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Sunday, Nov 8, 2009
A doctor argues that affirmative action and ignoramus patients organizations are ruining American healthcare.
Feb 12, 2001 | 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.
