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 redistributiomism. 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, MD., 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. 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 modem 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.
Furthermore, there has been a loss of any belief in the transcendent purpose or meaning to human life. In these circumstances, living as long as possible, almost at any cost, has become for many the main preoccupation of life, which is another reason that—at a time when people are healthier than ever before in the whole of human history—trivial risks to health are taken so seriously, and why the policy suggestions of epidemiologists are accepted uncriitically. Health and safety are to us what salvation of the soul was to an earlier age. I do not recall having read anywhere—not even in Dr. Satel’s book—that health, while obviously desirable, is not the summum bonum of human existence, and it is not therefore the measure of all things. Not every prohibition or positive injunction that would preserve life is justified. For example, lives would undoubtedly be saved if people did not mountaineer, but it does not in the least follow that people should be prevented from indulging in this dangerous pursuit.
One of the high priests of the new public health quoted by Dr. Satel is Richard Wilkinson, a profossor at Sussex University, an institution of learning that possesses nothing as reactionary or retrograde as a medical school. The professor has just brought out a slim volume entitled Mind the Gap: Hierarchies, Health and Human Evolution, on whose cover a minatory extract appears: “Inequality kills. People die younger in countries with greater inequalities in income.”
One looks in vain in his work for even the faintest recognition that attempts in the not so very distant past to bring about the kind of equality he clearly favors (except, probably, in his own university department) have entailed quite a lot of killing, in a manner far more direct and brutal than that allegedly attributable to inequality of income. He expresses an obvious nostalgia for East European Communism, though its health legacy to Russia is hardly very splendid (it is healthier to be a peasant in Central America than a Russian). It is doubtful whether he would consider the huge advances in the health of the Spanish population under the rule of Franco—far greater and more durable than anything achieved under Lenin or Stalin—as an argument for the adoption of Falangism. When comparing Sweden and the United States from the point of view of life expectancy, he omits to mention that the differences are comparatively small and unimportant or that the populations of the two countries are very different and therefore not easily comparable: one being small and homogeneous, the other large and heterogeneous. Denmark, a highly egalitarian country, has health indices inferior to Britain’s.
Wilkinson’s characterization of Japanese society—whose members have the highest life expectancy in the world—as egalitarian is surely preposterous, especially as he argues that the search for social status in hierarchical societies induces the stress that kills, via the effects of such stress upon the hormonal system. There can be few societies in the world in which hierarchy is as rigid as in Japan, which is not so much an egalitarian society as a conformist one.
Of course, conformity is precisely what political correctness seeks to bring about: conformity not merely of the outward variety—though that too is demanded—but of the inner kind, conformity of the soul as it were, so that heretical thoughts, as in Orwell’s Newspeak, are no longer expressible or even thinkable. Diversity is permissible only so long as everyone acts, talks, and thinks the same.
The politically correct are more interested in the purity of their own doctrines than in the lives of the mere individuals who are affected when these doctrines are put into practice. Dr. Satel animadverts with justified rage to the civil libertarians who defend the abstract right of schizophrenics to sleep in doorways, shout obscenities at passersby, and neglect themselves to death: psychosis being an alternative way of life, an exploration of inner space or a natural and dignified response to an oppressive society. It is true, as Dr. Satel admits, that in the past considerable abuses were committed in the name of psychiatry, but to suggest that therefore psychotics should be left to their delusions and hallucinations is a little like suggesting that no abdominal surgery should be performed because Sir William Arbuthnot Lane, an eminent British surgeon at the turn of the century, used to perform colectomies on the rich to rid them of the autointoxication that he claimed was ruining their health. If past error is to prevent us from present action, we should all do nothing at all. and to do nothing for psychotics is not tolerance or broadmindedness, but callousness and indifference.
Dr. Satel warns of the political correctness that has taken hold of nursing schools. From the purely practical point of view, this is one of the most dangerous developments in modern medicine, and it has gone much further in Britain than in America. It has already been partly responsible for the acute shortage of nurses in our hospitals.
Nursing, being an essentially practical activity, used to be taught on an apprenticeship system. It has been turned into an academic subject, however; and, as in many other spheres, the academy has been taken over by ideological entrepreneurs and careerists. The syllabus of the modern nurse in training is stuffed with “Resentment Studies”: the horrors of patriarchy and medical dominance, for example. The most terrible postmodernist bilge about alternative, non-scientific, non-masculine ways of knowing is shamelessly propagated, so that now many nurses in America believe in “human energy fields,” which they are more likely to try to change than a patient’s bedsheets. As for the Resentment Studies, they do not so much transform nurses into harridans and harpies, as it is their intention to do, as put them off nursing altogether. The drop-out rate from nurse training has never been higher.
Dr. Satel’s book is, alas, by no means exhaustive. The pharmaceutical companies, for example, are a favorite object of hatred and scorn among the politically correct, who seem to expect of joint stock companies a selflessness equal to that of St. Francis of Assisi. I recall a controversy some years ago over the export, to Africa of the long-acting contraceptive injection, which was not used at the time in North America or Europe because of fears that it might increase the incidence of uterine cancer. The pharmaceutical company that manufactured it was accused of dumping dangerous products in Africa.
