How Woke Politics Is Corrupting Medicine with Psychiatrist and Yale Lecturer

Summary

Podcast Summary: The Comedy Cellar: Live from the Table

Episode: How Woke Politics Is Corrupting Medicine with Psychiatrist and Yale Lecturer
Date: March 19, 2025

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Episode Overview

This episode features Dr. Sally Satel, a psychiatrist, lecturer at Yale, and senior fellow at the American Enterprise Institute, in an in-depth conversation about the ways social justice activism—described here as "woke politics"—is transforming and, in her view, often corrupting the fields of medicine and psychotherapy. The table of comedians and guests explore debates over mental illness, systemic racism in medicine, the opioid crisis, identity politics, personal accountability, and the culture wars now gripping medical and academic institutions.

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Key Discussion Points & Insights

1. The Intrusion of Social Justice Into Medicine

[01:10, Main theme introduction]

• Dr. Satel highlights increasing pressure in medical training and therapy to align with progressive political ideologies, sometimes at the expense of patient care.
• “It just represents a political intrusion into these professions where people really forget it's about treating someone. It's not about enacting your political causes or recruiting patients to them.” (Dr. Sally Satel, 13:00)

Memorable Example: Doctors Encouraged to Discuss Voting

• Reports of hospitals instructing doctors to talk to all patients about voting, regardless of the appointment context.
• Controversy at UCSF where doctors participated in political protests outside hospitals ([13:00]).

2. Mental Illness, Agency, and Accountability

[03:14–10:49]

• Dialogue on whether extreme, racially-motivated violence constitutes mental illness (e.g., “black rage” defense, psychosis as disinhibition).
• Dr. Satel criticizes pathologizing social or racial anger, stressing importance of accountability alongside care:
  • “Even if you don't want to blame... you have to have accountability. You have to have containment if someone is really dangerous” (Satel, 04:13)
• Host recounts personal stories—one of state overreach in psychiatric care, the other about its absence—highlighting policy dilemmas.

3. The Opioid Crisis and Theories of Addiction

[13:17–22:23]

• Dr. Satel explains her “near cancellation” experience after a lecture on the opioid crisis in rural Ohio, where she discussed addiction as involving personal agency.
• Controversial View: She challenges the narrative that addiction is solely a brain disease, arguing for a complex interplay of biology, environment, and culture.
  • “It changes your brain, but those changes do not render a person impervious to consequences... There’s lots of spontaneous remission as well. People who just stop on their own.” (Satel, 21:56; 22:32)
• Pushback from students and colleagues shows the entrenched expectation that addiction is only a passive, medicalized brain disease ([17:16], [19:48]).

4. Race, Health Disparities, and Systemic Bias

[25:26–34:40]

• Dr. Satel describes being accused of racism for suggesting that health disparities stem from more than just provider bias—including socioeconomic factors, health literacy, and personal agency.
  • “It's not that these differentials [in care] don't exist... but if you're going to conclude [doctors are racist]... you have to explain every other reason why these differentials... might exist.” (Satel, 25:41)
• Discussion of the “pipeline issue”—disparities in medical school admissions track back to educational inequalities in childhood.
• Race Concordance: Ongoing debate about whether patients benefit from having doctors of the same race; Dr. Satel argues supporting evidence is weak ([29:27–34:15]).
  • Cites the “black neonate” study: higher mortality among black babies treated by white doctors appears tied more to the complexity of cases than doctor race.

5. Woke Culture, Censorship, and Academic Freedom

[13:00–34:40]

• Dr. Satel recounts how her lecture, aimed at honest exploration, led to fierce complaints and threats to her academic status—characterized as a “near cancellation.”
  • “They wrote him this long letter... almost a parody of these kinds of things: ‘How dare I talk about responsibility in addiction?’” (Satel, 19:45)
• The conversation underlines a chilling effect, where heterodox views are met with ostracism rather than debate.

6. The Pipeline Problem and Solutions to Disparities

[36:15–38:40]

• Host and guest agree that disparities in medical professions (e.g., few black doctors) are better explained by longstanding inequities in K-12 education than by bias in admissions or practice.
  • “100% of our attention needs to go to getting young minority kids to be basically indistinguishable from non-minority kids in like the seventh or eighth grade.” (Host, 37:17)

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Notable Quotes & Moments With Timestamps

• On medical woke-ism:
  • “In one hospital, actually, doctors were to talk to patients, any. All patients about voting. Who ever heard of such a thing?” (Satel, 13:00)
• On accountability and compassion:
  • “You have to have accountability. You have to have containment if someone is really dangerous. And you have to have deterrence—not just for them... but also a signal to the community that this is what happens and it's not tolerable” (Satel, 04:16)
• On the brain disease model of addiction:
  • “Does it change the way a brain might change in Alzheimer's or something... where a person can no longer respond to rewards and consequences?” (Satel, 21:24)
• On racism in healthcare:
  • “It’s not that these differentials between racial groups don’t exist... but if you’re going to conclude that [racism is the cause], you have to explain every other reason why these differentials might exist.” (Satel, 25:41)
• On personal experience with the system:
  • “So rather than the consequence that his family wants to help... help my son. No, we're gonna give him an order [of protection]... he can't even go home. And he went to the bridge and he dropped off.” (Host, 09:50)
• On the diversity push in medicine:
  • “...so much pressure on having a diverse workforce… And it’s based on this theory that patients will do better if they're treated by someone of their own race or ethnicity. But it turns out that research that's put forth to demonstrate that is really weak.” (Satel, 30:22)
• On cancel culture in academia:
  • “It was almost. How dare you bring her in. You should check with us who you're going to have speak to us. And we need veto power. And we are re-traumatized. She re-traumatized us after January 6th...” (Satel, 34:25)

