Bitter Pill. - Review - book review

PC, M.D.: How Political Correctness Is Corrupting Medicine, by Sally Satel (Basic, 285 pp., $27)

Psychiatric patients literally running the asylum, university professors calling for socialism as a public-health measure, respected journals hurling accusations of "medical racism": Sally Satel describes all this and more in her provocative and fascinating survey of the infiltration of the American health-care system by political correctness.

Satel, a psychiatrist at Yale University School of Medicine who works with inner-city drug addicts, first surveys the triumphs of the public- health movement since the 19th century, beginning with its victories on sanitation issues-things like clean water, indoor plumbing, and uncontaminated foods-and continuing with such measures as pasteurization, vaccinations, and antibiotics, which enabled rapid progress toward the eradication of infectious diseases. Public-health measures helped bring syphilis and tuberculosis under control, and-in the postwar period-improved the overall health of the populace through valuable campaigns to encourage people to quit smoking, wear seat belts, cut down on cholesterol, get more exercise, and monitor their blood pressure. These successes showed that a reformist impulse- combined with rigorous science-could produce tremendous advances in health, safety, and quality of life.

But in the 1990s, this lesson mutated into the "social production" theory of disease, which holds that diseases may be caused, not by biology or lifestyle choices, but by economic oppression and its resulting deprivations. As a result, the National Institutes of Health sometimes awards grants for the study of discrimination, racism, "classism," and "powerlessness."

Satel argues that this is not merely a harmless distraction, because it diverts resources from research that could actually improve people's lives. Worse, telling the public that poor health is the result of victimization rather than unhealthy behavior undercuts any incentive to quit smoking, drink less, eat better, or exercise more. The shift within the medical profession from an emphasis on individual responsibility in matters of health to a doctrine of victimization and helplessness is a pervasive theme in PC, M.D.

To laymen, Satel's chapter on nursing will be especially shocking. Nurses now perform more complex tasks than ever, yet the profession is eroding from within: Admissions policies at nursing schools are bizarre and lacking in standards; professors at these schools are oblivious to scientific method. The result of this faulty education is, predictably, a large cadre of demoralized and inadequately trained nurses.

The education of physicians has also been compromised by politically correct shibboleths. Early feminist attacks on medical education may have been based on legitimate objections, such as the fact that women weren't allowed into top-flight medical schools. But these grievances are a thing of the past-and have been replaced with sheer cant and a rhetoric of imagined victimization. Surgical approaches to breast cancer, for example, are said to be rooted in misogyny, and medical hierarchies based on training and education are described as a mere "patriarchy."

Even refereed medical journals are not safe from the hazards of PC. Satel discusses a headline-grabbing New England Journal of Medicine report from February 1999, which alleged racial bias in the treatment of heart disease, with blacks routinely receiving inadequate care. ABC News, USA Today, the Chicago Tribune, The Economist, and other mainstream media outlets uncritically reported the study's inflammatory conclusion. Ted Koppel introduced Nightline's coverage of the study by mentioning James Byrd, the black man who was dragged to his death in Jasper, Texas. Predictably, the eventual revelation that the data were flawed by statistical legerdemain of a particularly obvious kind-in fact, the study showed no significant difference in the treatment given black and white patients-didn't make the papers. Research suggesting a relationship between racism and hypertension in blacks was almost as widely cited-and every bit as bogus.

Satel also makes a convincing case against the excesses of the anti- psychiatry "consumer survivor" movement, which consists of former psychiatric patients who define their treatment as more detrimental than their underlying illnesses. Unfortunately, Satel's argument in support of the involuntary hospitalization or medication of some patients with severe mental illness-persuasive, as far as it goes- leaves some important questions unanswered: Why should the state have the right to medicate an individual against his will? Why should someone concerned with individual liberty accept and encourage this practice?

The case is easiest to make in connection with criminal conduct, where it is certainly more humane (not to mention cheaper) to treat an underlying psychiatric disorder than to incarcerate a psychotic. Similarly, many homeless people are actually mentally ill, their psychiatric disorders frequently complicated by alcohol or drug abuse. They need compulsory treatment and drug testing as much as they need housing. It is certainly reasonable in such cases to require cooperation with treatment as a condition for receiving public assistance. Satel does a fine job of explaining why involuntary treatment may be advisable in such circumstances, but she leaves it to the reader to discern the general principles that ought to govern such decisions.