Bitter Pill.(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."