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