Doctoring the Facts

American Outlook, May/June 2001

By Ronald W. Dworkin

My first experience with political correctness in medicine came while I was  a medical student. I was assisting on a late–first-trimester abortion—an unusually bloody one—and while holding a clamp in my hand, I suddenly grew faint. A combination of alarm and increasing dizziness compelled me to drop the clamp, excuse myself, and quickly leave the operating room. By the time I made it outside, the world was spinning, and had I not squatted immediately, I would have fainted.

The chief resident—a woman—followed me out and asked me what was wrong. I told her that I was not sure, that perhaps all the blood had gotten to me or maybe I was just overtired. Then, while I was still in the squatting position, she leaned over and asked me, in a severe tone, “But you still believe it’s a woman’s right, don’t you?” I put my arm up over my head, palm facing outward, and in this defensive position cried, “Yes, yes.” The chief resident said nothing; she just looked me up and down as if inspecting a prisoner. Clearly, the most important thing to her was not my physical well-being but the sanctity of her favorite principle. Even though I was incapacitated and practically sprawled out on the floor, her natural urge to sympathize was quashed by another, more aggressive impulse, the need to judge people politically.

Such an arrangement of priorities, whether in defense of liberal or conservative principles, is a telltale sign of fanaticism. In recent years, such fanaticism has been found commonly on the Left—largely in college humanities and social science departments. Radicals preaching multiculturalism have taken over these departments, put their ideology in place, and silenced any dissent. Both students and applicants for teaching positions are now judged politically; real accomplishments have come to mean less and less.

According to the multicultural belief system, life is a story of unequal power relations based on race, class, gender, and sexual preference. This point of view, in itself, is not political correctness. Conservatives, after all, have their own point of view. Political correctness is not an ideology so much as a fanatical implementation of ideology. It manifests itself when other points of view are driven underground; when deceit and trickery are used to manipulate evidence in the name of progress; when the basic democratic impulse to encourage others to speak is quashed; and when believers adopt military tactics, using fear and intimidation to get what they want.

One could argue, of course, that it does not matter too much that America’s humanities and social science departments have become bastions of political correctness. As one college president put it, “No one ever died of English.” At most, political correctness in these realms is a nuisance—it has never really put anyone in harm’s way. But according to Dr. Sally Satel, in her convincing and well-researched book PC, M.D.: How Political Correctness Is Corrupting Medicine, the relatively benign phase of political correctness is coming to an end. Multiculturalist intolerance is now seeping into medicine, where real lives are directly at risk. The culture wars in America have thus taken an ominous turn.

Dr. Satel, a practicing psychiatrist and a resident fellow at the American Enterprise Institute, is involved in both clinical medicine and public policy, and is therefore eminently suited to write on the subject. Her comfort with the subject matter allows her to assume a calm, thoughtful style—she does not have to conceal a lack of knowledge behind convoluted or precious language, nor does she have to prove herself worthy of the subject by being strident. In the culture wars, where books often turn into hand-wringing tirades, this is refreshing.

Dr. Satel makes several useful new contributions to our understanding of politics and medicine. First, she exposes the deceptions propagated by radicals who use clinical studies to promote their multicultural worldview. One such study, published in 1999, suggested that racism is behind the tendency of doctors to recommend blacks for cardiac catheterization at a lower rate than whites. Dr. Satel shows that the referral rates for white men, white women, and black men were actually the same in this study; only the referral rate for black women was lower, for reasons that were unclear. Had the researchers not purposely lumped the rates for black men and black women together, they could not have produced the lower rate for all blacks and used it as evidence of racial prejudice.

Another study cited by Dr. Satel points to racism as the cause of lower kidney-transplant rates among blacks relative to whites. Again, Dr. Satel explains what is actually going on. The cause of the discrepancy lies not in politics or prejudice but in culture and biology: blacks decline the procedure more often than whites and, for reasons of biology, are less likely to have a perfect antigen match between donor and recipient. The lack of a complete antigen match dramatically increases the rate of organ rejection, which compels doctors to hold off on a procedure that already involves significant risk.

In exposing the statistical and interpretative tricks used by health care multiculturalists (whom Dr. Satel calls “indoctrinologists”), Dr. Satel does for medicine what Christina Hoff Sommers did for feminism in her book Who Stole Feminism? Sommers exposed the fallacies behind feminist claims that wife abuse, sex discrimination, and sexual harassment are not only common phenomena in America but actually on the rise. She showed that the data supporting these claims was wrongly interpreted or even nonexistent. Likewise, by carefully scrutinizing the claims of those who declare the practice of medicine to be riddled with racism, sexism, and classism, Dr. Satel shows how many of these accusations are simply groundless.

It is important that this be done, because accusations of racism and sexism are what multiculturalists use to advance their political agenda. Multiculturalists have a solution in mind—radical social change—but they cannot implement it unless they can demonstrate a serious problem to which to apply it. This is why multiculturalists pound and distort statistics until they resemble a serious problem such as racism: so that they can then take them to the airwaves as exhibits with which to build support for their political agenda.

