PC, MD - How Political Correctness is Corrupting Medicine by Sally Satel, MD, Basic Books, New York, 82000, x & 285 pp, $27, ISBN: 0-465-07182-1

Review by Del Meyer, MD

What makes us sick? According to Dr Satel, a practicing psychiatrist and lecturer at Yale University School of Medicine, more often than ever social activists, scholars and even health professionals are telling us that the culture of medicine is to blame for many illnesses. They are not talking about health insurance woes, fifteen-minute office visits or medical mistakes, but something more sinister. The New England Journal of Medicine claims that white men get the best treatment for heart disease. Discrimination is a cause of differences in health between blacks and whites. Women's health advocates assert that the patriarchal medical establishment has kept women from participating as research subjects, depriving them of the benefits of medical breakthroughs. (Women actually comprise 62% of the six million participants in NIH-funded research.) Former psychiatric patients, calling themselves "consumer-survivors," condemn the health care system for violating their human rights. They are on a crusade to "limit the powers of psychiatry by making consumers full partners in diagnosis and treatment."

Brown University's Sally Zierler says, "The practice of public health is the process of redesigning society." On the assumption that social conditions are the primary reason for ill health, she and her colleagues urge the redistribution of wealth to ensure the even distribution of health. Sally Satel agrees that the relationship between health and social status is not a trivial one, but taking responsibility for one's own health is now virtually ignored. After all, if AIDS is a "biological expression of inequality," as Sally Zierler has put it, we can't hold people accountable if they place themselves at risk for contracting HIV. We must understand that using a condom is hardly a priority for those who are "seeking sanctuary from racial hatred through sexual connection," as Zierler claims. Doctors like Sally Satel who expect their addicted patients to stop using drugs and to start using condoms--and if all else fails, to use clean needles--are accused of blaming the victim.

PC medicine puts ideology before patients. But it is critical to understand that injecting social justice into the mission of medicine diverts attention and resources from the efforts to find ways of making everyone better off, regardless of race or sex. Satel calls these activist "indoctrinologists" since their prescription for cure is ideology and social reform. Their chief pathogens are capitalism, meritocracy, and even the scientific method. PC medicine has flourished because too few people have been paying attention. The preoccupation of the nation with headline-grabbing subjects such as HMOs, Medicare and uninsured Americans--all pressing issues indeed--has allowed the indoctrinologists to swoop in under the radar and thus gain momentum. in the medical schools, post-graduate programs, editorial boards of prestigious medical journals, directors of academic and professional societies, and their editors.

Satel describes how in South Carolina where a viable fetus is considered a person, child abuse could occur if crack-addicted women had succeeded in their crusade for freedom to use cocaine even during the third trimester of pregnancy. This is not unlike David Horowitz pointing out that gay people, who were responsible for 95% of the AIDS in the 1980s, maintained that testing their blood for HIV violated their civil rights to donate blood. This introduced HIV into the heterosexual drug using and hospitalized blood requiring communities such as hemophiliacs and cardiac surgery patients, of which Paul Gann in our community was one.

As Sally Satel says, the PC prescriptions will be hazardous to our health.