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Significant Timestamps

• 00:00–01:10: Introduction & guest background
• 01:10–04:40: Introduction of the “social justice in medicine” topic
• 09:50–10:49: Host’s personal tragedy highlighting gaps in mental health intervention
• 13:00–17:16: Satel's cancellation experience & the progressive transformation of medical training
• 19:45–22:44: Theories of addiction and response to consequences
• 25:26–34:40: Racism, health disparities, medical school admissions, critique of “race concordance”
• 36:15–38:40: Pipeline problems in education and their downstream impact on representation in medicine

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Overall Tone & Style

The conversation is lively, candid, and punctuated by personal anecdotes, gallows humor, and rapid-fire exchanges—consistent with the Comedy Cellar’s brand. Dr. Satel is articulate and measured, while the hosts oscillate between skeptical questioning, personal storytelling, and an undercurrent of irony and frustration with today’s culture wars.

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For Listeners New to the Episode

This episode provides a thought-provoking, sometimes provocative, glimpse into current debates on race, medicine, and mental health. The discussion will appeal to those interested in the challenges confronting free inquiry and evidence-based medicine, as well as anyone curious about the impact of current cultural trends on psychiatry, medical education, and society more broadly.

Transcript

[A]

Sally Satell. You have the introduction, Dick.

[B]

Yeah, well, Sally Satell, now, I'm sorry.

[A]

For making you sit through all that. Although it might have been interesting. It was because we had a technical problem and it got all backed up. Go ahead.

[B]

Sally Satell is a lecturer at Yale University School of Medicine, senior fellow at the American Enterprise Institute, and a psychiatrist, I guess you had mentioned, too.

[C]

I am.

[B]

Which a psychiatrist is like a psychologist, but can prescribe medication and charge more.

[A]

Okay. Composite of the mic. Although.

[B]

Although I had a friend who went to a nurse practitioner who charged 500 an hour for therapy.

[C]

I wonder what therapy that was.

[B]

What? I said it seemed a little outrageous to me. Is that. Does that seem right to you?

[C]

No, that's exorbitant. I've never heard that.

[A]

Okay, so we were going to have you on right before COVID started to talk about all these people armchair diagnosing Donald Trump for his.

[C]

Oh, I did that. Yeah, we did that.

[A]

Oh, we did that.

[C]

Then there was some. Something else. And Perianal can't. Maybe it was about the opioid crisis, because that's something I work on.

[A]

What's your hot issue today? You wrote on your persuasion not long ago, what's in your burning?

[C]

Oh, gosh. Well, it's the, you know, intrusion of social justice into medicine and psychotherapy. And actually antisemitism plays a big role in that as well.

[A]

This is actually a fascinating topic because this came up when Dylann Roof killed all those people in the black church. And the question is whether or not extreme, racially motivated violence is a sign of mental illness or not.

[C]

Yeah, actually, that goes back quite a.

[A]

Ways to at least Bill Cosby's psychiatrist guy, Chester Poussaint.

[C]

Is that right?

[A]

Yeah. Remembering the time. I remember sending that around at the.

[C]

Time, I think that was in the 60s. And they tried. Dr. Poussaint and colleagues tried to get some variants of black rage into the dsm, the Diagnostic and Statistical Manual for each of its editions. They tried to get that in and they failed each time. And they even tried. Back in 2012 was the last edition, DSM 5. And again, some variant of it was proposed. I'm so glad that they. They did not, because, frankly, it's absurd. I mean, one can be psychotic and one can be psychotic about black people or Jews or anything, but that's a different category. We have a label for that. But also, it seems to me if you're someone who's so worried, and rightly so, about any kind of white hostility towards blacks, you don't want to give people a pass. Can you imagine in. In a litigation setting that's an excuse or that's mitigating in some way. Oh, well, you know, judge, my client here murdered this black man because he was suffering from black rage. I mean, you don't want to set that precedent. It's absurd.

[A]

The black rage was the claim by the. There was like a black serial killer. What was his name in D.C. the one in.

[C]

Oh, that was from Malvo. That was right after 211. Then there was the Atlanta Killer before, but that was children, but it was black children. And I believe that killed.

[A]

But is it not true that. Because I seem to hear it in the rage of like mentally ill homeless people and stuff. They do seem to start spouting out racist shit, anti Semitic shit.

[C]

Well, that's partly. Cause people are just disinhibited when they're psychotic. A lot of them are also probably.

[A]

So we all carry that. But they just drinking.

[C]

No, no, no. Well, these people have so hard on the street. And for all you know, that outburst was, you know, target at the last person who assaulted them or tried to, you know, to rob some steal something.

