Not even medicine is immune to political correctness. I realized this a few years ago when a colleague told me about San Francisco General Hospital.

At the Hospital, whenever a new psychiatric patient was admitted he was assigned to a ward specializing in one of six groups. African American patients were sent to what was called the Black Focus Unit; women who were depressed or psychotic to the women’s unit; gays, lesbians, and bisexuals to their respective units; and so on for Latinos, Asians, and HIV-positive individuals.

The only patients without a ward dedicated to them were white male heterosexuals: They had to make do with the random unoccupied bed on the other wards.

The staff on each ward was guided by a "curriculum," which specified procedures for treating members of the group; the core feature of the curriculum was educating patients in the ways society had victimized them: the malignant effects of patriarchy, racism, homophobia, and so on. The psychiatrists who ran their various programs apparently believed that psychological readjustment was not possible without an understanding of one’s place in the ongoing drama of the dominant and the disenfranchised.

This worrisome little adventure in psychiatric apartheid captures the logic of postmodern medicine: that patients should be regarded as members of victim groups, not as individuals who are suffering.

Alas, the long march of political correctness through the institutions, starting in university humanities departments, has not stopped at the doors of our hospitals and schools of public health.

The first chapter of my book PC, M.D. is devoted to the growth of this movement, postmodern—or politically correct—medicine. And its unfortunate, possibly disastrous, consequences are what I will talk about today.

A few years ago I attended the annual meeting of the American Public Health Association and saw on vivid display the belief held by its elite that our health is almost entirely at the mercy of social forces. Draped across the main meeting hall was huge banner announcing the theme of the conference: "Social Justice in Public Health." The keynote speaker: not a latter-day Albert Schweitzer, but John Sweeney, president of the AFL-CIO, who extolled the virtues of unionization.

I attended a popular session called "Putting Politics into Public Health Education," at which a professor from the Berkeley School of Public Health urged his colleagues to "merge the academy with advocacy."

And indeed they are.

In many schools of public health, in fact, the quest for social justice seems to overshadow the primary mission of public health—tracking and preventing injury and disease. Former dean of the Harvard School of Public Health, Harvey Feinberg: "A school of public health is like a school of justice."

Nancy Kreiger, also of Harvard School of Public Health, was one of the speakers at the annual meeting. Just one month before, in October 1996, she and a colleague made headlines by publishing an article in the American Journal of Public Health claiming that the stress of being a victim of racial bias could account for the higher rates of high blood pressure in African Americans. Never mind that the raw data did not support her conclusion, the idea that, according to a Washington Post headline, "Discrimination May Cause Hypertension in Blacks," took hold. It even appeared in President Clinton’s 1998 Initiative on Race, which stated that the "discrimination may create stress leading to poorer health among members of racial minorities."

I acknowledge that is does make a compelling story to claim that victimhood is manifest in the body, not just the soul. But Krieger’s data did not support that story.

Needless to say, we all want a healthy and humane society, but practically speaking, patients with high blood pressure can do a lot more for their health over a short period of time than can campaigns for social transformation. The data do support that.

Take something as mundane as a low-salt diet. This by itself can sometimes correct high blood pressure, especially in black individuals, who tend to have "salt-sensitive" hypertension more often than whites.

More interesting is a study on blood pressure treatment from the National Institutes of Health. When subjects enrolled in the study, the anticipated relationship between socioeconomic status and incidence of hypertension was seen. But after a few months on medication and diet, the relationship between socioeconomic status and this particular health variable disappeared.

This study makes a very powerful point. It shows that the health-wealth linkage, so dear to purveyors of PC medicine, is not necessarily fixed. But you won’t hear that from them. You also won’t hear about Mexican women who are recent immigrants to the U.S. Their babies have the among the lowest infant mortality rates (6 per 1000 live births; same as whites) even though they themselves are among our poorest citizens, are the least likely to have public health insurance, and have the highest rate of births outside of a hospital.

So shocked were the researchers who first made this observation that they called it the "epidemiological paradox." But it’s not really such a mystery. Pregnant Mexican-American women make sure they have good nutrition and rarely smoke, drink, or use drugs.

In fact, one would never know, listening to the new public health elite, that people have considerable control over the majority of threats to their health. About half to two-thirds of all premature deaths (death before age sixty-five) are postponable or preventable, three factors alone—smoking, being overweight, and drinking too much—accounting for the largest share of risk. It is not "blaming the victim" to acknowledge this—as one Centers for Disease Control and Prevention (CDC) official has charged—if anything, it is dereliction of duty not to acknowledge the elements of lifestyle that we can control.