Well, I used to give that injection at a hospital in a remote corner of Africa, under a portrait of the pope at a Catholic mission where I did a weekly clinic. The mission was presided over by an aging and devout Swiss nun who recognized the need of poor African women, exhausted by annual childbearing, chronic illnesses, and ceaseless toll at home and in the fields, for respite from the rigors of procreation. Since their husbands wanted them to have yet more children, and would hear of no contraception themselves, a quarterly visit to the clinic for their secret injection was the perfect solution to their problem. It was almost certainly life-saving, for the maternal mortality rate was alarming, and increased rapidly as women bore more babies.
I never taxed the nun with the apparent contradiction between her doctrine and her conduct; everything between us was completely unspoken. But when I returned to Europe, I was astonished at the vehemence with which people would argue that the pharmaceutical company was guilty of racism by selling in Africa what it would not or could not sell at home. In vain did I describe the worn-out women to whom I had given the injection. A hypothetical increase in the rate of uterine cancer was the least of these women’s worries, unlike anaemia, obstructed labor, or rupture of the uterus, which were clear and present dangers, so that even if the pharmaceutical company’s motives were wholly mercenary and reprehensible, its injection was still of great benefit to some of the poorest people in the world. But what counted for the politically correct was the generosity of their anger, and, unlike the aged nun, they were utterly inflexible, lacking equally imagination and compassion.
The area in which I practiced in Africa was, of course, malarious, but DDT was not used to protect the people from the dangerous predations of anopheline mosquitoes, and no substitute for it had (or has) yet been found. It is probably fair to say that Rachel Carson singlehandedly did more damage to Africa, though admittedly without intending to, than three centuries of the Atlantic slave trade. She was one of the founding earth-mothers of ecological correctness, and the abandonment of DDT spraying, by coincidence shortly after malaria had been finally extirpated from Europe and North America through its widespread application, led to a resurgence of the disease in Asia and Africa. At the height of the DDT campaigns, there were precisely twenty-seven cases of malaria a year in the whole of Sri Lanka; nowadays, there are hundreds of thousands of cases, too many indeed to be properly numbered. North American and Scandinavian aid agencies still decline to use a chemical abroad that they are not allowed to use at home, thus giving the recipients of their attentions the not altogether mistaken impression that there is more rejoicing in Washington and Stockholm over the safety of one owl than over the better health of hundreds of millions of people. Of course, even the ecological effects of properly conducted DDT anti-mosquito campaigns may be doubted, but the precautionary principle is applied. After all, there is never likely to be any shortage of humans on earth, but once a little feathery or furry species is lost, it is lost for good. Ergo, it is best before using DDT to wait until it is proved safe beyond all reasonable doubt, that is to say, of course, never ever. Besides, the several protozoon species that cause malaria have their rights too: is it not the rankest genocidal speciesism to wish them eliminated from the face of the earth?
One of the problems with attacks upon political correctness is that of definition. Dr. Satel does not try to define it, perhaps because we all know it when we see it, though it is difficult to say precisely what it is or what its distinguishing features are. It is a form of pious secular humbug, no doubt arising from a distorted, deformed, and debased religious impulse. It is, among other things, the attempt to fill an existential void—what Salman Rushdie, in one of his few felicitous phrases, calls “the god-shaped hole”—with an unthinking utopian principle, the cost of practicing which almost always falls upon someone else. It gives a warm but delusory glow inside, like whisky quickly swallowed on a cold night. It is morality for solipsists.
Doctors above all others should be immune to it, for two reasons: first, by the nature of their occupation, for they, cannot be solipsists. Second, they understand the inherent limitations of human life, and therefore retain a sense of irony. They believe in progress but not in perfectibility, least of all of the human heart. Once they abandon the clinic, however, and become politicians, administrators, or full-time editors of journals, they lose their hold on reality and become as susceptible as anyone else to the allure of humbug. Political correctness has been around longer than we generally imagine. The late Dr. Michael Shepherd, a distinguished professor at the Maudsley Hospital in London, was a British delegate to a world health conference, held periodically by the World Health Organization, about thirty years ago. Utterly bored by the expressions of hypocritical piety, he decided to put the cat among the pigeons, and proposed the motion “War is bad for health.”
Needless to say, there were many wars being waged at the time, and most of the delegates were in the pay of the governments that were waging them. They turned upon him with ferocity, as he knew they would. Which war, exactly, did he mean? Was he not aware that the particular war that their government was waging was waged precisely for the sake of health, at least in the last analysis? Did he not realize that longevity in the long run required corpses in the short? Beneath the veneer of piety, all the old antagonisms, aggression, and hatreds seethed like lava waiting to erupt.
Dr. Satel has performed a valuable service in demonstrating how political correctness can and does distort the practice of medicine. Her prose is simple and direct, her meaning always clear. Some of her quotations beggar belief, but she is not the kind of author to tear words out of context merely to make a point. The self-righteousness, grandiosity, and lack of historical perspective of her epidemiological, feminist, and new-age interlocutors are startling. They seem to believe that, until their most fortunate advent, all was wrong with the world, and that nothing existed before them but ignorance, oppression, and blind prejudice: hence the view that, in the words of Bakunin, the urge to destruction is also a creative urge. Indeed, for them it is the only creative urge. The medical tradition can withstand the onslaught, but only if someone defends it, as Dr. Satel does with considerable bravery and style. All that is necessary for political correctness to triumph is for the intelligent to remain silent.