[B]

But I'm saying I don't believe in free will. So I give everybody a pass. And yes, that includes Hitler. I'm sorry, but we still have to deal with them. We still have to keep them off the streets and we have to provide deterrent.

[C]

Oh, definitely.

[B]

So whether you're gonna assign blame is a separate question. I don't assign blame really. I mean I do because I'm a human and I react, but I don't really intellectually assign blame.

[C]

Well, you have to assign. But I do is you have to have accountability.

[B]

But you have to have accountability.

[C]

You have to have containment if someone is really dangerous. And you have to have deterrence, not just for them the next time, you know, this is what can happen to you if you commit this transgression. You could go about the jail, but it's also a signal to the community that this is what happens and it's not tolerable. So. So even if you don't want to blame, if you're not a retributivist, you don't want to blame people.

[B]

Well, I can't be because we're all robots.

[C]

It's often the same when it comes down to practically how you work in the society. It would come down to the same thing anyway. You'd still have to. I mean, again, we're talking about a criminal here, not someone who's severely mentally Ill. And that's why they're hostile or violent, those people. And this is, I know, a big ongoing discussion in New York and San Francisco and other places. I'm a big believer in benign paternalism. The commitment laws are there, they're on the books, it's a state issue. Some are more stringent than others. Stringent, meaning you have to be in imminent danger of committing suicide or homicide. Imminent is usually defined vaguely as anywhere between 1/2 and 24 hours from, from now. But then there's a looser definition which is grave disability, which is you're so psychotic you really can't protect yourself, you can't satisfy your food and shelter and you're going to stay out in the park and get frostbite because everyone's going to poison you. And then there's an even more generous definition which is need for treatment. And I actually believe in that too. But this all goes through a judge. You know, there were certainly abuses of this in the past. If anything now it's the mirror image. We have too high a threshold for intervening and it's horrible situation.

[A]

Well, I've had both experiences in my life. You know, it's funny how I always say that a lot of times when people are having disagreements it's just a matter of priority. Quite often they are both right. Both sides of the immigration debate are right about the things that they're focusing on. Both sides of the welfare debate were right about the things they're focusing on. So I had somebody in my family with serious mental illness, schizophrenia in the late 60s and 70s and he was a victim of many of these horror stories, just most horrible treatment. He died not long ago. So I remember that in my family. And then much more recently I had a friend who also was suffering mental illness and the state wouldn't intervene and he jumped off the Queensborough Bridge and is dead also. So on both ends, this failure to find the sweet spot, for lack of a better word of policy, led to horrible outcomes.

[C]

Yeah, and I don't think you're right when you say both sides have points. But I don't think that. But I've seen too often a person say, well if we do this, you know, X will happen and we should concede it. Yes, X will. But think of the larger universe of trade offs. Isn't that worth it to save this life?

[A]

Oh, this reminds me, I don't want to say of the congestion pricing argument I've been having because what you say is exactly right. Just admit like I had this big argument with this lady, Catherine Wilde. Leslie, I'm like, can you just admit that the whole theory of congestion.

[C]

Oh, yeah, I listened to that.

[A]

Oh, the whole theory is predicated on the notion that we will price the poorer people off the roads. She wouldn't say yes. As opposed to saying, what'd you say? Yes, but, but. But I think it's worth it.

[C]

And if it were your. And if we're your kid. I mean, you can personalize when it comes to mental illness. And you don't often. Don't have to go too far to personalize it. You're just. But it's. What if it's your kid? What if it's your kid on the street like that? Your kid who was, you know, had a great promising career, was at Queens College or whatever, Harvard. And now he's psychotic, hallucinating on the street, begging. It was a girl just raped last night. You still want them out there?

[B]

Think about that.

[A]

Well, I'll fill in the details of this story. It was a very Good friend. One of these kind of classic things that you would know. He was fine. He had his first episode with manic depression in his late teens or something. Then it went into remission. Then that's when I met him. I was very good friends. And then his 30s, it came back. He was in and out. He didn't want to take meds. Cause he didn't like the. Anyway, kind of a classic story, as I've learned. And he was home at his mother's house. And he was acting in a way. He never hurt anybody, but he would get what appeared to be dangerous. Kind of like what you imagined was the guy was acting like right before the guy. What was his name? Who killed the guy on the subway? Penny. Penny. Yeah. Like that situation. And so his parents or his mother and his sister called. Called the police because they were afraid that he was dangerous. And the police came and they. And they immediately wanted to arrest him. And then the very people. Family who had begged the police to come help him say, no, do not take him to jail. He needs to go to the mental hospital. And they tried to show him. They were trying to show him history, whatever. Police said no. They took him before a judge. The judge issued an order of protection. So now he had no place to go. So rather than the consequence that his family wants to help. Help my son. No, we're gonna give him an order. We're gonna grant order of protection. They didn't ask for it. And now he can't even go home. And he went to the bridge and he dropped off.

[B]

As I understand it.

[A]

It's unbelievable.

[D]

It's heartbreaking.

[B]

As I understand it, in manic depression, the manic phase is where they don't take their meds and thus becomes dangerous. Is that correct?

