The need for political correctness in scientific writing

It is not immediately obvious why political correctness should feature so strongly as sacred cow number two on the hit list of visitors to the BMJ’s website. Certainly, spouses have become partners lest the unmarried should take offence, and prostitutes have been transformed into sex workers (not that they are likely to be much concerned either way about their job title). But this can be lived with, and there has been nothing in medicine to compare with “Gingerbread Person,” “Baa, Baa Green Sheep,” or the myriad other absurdities of the politically correct lexicon.

This verbal hygiene is, however, only the outer shell of political correctness. More serious is the censorship of significant facts and observations from scientific writing and which in turn explains why there is such a disparity between the everyday world as experienced by doctors and its bowdlerised, scarcely recognisable, reflection in the medical journals.

Consider, for example, an instructive comparison between Sir James Spence’s classic 1954 study A Thousand Families in Newcastle upon Tyne¹ and more recent investigations into the links between poverty and health such as the Black report.² Sir James Spence’s study found that more than one in 10 houses were “unfit for human habitation,” four out of 10 lacked a bath, and one in four had only an outside water closet which was shared with several other families. These appalling, unsanitary, overcrowded living conditions, he argued, could readily account for the infant death rate of 44 per 1000 live births.

By contrast, the Black report, almost 40 years on, omits to point out that 98% of households have their own bath (and 91% have a colour television set) and that perhaps this might have something to do with why the infant death rate has fallen fourfold in the intervening decades.

Furthermore, Sir James described “the outstanding characteristic” of the families in his study as “the skill with which the majority maintained the health of their children” in these adverse physical circumstances. None the less, there was a minority of “problem families” whose children fared badly, whom he subdivided into “the friendly but incompetent,” “the sullen,” and “the vicious.” He gave illustrative examples of each, including one family living in a condemned and crumbling two roomed tenement flat with no running water and whose water closet was out of order and where “most of the money in the household went on drinking and gambling.” The phenomenon of problem families also does not feature in the Black report.

The upshot of this comparison is that, whereas Sir James’s lively sympathetic study is readily recognisable as reflecting the real world of the 1950s, the omission by the Black report of the particularities of the circumstances and competence of “the poor” results in a quite unrecognisable picture of the relation between poverty and health in the 1980s.

At the heart of this comparison lie the two essential characteristics of political correctness. Firstly, society is perceived as consisting of many different minority groups, such as “the poor,” each of which is a victim of an unfair and inegalitarian system. Secondly, moral judgment is suspended to avoid the charge of appearing “judgmental.” Thus it is not permissible to even hint at the possibility that perhaps social incompetence might have something to do with the health problems associated with poverty.

The lifestyle theory of disease is similarly permeated by the same dead hand of political correctness. The public once again is a victim, but this time of the powerful alcohol and food industry. The politically approved “healthy diet” anathematises private pleasure, and even if it were true that drinking skimmed milk or eating vegetables five times a day protected against cancer, few doctors have the time or inclination to cajole their patients into making substantial changes to what they eat. These practical difficulties that loom large in everyday practice are scarcely touched on in the thousands of articles on the alleged relation between diet and disease published over the past 10 years.

Political correctness is an idealist philosophy that seeks to make the world a better place by wishing it to be so. Medicine, on the other hand, is a practical business that must deal in the warts and all of reality. They are incompatible and, as the visitors to the BMJ’s website insist, it is time for political correctness to meet its nemesis in the abattoir.