Satel Diagnoses Malady Afflicting U.S. Medicine

Insight Magazine, March 1, 2001

By Stephen Goode

Sally L. Satel says multiculturalism, victimology and the rejection of individual responsibility have become entrenched in medicine and in its practice.

Sally L. Satel is a staff psychiatrist at a drug-addiction clinic in Washington, as well as a lecturer at Yale University’s School of Medicine and the author of PC, M.D. (Basic Books, $27, 256 pp), a powerful look at “how political correctness is corrupting medicine,” which happens to be the subtitle of her book.

“Politically correct medicine puts ideology before patients,” Satel tells Insight. This manifests itself in a variety of ways: For example, a Harvard professor of public health who tells her students that racial discrimination causes high blood pressure among blacks, or nurses who claim to be so oppressed by the patriarchal, male-dominated U.S. medical system that they can’t provide their patients with the kind of care that they should.

Satel dubs the practitioners of PC medicine “indoctrinologists,” a useful term that underlines how much they allow their own political agendas to dominate what they write, think and do about medicine. In putting politics before everything else, PC medicine wastes research time and money on bogus studies that lead to spurious therapies that cure no one either physically or emotionally and can cause great harm, says Satel. And by locating the causes of sickness in such social problems as sexism and racism, PC medicine detracts from individual responsibility to maintain health through proven methods such as good diet, exercise and wise use of products such as alcohol and tobacco.

Insight: It’s very surprising and disheartening to read in your book how public-health officials are arguing for major social change as the best way to make Americans healthy.

Sally L. Satel: The idea that social forces are so profound in shaping health has caused some public-health experts to be dismissive of, or even contemptuous of, encouraging people to do what they can to ensure their own health. For the indoctrinologists, the major threats to our health are social injustice and income inequality, and their prescriptions include income redistribution and that sort of thing.

Obviously, it is not at all healthy to distract us from the fact that there is a lot that people can do about their own health. To be fair, it’s not that they say, “Don’t go on a diet.” They don’t discourage people from taking care of themselves, but they certainly don’t emphasize it and often don’t even mention it.

I don’t mean to imply that every professor in our schools of public health endorses politics over prevention. In fact, some are very critical of this trend, and there still are aggressive efforts to advance public education about health and lifestyle risks.

nsight: But there is some connection between being healthy and having a certain amount of wealth, isn’t there?

SLS: I’m not disputing the correlation between health and wealth. That correlation is well-established. Material comfort makes a difference. So does flexibility — the kind of flexibility that usually allows people in better-paying jobs to take the day off if they feel sick or that allows them to spend three hours waiting in a doctor’s office.

I don’t mean to imply that everything’s just great. There are a lot of uninsured people, for example. But the kinds of things people can do for their own health are being overshadowed by indoctrinologists such as the professor at the Harvard School of Health who claims that the disparity in hypertension between whites and blacks is due to the fact that African-Americans experience the stress of racism and that stress causes elevated blood pressure.
We do know that stress affects health. There’s no question about it. But her study didn’t prove her contention. To her, however, it is a public-health prescription to fight racism. Now that is something that Americans want to do. We all want a healthy, humane and just society. But there is a lot more that individual men and women can do for their blood pressure by, for instance, following a low-salt diet. It’s not a very dramatic thing to do, it’s not talking about major social upheaval in the name of health, but it works.

Insight: The politically correct studies you mention in your book seem to assume that the people they’re talking about are all victims and can’t improve their conditions on their own.

SLS: Victimology pervades everything. There is an utter lack of hope or faith in people’s ability to be responsible. I mention in my book the public-health professors who excuse growing rates of HIV among black women. When these professors talk about it, they say it’s understandable that such women would engage in risky sex and that a condom becomes less of a priority when one has to deal with the stress of living in a racist and sexist society.

Now I am not saying that a lot of drug addiction and reckless behavior aren’t the products of human despair. There’s no question about that, and it is something we as a society want to address. But public health has to be more narrow in its focus. Otherwise, it will dilute its resources and blur its focus, and we’ll take our eyes off the things we have to do right away with regard to HIV.

Yet every year the American Public Health Association [APHA] puts out scores of policy statements on everything from the war in Nicaragua to campaign-finance reform — conflicts that have nothing to do with public health.

In fact, the American Public Health Association still is opposed to mandatory testing of pregnant women for HIV. The reason such testing is so important is that we know that, if you administer antiviral medications toward the end of pregnancy, you can reduce substantially the transmission of the virus to the fetus. It’s the only instance we know where you actually can cure someone of the virus, but the APHA doesn’t approve of that testing because it’s not consistent with the feminist or gay agenda.

Insight: Much of what you’re talking about amounts to a profound questioning of the ways of science and rigorous research — the ways we’ve gained valuable medical knowledge in the past.

SLS: In their effort to demonize the traditional scientific approach, the indoctrinologists will reject that approach by saying, “It’s only the Western mind that demands ‘proof.'” They will criticize classical scientific methodology by saying, “We know that logic is nothing but a tool of domination” by the male scientific hierarchy. And they’ll say with approval that “women’s ways of knowing are superior.” By women’s ways of knowing they mean intuition, subjectivity, emotion.

Insight: All this is a major shift in the way public health has been approached, is it not?

SLS: We can talk of three eras in the history of public health. First, there was the era of sanitation. It goes back to biblical times with warnings such as, “Don’t drink the water if there’s a dead animal in it,” that sort of thing. Then there was the biological era of vaccines, medication and pasteurization. Even 50 years ago, there were common infectious diseases to which we could succumb.