[C]

Well, often that's how one becomes mad. That usually precedes the mania, is that sometimes people are doing so well they don't want to take their medication. They think they don't need it anymore. And if it's medication for bipolar illness. Right. Then that's when the mania can recur or the side effects are really objectionable of some of these meds, unfortunately, and they just don't want to tolerate them anymore. But it's a spiral, or are there doctors?

[D]

It's a spiral each time. And each time it gets worse?

[C]

Well, it's a little more refractory each time. That is true. So that, for example, if you have recurring, let's say, severe, depression and it's treated, but it comes back, it will be, on average, a little more refractory each time. Maybe harder to treat each time, but we do.

[A]

What does that word mean, refractive?

[C]

That it's just hard to respond to. Intervention.

[A]

What are the other. So what are the other. I wish you would be a regular guest because this kind of like quackery that passes it through the news all.

[C]

The time, you know, you should have, if you want to have a show on, just on mental illness. And I'll love to come back for it, but you could have them to yourself. Jonathan Rosen. Oh, you've had him.

[A]

No, I met him at a party.

[C]

That book is a master.

[A]

I'm halfway through that book. The Greatest Minds, Best Mind.

[B]

It's magnificent.

[C]

Yes, he's a brilliant.

[A]

Yeah, yeah. He listens to this show. I'm sorry that I got the name of the book wrong, if you hear this one. But yeah, I really do wanna have him on. So what are the other hot issues now? Is Trump mentally ill? Oh, again, Elon Musk mentally ill?

[C]

No, but there's certainly a streak of grandiosity. And apparently this is all by report, so, of course, I haven't spoken to him or examined him, but apparently he's quite a prolific taker of psychotropics, ketamine.

[A]

Who is Elon Musk?

[B]

Musk.

[C]

Musk. So that. That would fuel whatever grandiosity.

[B]

Do you think Musk is on the autism spectrum?

[A]

Because, you know, she's not permitted to say that.

[B]

We, I.

[A]

We had it.

[B]

Well, he's.

[A]

He has said he's on the spectrum.

[B]

I Mean, I recently met a kid who's a mild Asperger and, you know, there's no ambiguity there. I mean, you know, it hits you over the head like a ton of bricks. Where musk is, there's a spectrum.

[C]

I mean, that's a phrase goes now, spectrum disorder, but there's always a range.

[B]

But if he is autistic, he's the mildest of autism. So mild that it's not even worth bringing up. Be like me saying, I know karate and I'm a yellow belt.

[C]

Okay, back to the. Okay, all right, so yellow belt. All right, so that, that article. Let's just get back to the persuade. You want to go back to the.

[A]

Yeah, yeah, please. Whatever you want to talk about. Usually, I know we guess whatever they're burning to talk about is the best thing they should talk about.

[C]

All right, I'll talk about my cancel, my near cancellation experience.

[A]

Okay.

[C]

Because this is an entree into the larger topic of how medicine, the medical profession, at least medical training, I should say, and the practice of therapy is actually being just steeped in progressive dogma. And it just represents a political intrusion into these professions where people really forget it's about treating someone. It's not about enacting your political causes or recruiting patients to them. In one hospital, actually, doctors were to talk to patients, any. All patients about voting. Who ever heard of such a thing? Admittedly not who to vote for, but to vote. And I think it was at ucf. I want to get this wrong, but UCSF doctors were. Do you remember this was in the Times in June. They were wearing keffiyehs and screaming intifada, Intifada. Outside the hospitals. You could hear it in the patients rooms. This is just stunning.

[A]

Yeah. And you wrote about how psychiatrists or psychologists were contradicting their patients for being Zionists and stuff like that.

[C]

Oh, yeah, yeah. This was. I'll give you. I'll go back. We don't have to do my cancellation.

[A]

No, no, do cancellation. Do cancellation.

[C]

Okay. But I want to.

[A]

We love cancellation stories. Go ahead.

[C]

Yeah, I call it a near cancellation story because the stakes weren't that high. I'm still a lecturer. Thank God the chairman allowed me to keep my title. But yeah, I was giving a presentation on a year I'd spent in a small town in Ohio. This was 2018, 2019, helping with the opioid crisis. There was. Do you know, half of all counties do not have a psychiatrist in this country? So the county it was in didn't have a psychiatrist. Anyway, so I went there For a year. And it was extremely interesting, as you can imagine. I called it. And I called my talk My Year Abroad, Ironton, Ohio, which is in southeast Ohio, and the opioid crisis. And I talked. I showed photos of the town. And, you know, it was just. Of course, it was a very suffering and decaying place. And, you know, sometimes these photos almost look poetic, if you know what I mean. But they're certainly depressing when you think of the economic situation. And I didn't show pictures of anybody with a needle in their arm. There was no human in them. It was just rusted machinery and that kind of thing. And I talked about. So I talked about the town. I talked about my theory of addiction, which involves agency very much, but also that people turn to drugs basically for two basic reasons. One is that there's a lot of inner turmoil, that they're suffering, or they're in environments where they feel there's no hope. And, of course, that's the classic depths of despair. And that was relevant to my story. And then I talked about how you can blame the Sacklers, and you should. It was the Jews after it, and there was significant deception on their part. But if you want to understand an epidemic, you can't just blame a drug.

[B]

Company, because that drug, by the way, it's excellent. Oxycontin. Yeah. Can have some very, very good uses.

