NRO Weekend, January 13-14, 2001
Deadly PC
Playing politics with medicine. An interview with author Sally Satel.

By Kathryn Jean Lopez, NR associate editor-----lopezk@ix.netcom.com

ally L. Satel is a practicing psychiatrist, lecturer at Yale’s school of medicine, and a fellow at the American Enterprise Institute. She is the author of PC, M.D.: How Political Correctness Is Corrupting Medicine.

Kathryn Jean Lopez: You are a practicing psychiatrist. What made you become a commentator too? Weren't you busy enough? When did that happen?

Sally Satel: I became interested in the policy angle when I was on the faculty at Yale medical school. I was in charge of a treatment unit for drug addicts and realized that many of our patients were receiving disability benefits simply for being addicted. They used this money — no surprise — to support their habits. The cash came from a program within the Supplemental Security Income program designated for individuals who couldn't work because they were too intoxicated.

Of course, that's not how the Social Security Administration and patient advocates saw it: They believed that these men and women needed financial support because they were suffering from the disease of addiction.

Although I am skeptical of the "disease model" of addiction — another essay — the point is that our patients' treatment was being undermined by a program intended to benefit them. I became interested in changing the organization of that disability program so that the financial benefits were used in a time-limited fashion as an incentive toward recovery rather than as a reward for being dysfunctional. So I started writing about that and then in 1993 I took a congressional fellowship sponsored by the Robert Wood Johnson Program. I worked for Senator Kassebaum and the very month I started on the Hill, Republicans introduced a bill to change the SSI program. I got to help write the new legislation and, ultimately, it passed. At that point, I developed a raging case of Potomac fever, left New Haven and moved to DC permanently.

Lopez: What made you write the book?

Satel: I wrote PC, M.D. because the clinical and academic values I was taught — patients before politics, honest science — are under threat.

Lopez: There are many problems in medicine. Malpractice litigation abounds, for instance. Is political correctness more dangerous? How so?

Satel: Yes, there are certainly problems: 44 million uninsured, medical errors, 15-minute HMO visits. It's because the public is so concerned with these matters, rightly so, that the purveyors of PC medicine have swooped in under the radar. There are other reasons too: the inexorable march of PC through the institutions; probably a feeling of guilt regarding the atrocious Tuskegee experiment; separate-and-not-so-equal hospitals for whites and blacks up until the 60's in some southern hospitals; paternalism, especially within the male gynecologist-female patient relationship.

That said, I think PC medicine is more dangerous in at least one way. It is based on deception. In keeping with the spirit of political correctness — which is, as I define it, an orthodoxy designed to maintain victim status — PC medicine is all about misrepresenting the origins of disease and its remedies in an effort to undermine what's perceived as the dominant culture.

The public-health profession, especially in schools of public health, has forthrightly taken on the issue of "social justice." I've documented numerous examples of public-health professors who teach their students that unless we abolish income inequality and oppression, there is little hope of a healthier society, especially among the less well-off. The major effect of this is to downplay, if not undermine, the role of personal responsibility in health. Indeed, half to two-thirds of premature deaths (death before age 65) can be postponed or prevented if people don't smoke, don't overeat, drink too much, practice safe sex, and so on.

Lopez: There's an interesting debate you highlight in your book in regard to racial preferences. What's the case for racial preferences in regard to enhancing minority health? How does that work?

Satel: Interesting that you use the word "debate." Since the Bakke incident of the 70's, there's been hardly any debate within the medical profession. The Thernstroms and the Center for Equal Opportunity have looked into racial preferences in medical schools, but otherwise it appears to be an unquestioned truism within the medical and public-health worlds that racial preferences are necessary. The key argument is that (a) health disparities exist between whites and minorities; (b) these disparities are due, in large part, to the inability of white physicians to relate to their minority patients; (c) we thus need more minority physicians.

My research (and my experience) indicates that (b) and (c) are wrong. As far as disparities go, they are real. For example, blacks and Hispanics and Native Americans have lower life expectancies and high infant-mortality rates, among other outcomes, compared to whites. Bias, however, among doctors does not appear to account for this. In cases where doctors perform invasive techniques at different rates, one can often find an explanation (i.e., other clinical differences among African-American patients — such as higher rates of diabetes or high blood pressure — would affect the outcome of the procedure) or relevant variables (i.e., patient refusal of the procedure; the doctor's rationale for not offering it) were not assessed.

There is some evidence that doctors are less likely to ask black individuals if they would donate a kidney to an ill relative. The likely reason is because refusal rates are higher and doctors may just assume that the family may refuse. This is wrong: They should ask everyone. But it's not bias that keeps them from asking.

Surveys show that patients care most about having a competent doc who can spend some time with them; race or ethnicity is just not that big an issue. Of course, some black patients prefer black physicians (and that is an argument for patient choice, not racial preferences) but surveys show that some specifically do not want a same-race doctor.

The most striking aspect of racial preferences, in my view, is how far down into the applicant pool medical schools are reaching in order to have a diverse student body. In my chapter on race and health, I document the considerable differences in test scores and grades between incoming white and black (sometimes Hispanic) students and the trouble that the latter often have in medical school: higher dropout rates, multiple failures on boards.

