The Indoctrinologists: Sally Satel diagnoses politically correct medicine

The Weekly Standard, January 22, 2001

By Eric Chevlen

John O’Sullivan, editor at large of National Review, famously observed that all organizations that are not explicitly right-wing become left-wing over time. For those who thought that science and the practice of medicine could somehow be a haven from such corruption, Dr. Sally Satel has some sobering news.

The “indoctrinologists” are everywhere — in the medical schools, the post-graduate programs, on the editorial boards of prestigious medical journals and the directorates of academic societies, and of course very much in the government bureaus regulating the practice of medicine. Like the criminologists who prefer attacking the “root causes” of illegal behavior to jailing criminals, the indoctrinologists seek to promote the nation’s health by exposing and extirpating the deep-seated sources of our suffering. We are a sick society, they say, both literally and figuratively. Not surprisingly, the health experts have identified the chief pathogens of our sickness to be capitalism, meritocracy, and even the scientific method itself.

Satel is a practicing psychiatrist, with particular expertise in the difficult field of treating drug addiction. She is also the W. H. Brady Fellow at the American Enterprise Institute. Her book reflects both these facts. Particularly good are the firsthand descriptions of the depredations political correctness has wrought in psychiatry and psychology. Less praiseworthy is the heavily annotated book’s occasional glut of statistics and quotations.

The intrusion of political correctness into medical practice is no mere academic concern. It has real victims, even casualties. PC, M.D. tells the story of Margaret Mary Ray, who suffered from schizophrenics. Ray’s life was a series of sojourns in psychiatric hospitals and jails, distinguished only by her brief notoriety for delusionally stalking comic David Letterman. Like many schizophrenics, she managed fairly well as long as she took her medicine, but deteriorated rapidly whenever she stopped. After she was arrested, a judge released her and, according to the New York Times, “openly lamented the absence of any legal mechanism to make sure she received medical help.” Two months later, in October 1998, Ray knelt in front of an onrushing coal train and was instantly killed.

Actively psychotic patients, riven by delusions and hallucinations, usually lack the insight to recognize their need for medication. Treatment must often be imposed by court order. But a small but vocal cadre of former psychiatric patients and civil liberties lawyers are eager to block such interventions. Satel writes, “Being required to take medication is hardly a violation of the civil rights of a person who is too ill to exercise free will in the first place. The freedom to be psychotic is not freedom.”

The former psychiatric patients who have banded together to fight the scientific treatment of mental disorders call themselves “consumer-survivors.” Their movement — including groups like the Insane Liberation Front, founded in 1970 — grew out of the radicalism of the 1960s, which romanticized psychotics as dissidents, and demonized psychiatry as an instrument of social control by the ruling class. Activists have been successful in paring involuntary treatment laws, and in restricting the availability of electroconvulsive therapy, probably the safest and fastest therapy for life-threatening melancholic depression in the elderly. Ironically, the consumer-survivors who are active in the movement are not at all representative of the group they purport to speak for. Only the most functional of mental health patients have the personal and social resources to pursue such activity.

Indoctrinologists see victims of oppression elsewhere too. According to them, the entire structure of society is patriarchal and oppressive of women. It is no surprise, then, that nursing, a career traditionally dominated by women, is a major battleground in the war of political correctness.

One manifestation of this is “therapeutic touch,” a nursing intervention that does not even merit the description of unproven, since it is now disproved. Therapeutic touch is a double misnomer, since no actual touching is involved, and its therapeutic benefits are illusory. The practitioner passes her hands over a patient to adjust the “human energy field.” Sometimes she literally shakes the bad energy off her hands at the foot of the bed.

While therapeutic touch is justifiably risible, its impact is not. Articles on the subject appear in major nursing journals, and courses in its method are taught at national meetings. At heart, therapeutic touch is a rejection of evidence-based medicine, even of science itself. The rigors of the scientific method are seen by the minions of political correctness as an active devaluing of the feminist view of reality — the reality described in Nursing Science Quarterly as “open-ended, ambiguous, dynamically constructed, incessantly questioned, endlessly self-revising, never set, but floating and moving with the river of life.”

Feminism is also the force behind the myth of the second-class medical citizen. Senator Hillary Clinton has remarked on the “appalling degree to which women were routinely excluded from major clinical trials of most illnesses.” During the recent campaign, vice president Al Gore said, “Throughout my career, I have fought for more research funds for those diseases so recently considered less important because they befell only women, such as breast cancer . . . I pledge to you: Women’s health will always be at the top of my agenda.”

Satel writes, “It is hard to know what more Gore could do. Women represented 62 percent of the more than six million participants in NIH-funded research in 1997.” The occasional gender disparity seen in clinical trials comes not from a purposeful exclusion of women, but from the unequal distribution of illness in society. For example, middle-aged men (especially smokers) are at much greater risk of coronary artery disease than are their wives and sisters. It is mathematically demonstrable that any clinical trial of such a male-predominant disease which made a point of including men and women in equal numbers would necessarily (1) cost more, (2) take longer, (3) require more patients, or (4) be less conclusive. By the same token, studies of Alzheimer’s disease must enroll more women than men, since women are at greater risk of developing it. Since women live an average of seven years more than men, and make more doctor visits than men, it would be unreasonable to claim that they are victims of societal health care oppression.

And that brings us to the question of race. Satel argues that the disparity of treatment for serious diseases, such as coronary artery disease, end-stage kidney failure, and cerebrovascular disease, should not be conclusively interpreted as evidence of racial prejudice in the health care system. Here she is directly at odds with politically correct propaganda.

Satel carefully dissects the well-publicized study by Kevin Schulman and others at Georgetown University Medical Center. The researcher recruited 720 general internists at medical conventions, and asked them to make a medical decision concerning four “patients” portrayed on videotape by actors. The actors were a black man, a black woman, a white man, and a white woman. They gave comparable histories in the videotape, and had similar laboratory findings.

Schulman reported his findings in the prestigious New England Journal of Medicine. He said that 91 percent of the white male patients were referred for cardiac catheterization, while black men, and women of both races, were referred for cardiac catheterization 85 percent of the time. “Our finding . . . may suggest bias on the part of the physicians,” he wrote. “However, our study could not assess the form of bias. Bias may represent overt prejudice on the part of physicians or, more likely, could be the result of subconscious perceptions rather than deliberate actions or thoughts.”

Satel points out that the study was widely reported when it was published, but the legitimate criticism it received went practically unnoticed in the popular media. One criticism was based on the fact that the physician audience assessing the videotaped interviews found white males “most likely to sue.” Perhaps the blacks and women were not being referred for cardiac catheterization too little; perhaps the white men were being referred too much. A more serious criticism is based on the statistical sleight of hand that Schulman employed. As one powerful rebuttal pointed out, the Schulman analysis compared the referral rate for white men with that for the aggregate of the other three groups. If the aggregate were broken up into three groups, the data would show that white men, white women, and black men were all referred with the same frequency. Only black women had a significantly lower referral rate. For reasons that remain unclear, they were 88 percent as likely as white women and men of both races to be referred for catheterization. The editors of the New England Journal took the unusual step of apologizing to their readers: “We take responsibility for the media’s overinterpretation of [this] article . . . The evidence of racism and sexism in [the Schulman] study was overstated.” Undeterred, Schulman went on to say that his study would nevertheless “encourage the medical profession to eliminate unconscious bias that may influence physician’s clinical decisions.”

Surely what these left-wing assaults on medicine deserve is exposure to light and scorn, which Satel ably provides in this book.

Eric Chevlen practices medical oncology and pain medicine in Youngstown, Ohio.