[C]

Mm. It saves some people's lives. There's no question. You never know that from listening to people. It's an excellent drug. It's really just Oxycodone, but in a.

[A]

You know, time release.

[C]

Extended. Yeah. Extended form. And that has its own advantages, because then you don't get breakthrough pain. You can, you know, be on a medication for many more hours a day. But in any case. But it also was clearly abused and overprescribed, and all that's true. And they, as I say, downplayed the addictive properties of it, but they didn't deny it. It's Schedule two. It says that on the bottle. It says that on the label. But in any case, my larger point was, you know, there's never. There is. There was a web of derelictions to how this happened. And there was also a very, very hungry population. Was in a lot of.

[A]

What did you say that got you in trouble?

[C]

That.

[A]

That's it.

[C]

That I didn't. Yeah. So that you didn't blame the.

[A]

I thought you were just getting. Setting the table.

[C]

No.

[A]

Why'd that get into trouble?

[C]

Because this has to be a narrative of oppression. And so after the Talk, which started late because it started late.

[A]

That happens wherever you go.

[C]

It does. This is about me. And so, unfortunately, it was zoom, because it was. The beginning of. It was, oh, this is a very important thing. The date of my talk was January 8th, 2021, right after January 6th. So I'm finished with the presentation. And then I could feel wafts of chilled air coming off the computer. I just knew it didn't go over well. And sure enough, the first question was a young kid, I mean, one of the trainees, saying, well, I'm from rural Missouri. And I expect him to say, oh, things are different here, there. Or they're same in this way and different that way, or something. Perfect perspective that would complement what I'd been talking about. I'm offended, and I'm offended. And I thought to myself, here we go. And so then he went on. He thought. He said that I otherized people because of the pictures, because of the title, My Year Abroad, which is kind of irony, you know.

[A]

Is there any racial component to this?

[C]

Yeah, well, turns out there is a racial component, but we're still talking oppression because these are poor white people. And anyway, about a month later, I got an email from the chairman, who was actually a friend. We were interns together. He's a brilliant man. He's done brilliant work on ketamine and other things, but that's his most recent big discovery, anyway. And he says, I don't know. This is a hard email to write, and I'm sorry, but when you came, you offended so many people. And here's the note I got from the. Of course, unsigned. We don't know how many folks. It could be two really angry people or more, who wrote him this long letter that is almost a parody of these kinds of things about, you know, how I offended everyone and transgressed. How dare I talk about. Yeah. Responsibility in addiction. How dare I talk about. They read other things. I. They. They must have. I think someone primed them.

[A]

What. What is the socially acceptable theory of addiction that they.

[C]

Oh, it's a brain disease. And it's. That's it. You caught it. You basically. You catch addiction.

[A]

Not. Is it genetic or.

[C]

Oh, no, no, no. Actually, it was very complicated, as you can imagine.

[A]

No, but their theory.

[C]

Yeah. Oh, their theory of addiction. I'm saying, is that a brain disease? Oh, is that.

[A]

What does brain disease mean? It means that virus or.

[C]

No, I'm sorry. Yeah. It means that with continued exposure to a substance. Fill in the blank. Anything, cocaine, alcohol, that your brain undergoes changes which it does. But those changes do not render a person impervious to, let's say, consequences. And they are going to say that no, a person. There's their brakes. In fact, the head of one of the people who is a vigorous promoter of this will say the brain has lost its brakes. In other words, its frontal lobe is effectively.

[A]

Well, let me ask you. First of all, let me just stipulate. It's absurd that any disagreement about this topic should ever be considered like you've crossed the line of. Of decency. Like, actually, you know, one of my beefs with this whole. That forgot to mention with this other. Whole other Dave Smith thing is that by. By saying engage with the facts, you kind of elevate. They're kind of elevating things into a reasonable minds can differ argument because. But this is the opposite.

[C]

No, they were actually saying they had a line.

[A]

They're saying reasonable minds can't defer.

[C]

They said, this is beyond the pale. I feel I'm jumping all over the place. I should just finish what I. How I see a difference.

[A]

Okay, then I have a question about that.

[C]

Okay, sure. But, yes, of course, the brain changes. The question is, does it change the way a brain might change in Alzheimer's or something like that, where a person can no longer respond to rewards and consequences? So, for example, if you say. And there have been so many studies on this, it's called contingency research. And Carl Hart, I don't know if you're familiar with him, but he wrote this book, Drug Use for Grownups. It was very controversial. He's a psychologist at Columbia who takes heroin regularly. And it does it in a controlled way. But in any case, don't try that at home.

[B]

That's possible.

[C]

It is possible.

[A]

Documentaries about that, Old junkies.

[C]

But in any case, yeah, we know that people with drug problems respond to consequences because everyone who walks into our methadone clinic is there because their wife was gonna leave them, their probation officer is gonna violate them, their boss is gonna fire them, their kids can't stand them. You know, they're able to take that in, process it and change.

[A]

But I do want to ask you a question.

[B]

The fact that they need methadone, you know, illustrates that it is somewhat beyond their control. They need external help.

[C]

Those. They know, they recognize that. Yeah. And I give them credit for coming in, but there's lots of spontaneous research, spontaneous remission as well. People who just stop on their own as well.

