PC, M.D.: How Political Correctness Is Corrupting Medicine (review)

Sally Satel. PC, M.D.: How Political Correctness Is Corrupting Medicine. New York: Basic Books, 2001. 256 pp. $27.00 cloth; $16.00 paper.

The dramatic demographic changes seen in the 2000 census data confirm that rising ethnic and cultural diversity is a pressing legal, political, and public policy issue in medicine, health care delivery, and in American society in general.

Culture counts. National, ethnic, gender, and religious heritage strongly influence how one defines health and well-being and how one interacts with the health care system. Therefore, the need to become aware of and understand many cultures—multiculturalism—should not be controversial. Indeed, legal mandates and changing demographics raised overdue questions about taken-for-granted institutional racism, sexism, and ethnocentrism. Reexamination of organizational values and rules may invigorate—not harm—the nation's history of dynamic assimilation.

On the other hand, rising multicultural awareness—fused with the long-term crusade for racial and gender justice—has tended to mutate into an angry ideological critique of American society that cows dissent. Not intimidated at all is Sally Satel, an American Enterprise Institute senior fellow and Yale-trained psychiatrist. In PC, M.D., she challenges the politically correct orthodoxy that a fundamentally racist, sexist and class-based America generates a host of everyday injustices—including those reflected in epidemiology, statistics, and health care group disparities. She disputes therapies rooted in theories of "internalized oppression"—that women and minorities have low self-esteem and engage in self-destructive behavior because they have absorbed negative stereotypes. In the PC worldview, the system is to blame for a host of individual ills. Injustice produces disease; political empowerment and societal reform are the cures. Not necessarily, says Satel.

Satel regards PC medicine as a fourth and newest era of public health history—succeeding the previous three epochs of change characterized by improvements in sanitation, biological sciences, and then lifestyle. "Indoctrinologists" have migrated from universities and foundations into the medical schools and health professions. Their agenda of "redistributing health by redistributing wealth" has "swooped in under the radar"(7) while the nation and public health professionals were preoccupied with debate over managed care, Medicare, and problems of the uninsured. Satel takes issue with PC slogans that "a school of public health is like a school of justice" (21). Instead, she argues that the goal of public health is to prevent illness and injury in practical ways, raising public awareness of risks for accidents and disease while providing strategies to minimize them.

Satel acknowledges historical, collective patterns of inequalities, racism, and sexism in society and the health care system. But she firmly pushes the pendulum back toward the importance that individual responsibility and common sense play in fostering physical and mental health. At times, though, her emphasis on individual accountability may seem as dogmatic as the system-is-to-blame orthodoxy of her antagonists.

The core chapters of the book take on charges of gender and racial bias in mainstream medicine, the "consumer rights" movement in mental health, alternative medicine crazes pushed by an increasingly PC nursing profession, and the feminist and racially inspired victimization ideology in counseling.

Satel questions feminist charges that modern health care research neglects women, especially vis-à-vis underfunding of breast cancer studies. She points out that breast cancer research received five times the dollar amount accorded to prostate cancer in 1997 and three times the amount in 1999. She qualifies the statistical battle cry that one in eight women will get breast cancer—it is the one out of eight women who live to be eighty-five (the risk rises with age). For all adult women without special risk factors, a more realistic appraisal is one in two hundred. Besides, obsession with breast cancer statistics clouds greater dangers: nearly twice as many women succumb to lung cancer and millions more to cardiovascular disease. Nor, according to Satel...