By Sally Satel, MD
Perseus Books Ltd. 12/2001
Reviewed by: A Mark Clarfield, MD, FCFP, FRCPC
As a physician and as one who is no great admirer of the American system of health care, I was of course intrigued to dig into a book with such a title. Dr. Sally Satel, a practicing psychiatrist and fellow of the American Enterprise Institute, has issued a fierce broadside against the forces that she reckons are "corrupting" American medicine. Dr. Satel gives chapter and verse as to how what she labels "identity politics" [that is, giving preference to women, minorities and even "victims" of psychiatric treatment] has taken precedence over clinical imperatives. In other words, how "political correctness" has deformed the judgement of senior academics, medical and government officials so that not only are patients not helped, but they are actually harmed by the turn that things have taken.
An excellent example would be the movement of those who would "protect" schizophrenics from forced therapy with sometimes catastrophic results for the patient's (and others') health. Although Satel agrees with the purveyors of PC (whom she labels "the Indoctrinologists") that social forces can be a major health determinant, she takes strong issue with the implied notion that we should thus give up our sense of personal responsibility for our health.
The book is closely argued, with multiple examples from the fields of women's health, cancer, psychiatric illness and what she calls the "dumbing down" of nursing education. The book is well referenced and Satel seldom makes a factual point without a citation being listed to support her point.
Indeed, from her litany of complaints, the reader can see that there is indeed a lot remiss in the direction that some elements in the American health system are taking. However, there is unfortunately an element of "the sky is falling" to this book. This tractate is clearly a polemic and a call for action. If we heed not her warnings, "...their prescriptions [those of the Indoctrinologists] will be hazardous to our health."
There is hardly a word in the book about the other ills of American medicine; for example, the waste and inefficiency of it all or the fact that the US health outlay is more than 14% of its GNP (Canada of course spends far less and has better health statistics to boast for her smaller investment). Neither is there a word about the shocking fact that more than 40,000,000 Americans survive without any form of health insurance and that many millions more are underinsured.
Perhaps it should come as no surprise to the reader that Dr. Satel is a fellow of the American Enterprise Institute, not exactly the last bastion of social democracy. Her concern over the beliefs of the "Indoctrinologists" includes her oft-expressed fear that they might succeed in "
social actions that would disrupt our prevailing economic and social systems." Perhaps this is unfair but there is just the whiff of McCarthyism in her style.
The book has the tone not only of a warning. As one reads one example after another of some admittedly rather foolish notions of the PC crowd, I began to think that perhaps the lady doth protest too much. And my initial impression was strengthened by something which appeared in the New England Journal of Medicine (April 12, 2001, pp. 1170-1). In a most unusual move, Dr. Satel wrote to criticize a review of her book which appeared in that journal, protesting strongly what she perceived as a serious slight by the reviewer.
From the Right, Satel rightly criticizes the PC pushers for being more concerned with social and political issues than with the notion of health. However, the book is more of a polemic, albeit with an interesting message, than a sober account of what is so wrong with the American health care system today.
Dr. Clarfield, MD, FRCSC, is the Chief of Geriatrics, Soroka Hospital Centre, a Professor and Sidonie Hecht Chair of Gerontology, Faculty of Health Sciences at Ben Gurion University of the Negev in Beersheva, Israel , and an Adjunct Professor in the Division of Geriatric Medicine, McGill University and Jewish General Hospital, Montreal, Canada.