[A]

I recognize very early in my life when I would hang out with friends and that we'd all be drinking. It was very clear to me that whatever the effect alcohol had on me, it was different on other people. I would be kind of fine, and I could take it or leave it. And I would have, like three. No, no, I couldn't bear to have another one. And another friend of mine would be like, I need to have another, and another and another. And their personality would change. And even so. And I observed that, well, this has to be some genetic thing.

[C]

So I think that's true.

[A]

And so that even though I have agency not to become an alcoholic and that other person I'm referring to has agency not to become an alcoholic, he's still been dealt a bum hand.

[C]

I agree with you.

[A]

Yeah.

[C]

That's one of the lessons kids learn when their parents are alcoholics. It's, it's. It's either sometimes they go that way because there is the genetic predisposition. Plus they probably grew up in a chaotic household, so may have a lot of problems and trauma that they would want to medicate with alcohol. Or they never touch the thing at all because they've seen it. But in any case, yes, it's really a very complicated topic. I think the genetic loading is higher for some people than others. The environmental influence is higher for some people than others. The intrapsychic dimension is higher for some people than others.

[A]

Because this is one of my pet peeves with the whole theory of shrinks. You just did it. You just said it yourself.

[C]

Why?

[A]

Why? Why? I've said this on the show before. Well, I'm so honest. You wanna know why I'm honest? Because my father never lied to me and I learned to be perfect. No, no, that's wrong. My father always lied to me, and I swore I'd never be like it says, like, be somebody. Alcohol. They never touch it because they were born alcoholics or they do touch it.

[C]

But the thing is, you can explain anything, but. No, I'm seeing one person. I'm seeing you, Dan.

[B]

Hello.

[C]

And you have your whole complicated childhood history, your whole developmental trajectory. Then I'll charge you $600 an hour. But. But the point is, you're right. You know, there is a lot of. There are a lot of directions one can go in because humans do that. But when you have one human in front of you, and that's the one you're devoted to, then, you know, then you don't have to deal so much with all these hypotheses because you're basing your. You know. I'm basing the opinion on the Story of you.

[A]

So what was the racial thing?

[C]

Oh, well, they looked at other articles I had read. So they finally did some research, and I'd written an article called. Excuse me, it was a small booklet.

[B]

A while ago called the Famous Jewish Sports Legends.

[C]

No, it was the. That's my next book. But it's the.

[A]

It's a flyer.

[B]

It's from the movie Airplane.

[C]

It's called the Myth, the health disparities myth. And I'm sure you've heard that.

[A]

Oh, yes.

[C]

Okay. So the myth part was not that these don't exist.

[A]

Cut the cameras. Go ahead.

[C]

The myth part wasn't that. And this was clear at the introduction of this small book. It's not that these differentials between racial groups don't exist in terms of access to care, in terms of quality of care, in terms of the way doctors may even treat you. But. And this booklet was written as a response to these allegations that were very, very thick in the early 2000s, that doctors themselves were racist. Today, it's more. It's a systemic racism in medicine. But this was that doctors themselves were racist. And so what my colleague and I did was basically say, if you're going to conclude that that's what we would call a diagnosis of exclusion, you have to explain every other reason why these differentials in health status or in treatment might exist. So explain, you know, the class element, you know, the insurance element, the access to good care, the, frankly, health literacy, the extent to which people take care of themselves.

[A]

That's right. I mean, I've. Yes, I can see why you got in trouble. But I have to say, as an employer over the years, employing many different types of people, there's a huge difference in the way some people take care of themselves. There just is. And I've seen many, many people. For instance, I've had a lot of. I think 85% of the people I know who died in my life were black. And I could not say it was because of the way the doctors were treating them. It had nothing to do with that. And it's, you know, the musicians. And maybe that's. Maybe the musicians, not the race. But at some point, there was a pattern of just not taking responsible care. And of course, this could be. Maybe it is a kind of legacy of racism, in a sense, that things that are second nature to, like, my household are just not second nature to, like, my wife's Puerto Rican. Like, she'll describe her family in a way they don't take care of themselves or just the things they might believe.

[C]

About well, that's healthy.

[A]

What they should be about, diet, like, you know, like, this is all very tragic and it's, you know, I mean, I don't know you that well, but I'm sure that as you broach this topic, you did not broach it with hatred in your heart.

[C]

No, no, no, no.

[A]

And you're struggling with it.

[C]

We weren't even concluding there is no racism. We're just saying if you want to make statements like this, this is a methodological approach you have to take and you haven't. So you can't assert that doctors are racist. Really, that was it. I'm sure probably some doctors are, but.

[A]

Majority, maybe not enough to show.

[B]

I would suggest that patients might be, if not racist, you know, a doctor patient relationship is quite intimate. And would one not feel comfortable or more comfortable with somebody like themselves? I would think that there's some distrust from the patient side, you know.

[C]

Well, that's a very good question. And that's very topical because there's a big debate about the term for that is race concordance. Should patients effectively have doctors who are their own race? And this is one of the justifications for diversity in medical school, which I.

[B]

Think it's a good one.

[C]

Well, let's go through this.

[B]

Yeah.

