Political Correctness Is Corrupting Medicine

PC, M.D. Sally Satel Basic Books, 2000 Sally Satel, the author of PC, M.D. is a lecturer at Yale University who has practical experience in working with cocaine addicts. In her practice she has noticed that for success addicts need to want to change (and are often ambivalent about drugs), and need to take responsibility for getting better. A theme of this book is how modern trends for regarding people as members of victimized groups prevents them from taking responsibility for their own health. This shows up in the discussion of feminist counseling and multicultural counseling. In these, the emphasis is on political action and the status of women or oppressed peoples. The basic problem with the therapies is that there is no evidence that they work. However, there is a major risk of diverting the patient from what he can do to solve his own problems. They also appear to violate the generally agreed ethical standard that the therapist should not thrust his values on the patient. Likewise, the tale is told of the crack moms of South Carolina. That state tried to get them into treatment using the threat of arrest and imprisonment for child neglect or the delivery of drugs to a minor if they used drugs just prior to delivery, tested positive for drugs more than once during the third trimester, or if they refused treatment for drugs. The goal was to get the women into treatment for their children's sake. From a medical viewpoint the program worked. The number of cocaine positive drug tests among pregnant moms dropped from more than 20 per month to 5 or 6. The program produced the predictable outcry among the civil rights establishments, both among those who disliked the idea of forced testing, and among those charging racism because most of the affected mothers were black. Incidentally, since the book was published the US Supreme Court has held that the required blood testing of the South Carolina women with possibility of unfavorable results being sent to the police constituted an improper search. Satel quotes the joke about how many psychiatrists does it take to change a light bulb (only one, but the bulb must want to change! ). She believes (partially based on her own experience with addicts) that for any hope of success the patients must try to change. In her experience most addicts are somewhat ambivalent. The outside world often can supply the pressure needed to induce them to accept the responsibility of changing. The threat of imprisonment or of losing their children is one way to apply such pressure. Addicts are notoriously poor self-disciplinarians and treatment programs should help to provide them the discipline they lack. To Satel's credit she avoids overstating the damaging effects of cocaine, stating that follow up studies have failed to find the "horribly brain-damaged cohort of ghetto children predicted in the 1980's". From better studies it now appears that the effect of cocaine use on IQ is only about three points. However, the environment provided by addicted parents is very bad in many ways and few would doubt that getting mothers off of the drugs is highly desirable. One successful program offers mothers $200 for undergoing sterilization or $50 if they will obtain a sustained-release hormonal birth control pill, such as Norplant. As of the summer of 1999 the program had paid 57 women. These women had been pregnant a total of 423 times already, resulting in 161 abortions, 40 dead babies, and 175 babies in foster care. Arithmetic shows only 47 remained with their mothers, indicating that the large majority of the offspring were ending up in foster care. Given the high cost of foster care and abortions, such a program could be justified on purely financial grounds, and is amazingly cheap (I would not have expected many to accept sterilization at only at $200). Yet despite its success, this privately financed program has attracted great criticism. …