PC medicine may skirt the personal responsibility angle, but in other ways it has little sense of professional boundary. The American Public Health Association has issued position statements on aid to the contras in Nicaragua, war in the Middle East, and campaign finance reform.

Now I should say here that public health has always had a reformist spirit—this is inevitable and probably desirable in some regards. In the mid-1800s German physician and statesman Rudolph Virchow called physicians the "natural attorneys of the poor" recognizing that fitness and health were directly and inextricably linked to improving dismal living and working conditions and malnutrition.

By contrast, the currents of political correctness now flowing through the profession are generated not by pragmatism to change real circumstances but by an ideology intended to manipulate the way people think about the origins of disease and its remedies.

We are now on the threshold of the fourth era of public health. Most Americans are familiar with three eras of public health—the sanitation, biological, and lifestyle eras. The first of these, the sanitation era, goes back through the ages. When Moses was leading his people through the wilderness, observing rules for a hygienic campsite were vital to survival, including not drinking water with dead animals in it, burning clothes of a person who’d died from contagious disease, hand-washing. Fast-forward to modern times when the perfection of civil engineering including water purification and refuse disposal helped control contagions like typhoid and yellow fever.

The late 1800s marked the start of the biological era, when the bacteria that cause specific diseases were identified. Louis Pasteur developed the germ theory of disease and the process called pasteurization; this was followed decades later by the discovery of the sulfa drugs and penicillin and the polio vaccine in the 1950s.

The 1970s brought the lifestyle era, marked by campaigns against preventable injury and chronic illness: stop smoking, eat less, exercise more, wear seat belts, wear helmets, wear condoms.

Millions of lives have been saved, improved, and extended by the public health efforts of these three landmark periods. Now, at the turn of the twenty-first century, a fourth era, postmodern medicine, is emerging, powered by the idea that injustice produces disease and political empowerment is the cure.

It won’t enhance health, but it will blur the focus of public health profession and dilute its resources.

Lawrence Wallack of Portland State University sums it up well when he says, approvingly, that "The practice of public health is, to a large degree, the process of redesigning society. It is more about closing the ‘power gap’ than the ‘knowledge gap.’" His rationale is simple: Since health is related to wealth and social position, we should try to equalize power in society in the name of health.

An agenda that incorporates abstract, broad social goals into schools of public health cannot fail to have an impact on the upcoming generations of public health professionals. I recently spoke with a beleaguered professor—who refused to be named—at the Harvard School of Public Health. He bemoaned the fact that so many of his colleagues were politicizing their classrooms. He described the demoralization of his students who complained about feeling "utterly pessimistic . . . as if there were nothing they could do as public health experts until the revolution."

I contacted one of those students who had since graduated. She told me that she and a number of fellow students were learning no marketable skills. Though well instructed in what a colleague of mine calls Resentment Studies, to get jobs in their field they had to take courses at the School of Education and the Kennedy School of Government in order to acquire practical skills. "I wanted to have some credibility; I wanted to be able to do something."

Who are these teachers who seem so good at politics, perhaps even putting them before their students? Sally Zierler of Brown University’s Program in Community Health seems to be one. She herself told a reporter: "Those of us who were activists in the 1960s are now professors. In the 1950s we would have been blacklisted."

Indeed, at the 1998 American Public Health Association meeting, Zierler gave a lecture in which she told audience members that their goal as public health professionals should be to overthrow the "competitive meritocracy." Why? Because, in her words, "unequal distribution of goods and services and property and profit means that deprived populations are less able to protect their community from disease"—she was talking in particular about AIDS.

I call Zierler and her colleagues indoctrinologists: Their diagnosis is inevitably "injustice," and their prescription is political change in the name of health. Their vision is typically advanced in Marxist terms in which the world is a zero-sum game. In other words, the good health of the well-off somehow depends on the poor being sick.

The radicalized study of social influences on health even has a name: It is called the "social production of disease."

A favorite case that social productionists use to illustrate the point that good health of the well-off somehow depends on the poor being sick is the Whitehall study. Conducted from 1967 to 1977 on British civil servants, the first phase of the study found a gradient in mortality from heart disease that increased from the top grade of employment and pay down to the lowest-paid, menial jobs.

There were five grades of civil service, and the death rates, as expected, were highest at the bottom. After all, folks at the lower reaches of socioeconomic status are more likely to smoke and drink, are less educated about health risks. Access to health care was not an issue because of the National Health Service.

But the researchers were surprised to find that the workers in the second-highest tier—well-educated, well-paid folks—were still substantially more likely than those at the very top to die of heart disease before a certain age. Their interpretation of the top-tier versus second-tier difference was that the second-tier workers experienced the stress of having "low-control jobs": a lot of responsibility with minimal authority.

