the loose in hospitals all over the country. She tells us:

A typical TT session lasts between ten and thirty minutes; it is performed by a practitioner who first must be ‘centered’ — a state of mind achievable through meditation. She scans the patient with hovering hands, searching for imbalances in the energy field. . . . Then she sweeps her hands over the patient in order to distribute excess energy to areas of deficit. Fanatics launch into TT unasked; one man thought he was getting Last Rites when he saw hovering hands.

Likewise we learn that nursing schools now offer courses like: “Using Energy to Enhance Nursing Practice: Use of Color, Music, Touch and Movement,” “Aromatherapy for Nursing Practice,” and “Using the Power of Our Thoughts for Healing.” Along with this sort of female nonsense comes resentment of men in general, and nurses with chips on their shoulders. Dr. Satel tells us the British have the same problem: freshly graduated nurses who don’t know how to insert a catheter but are experts on “racism” and “gender oppression.”

Dr. Satel also takes a shot at affirmative action for doctors, noting the obvious perils of lowering medical school standards for non-whites. She points out that inner-city blacks often have complicated combinations of diseases that make them tricky patients. Incompetent, affirmative-action doctors are the last thing they need-nor do the rest of us want to fall into their hands.

Where this will all end is anyone’s guess. Dr. Satel assures us there are still many level-headed health workers who understand their job is to fix people, not society, but the forces set in motion in their profession are no different from those wrecking every other American institution. Until the country at large comes out of its decades-long sickness there is no reason to think the physicians will heal themselves.