Thursday, September 22, 2016

Zingers, The Clubhouse Turn, and “The Intelligence of a Macaroon’’: Chuck McCutcheon’s Presidential Debate Primer

By Chuck McCutcheon

Presidential debates feature many, many words — way too many for some people. But the language of the debates, and the media/political world’s reaction to them, leans on a surprisingly small handful of stock expressions and phrases.
One maxim for politicians – especially in debates – is that you don’t always answer the question that you were asked; you respond to the one that you want asked. So get ready to hear “The question we should be asking…,” in the manner of Democrat John Edwards in 2007, when he was queried about whether he considered Russia a friend or a foe. After a perfunctory nonanswer, he honed in on what he wanted to talk about: “I think the question we should be asking ourselves is, how does America change the underlying dynamic of what’s happening in the world? 
… I think for that to occur, the world has to see America as a force for good again, which is why I talked about leading an effort to make primary-school education available to 100 million children in the world who don’t have it.”

This pivot happens so often in debates that there’s a name for it: the “clubhouse turn.”  Northeastern University journalism professor Alan Schroeder, author of several books on presidential debates, traces the phrase’s origin to Michael Sheehan, a debate coach for Bill Clinton and other Democrats. “‘Clubhouse turn’ strikes me as a particularly appropriate metaphor to apply to debates, since this is a genre with other parallels to horse racing,” Schroeder said.

Another debate maxim is to trivialize unwanted topics by seeking to regain the rhetorical high ground. Hence the popularity of the term “distraction from the real issues.” Lobbyist Jim Manley, a former spokesman for Democratic Senators Ted Kennedy and Harry Reid, calls it “a tried-and-true way to help yourselves get out of the hole and on the offensive.”

Debaters may despise their opponents, but the trick is to avoid seeming petty. That means invoking “with all due respect …” as a preface to leveling criticism, with the perfunctory pretense of appearing fair-minded. It’s the political version of the Southern phrase “bless your heart.” As humorist Dave Barry once wrote in his mock language column: “It is correctly used to ‘soften the blow’ when you wish to criticize someone in a diplomatic and nonjudgmental manner, as in: ‘With all due respect, you are much worse than Hitler,’ or ‘No disrespect intended, but you have the intelligence of a macaroon.’’’

Debates are mostly remembered for their “zingers,” the supposedly spontaneous clever one-liners that can shift momentum toward the candidates who utter them. Former Sen. Lloyd Bentsen of Texas is probably best remembered for telling Republican Dan Quayle in the 1988 vice-presidential debate, “You’re no Jack Kennedy.” In the Internet age, though, it can be difficult to get in a well-executed zinger, as journalists are constantly watching for scripted talking points.

Also a typical part of any debate is the “hypothetical,” the common reporters’ tactic for trying to get politicians to say something newsworthy. Most politicians, in general, duck legitimate questions by dismissing them as hypothetical. “They even seem to want credit for maintaining high standards by keeping this virus from corrupting the political discussion,” political journalist Michael Kinsley once wrote. But in debates, they’re often inescapable. The last round of GOP gatherings is still noteworthy for the 2011 question that asked candidates whether they would reject a hypothetical deal that cut $10 from the budget deficit for every $1 in tax increases; every candidate raised their hand.

Of course, debate observers will obsess over whether any candidate’s performance is so momentous that it’s a “game-changer.” That phrase’s now-common usage irks some academics looking for less simplistic explanations of how elections are decided.

“When it’s used to label events, it’s used very freely, generally with no empirical basis,” said Bethany Albertson, a University of Texas political scientist who studies political attitudes and persuasion. “I guess pundits are incentivized to use the language because it makes whatever happened sound hugely important, but there’s no check on its use.”

More from Chuck McCutcheon

Tuesday, September 20, 2016

The Opioid Abuse Crisis: An Opportunity for Public Policy

By David Nagel, M.D.

“Those are rare who fall without becoming degraded; there is a point, moreover, at which the unfortunate and the infamous are associated and confounded in a single word, a fatal word, Les Misérables.”

