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by Sally Satel
Basic Books, 2000
Review by Markus Wolf, Ph.D. on Oct 25th 2001

PC, M.D.Hardly a newspaper is printed without containing at least an article of some attack or other against the medical profession, a noticeable number of them making their way into the courts. Former psychiatric patients accuse the institutions of psychiatric medicine of having abused them; nurses claim they are oppressed by a male system; women's rights advocates accuse medical research of neglecting the interests of women in their research; differences between the health status of minority groups in America is attributed to racial bias within the health system, further examples abound. The forces that attack the present medical system, its institutions and practices may be described as advocates of "politically correct medicine".

Proponents of politically correct medicine claim that the underlying causes of ill health are not the weak constitution of patients, bad sanitation, or an irresponsible lifestyle. They argue that the problem is a more fundamental one, capable of being adequately dealt with only by political, large-scale change. Their targets are social groups, institutions, and societal structures, not the individual usually identified as the patient.

Sally Satel, with her book PC, M.D. launches a powerful attack against the forces of politically correct medicine. In doing so, she wishes to steer medicine back towards addressing the needs of patients and restoring health through science. The book is of interest and accessible both to practitioners of medicine and health care consumers.

Each of the seven chapters (which may be read separately or selectively) dispels myths that are preventing patients from getting the quality of care to which they are entitled. Numerous examples are presented to show how political agendas have taken precedence over clinical imperatives.

Satel first presents the philosophy of politically correct medicine. She denies the claim that social position determines one's health. This is followed by a chapter in which attention is paid to the "consumer survivor movement", a group of former psychiatric patients who accuse the medical system of having violated their rights, and who demand control of the mental health system. Satel endeavors to show that consumer survivors are making things worse for the mentally ill, for those really requiring treatment and care. Disgruntled nurses are the center of the next discussion. These nurses have distanced themselves from the medical system by adopting alternative forms of therapy, claiming that the system is oppressing them. Satel claims that many of these therapies are bad and wholly unfounded. With respect to research, convincing arguments are furnished that conclude that women's interests are not being systematically neglected by medical research, on the contrary, Satel argues that most research benefits women and that they benefit most from medical care.

Ought women to be permitted to use cocaine when pregnant? This thorny issue is tackled by Satel in a separate chapter. Influential groups, such as the U.S. Commission on Civil Rights to the Association of American Medical Colleges, advocate the claim that bias in the medical profession is the reason why minorities are less healthy in America than whites. Counterexamples and alternative reasons are provided in an attempt to provide evidence of the contrary position. The final chapter is concerned with psychotherapy for victims. This includes "multicultural counseling". Advocates of such counseling presume that the personal problems of non-white patients stem from their difficulties to adjust to a racist society. By encouraging patients to focus only on external factors, they are denied self-exploration, seen by Satel as the true purpose of therapy and self-determination.

Is Satel's book a success against politically correct medicine? The answer must be an emphatic yes. We are reminded that the efforts of PC medicine to improve health through social justice do not prevent disease, treat symptoms, or improve clinical methods and procedures. They undermine the Hippocratic ideal, which is to put the patient first. The underlying theme is that ideology should not be put before patients.

Are Satel's presentations all convincing? She denies having the objective of defending the status quo, but the arguments presented, examples given, and positions defended sometimes give the impression that precisely that is being done. While Satel may convince the reader on some points, she may fail to do so on all. One example may be illustrative: she vehemently argues against nurses who adopt alternative treatments, claiming that they are unscientific. Her insistence that all medicine must be scientific gives rise to the question, whether she is not defending Western conservative medicine at the cost of all other approaches. It may be mentioned that some non-Western methods and techniques, which are often difficult to explain scientifically, such as acupuncture are increasingly being adopted with apparent success. Moreover, her criticism that non-scientific medicine sometimes leads to misdiagnoses and fatal mistakes is also true of scientific medicine. Satel must therefore face the criticism that her ambitious attempt to criticize politically correct medicine sometimes entices her to criticize too harshly. Despite this criticism, however, the book is a valiant effort to steer medicine back towards caring for the needs and interests of patients. It reminds us that individuals ought to be the primary concern of the medical profession.

© 2001 Markus Wolf

Markus Johann Wolf is a doctoral student in philosophy at the University of South Africa, a distance education institution, and lives in Austria. He has particular interest in philosophical problems of social and ethical matters, his main field of interest being ethics. His doctoral thesis deals with the ethical justification of punishment.

Related link:

Sally Satel Web Site