An interview with Dr. Sally Satel
Scott Jacobsen with In-Sight Journal interviews AEI's Resident Scholar Dr. Sally Satel

Article Highlights

  • Politicized medicine can come from both directions: left and the right.

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  • 118,000 people await a kidney, liver, lung, or heart. 18 of them will die tomorrow because they could not wait for a donated organ.

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  • I feel passionate about changing the law that makes it a felony to give something of value to a potential donor.

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1. What is your current position?

I am a Resident Scholar at American Enterprise Institute (AEI) and the Staff Psychiatrist in a Methadone Clinic in Washington, D.C. I am also a lecturer at Yale University School of Medicine.

2. What positions have you held in your academic career?

I was an assistant professor of psychiatry at Yale University from 1988 to 1993. From 1993 to 1994, I was a Robert Wood Johnson Policy Fellow with the Senate Labor and Human Resources Committee.

3. What have been your major areas of research?

I have written in academic journals on topics in psychiatry and medicine, and have published articles on cultural aspects of medicine and science in numerous magazines and journals. I am author of Drug Treatment: The Case for Coercion (AEI Press, 1999) and P.C., M.D.: How Political Correctness Is Corrupting Medicine (Basic Books, 2001). I am co-author of One Nation under Therapy (St. Martin’s Press, 2005), co-author of The Health Disparity Myth (AEI Press, 2006), editor of When Altruism Isn’t Enough – The Case for Compensating Kidney Donors (AEI Press, 2009) and, most recently, co-author of Brainwashed – The Seductive Appeal of Mindless Neuroscience (Basic Books, 2013)

4. What is your most recent research?

My new book has focused on the extent to which brain science, and brain imaging in particular, can explain human behavior. For example, what can a “lit” brain region tell us about an individual’s thoughts and feelings?

There is enormous practical importance for the use of fMRIs and brain science. However, non-experts are at risk of being seduced into believing that brain science, and brain imaging in particular, can unlock the secrets of human nature. Media outlets tend to purvey information about studies of the brain in uncritical ways, which foster misimpressions of brain science’s capabilities to reveal the working of the mind.

5. You published a new book called Brainwashed: The Seductive Appeal of Mindless Neuroscience with Dr. Scott O. Lillienfield. What is the core argument of your new co-authored book?

My co-author, psychologist Dr. Scott Lillienfeld, and I talk about “losing the mind in the age of brain science.” We mean that brain-based levels of explanation are regarded as the most authentic and valued way of explaining human behavior. Sometimes this is the proper way to go (when we want to uncover the workings of the brain for clinical purposes or to achieve new insight about the mechanisms of memory, learning, emotion, and so on). Understanding people in the context of their lives — their desires, intentions, attitudes, feelings, and so on — requires that we ask them, not their brains.

To clarify, all subjective experience, from a frisson of excitement to the ache of longing, corresponds to physical events in the brain. Scientists have made great strides in reducing the organizational complexity of the brain from the intact organ to its constituent neurons, the proteins they contain, genes, and so on. Just as one obtains differing perspectives on the layout of a sprawling city while ascending in a skyscraper’s glass elevator, we can gather different insights into human behavior at different levels of analysis.

With this template, we can see how human thought and action unfold at a number of explanatory levels, working upward from the most basic elements. A major point we make in Brainwashed is that problems arise when we ascribe too much importance to the brain-based explanations and not enough to psychological or social ones.

6. You have argued against politically correct medicine. How do you define this form of medicine? How is it detrimental to the discipline? In turn, how does it corrupt Public Policy decision-making?

I refer you to my book P.C., M.D.: How Political Correctness is Corrupting Medicine.

In short, the book exposes ways in which the teaching of medicine and public health, and also its practice, is distorted by political agendas surrounding the issue of victimization – in particular, the notion that poor health of minority populations (e.g., ethnic minorities, severely mentally ill people, women) is due to social oppression. In P.C., M.D. and The Health Disparities Myth (Click for full text), for example, I show that despite insistent claims that racially biased doctors are a cause of poor minority health, there are no data to support this.

Politicized medicine (which is different that PC medicine) can come from both directions: left and the right. For example, pro-life advocates exaggerate the extent to which abortion leads to depression and misrepresent aspects of the stem cell debate.

7. Whom do you consider your biggest influences? Could you recommend any seminal or important books/articles by them?

I greatly admire James Q. Wilson and had the honor to know him through AEI, where he was the Chairman of the Academic Advisory Council. In his 1993 book, The Moral Sense, Wilson was impatient with moral relativism, especially the idea that man was primarily a product of his culture. He argued that a moral sense was part of our basic nature, rooted in evolutionary biology.  However, he took issue with the over-correction to cultural determinism borne by rigid biological explanations of human behavior.

I am a fan of psychologists Steven Pinker (Blank Slate) and Timothy D. Wilson (Strangers to Ourselves).

8. What do you consider the most important point(s) in the cross-section(s) between Health Science and Public Policy?


Disability Reform and Mental Health Treatment are among the most important to me. In the case of Disability Reform, constructive ways exist to use incentives for guiding people back to the workforce or some kind of productivity. Unfortunately the system of disability entitlements, Social Security and veteran’s benefits, do not make good use of incentives to counteract the kind of learned invalidism that comes with chronic dependence upon disability payments. As for Mental Health Treatments, there are enlightened programs in use (though not widespread enough) to ensure that the most ill patients follow treatment recommendations and stay safe while living in the community. These programs entail a kind of civil commitment called ‘Assisted Outpatient Treatment’ and they require some strength of will on the part of policymakers to both enact and then enforce. For an effective example from the New York Times, click title: Program Compelling Outpatient Treatment for Mental Illness is Working

Additionally, organ shortage interests me. Today, 118,000 people await a kidney, liver, lung, or heart. Eighteen of them will die tomorrow because they could not survive the wait for a donated organ. Current law (1984 National Organ Transplant Act) demands that organs are given as “gifts,” an act of selfless generosity. A beautiful sentiment, yes; but for those without a willing loved one to donate or years to wait on an ever-growing list, altruism can be a lethal prescription. (Full disclosure: in 2006, I got a kidney from a friend. If not for her, I would have spent many miserable years on dialysis.)

The only solution is more organs. We need a regulated system in which compensation is provided by a third party (government, a charity, or insurance) to well-informed, healthy donors. Rewards such as contributions to retirement funds, tax breaks, loan repayments, tuition vouchers for children, and so on, would not attract people who might otherwise rush to donate on the promise of a large sum of instant cash in their pockets.

With private buying kept unlawful, available organs would be distributed not to the highest bidder, but to the next needy person according to a transparent algorithm. For organs that come only from deceased donors, such as hearts, or those that are less often given by loved ones, like livers and lungs, a pilot trial of government-paid or charity-financed funerals makes sense.

I went into detail here because I feel passionate about changing the law that makes it a felony for anyone to give something of value to a potential donor.

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About the Author

 

Sally
Satel

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