I think it was not until the 1970s that the U.S. surgeon general first spoke of “lifestyle issues” — wearing your seat belt, wearing a condom, not smoking too much. That is the era in which we now find ourselves.

Those three eras reflect the thrust of public health over time. Indeed, public-health people are the unsung civic heroes. When there’s an earthquake or some natural disaster, they’re the ones who are in there so we’re not all dropping dead from E. coli outbreaks.

People take public health for granted because it has tended to work so well. But now there’s this new era we’ve come to, which I believe is to some extent propelled by public-health people feeling a need to start opening a new frontier in order to maintain the great tradition of the past.

Insight: There also have been changes in the kinds of people going into public health that account for the new ideological emphasis, haven’t there?

SLS: Way back in 1872, when the American Public Health Association started, it was all physicians. Then it became “sanitarians,” who were sometimes physicians, sometimes epidemiologists or toxicologists. But they were all people with a real appreciation of rigorous research and science.

Increasingly it’s been the softer sciences that are finding a home in public health — sociologists, anthropologists. This is not to say that one cannot do rigorous research on what are called the social determinants of health. It can be done. But sometimes the research seems to be driven more by ideology than by asking a measurable question, which is the traditional scientific approach.

What makes no sense is for the public-health person to start being an activist, say, for antipoverty programs. You frequently hear the pleas we’ve talked about for income redistribution and other egalitarian goals in the name of health. But there are other ways to interpret some of the correlations that the indoctrinologists say have to be interpreted as calling for major social change.

For example, we know that marriage and good health correlate. But we really don’t hear much encouragement to marry in the name of public health. Religious affiliation and health correlate, but you don’t hear these same indoctrinologists proclaiming the virtues of religiosity.

Insight: Some nurses have developed something they call “therapeutic touch” to treat patients. Is that another instance of ideology overtaking science-based medicine?

SLS: It is an elaborate scheme of therapy and etiology of disease that has no basis in reality. When women’s-studies programs went into the nursing schools, some began teaching that female nurses are women first and nurses second. To resist the so-called male medical hierarchy, they would have to develop women’s expertise, or feminist healing.

They say they don’t believe the doctor should have what they call, quote-unquote, “rightful-knower status.” To challenge the hierarchy, they are promoting alternative medicine, politically correct medicine, specifically the aforesaid therapeutic touch. Of all the nonsensical bad therapies, I believe they chose therapeutic touch because it was developed by a female nurse.

It’s based on a nonscientific theory, which is that everyone, perhaps every living organism, is surrounded by an energy field. In our case, it is a human energy field. If that field is not flowing smoothly and the “energy” is somehow backed up, then it adversely will affect the healing of wounds and infections. Backed up, it can produce high blood pressure, PMS [premenstrual syndrome].

They claim to believe the way to relieve this backed-up energy is to smooth out the energy field. So they perform this smoothing out by 15 to 30 minutes of “therapeutic touch” in which their hands appear to stroke the patient but really are moving around the body about 5 inches away. Apparently, if you don’t do it right the energy can back up and the nurse or patient can suffer harmful consequences.

Insight: You mention that there are no rigorous studies that prove the effectiveness of therapeutic touch, even though there are some nurses who swear by it.

SLS: Everyone knows that a patient who is lonely or bored is going to feel better after someone has spent some time with him, so of course there are patients who will say that, yes, therapeutic touch did help them.

I want to emphasize that these nurses very sincerely believe in what they’re doing, and they care about patients. But the fact is that there are times where therapeutic touch could be life-threatening by being practiced in place of a traditional therapy.

It’s also debasing to nursing education. The average nurse still is responsible and hardworking, so all this silliness about therapeutic touch couldn’t come at a worse time because we’re facing a massive nursing shortage. Nevertheless, therapeutic touch is being taught with the same energy, enthusiasm and seriousness as courses in physiology and anatomy. It’s taken quite seriously by the American Nurses Association and the National League for Nursing, which is an accrediting body for nursing schools. It’s being taught in 80 nursing schools in North America.

Insight: You’re not much of a fan of what’s called multicultural counseling for psychological problems, are you?

SLS: In multicultural therapy some of the more radical therapists go out of their way to tell the patient that many things are indeed not under his or her control. They tell the patient that he or she is a victim of the patriarchy, of racism. The multicultural-therapy movement is a great example of deliberately taking the focus off individual responsibility.

When you think about the true purpose of therapy, this is nothing less than malpractice. Therapy is about introspection. It’s about observing yourself and seeing how you unwittingly sabotage yourself, which we all do. In a therapy like multicultural therapy, there is someone telling you constantly that your distress results from external factors and that part of your therapy must be to become active in social causes.

You’re told you feel bad because you live in an oppressive environment, so you concentrate on therapeutic strategies that don’t focus on your responsibility for yourself and what you can do to change yourself and how you can modify your relationships with other people. No, the therapeutic strategies are about going out there and marching for civil rights or women’s rights because it’s society that’s the problem, and we have to change the whole of society to feel better.

I don’t say there aren’t situations where people are discriminated against. What I’m saying is that if that’s the problem you don’t need a therapist, you need a lawyer.

Insight: But don’t the politically correct say they have true compassion for patients and the rest of us don’t?

SLS: I say turn the compassion tables on them! Tell them they’re the ones who are not being helpful to patients by not focusing on how they can deal with their health problems right now.