Personally, I find the Whitehall study compelling. We surely know from lab studies that when animals like rats and monkeys are not able to control their environment—to escape a shock, for example—they suffer physically: They lose their fur; their immune systems are suppressed; they become sluggish-passive. It ’s called learned helplessness . . . and it probably occurs in people too, though it’s harder to study experimentally.

Let me say that the original British researchers who conducted the Whitehall study were cautious and responsible in their interpretation of their data. It is the latter-day indoctrinologists who have used the Whitehall study as a cautionary tale about the perils of economic hierarchy. As John W. Lynch and George A. Kaplan of the University of Michigan speculate, "Health may be affected through individual appraisals of relative position in social order."

Richard Wilkinson of the University of Sussex in England, who is considered the father of social production theory, is more emphatic: "The higher health achievement of egalitarian societies makes a persuasive case for the redistribution of income." Wilkinson bolsters this statement with research that claims to show that countries with higher levels of income inequality have citizens with lower life expectancies.

But wait a minute. What about alternative lessons to be gleaned from Whitehall? For example, couldn’t we just as reasonably view the study as an object lesson in the importance of free enterprise, accountability, and opportunities to be creative on the job and the promise of social mobility? To have high job control.

And what about the relentless emphasis on health and wealth relationships? These academics could just as easily look at the linkage between education and health and take up the fight for school choice in inner cities with failing public schools if they burn to be social activists. And wouldn’t it make sense to encourage marriage and religious activity, since both are associated with better health?

The answer by now should be clear: The only acceptable remedies in PC medicine are social actions that would disrupt our prevailing economic and social systems.

Vexing also is the nihilism with which indoctrinologists regard the individual. So socially constructed is health, they insist, that there is not much the individual can do to influence his well-being. I find this lack of faith in people disheartening. I am much more optimistic—perhaps because, unlike the ivory tower indoctrinologists, I get out once in a while.

I work as a staff psychiatrist in a methadone clinic in northeast Washington, D.C. Methadone, a long-acting heroin replacement, could be considered a treatment of last resort for many addicts. Yet with the exception of a handful of our most mentally ill patients, it is the rare patient at our clinic who is clueless about how to get himself together.

Not all of them want to take advantage of the relapse prevention therapy we offer and job training programs, but many patients choose to do so. And it works! Is it hard for them? Most assuredly, but what can PC therapy offer them instead? Simply the demoralizing message that drug abusers truly don’t have a choice or a chance—that is, until sexism or racism disappear or inequalities in wealth are abolished.

The message about oppression was exactly the one given to patients at another drug treatment program I encountered; it was part of the District of Columbia superior court. The patients were nonviolent offenders who had been charged with minor drug crimes and were given the option of going to a treatment program instead of to trial and, possibly, then onto jail.

The patients were all African American men in their twenties and thirties. Most of them did not graduate high school; a number had GEDs. Most were functionally illiterate with poor math skills. They had minimal work experience. When I got there the clinicians (counselors) were practicing a kind of therapy called "multicultural counseling" (MCC).

The main tenet of MCC—which will sound similar to the doings at San Francisco General—is that the patients’ symptoms are a result of friction between him or her and the oppressive society.

Accordingly, these patients spent many of their five court-ordered hours a day in the program sitting in counselor-led groups talking about how they felt oppressed. Sometimes they did art projects, like coloring in stenciled pictures of the African continent as part of an effort to promote ethnic pride.

When I met with the patients, individually I asked them what they thought of the program. They were struggling to be polite: "Mickey Mouse" and "a waste of our time" were common characterizations. What they wanted, they said, was to get a GED and learn a trade like plumbing or electrical wiring and join a union. If the situation weren’t depressing enough, the patients had no choice but to remain in a third-rate program because they were ordered there by a judge. Don’t get me wrong; the fact that they were required to attend was a blessing. That precious opportunity was squandered, however, on feel-good exercises conducted by multiculturally oriented counselors who left them as uneducated, as unemployable, and thus as vulnerable to relapse (and crime, I should add) as when they came in.

Now, you may be thinking, yes this is a shame and a badly run program, but how common is it?

MCC is very common. Virtually all graduate programs in counseling have courses in it; one can specialize in it. MCC is heavily promoted by the American Counseling Association; graduates of the counseling programs populate public school systems, social services, and criminal justice.

Wrapping up now I don’t want you to think that I am defending the status quo of our health care system—too many uninsured, gross inefficiencies, and so on. Right now the health care safety net, including public primary care clinics, needs shoring up, and I was glad that the recent Congress made strides in passing legislation to help remedy that. But public health is not equipped to fight widespread injustice and cannot squander on a utopian vision the energy and resources needed to prevent and combat the chronic diseases and disabilities from which Americans are suffering right now.

