Sally Satel, a W. H. Brady Fellow at AEI and the author of PC, M.D.: How Political Correctness Is Corrupting Medicine (Basic Books, January 2001), delivered the fifth of the Institute’s 2000-2001 Bradley Lectures on January 8. Edited excerpts follow.

A few years ago, a colleague told me about San Francisco General Hospital. Whenever a new psychiatric patient was admitted to the hospital, 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 own unit; 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.

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

Most Americans are familiar with three eras of public health: the sanitation, biological, and lifestyle eras. Millions of lives have been saved, improved, and extended by the public health efforts of these three 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.

But this era will not enhance health. It will blur the focus of the public health profession and dilute its resources.

The diagnosis of the public health professionals who advocate postmodern medicine 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, that is, the good health of the well-off somehow depends on the poor being sick. So socially constructed is health, they insist, that the individual can do little to influence his well-being.

But the link between wealth and health is not necessarily fixed. 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 alcohol—account for the largest share of risk.

Public health has always had a reformist spirit, but 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. The only acceptable remedies in postmodern medicine are social actions that would disrupt our prevailing economic and social systems.

I am not defending the status quo of our health care system. It has too many uninsured individuals and gross inefficiencies. 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.

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? Already many programs are evaluated by how much the "self-esteem" of subjects has improved. Hard data on health outcomes, such as vaccination rates and compliance with tuberculosis medication, are a distant second in terms of importance.

I urge you to resist postmodern medicine. Object when medical professors politicize their classrooms, practice "multicultural" counseling, or dumb down nursing education. Object when we waste money on federal grants to fund research on the health effects of unquantifiable variables such as "powerlessness" and "classism."

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.