The tornado of controversy and condemnation that justly swirls around Representative Todd Akin’s promulgation of junk science draws energy from many smaller storms generated by the use of medical arguments to justify political views. Just a few weeks, ago the Federal Court of Appeals for the Eighth Circuit upheld a South Dakota law which requir[es] doctors to misinform women seeking abortion that they face an increased risk of “depression and related psychological distress” as well as an “increased risk of suicide ideation and suicide” should they elect that procedure. As a physician, I am as outraged by this ruling as by Akin’s claim that the emotions surrounding a rape prevent pregnancy.
Politicians of every sort use medical data to support their positions when they can. A medical imprimatur conveys concern for others’ well-being, along with a sober commitment to science and, thus, to reality. Many policies legitimately require a general discussion of medical information, to guide the apportionment of resources and the setting of priorities in programs and policies. We cannot, and should not, expunge medically supported argument from political discourse. However, irresponsible use of such arguments endangers both society and the medical profession. We have learned the hard way that many facts, even those on which we as physicians act, are really hypotheses or myths. Remember when we knew that stress was the main cause of ulcers, or that thalidomide was a safe sedative for pregnant women?
Psychiatric facts are particularly open to such misuse. Psychiatrists cannot substantiate diagnoses by objective tests. Psychiatric models of causality are so weak that we purposely separate diagnosis from etiology. Both Akin’s claim and South Dakota’s law capitalize on this weakness. Akin’s suggestion that fear prevents pregnancy represents an outdated understanding of the mind body relationship. As Paul Blumenthal from Stanford said in Maureen Dowd’s recent New York Times’ column, “If wishing ‘I won’t get pregnant now’ made it so, we wouldn’t need contraceptives.” The South Dakota law relies on discredited claims that abortion causes (or prevents) psychiatric disorder.
Clinicians know know how hard it is to communicate either risk or reassurance to patients. Obvious distortions , like telling a rape victim that her chance of becoming pregnant are vanishingly small, are fairly easy to refute, as they contradict known facts. On the other hand, to tell a patient seeking abortion that she “faces an increased risk of suicide and suicidal thoughts” is to imply that abortion causes suicide, even if the phrase itself slithers away from making such a claim. To require physicians to mislead—speaking plainly, to lie—to patients is an abuse of political authority, now backed by judicial authority.
This situation is not new. The corruption of medicine for political ends was an essential component of Hitler’s propaganda machine, which justified genocide with medical metaphors and concepts from eugenics. The corruption of psychiatry to suppress dissidents in Russia and China is a tactic that the American Psychiatric Association, along with other professional organizations, has openly sought to oppose.
Our obligation to help leaders and the public distinguish between valid and corrupt uses of science is central to the integrity of our profession. Beyond harming individual women, political platforms, laws and judicial decisions that twist medical knowledge for political purposes undermine the trust that patients put in all doctors and the profession of medicine itself. The potential damage extends beyond the boundaries of medicine, since trust in legitimate authority is what makes democratic government possible. Akin’s unspeakable assertion , like the Federal District Court’s dreadful opinion, are ominous signs of things to come, if we allow such misuse of medical argument to stand unchallenged.