Language Police
“PC, M.D.” by Sally Satel
A doctor argues that affirmative action and ignoramus patients organizations are ruining American healthcare.
In 1986, Yale surgeon and author Sherwin Nuland was sitting on a bioethics committee that was hearing the case of a heart surgeon who wouldn’t operate on a patient with AIDS because he had abused intravenous drugs.
The patient needed a lifesaving procedure to replace one of the badly infected valves in his heart, but the surgeon said he couldn’t justify the operation for an intravenous-drug user. He rank-ordered patients with HIV, he said unapologetically: He would operate on hemophiliacs who had contracted the disease through blood transfusions and on gay men who had contracted the disease through sex, but he wouldn’t operate on drug abusers who had contracted it through dirty needles. Dumbfounded, Nuland realized at that moment that, for doctors, “the lives that have the most value are those with which we most identify.”
Not much has changed in a decade and a half, and a growing number of studies suggest that perceptions, race and gender do have an effect on the care provided to patients. When I show up in an emergency room with my inevitable heart attack, a number of studies suggest that I will have a much better chance of receiving lifesaving therapy than a white woman, a black man or a black woman, in that order, does. Hispanics in Los Angeles and blacks in Atlanta were much less likely than whites to receive pain medication when they came to the emergency room with broken legs, according to other studies. When they leave the hospital, according to a recent study, many minority patients can’t find the powerful painkillers they need in their neighborhood pharmacies. The disparities, including those in organ transplantation, go on.
But Sally Satel, a practicing psychiatrist, isn’t worried. In her new book, “PC, M.D.,” she dismisses these studies and others as seriously flawed outgrowths of a politically correct movement that’s taking over medicine and threatening to put patients in danger. Satel is more worried that patients are being discouraged from taking greater responsibility for their health. They’re no longer being counseled about improving their diets, taking preventive measures against sexually transmitted diseases or quitting drugs; instead they’re being encouraged to accept their status as victims of an unjust healthcare system founded on racism and sexism. By claiming oppression, groups from nurses to former psychiatric patients are overrunning medicine and championing causes — “therapeutic touch,” “multicultural counseling” and affirmative action in medical school admissions, among others — that are at odds with good patient care. “At best, they create distractions and waste money; at worst, they interfere with effective treatment,” Satel writes
To be sure, there are problems with some of the studies that suggest that racism exists in medicine. For example, a study on differences in the treatment of lung cancer between blacks and whites never asked whether black patients, who fared more poorly, showed up at doctors’ offices later in the course of the disease. But pointing out flaws like this doesn’t make the studies completely invalid. Many studies have flaws; we still base clinical decisions on them. When the sheer mass of studies, each with minor flaws, points in a certain direction, we act on them. When a whole bunch of studies says basically the same thing, we should probably be worried about it.
Most damning to Satel’s argument, however, is that she doesn’t try to deny that minorities don’t have the same access to care that whites do. She just says that the studies fail to prove that these inequalities are due to racism. Unfortunately for her, that’s a pretty major concession. Even if we can accept that all Americans don’t have equal access to country clubs, most of us believe that we should have equal access to healthcare. The data says we don’t, and whether that’s a result of conscious racism, institutional racism or no racism at all, it’s a reality that decent people want to remedy.
Satel also has a real problem differentiating fringe academics from in-the-trenches doctors, or even mainstream doctors. For example, she dwells at length on Brown University public health professor Sally Zierler, whose theories on HIV seem to eschew practical prevention (i.e., condoms) in favor of victimology (i.e., those who don’t use condoms are “seeking sanctuary from racial hatred through sexual connection”). That sounds scary, and it is. But who’s listening? No practicing doctors I know, and Satel doesn’t provide any evidence for any, either.
If Satel’s statistical deconstruction of studies of racism in medicine is convincing to some, she fails completely in her attempts to show that the menace posed by political correctness to medicine is anywhere near as serious as she contends. (“Indoctrinologists,” as Satel terms “politically correct practitioners” of medicine, have “infiltrated” respected academic journals. I think the ghost of Sen. Joe McCarthy is smiling.)
In only a few places in the book does Satel bother to provide any quantitative evidence that “political agendas … are diverting resources from vital clinical tasks” or that political correctness can have “life-or-death consequences.” In one, we learn about a $200,000 teaching grant from the Department of Health and Human Services and a $355,000 research grant from the Department of Defense — both on the subject of a very questionable technique known as therapeutic touch. The technique is crap, as I’ll readily acknowledge; Satel points out, correctly, that a 9-year-old was able to debunk it in a study published in the Journal of the American Medical Association. A similar debunking was posted to Medscape General Medicine, an online medical journal, just last month. But with each department’s annual budget on the order of hundreds of billions of dollars, I just can’t get that exercised about these small grants.
