You would hope that medical journals were free from political correctness, but if so you would be sadly underestimating the thoroughness with which our intellectual redoubts have been colonised and taken over, so to speak, by people of a certain rather uniform general outlook.
They are the kind of people who use the words equality and equity interchangeably, who believe that poverty is having an income of less than 60 per cent of the median income irrespective of what the median income actually is, that you can have positive discrimination without negative discrimination, and that all differences in outcomes between groups must be the result of social injustice. Their most cherished freedoms are those to take drugs, have abortions and change sex. Of freedom of speech and opinion they are rather less certain; but they have a tendency to discover rights whose existence was unsuspected until quite recently.
They tend to be big-government types (themselves in government, of course, because they are deserving, rational, wise and well-meaning). And it is scarcely surprising that when people with such a mind-set control medical journals, the distinction between science and advocacy should sometimes be blurred.
Just how much this was so became clear to me on reading the New England Journal of Medicine for a year (2017) more closely than usual. The NEJM is, with The Lancet, the most prestigious medical journal in the world, and the media are apt to take its pronouncements as holy writ. Most doctors — I was one — skim journals and read the abstracts and conclusions of articles and assume that the editors have ensured that the conclusions are justified by the evidence presented. They trust the institution, but I discovered that they may not be altogether justified in doing so.
Let me give a single example of how science and advocacy become blurred — always in the direction of those with what Thomas Sowell has so succinctly dubbed "the vision of the anointed."
A huge and diligently statistical study was carried out, using the records of 60,935,443 Medicare patients, to correlate air pollution with overall death rates from all causes. There was, as expected, a correlation.
From this, both the authors of the article and that of an accompanying editorial titled "Air Pollution Still Kills," concluded:
These findings suggest that lowering the National Ambient Air Quality Standards [the permitted levels of pollution] may produce important public health benefits overall, especially among racial minorities and people with low income.
It is clear from this that, despite the immense statistical sophistication of the results, whose reasoning very few doctors could possibly follow, the authors and editors have made the elementary mistake of confusing correlation with causation, presumably because they liked the consequences of such a confusion.
In fact, they gave good reasons (without noticing them) for thinking that in this instance correlation did not mean causation. They noted that the effect on blacks was four times stronger than on whites, and while this could conceivably be a purely biological difference in the ways blacks and whites cope with polluted air, but is much more likely to be the result of intervening variables.
Indeed, if you performed the same investigating, say, the illegitimacy rate with air pollution, it is likely that you would find as strong, perhaps even a stronger, correlation: but no one would suggest lowering the illegitimacy rate – if anyone dared suggest such a thing at all – by reducing air pollution.
Note also that the authors and editors are fortunate to live in a costless world, that is to say, one in which large scale measures proposed by themselves have, and have only, the desired effects.
It is not only in large things, but in small, that political correctness makes itself felt in the pages of the NEJM. In 2017, it lectured readers on the correct vocabulary to use with regard to transsexualism (an incorrect term). There was cis-gender, for example, and trans-gender, a bit like the Cis-Jordan and Trans-Jordan of my stamp collecting days. We were warned that concepts were still evolving, and so vocabulary will change too. You can say that again.
In an otherwise excellent and fascinating article on the prevention of obesity in mice by use of antibodies against a certain hormone, we read:
The F[ollicle] S[timulating] H[ormone] antibody treatment resulted in significant decreases in fat mass in female and male mice.
Female and male mice: surely in English, male and female mice would be the normal way to put it, not because anyone supposes that male mice are so much more important than female, but merely for the rhythm and euphony of the language?
However, what are rhythm and euphony to set against thought control by those with the vision of the anointed, whose goal is to produce perfect equity — or is it equality? Doesn’t matter, for they are the same thing.
This piece originally appeared at RealClearPolicy
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Theodore Dalrymple is a contributing editor of City Journal, the Dietrich Weismann Fellow at the Manhattan Institute, and the author of many books, including Out into the Beautiful World and the recently published False Positive: A Year of Error Omission, and Political Correctness in the New England Journal of Medicine (Encounter Books).
This piece originally appeared in RealClearPolicy