Dr. Satel provides another important service by delving into a subject rarely discussed in public affairs circles: the transformation of public health. In the early twentieth century, public health was equated with community health. Sanitation, food inspection, and the control of epidemics were viewed as legitimate areas for government involvement because they benefited the general public, not simply one or two interest groups. In the 1970s, however, popular attitudes toward public health began to change. It came to be seen as the provision of health care for the poor, including free clinics, drug rehabilitation, teen pregnancy counseling, and the like. Public health advocates encouraged this trend by joining their political fortunes to an expansionist welfare state and concentrating their attention on the health of society’s disadvantaged. This strategy provided a useful way of obtaining project-specific federal money, but in the long run it had a ruinous effect on the nation’s public health activities. As public health became synonymous with health care for the poor, the average person no longer saw it as a common social enterprise, which is one reason why it has fallen on the public’s list of priorities.

Dr. Satel explains the transformation of the idea of public health by describing its most recent manifestation. Some public health advocates no longer want simply to increase the budgets of inner-city clinics or vaccination programs. On the contrary, they want to transform the entire political and economic system of the United States. The activists argue that this transformation is necessary because until radical change is accomplished, all the American people will never have equal health. Minorities and the poor will continue to have higher rates of disease and reduced longevity. But the multiculturalists’ commingling of public health and victim politics is counterproductive because it pushes public health—a very important social enterprise—even further from society’s main areas of concern. The new paradigm causes people to see public health not as something for the poor, which was bad enough, but simply as politics by another means.

Reading Dr. Satel’s book, one gets the sense that some public health multiculturalists retain only a nominal interest in activities that actually affect the public’s health—sanitation, food safety, and so forth. The multiculturalists focus their attention on tax policy, gender relations, and social justice, and although they may occasionally talk about sewage treatment facilities or bacteria counts and depict themselves as eager to see the big picture, they often seem overly willing to skip the dull, routine aspects of preventive health and concentrate instead on politics. They are like teachers in college language departments dominated by multiculturalism, who spend their time writing about homophobia in literature and then tell students that if they want to learn French or German they should go to Berlitz.

Still, the fact remains that a person’s health status does depend to some degree on race and socioeconomic background. How, then, should society deal with this problem? Some might argue that this painful state of affairs is simply part of the larger problem of existence; just as the Bible warns idealists that “the poor will always be with you,” so is it unavoidable that the disadvantages of poverty—including higher rates of disease and reduced longevity—will never go away. Simple decency requires all of us to make a good-faith effort to help alleviate the worst aspects of this problem, but over time, the only real answer is for people to learn to cope with it. A social and economic revolution intended to make everyone’s condition equal and identical can only beget more misery.

There is something wise yet uncomfortably Darwinian in this notion, and so Dr. Satel puts forward an idea that has its roots in the nineteenth century, when Victorian social thinkers used it to justify limitations on government involvement in the health affairs of individuals. Health, they argued, turns on personal responsibility, even personal morality, and this notion implied that policymakers should refrain from intervening aggressively in health care—and not feel guilty about it.

One symbol of this “get tough” attitude was the decision to distribute health care to the poor only when they entered the workhouse. Advocates of this approach argued that the threat of the workhouse not only encouraged poor people to behave responsibly and maintain good health but also kept them from trying to pass themselves off as victims in order to go on the public dole. One Victorian moralist said, “The threat of the workhouse causes the lame to walk, the dumb to talk, and the blind to see. It truly is an act of renovation.”

When Dr. Satel argues against those who see the disadvantaged as simply “passive victims of malign social forces” and instead promotes the idea of personal responsibility, a tincture of Victorian morality is evident in her attitudes. But unlike some of the nineteenth-century moralists, Dr. Satel does not take the notion of personal responsibility to the extreme; her argument for preserving some degree of individual accountability in health seems quite reasonable in a world where government is already quite involved. Between the multiculturalists who argue for a more activist state and the libertarians who argue against state involvement altogether, Dr. Satel lies somewhere in the sensible middle.

Ironically, what is new in the debate over how to manage the health problems of the disadvantaged is not the conservative notion that health is a matter of personal responsibility, but the radical notion that medicine itself is a corrupt institution that must be fought. In the Victorian era, reformers wanted to bring medicine and science into the lives of the poor. They saw these beneficial endeavors as something good. Today’s multiculturalists, by contrast, show a distrust of medicine and science. This is why many radicals not only concentrate their efforts on wholesale political change but also have formed an alliance with those who support non–evidenced-based remedies such as alternative medicine. To many multiculturalists active in the field of public health, simply making Western medical services more available to the disadvantaged is not enough.

In a perverse way, the multiculturalists benefit from another harsh truth that is rarely acknowledged in public. Epidemiologists have long recognized that in more than half of all cases seen by doctors, the medical treatments have no effect on the ultimate outcome: patients either get better on their own or remain with the disease that originally caused them to seek help. If this is true, there is nothing really dangerous about multiculturalists injecting their ideology into the field of medicine. If, in the majority of cases, doctors cannot help anyway, there really is no harm in letting alternative, nonscientific approaches to medicine like “touch therapy” and magnet therapy into the system. From an epidemiological point of view, it may not matter.

Many conservatives believe that the multicultural revolution can be contained within the humanities and social science departments of major universities, thinking that once they present the real scientific facts, the multiculturalists will run for cover. To some degree, this is what Dr. Satel does. She calmly and dispassionately dispenses facts and asserts the value of traditional allopathic medicine. But there is more weakness and failure in medicine than most people realize. Those who fight the culture wars from the Right and believe that medicine can be turned into a fortress from which to launch a successful counterattack in the culture wars should not be too confident. Dr. Satel gives conservatives their best chance, but even that may not be enough.

Ronald W. Dworkin, M.D., Ph.D., is a senior fellow of the Hudson Institute and director of its new Center for the Study of Bioethics, Culture, and Health Care.