Nor could I get excited about “$40 million in grants [made] available to applicants who wanted to develop trauma programs for women” in 1999, although at least in that case it’s a slightly more substantial sum of money when compared with the $2 billion to $3 billion budget of the grant-making federal agency, the Substance Abuse and Mental Health Services Administration. Even if one agrees with Satel that such grants are a bad thing (hardly self-evident, since in addition to the questionable trauma claimed by many, there is real trauma faced by battered women), she doesn’t say whether the grants were actually made; they were only “made available,” which often means unclaimed.
It would be useful to compare the funds spent on all of the studies and programs Satel finds flawed or useless with the total healthcare budget or some segment of it. That would help determine just what part of the healthcare budget was siphoned off, according to Satel, by the $5 million awarded by New York, the $1.6 million awarded by New Jersey and the $1.2 million awarded by Tennessee to “consumer-run” health organizations in 1995.
Satel’s backup material is sloppy elsewhere as well. In trying to counter the charge that women aren’t included in clinical trials of drugs, rather than find real numbers, Satel simply relies on a professor of psychiatry at Yale and the former head of a Food and Drug Administration division who told her that “women were routinely included” in studies of antidepressants in the 1950s and 1960s. No counts. No data. She lists the percentages of women overall in government-sponsored trials, but the important question is how much of medicine being practiced on women today is based on trials performed on men years ago — and she doesn’t address that.
Satel’s lack of attention to total costs — and to real analysis of data like the number of women in trials — is unacceptable in any sort of rigorous argument. Search high and low for evidence of a larger trend, and all you’ll find is Satel suggesting that “the anecdotal cases I have uncovered are probably the tip of the iceberg.” Simply attacking what Satel considers common-sense health programs can get you painted with the same politically correct brush as the true wackos. In Charleston, S.C., in 1989, police and health officials created a harsh policy that basically equated drug use during pregnancy with child neglect or delivery of drugs to a minor. Of course, the ACLU and other groups were up in arms. Satel launches a tirade against those who opposed the policy, seeming to forget that putting pregnant women in jail is a pretty horrible idea, and that the basis of the policy — that a fetus is a minor — violates Roe vs. Wade.
When Satel decries affirmative action in medical school admissions, she sounds a typical conservative alarm filled with tautologies presented as stunning conclusions. For example, because of fewer opportunities at the high school and college level, minority students admitted to medical school are less prepared for the curriculum, so they do relatively poorly in their courses (and some fail and have to drop out). Then, of course, they do poorly on medical board exams. None of these revelations seems particularly earthshaking, and dwelling on them ignores the intangibles that are probably equally as important as grades in being a doctor — intangibles that Satel spends just a page and a half on. And she offers without comment the idea that women are not rising more quickly through academic medical ranks because they’re taking time off to raise families. It’s 2001. Most reasonable people agree that husbands can and do now shoulder some of that burden.
The thought control Satel is trying to promote seems more dangerous than the wacky ideas of a few public health school faculty members. Satel is trying to wrest control of medicine back from patients, whom she sees as ignoramuses who can’t possibly know what’s good for them. Big, paternalistic government is bad, according to conservatives, but paternalistic medicine is evidently good, according to Satel, who doesn’t seem troubled by the contradiction between diminishing patient autonomy and encouraging patients to take responsibility for their own healthcare. She’s arguing for a remarkable sort of paternalism.
This all fits in nicely with managed care’s plans for the world: Cut down the amount of time doctors can spend with patients, who will then run to the Internet for medical advice. But there they’re more likely to find charlatans and snake-oil salesmen than reasonable medical opinions. Managed care, which presents more clear and present danger to the public’s health than anything denounced in Satel’s book, is barely mentioned. When it is, it’s praised for cutting down lengths of stay in long-term mental hospitals and defended against charges that minorities aren’t well represented in physician rosters. Similarly, Satel ignores the influence of politics on the medical arena when she agrees with certain policies, such as those against abortion.
Satel’s thesis would be less troubling if she presented a clear vision of how to equalize the inequities in healthcare, which she acknowledges, even though she doesn’t think they’re the result of sexism or racism. She seems at one point to encourage “cultural competency” — defined by the American Medical Association as familiarity with the “beliefs, values, actions, customs, and unique health needs of distinct population groups” — although this itself is a politically laden term and her message is muddled.
Satel approvingly cites Anne Fadiman’s “The Spirit Catches You and You Fall Down,” the well-received 1997 book about the cultural clash that resulted when the immigrant parents of a young Hmong girl with severe epilepsy resisted American doctors’ attempts to treat her. “In this account there are no villains,” Satel writes. That’s what the reviews all said, but has Satel actually read the book? While I agree that the book is a more balanced and powerful account of such a story than can be found elsewhere, I finished reading it with the distinct impression that the doctors were the villains, even if well intentioned. (That impression was only bolstered by hearing Fadiman at a recent conference refer to the girl’s persistent vegetative state as being the fault of a medical mistake.)
Satel is a conservative ideologue in a doctor’s white lab coat. Unfortunately, her voice is likely to carry a lot of weight among those who will be setting health policy in the Bush administration. Even Satel agrees that there is a problem in the delivery of healthcare to minorities. Rather than lambasting those who are trying to identify the source of the problem, conservatives should join liberals in trying to figure out how to solve it.
