Reviews

How Political Correctness is Corrupting Medicine, by Sally Satel, M.D. Basic Books, 2000, 233 pp., $27 hardcover.

It seems that a shrill and stubborn minority of medical professionals has finally caught the flu that has infected other segments of nation before them-the work place, the law, and the universities. Those who have the fever, whom Sally Satel calls "indoctrinologists," are scattered through out prestigious schools of public health and professional associations. The view taken is familiar: Minority groups and women are oppressed by white males. White men get the best treatment for heart disease, nurses suffer from a patriarchal establishment, discrimination and racism create stress, leading to poorer health in minorities. The solution also we have heard before: address the root causes of racism, classism, sexism, and homophobia.

Sally Zierler of Brown University's Department of Community Health well represents the P.C. crowd. At the annual meeting of the American Public Health Association Ms. Zierler imparted her five recommendations for curbing the AIDS epidemic: limit the power of corporations, cap salaries of CEOs, eliminate corporate subsidies, prohibit corporate contributions to politicians, and strengthen labor unions. Ms. Zierler believes that the goal should be to overthrow the "competitive meritocracy" because

...unequal distribution of goods and services and property and profit means that deprived populations are less able to reduce [HIV infection] in their community.

Nancy Krieger, who is an epidemiologist at the Harvard School of Public Health, claims that women are driven toward AIDS and addiction:

In response to daily assaults of racial prejudice and denial of dignity, women may turn to readily available mind altering substances for relief. . . . Seeking sanctuary from racial hatred through sexual connection as a way to enhance self-esteem . . . may offer rewards so compelling that condom use becomes less of a priority.

Gladys H. Reynolds of the Centers for Disease Control blames doctors for the mess. She writes in Annals of Epidemiology:

We in the scientific community are no different from the public or the media: We bring everything we have been taught by our culture-our xenophobia, our homophobia, our racism, our sexism, our "classism," our tendency to "otherize."

The author, Sally Satel, believes these charges could lead to genuine tragedy as the numbers of preventable deaths increase as the focus of modern medicine is wrenched away from the search for practical ways to prevent injury and disease. Sally Satel is a practicing psychiatrist (her real-world experience includes being on the staff of a methadone clinic in northeast Washington D.C.) and a lecturer at Yale University School of Medicine. She points to the last 150 years in which millions of lives have been extended, improved and saved by an "honest application of science, education and a focus on personal responsibility." She describes three eras, the first in the mid-1800s, which concerned contagious diseases such as typhoid, tuberculosis, and yellow fever. Public health officials developed water purification, refuse disposal and extermination of disease-carrying pests. The second era began with the invention of the microscope at the end of the 1800s when the bacteria that cause specific diseases could be seen for the first time. In the first half of the twentieth century antibiotics, vaccines, pasteurization brought rapid victories against polio, smallpox and diphtheria. The third era begun in the 1970s is marked by campaigns against preventable injury and chronic illness. The surgeon general led by urging people to improve their lifestyles. The message was change behavior and save lives. She quotes Richard Pasternack, director of preventive cardiology at Massachusetts General Hospital:

If you eliminate the factors that we know about, which are largely lifestyle issues-smoking, high blood pressure, high cholesterol, lack of exercise and diabetes-you can eliminate somewhere between seventy and ninety percent of disease in our population.

Dr. Satel acknowledges that poorer people tend to be less healthy than wealthier people. Poor and poorly educated people still die younger than the more affluent, even though the probability of dying between twenty-five and sixty-four has been declining since 1960. She cites many factors over which the poor have little control. Low-paying jobs tend to have less flexible hours, making it difficult to get to the doctor's office. Finding a reliable babysitter, and then taking two buses to the clinic can be a daunting task. Poorer people buy smaller and thus less safe cars. They know less about healthy habits and are more likely to be victims of crime. Social service bureaucracies are sometimes intimidating, with waiting lists and inconvenient scheduling systems. Low-wage workers are less likely to have health insurance paid for by the employer and so are unlikely to receive regular and timely care.

Black children are four to six times as likely as white children to die from asthma. Problems with this lung ailment have been increasing since the 1980s, with five million children presently afflicted. The "trigger" for asthma is the cockroach, as tiny parts of its body are shed and inhaled, causing allergic reactions-rodents and dust mites also cause problems. Even if a single mother keeps a clean apartment, there is little she can do if her neighbors don't.

Dr. Satel relates the experience of one her patients: The woman was burned out of an apartment building when a neighbor fell asleep while smoking. She had no fire insurance. She didn't want to stay with her only relative, her sister, because her sister smoked crack cocaine and had an alcoholic boyfriend. The unfortunate woman and her asthmatic son spent weeks in a damp shelter until the boy caught pneumonia and had to be hospitalized. In this way, Dr. Satel says, social class got "into the body" of her patient's son.

But Dr. Satel does not draw the same conclusions to these real and pressing problems that her politically correct colleagues do. To be sure the workings of the public health bureaucracies should be improved. But the less well off do tend to have habits that are not conducive to good health. The focus in solving these problems should be on changing these self-destructive habits rather than controlling the salaries of CEOs or undermining the "competitive meritocracy." It is to civil society and its members that we must look for answers-teachers who can discipline, parents who pay attention, involved neighbors, and ministers who are unafraid to minister. Dr. Satel says:

...indoctrinologists consistently home in on aspects of these relationships that fit a particular political orientation. For example, noting that wealth and health correlate, some pubic health experts condemn capitalism and decry efforts to roll back entitlement programs and racial preferences in college admissions. However, if they must be social activists, these experts could just as easily fight for school choice in inner cities with failing public schools. After all, we know that education is linked to both future earnings and health. And wouldn't it make sense to encourage marriage and religious activity, since both are associated with better health. It would, but don't expect to hear as much about these options from the practitioners of P.C. medicine-they simply do not fit their political agenda.

The Little Ice Age: How Climate Made History 1300-1850, by Brian Fagan. Basic Books, 2000, 246 pp., $26.

Written for the lay reader by a professor of archaeology at the University of California, Santa Barbara, this fascinating study casts a new light on the links between climate and history. Recent work by many scholars has made this possible.

One example is the exploration by the Norse of Iceland, Greenland and the coast of North America during the medieval warm period of one thousand years ago.

A minor criticism is that temperatures are given in metric units, making reading slightly difficult for the average American. The book ends with a chapter on the greenhouse effects of the industrial revolution entitled "a warmer greenhouse."

We would like to thank the following people for their generous contributions in support of the publication of this journal: William D. Andrews, Lee R. Ashmun, Harry S. Barrows, Dean A. Benjamin, James B. Black, Cliff Chambers, Eugene H. Donovan, John J. Duvall, Gary D. Gillespie, Robert L. Gilmore, Joyce H. Griffin, Violet H. Hall, Mrs. Thomas Hall III, Nancy W. Hearding, Jack Hooley, Marjorie J. Ihle, Herbert London, Henry M. Mitchell, R. L. Oshsenhirt, Howard J. Romanek, Harry R. Schumacher, Frank T. Street, Julian Tonning, Raymond C. Wanta, F. K. Williams, Lowell M. Winthrop, Chris Yunker.