The philosophy of PC medicine is not quarantined in the ivory tower, as the patients in San Francisco and the D.C. drug treatment program well know. Graduates of the schools of public health go on to run state health departments and divisions within the Department of Health and Human Services and the CDC.

What will happen to health education programs if the people charged with funding and administering them think that social forces so overwhelmingly determine health and that individual efforts are largely meaningless?

How will they measure the success of programs, say AIDS prevention programs? Already we see that many programs are evaluated by how much the "self-esteem" of subjects has improved . . . not whether HIV transmission rates declined. In my book I write about "empowerment research"—often funded by the CDC—which is based on making the community feel more empowered. Meanwhile hard data on health outcomes (such as vaccination rates, compliance with tuberculosis medication) are a distant second in terms of importance.

I wonder whether the new public health officials shy away from mandatory testing and partner notification in the case of an infectious STD because of the paternalism intrinsic in such a policy? (The American Public Health Association has been silent on HIV testing of newborns and has opposed mandatory testing of pregnant women; that is important because viral medications can cut HIV transmission rate to the fetus.)

It is the indoctrinologists who made the rest of the book possible; each chapter describes how victimology has infiltrated medicine. I tell the story, for example, of how women’s studies programs have gone to nursing school where they are pushing an antiscience agenda. As health journalist Sarah Glazer wrote recently in The Public Interest, "words like quantitative research and even measurement are code for all that is patriarchal and insensitive about modern medicine."

The most glaring manifestation of PC nursing is the embrace of alternative medicine. One of these is therapeutic touch (TT): supposedly cures anything from migraines to infections by smoothing out the energy fields that surround us. Nonsense. Yet it is endorsed by the American Nurses Association and the National League for Nursing, the accrediting body for nursing schools. TT is taught in about eighty nursing schools.

We are on the brink of a disastrous nursing shortage and need the most astute nurses we can find, not those trained to believe in quack therapies and that the male medical hierarchy is suppressing them. (Look at the National Council for Reliable Health Information, which tracks patient casualties of PC nurses, such as the nurse practitioner who performed TT on a woman who complained of abdominal pain and who subsequently died from a ruptured appendix.)

I also predict you’ll be hearing more about the so-called health gap between minorities and whites. There is a health gap: On measures such as infant mortality, life expectancy, cancer screening, African Americans fall short. This is a problem, and it must be tended to but not by indoctrinologists who look for and find a power struggle behind every health problem.

Doctors and public health professionals of the PC persuasion were interviewed by the U.S. Civil Rights Commission for its 1999 report on health. In the end what the USCRC informed Congress and the White House was that "racism continue[s] to infect" the health care system.

I have reviewed in depth the data on alleged bias in the delivery of health care procedures in researching PC, M.D., and what I found is not evidence of systematic bias but the fact that some African Americans do harbor distrust of the medical system. (The long shadow of Tuskegee and memories of segregated hospitals as recently as the 1960s still linger.) Thus, baseless rhetoric about bias can only inflame suspicion. More realistically, it is attitudes about health and the health care system (and access to some extent) that contribute the most to the health gap. This is why the grass-roots community– medical center partnerships are the most promising ways to help shrink the gap.

I’ll just mention a wonderful program out of Howard University: MOTTEP (Minority Organ Tissue Transplant Education Program). Organ donation—especially of kidneys—is an important issue in the black community since black patients represent over one-third of patients on the renal transplant waiting list. Donation rates can’t keep up—especially live donations. MOTTEP educates the community about the transplantation process and encourages families to discuss this, sign organ donor cards, etc.

MOTTEP is now in over a dozen cities, sometimes working with black churches, and the donation rate has increased.

I encourage my colleagues to resist PC medicine. They must object when fellow professors politicize their classrooms, practice MCC, or dumb down nursing education. They should object when we waste money on federal grants to fund research on the health effects of unquantifiable variables such as " powerlessness and classism." An agency at the National Institutes of Health is making such grants available, and while I don’t want to censor research, I am certain that such work would be of dubious scientific merit: After all, if you can’t measure a variable, it’s hard to ask and answer questions about it.

The phenomena I discussed today are talked about in closed circles and between people who share the assumptions that malignant social forces inevitably lie behind differences in health and who think that self-care is a quaint middle-class value. But it is my hope that sunlight and common sense will be the best disinfectants. I await the day when San Francisco General Hospital desegregates its psychiatric units and embraces the not-so-radical idea that the individual, with his unique characteristics—and not his group membership—is the rightful focus of health professionals.