We have lowered standards dramatically so that there will be more minority doctors. Of course, minority students who are admitted competitively do fine. It's just that, on average, grossly underprepared students perform poorly and, one reasonably fears, go on to become second-rate graduates.

Lopez: Your section on women is fascinating. What are the biggest lies promulgated by gender-based medicine?

Satel: The women's health movement of the late 80's, 90's, and 00's is fueled by aggrievement and misinformation. The biggest lies are these:

1. Women were not included in clinical trials until 1993, when the HHS Office of Women’s Health and some women senators made a fuss. Truth: Women have been included in trials for decades; see chapter on Sisterhood and Medicine.

2. Women researchers are not receiving grant money at rates equal to men. Truth: According to NIH data from 1993, women fare as well as men.

3. Breast-cancer research is underfunded. Truth: Based on years of healthy life lost, breast cancer is one of the five most generally funded diseases. The others are dementia (Alzheimer’s), cardiovascular, AIDS, and diabetes. Women are over-represented in the Alzheimer’s category because they live longer than men. Thirty percent of women die from heart disease, 4% from breast cancer.

Lopez: In the book, you quote Republican Sen. Olympia Snowe from the mid ’90s: "It was my female colleagues and I who led the charge to put an end to clinical trials conducted entirely on men — even for breast cancer." How do you get through to these people, if the medical profession is lying?

Satel: The medical profession isn't lying. Olympia Snowe, her fellow senators, and the Congressional Women's Caucus got a lot of their information about women's health from the HHS Office of Women's Health. That office, at least until 1997, regularly dispensed incorrect data to Hill staff and lawmakers. It's the advocates and the PR departments of agencies like the Office of Women's Health that have the ear of the media and thus end up being the source of much distortion.

Lopez: What is oppression-based therapy and how widespread is it?

Satel: I describe two types of oppression-based therapy in PC, M.D. One is called "multicultural therapy" and the other "feminist therapy." They both posit that (a) the most important aspect of a patient's psychology is his or her membership in a victim group; (b) psychic distress comes from living in a racist or patriarchal society, (c) therapy entails activism since it is the malignant environment that made the patient ill in the first place. The most radical versions of these, in my view, are malpractice. The legitimate purpose of therapy is to help the patient gain insight, not to externalize the cause of his problems. He must understand how he unwittingly sabotages himself from attaining his goals.

To my deep chagrin, the oppression-based therapies are not on the fringe. The American Counseling Association is a proud and vocal proponent of multicultural therapy. It is taught in virtually every counseling graduate program. Feminist therapy, to my horror, is endorsed by the American Psychological Association.

Lopez: What is happening to the nursing profession? You describe therapeutic touch in your book, an approach embraced by major nursing groups, fueled by "a fiery resentment of the medical establishment, the so-called male medical elite." Is this the nursing profession today?

Satel: Women's studies programs have gone to nursing school where they are promoting an anti-science, anti-doctor, and anti-technology agenda. To be fair, the average nurse is a sensible, hard-working individual; but postmodern nursing has a strong foothold. In addition to a poststructural nursing literature that would make Alan Sokal envious — but is not a hoax — the most obvious manifestation is the embrace of quack alternative medicine, especially something called Therapeutic Touch (TT). TT practitioners claim that TT can cure anything from a yeast infection to migraines via the process of smoothing out the (apocryphal) energy fields that surround our bodies. Sessions consist of a TT (or reiki) specialist sweeping her hands all around the body but several inches away. Needless to say, scientific evaluation of TT shows that it produces no effects.

To be sure, nurses share their fervor for TT with millions of other Americans who swear by unproven or discredited techniques. But their TT campaign is also driven by a fiery resentment of the so-called male medical elite. Once again, the drama of the dominant over the disenfranchised. Lest you think this is some harmless, fringe trend consider:

1. The American Nurses Association and the National League for Nursing (which accredits nursing schools) actively promote TT. About 80 nursing schools teach it. The Colorado Board of Nursing says it is well within "mainstream" nursing practice.

2. The National Council for Health Information documents misadventures due to the practice of fad therapies. The council has recorded a number of cases of nurses performing TT on patients instead of recognizing that their distress was due to life-threatening conditions (in one case, bleeding in the brain; in another, appendicitis).

3. It is well documented that we are on the verge of a massive nursing shortage. By 2010, it is estimated that the American nursing workforce will have 20 percent fewer nurses than are needed. More than ever, we need astute nurses who don't waste their time believing or practicing quackery, especially in the context of a power struggle with physicians.

Lopez: Is there hope for medicine?

Satel: To a large extent there is a built-in check simply because we demand the technical excellence that modern medicine gives us and we won't tolerate a decline. I wrote the book to expose these developments to the public and to embolden my colleagues to speak out when they see their colleagues entertaining these ideas and practices. The vast majority — except perhaps in the field of mental health and in schools of public health — are not receptive to PC trends, indeed many think they are absurd and harmful. A lot could be done by Secretary Tommy Thompson by appointing smart, no-nonsense folks to the directorship of the Centers for Disease Control, National Institutes of Health, and various other agencies within HHS that fund and promote some of these trends.