[C]

And it does make intuitive sense. And I certainly think that may be true for someone who doesn't speak the language. Would be, can you imagine having a doctor who spoke your language? That would be incredible. That would be wonderful. And we have interpreters. But I think it would be amazing for a person, you know, who didn't and to have that or somebody.

[A]

But that's language concordance, not race concordance.

[B]

Well, that makes perfect. Obviously you need to speak.

[C]

And then, you know, there's this whole idea that, you know, a lot of when we tried to get folks to take the COVID vaccine, you know, going to the black churches, going to the black barbershops, this kind of thing. Yeah, there's something to that for sure. But the idea behind the diversity in medical school, and it's a, it's a major push. Affirmative action was very, very active in medical schools.

[B]

I just want to be clear. I'm not, I'm not in favor of finish. Okay.

[C]

Yeah. There's more.

[B]

Okay. Because when I said diversity is a good thing.

[C]

Yeah.

[B]

I'm not in favor of lowering standards. I'm in favor of encouraging people that might not otherwise get into the field.

[C]

I agree. And that is. That was the old definition. I thought of affirmative action. I'm sure that's How I got into my colleague is because my parents didn't go to college. They weren't that savvy about it and they were wonderful. And had not I was reached out to by this Cornell, I would never have even applied to a place like that. So I'm grateful and in a way I'm an affirmative action beneficiary in that sense. But anyway, so there's so much pressure on having a diverse workforce, which of course we would all like if again, all things being equal, there's so much pressure on that. And it's based on this, I would say this theory that patients will do better if they're treated by someone of their own race or ethnicity. But it turns out that research that's put forth to demonstrate that is really weak. And one of the first, I mean one of the most high profile ones you've probably even heard of, it was the black neonate story. That sound familiar? This was a paper published in the Proceedings of the National Academy of Sciences, I think in 2023. I know it was 2023 because Ketenji Brown Jackson had it. In her decision, her descent from the affirmative action ruling. She brought this up as a justification for the diversity, although they. For affirmative action, although they don't never say the lowering of standards. And unfortunately that's just true. And there's good data on that done by Mark Perry when he was at American Enterprise Institute, that whites and Asians have to have a much higher GPA to get accepted. But in any case. And so wait, just lost my train of thought for a second.

[B]

Ketenji Brown Jackson.

[C]

Yes, thank you. Thank you.

[A]

Lowering of standards.

[C]

Yeah. So this study said that when black neonates were treated by white doctors, they had a higher death rate than when they were treated by black doctors.

[B]

Neonate meaning a newborn.

[C]

Oh, yes, newborn. And well, it turns out, and that really made quite a lot of headlines. Yeah. And she put it in her. I don't blame her. I don't expect her to read the paper. In fact, the AMA was the one who said, oh, put this in, because.

[A]

I was jarred by that story when it came out to it.

[C]

It always sounds these things should be a little skeptical, but in any case, maybe it's true. So look at the data and it turns out that the black babies, overall, we're talking averages here, but were lower birth weight babies. And that is probably one of the biggest predictors of whether a child, a little baby is going to do well. They may have been born premature or they may have not had good Thriving. But in any case, they're already behind the medical aid ball when they're born low birth weight. And who treats the low birth weight babies? It's the neonatologists. Who has taken the fellowships. This is a very sophisticated, advanced form of pediatrician. Well, they're white. The majority of them are white. So in other words, the white doctors were treating the sickest babies. So it's not a surprise that they had a higher mortality rate. And in fact, when you really, a colleague, Ted Frank of mine, really dove into the tables there, it turned out, unfortunately, that the black doctors, the patients, some of the white babies treated by the black doctors had higher mortality. But that was never mentioned. But in any case, it was.

[B]

Not only was it ever mentioned, it's going to be edited out of this show.

[A]

Look, I.

[C]

Well, that's how we almost got canceled.

[A]

We almost have to wrap it up. I want to say.

[C]

Wait, don't you want to hear the end of my cancellation story?

[A]

Oh, yes, of course.

[C]

Okay. Okay.

[A]

Okay.

[C]

So, yeah, so I get this letter from the chairman and then he shows me the letter that these people, these folks wrote, which is really like a cultural artifact at this point. It was almost. How dare you bring her in. You should check with us who you're going to have speak to us. And we need veto power. And we are re. Traumatized. She re traumatized us after January 6th and the chairman, you know, you took.

[A]

An oath not to do no harm. You're not supposed to traumatize people. You're a psychiatrist. But go ahead, go ahead.

[C]

And luckily, you know, I knew he would do the right thing. He didn't follow through. But he was put in such a horrible position. He had to placate these students who had such irrational expectations of what a presentation was like.

[D]

But this is insane that you're saying you don't know if it was two people or 100 people.

[A]

I mean, this is never 100 people.

[D]

Of course not. But this is insane that it's. They're not saying.

[C]

Insanity is pretty standard not to sign these things.

[A]

I just want to say on the.

[C]

I don't know how I could have any, you know, retaliation on them. That's ridiculous. And I wouldn't.

[A]

On our, on our. To kind of wrap it up on our racial predicament in this country. This is not going away. It's a terrible problem. And there is an inherent contradiction because if you look at the statistics of how poorly young minority students are doing in schools reading five, six grades below level, you know, and these are the Statistics which are cited by advocates of minorities and saying, listen, look, look how we're doing this, this, we need attention, we need progress, this and that.