The audacity of “hopefully”
The AP Stylebook makes a change -- and breaks our hearts
It was bad enough last year when Oxford edged toward edging out that most beloved and sensible of punctuation marks, the Oxford comma. This week, the venerable AP Stylebook has decreed that “Hopefully, you will appreciate this style update, announced at #aces2012. We now support the modern usage of hopefully: it’s hoped, we hope.” To which a million language nerds replied, Noooo!
Continue Reading Close
Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
The loud American I swore I’d never be
When I moved from Canada people mocked me for my "aboots." I promised I wouldn't change. I was wrong
(Credit: dundanim via Shutterstock) If you met me after I moved to America, you would likely notice a few things. I’m tall. I wear a lot of flannel. I have questionable taste in shoes. And I sound absolutely adorable. I know this because I have been told it over and over since I moved from Canada five years ago. “You sound adorable,” said a neighbor in my East Village walk-up during my first week in New York. “Adorable,” said a classmate at grad school orientation, right before he told me that Canadians all seemed dreadfully boring.
I had no idea I even had an accent, let alone that I sounded adorable, before I moved here. But in learning about the way I spoke, I ended up learning a lot about my adopted country — and about myself.
For most Americans, it’s almost impossible to tell a Canadian accent from a Midwestern one. And to be fair, the differences are pretty subtle. We pronounce some of our vowels like the British (something linguists call “Canadian shift”), and raise our diphthongs before voiceless consonants (called “Canadian raising”). But most people identify us by our different ways of pronouncing “au” sounds — which, to some people, sounds like “oot” and “aboot” — and our tendency to say things like “eh” and “heh” at the end of tentatively declarative sentences.
To make it more confusing, most Canadian celebrities seem to lose their accents as soon as they become even mildly famous. You’d never think that Rachel McAdams or Jim Carrey both hail from Ontario by listening to them. The Canadian of the moment, Ryan Gosling, has famously shifted from a Cornwall, Ontario. accent to a butch Brooklyn truck driver accent over the course of his career. There are even companies that specialize in teaching Canadian actors to start talking like Americans.
Thomas Rogers is Salon's Arts Editor. More Thomas Rogers.
Concise Oxford Dictionary adds “sexting,” “woot”
"Current English" lexicon welcomes words that range from "cyberbullying" to "jeggings"
In 1911, Henry and Frank Fowler published “a completely different kind of dictionary, one that sought primarily to cover the language of its own time” — the first Concise Oxford Dictionary. This year, the 12th edition of the popular lexicon hits shelves, complete with several hundred new entries.
The “Concise” differs from its behemoth cousin, the OED, in philosophy as well as size. As the following promotional video explains, the shorter work aims to provide an accessible guide to “current English” — the language as it is actually used day-to-day — rather than a survey of its words’ historical meaning. (Where size is concerned, it’s worth noting that the new COD boasts just over 240,000 words and phrases, compared to the 20-volume OED‘s 600,000.)
Continue Reading CloseEmma Mustich is a Salon contributor. Follow her on Twitter: @emustich. More Emma Mustich.
Abusing the word “rape”
The use of it as a punchline and lazy shorthand for awful experiences is a reminder that language matters
Just yesterday, I wrote critically about the push to use the term “birth rape” to describe abusive experiences during labor. Today, the U.K. Guardian kicked off a related debate with an excellent piece about “the rise of rape talk.”
Kira Cochrane writes that “the use of the word ‘rape’ to describe all kinds of bad experience — from getting beaten up in a boxing match, to having your hairdo completely ruined — has recently become usual, average, shruggable.” She compares this linguistic shift to how “the word ‘gay’ has been twisted by pop culture, used to refer to someone or something a bit uncool” — rape is “now regularly used where ‘nightmare’ or an apt expletive would previously have been in order.” She gives some familiar examples: “Twilight’s” Kristen Stewart comparing being hounded by paps to being raped, that controversial scene in “Observe and Report” and the usual vitriol from Glenn Beck and Rush Limbaugh. Cochrane also gives a more startling personal example:
Continue Reading Close
Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory.
The ridiculous “$#*! My Dad Says” controversy
The title of CBS's new fall TV show is drawing complaints, but hiding that swear word isn't going to protect kids
CBS officially refers to it in print as “$#*! My Dad Says.” In promos, it’s “Bleep My Dad Says” — not “[bleep sound] My Dad Says,” but “Bleep My Dad Says.” And its identifying image, of William Shatner with tape over his mouth, makes it clear this sitcom is well aware of that which cannot be said. It’s shit. As in, the Twitter phenomenon Shit My Dad Says, the thing that turned into the best-selling book “Sh*t My Dad Says,” now watered down even further into a series of nonsensical characters to become a prime-time sitcom on the Tiffany network.
Continue Reading Close
Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Page 1 of 4 in Language Police