Sally Satel, a psychiatrist with strong credentials in several areas of public health, including drug addiction and its treatment, boasts additional qualifications rare among her peers. Highly conversant in the ways of Washington, she has made a second career as a practicing journalist, specializing in the fields of health and science and their intersection with public policy. As a writer, she is exceptionally conscientious about doing her homework and presenting opposing views fairly, while also getting quickly and efficiently to the point.
Underlying many of Satel’s concerns is one of the least known and most remarkable victories won by the academic orthodoxy known as political correctness, or “PC.” Much has been written about this fashionable fixation on victimhood, oppression, and the inescapable trio of race, class, and gender, a fixation that has disfigured the study of most subjects outside the hard sciences in our schools and universities. What this book demonstrates is the extent to which doctrines of political correctness have also moved into and occupied vast regions of the health and health-service professions: medicine, public health, nursing, and social work. Although these doctrines may not yet thoroughly dominate official discourse and policy, they exercise a profound and pernicious influence, to the detriment of science and sound medicine alike.
Even Readers who have followed developments in Satel’s particular fields of interest are likely to be unpleasantly surprised by the sheer weight and scope of the cases she covers in this book. A long chapter on “Race and Medicine,” for example, documents the increased acceptance in medical circles of the idea that what accounts for the differences between black and white Americans in health and health care is, in the words of one distinguished doctor at Bellevue Hospital in New York, “racism, flat out.” (In her typically careful way, Satel, after laying out the evidence that allegedly supports this idea, then gives us the hard data refuting it.) Similarly, in “Sisterhood and Medicine,” she takes up the widely propagated—and quite false—claim that women are overlooked in clinical trials, while in “Therapy for Victims” she deals with the emerging focus on social oppression as an analytic concept informing health policy and clinical practices alike. And so forth.
One subject examined in depth in PC, M.D. is the “recovered memory” movement. This will be familiar territory to anyone who has followed the breathless accounts, many by disturbed young women acting at the encouragement of their therapists, of supposedly long-repressed incidents of sexual abuse at the hands of male relatives, not to mention the flood of accusations concerning satanic rituals and unmentionable acts of violence being performed upon innocent children by their professional caregivers.
The devastation wrought by the recovered-memory movement has now more or less been acknowledged; with some exceptions, as in Massachusetts where the defendants in the notorious Amirault case still await justice, improper court convictions resulting from it have been overturned, if after the lapse of many years. But what has not been undone is the evil visited upon the accused and their families. Nor—and this is where Satel comes in—is there any understanding of the roots of these latter-day witch trials in theories that to this day continue to be propagated in our schools, colleges, and learned professions.
In still another corner of the medical forest, Satel visits a much less publicized movement that goes by the name of “therapeutic touch” (TT). This hodge-podge of faith healing (via the laying on of hands), New Age ecstasy, prescientific thought, and misapplied terminology from the field of physics is taught and practiced everywhere from our most distinguished medical centers to hospitals in remote parts of the country. It is based, in brief, on the notion that the human body is invested with an “energy field” that can be felt by trained practitioners. By judicious movements of their hands—the “touch” is metaphoric; there is no actual physical contact—these practitioners can reorient the energy field from its existing state of disorganization, supposedly the true cause of an individual’s malady, toward a normal, healthy state of alignment.
Not long ago, a documentary about this technique appeared on public television. Although a number of critics were included in the show, the overall emphasis was quite positive, with endorsements coming from, among others, a prominent cardiac surgeon at Columbia’s College of Physicians and Surgeons who testified that he was happy to make TT available to patients undergoing open-heart surgery. Of course, as Satel patiently demonstrates, not only is TT absurd as “theory,” but it cannot and does not work: the testimonials may mount by the thousands, but there is still not a single respectable, peer-reviewed clinical trial in which TT has outperformed a placebo.
Nevertheless, TT flourishes nationwide, promulgated in part by a nursing profession that, through the good offices of women’s studies and an academic field called the sociology of science, has been brought to a high degree of hostility toward doctors and the “privileged” forms of medical science. As such, it is but one of an array of “alternative” or “complementary” practices that reject the scientifically-based in favor of the intuitive, the “multicultural,” or any other form of “knowledge” that has been “marginalized” by the medical “patriarchy.”*
At The heart of many of the cases examined by Satel is the “social-production” theory of disease. The core principle of this theory is that physiological failure in individuals is caused not by inherent or behaviorally generated biological processes but by invidious social conditions (as in, “AIDS is a social disease caused by racial and class discrimination”); the same goes for inequalities in states of health and disease among groups. Therefore, the first obligation of public-health professionals, as of the victims of disease themselves, is to fight for social change.
In PC, M.D., Sally Satel does not argue that social conditions and social change are irrelevant to public health and disease. She does argue that the increasingly exclusive emphasis on these factors diverts attention, funds, and support from practical means for the amelioration of suffering. That is disgrace enough. The public-health crises with which we are beset will be overcome not by the waving of political banners but by expert medical treatment, close supervision, changed behaviors, and an honest coming to terms with reality. Toward that end, this book is a thoughtful and authoritative guide.
* For more on alternative medicine in general, see “The New Snake Oil: A Field Guide,” by Samuel McCracken, Commentary, June 1999.
PAUL R. GROSS is University professor emeritus of life sciences at the University of Virginia and the co-author of Higher Superstition: The Academic Left and Its Quarrels with Science.