[C]

Yeah, Roland Fryer seems to have a great answer.

[A]

Yeah, but, but then there, but then there's an utter contradiction and it's almost, you know, it's, it's upsetting and maybe even angering that this is all true. The disparities in how children are doing are tremendous and that's real. And from that it's utterly predictable and almost a certainty that you would expect to see huge disparities on the other end when they grow up. And you. Why aren't there more black brain surgeons? Why are there? Well, because you didn't take care of them when they were kids.

[C]

It's definitely a pipeline issue. And medical school is not where you correct the pipeline.

[A]

That's right. So you don't go to a medical school. How come there's not more, oh, you must be racist admissions here at this medical school. Why are there not more black doctors? We know the reason. The reason is because there's not more black children doing well. Because you've abandoned these kids when they're young. And that's where I've always said 100% of our attention needs to go to getting young minority kids to be basically indistinguishable from non minority kids in like the seventh or eighth grade. And if we could do that, we. All these other problems disappear, poof, gone. Because that's what's causing them. And so long as that continues. How dare you. As I said, I'm gonna repeat myself. How dare you set upon looking at Harvard and say how come there's not more black kids? We know the reason, because you let.

[C]

Them down, of it being systemic racism. You know, there was racism. It initiated many of these problems. But right now it's not sustaining them. So it's not sustaining those problems. It was a causal element. But now there are other kinds of interventions that require dismantling racism. They require something that, that's vague. So vague. It's exactly what you said.

[A]

To the extent it is sustainable, it's on a, you know, as early in the pipeline. But the. I would, if you could measure like with, you know, some sort of medical instrument, levels of racism. The people being accused of racism here are the least racist people on planet Earth. The people in admissions officers and elite liberal institutions. There's nobody less racist than these people. If they are having disparities in their outcomes, that is because of other things than their God forbid Hatred of people who don't look like them.

[B]

No, I'm not.

[A]

We have to wrap it up.

[B]

Can I just ask. Get back real quick to the Dave Smith stuff. Yeah, I just want to give you. I want to ask you a question and give you a chance to address a common concern or common accusation leveled against you that you're using Dave for your own self aggrandizement.

[A]

No, the. The accusations. I'm trying to get on the podcast because I want the views.

[B]

Right.

[A]

Yeah, well, everybody, I mean anybody who knows me knows that to a fault. I don't care about the views.

[D]

Much to my chagrin, I might add.

[A]

No, I don't care about the view. I feel like he's debating me now in absentia, which is sleazy. Forgive me. You know, like I say, come on the show and let's discuss it, because I know a Twitter debate is gonna go badly. I know it gets. It's like text messaging arguments. It always. It escalates and gets worse than it might otherwise have been. And it's not a. It's not really a productive debate. So I said, come on the show and let's discuss it or invite me on your friggin show. I'm not trying to get views. We don't monitor. Monetize a little bit. There's no. He's wrong. What kind of. But I realize I can't convince people of that.

[D]

Well, I can.

[A]

Yeah.

[B]

Well, what if he said, well, let's come hang out at the Cellar and just debate it without.

[A]

I've asked him that before. I ask most of the people. I said, that's what most people. I get into things like, why don't you just come meet me in the. Ouch.

[D]

If you don't, I would just like to go on record and say, usually the biggest names of people who you are having these conversations with, you're doing it in private. And I'm like, why didn't you invite them on the show?

[A]

I have no ulterior motives to try to get podcast views.

[D]

I wish you did.

[A]

And I'll leave it to speculation as to why he won't come to talk about. He. He does a whole show about me. It's not the first time he's discussed me. This is the second time we did. He went on the Jake Shields, so remember? And, and he misrepresented me. You know, that's, that's, that's.

[B]

Are you in communication with him that he might come or. It's over.

[A]

I think it's over.

[B]

Okay.

[A]

All right. Dr. Satell, I'm sorry that you had to sit through that. Hopefully. That rant, but hopefully it was interesting.

[C]

I consider it a piece of sociology.

[A]

Yeah.

[D]

Are you going to die?

[A]

I actually, I was supposed to be. My whole dinner. I was supposed to be somewhere at 7 and now 7:06 and I have to run.

[B]

Oh, Il Molina.

[A]

No, on 8th Street.

[C]

So you're gonna have. You're done, right? I mean, you're gonna have Peter Beinart on.

[A]

We talked about that at one time.

[C]

I mean, that would be a good.

[B]

Sure.

[A]

I'm so tired of arguing.

[C]

Oh, okay. I thought you wanted to.

[A]

No, I, I, I, I, I mean, not.

[C]

All right. You know what I mean.

[D]

Okay.

[A]

Questions, concerns, info [e-mail] podcast.com seller.com. good night. Okay, I'm gonna run out.

[D]

I want that cut out, please.

[A]

The what? Where? My, my. Oh, no, I'm not cutting it out.

[D]

Come on.

[A]

I'm not cutting it out.

[D]

No, I never ask for stuff to get cut out. It's embarrassing.

[C]

I miss.

[A]

That's the best part is that it's embarrassing.