Morality for solipsists.

Medicine might at first sight appear to be an unpromising field for political correctness. After all, a broken leg is a broken leg, and there is pretty wide agreement about how to treat one, even among those who would agree about little else. But modern medicine rests upon intellectual foundations and institutional structures of precisely the kind that idle intellectuals love to destroy, rather as bored children pick the legs and wings off flies. And even fractured bones can be made to serve their turn in the great and ceaseless labor of undermining civilization.

The politically correct approach to broken legs is the following: accidents, as is well-known, happen much more frequently to the poor than to the rich. This is because of the impoverished and dangerous way in which the poor are forced by circumstance to live and work. The problem of broken legs will thus never be solved by mere curative treatment: we must go to its root causes, which are poverty and inequality (the poor indulge in unnecessary risk-taking to vent their rage, frustration, and despair at economic inequity). Those who concentrate on improving orthopedic technique are merely tinkering at the edges of human suffering and might even be making things worse by distracting attention from the real, underlying causes. The only way to free mankind of the curse of broken legs, therefore, is to lessen poverty and reduce inequality: in short, to raise both awareness of oppression and the rate of income tax, the panacea, the fount of eternal youth, and the elixir of life.

Is this satire? The problem with satire these days is that it is either reportage or prophecy. And, in fact, arguments that are virtually indistinguishable from the above appear regularly in the most important and respected medical journals, the last redoubt, apart from our schools of public health, of unreconstructed socialist redistributionism. For the editors of medical journals (particularly of The Lancet and the British Medical Journal) any inequality of outcome is ipso facto unjust. Use every man after his desert, they believe, and all should 'scape illness.

In PC, M.D., Dr. Sally Satel, a psychiatrist practicing in Washington, D.C., has bravely gathered together a number of examples of the corrupting or corrosive influence of political correctness on the practice of medicine.(1) She is not hysterical about them, and does not lose her sense of proportion: she acknowledges that, so far, the damage done has been limited and is likely to remain so while people continue to need real medical treatment carried out by real doctors. Neither does she subscribe to the Panglossian belief that all is for the best in this best of all possible worlds and that therefore nothing is susceptible of improvement. But she does believe that, on the whole, the medical tradition has served humanity well and that if the epigones of political correctness have their way unchallenged or unopposed, the tradition will be damaged to the lasting detriment of many patients.

Her first chapter concerns the new public health, as taught--or rather, as indoctrinated--in universities. This new public health has nothing to do with proper drainage, clean water supply, unadulterated food, or mass vaccination campaigns, as in the past. It is about every nook and cranny of human existence. There is little doubt that the new public health is potentially the new totalitarianism: for Dr. Satel cites professors who believe that there is nothing that is irrelevant to health or that is outside their province. Such professors accordingly claim the right (and duty) to meddle in and regulate everything. The Prussian state's Health Police were as cinema usherettes compared with modern epidemiologists, at least as they would like to be.

Dr. Satel lets the professors speak for themselves. They are advocates of a political point of view first--namely radical egalitarianism--and scientists second. But she does not explain why they should have been so successful in capturing their particular corner of the academy. This, surely, must have something to do with the temper of the times; their message has fallen on receptive ears. Why should this be?

In the first place, we have lost touch with our own past. We forget (if ever we knew) that only three or four generations ago health conditions in the most advanced countries in the world, as measured by infant mortality, life expectancy, and death rates, approximated those of sub-Saharan Africa today. We therefore have no sense of historical perspective by which properly to view our own problems, and thus epidemiologists are able to raise our anxiety about the most trivial or insignificant of risks. But if we are unable to assess the significance of a risk, we cannot rightly judge whether the measures proposed to eliminate it are justifiable. In other words, we make ourselves vulnerable to tyranny.