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Friday, Nov 27, 2009
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.