                         Victor Hugo, Les Misérables, Vol III, Book VIII, Chapter V

Jean Valjean still ranks as one of the great characters of literature. As the protagonist of Victor Hugo’s Les Miserables, Valjean finds a way to triumph over the evil of his fellow man — and in so doing he becomes a true hero, one who takes the gifts he has been born with, develops them, and then uses them to help all those around him better the world.

Idealistic French literature? Maybe. But there’s nothing completely abstract about this story; it happens every day in our country, just in a different form. In 1862 Hugo wrote: “So long as there shall exist, by reason of law and custom, a social condemnation which, in the midst of civilization, artificially creates a hell on earth…so long as ignorance and misery remain on earth, there should be a need for books such as this.”

Are we any different? I love my country, but we are not without sin. We lament our past injustices to Native Americans, African Americans, women, homosexuals, Jews, and others. We seek to fix the sins of the past, but there are others still who remain persecuted — and our social policies of the last hundred years have made an unnecessary living hell for both those who experience chronic pain and those who suffer from addiction. Currently, 35-40 million Americans suffer from what has been referred to as “high impact” chronic pain. Two and a half million Americans suffer from some form of “opioid abuse disorder.” For most of the past century they have all been treated like criminals, imprisoned by an ignorant system lacking mercy and falling decidedly short of justice. The social policies designed to help those addicted only harm those in pain, and what is needed is a change in perception — a cultural transformation, even — to de-stigmatize the stigmatized.

State and federal authorities’ stance towards opioid use and abuse has harmed many pain patients. I see the results every day in my office. The reality is that our options for treating pain are limited, and opioids are an important tool in this battle. So, the question needs to be posed to these authorities: if you are limiting access to opioids, what steps are you willing to take to help develop other options for care? This is not a new question, and perhaps it will receive greater emphasis as a result of the opioid crisis. It has been my observation that in colloquial terms, pain management and opioid prescription are too often viewed inter-changeably. It is also alarming that the needs of treating and preventing opioid abuse supersedes that of those who suffer from chronic pain, even though the ratio of those who suffer from high impact chronic pain to those who abuse prescription and non-prescription opioids approaches 20:1.

But hope is on the horizon. 

The National Pain Strategy is an extraordinary document that seeks to correct these problems. It acknowledges the issue of opioid abuse, points out the deficiencies in our ability to care for those who suffer, and offers a six point strategy for remedying these deficiencies by addressing: 1) population research, 2) prevention and care of chronic pain, 3) disparities, 4) service delivery and payment, 5) professional education and training, and 6) public education and communication. 

What is also exciting is that for the first time in my career, patient advocate groups are standing up for their rights. The Chronic Pain Advocacy Task Force has outlined four core beliefs which are being accepted by other groups including the National Pain Strategy. Moreover, the creation of state policies for medical cannabis is a direct challenge to failed federal drug guidelines. Cannabis and cannabinoids have great potential as therapeutic agents for pain, and at least 15 percent of pain sufferers risk government reprisal by illegally obtaining them for self-medication. 

Much is happening — finally — but much still needs to change. Pain patients are treated as pariahs by doctors, who often refuse to care for them. They are treated like criminals in a court system that views them as guilty until proven innocent. They are discriminated against in a workplace that sees them as a potential risk, or even just an extra cost. They are the targets of unsavory snake oil salesmen both in medical and non-medical settings. The list goes on.

In my book Needless Suffering: How Society Fails Those with Chronic Pain, I outline sixteen social institutions and how the behavior of each adversely affects the lives of those who suffer from chronic pain. More importantly, I offer solutions for these pervasive social and medical problems. My goal is to broaden the social discussion on chronic pain beyond just opioids and return a sense of dignity to those who suffer. As both a doctor and an author, I would like to see an end to the legion of Valjeans who suffer needlessly as a result of myopic policies. In doing so, I hope, like Valjean’s bishop savior, to provide mercy to the needy and a sense of hope to the hopeless. 

I welcome you to join this journey.