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Animal Farm, 1984 and The Hunger Games
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There was a time when Animal Farm and 1984 seemed to be apocryphal, even fanciful representations of political despotism and manipulation.
Of course, time showed that they actually reflected the potential consequences of the political passivity by the masses of the time.
The recent political shenanigans in the United States — and elsewhere — have sadly drawn these two classic texts of population vulnerability back into focus.
Before our international colleagues consider criticizing us, we should all note their problems, such as the idiocy leading up to “Brexit,” the recent electoral confusion in Germany and the ever-present farce of Australian politics, just to name a few.
Of course, we should never forget that, despite some flaws, those of us living in democratic society are vastly ahead of those subject to the totalitarian states that George Orwell criticized so effectively. Hopefully we will be able to retain our freedoms.
State of the electoral season
In a discussion regarding the “winner” of the recent televised first presidential debate, Chuck Todd — host of NBC’s Meet the Press — commented that he felt sorry for the American people. That phrasing certainly resonated with me.
I simply cannot recall a more troubling electoral season for anyone with even a passing interest in current affairs, in which critical sociopolitical issues have been ignored in favor of personal attack, posturing, rhetoric, innuendo and nonsense.
It is not difficult to understand why our community’s revulsion for the dysfunction inside the beltway has led to the presentation of some unusual candidates for the top job. Sadly, much of the behavior shown by many candidates in the primaries and subsequently could only be described as puerile.
This also seems commensurate with the electorate characterized by a dramatic increase of the impact of social media, heavily populated by anonymous, cowardly, threatening bullies with extreme views who seem pleased to harass, malign and threaten anyone with a contrary opinion.
Health care issues
More specific to our domain, whatever happened to a discussion of the critical health care issues of our time?
We live in one of the wealthiest nations in the world but are not able to contain costs, or to provide world-class care to all patients with life-threatening disease. Our attempts to influence community disease avoidance are pathetic. We continue to be caught in a vortex of being influenced to use expensive treatments, for a broad range of diseases, with precious little evidence that they work or that they have any value to patients or even the community at large.
Government continues to be influenced in defining its health care policies and outcomes by health care systems that are focused solely on wealthy, insured, well-nourished and educated patients — no surprise that they produce better outcomes than those systems that actually provide care to unselected sets of patients.
We seem to have lost the concept of true accountability in medicine, which has been replaced by the attempts of government organs to “regulate” our profession, when actually creating income through a culture of complex, indecipherable and confused legislation interfaced with aggressive and punitive investigation. Although some professional societies, such as ASCO, have taken leadership roles in trying to rationalize medical practice and avoid profligate waste of medical and fiscal resources, there remains a disappointing national ineptness in this domain, particularly at a political level.
I suppose we should draw comfort that the current presidential campaign is so focused on peripheral and personal issues that it has ignored the opportunity to address health care — and potentially screw things up even more soundly.
Physician influence
I find several things particularly troubling in the current campaigns, including — but not limited to — personal attacks on many populations within the electorate; the use of diversionary tactics; absence of planning; lack of knowledge of politics, strategy and global warming; paucity of common sense in electronic communication ... the list is just endless!
I recently reviewed the dramatic and iconic scene from the cult film Network, in which the newsman played by Peter Finch said, “I’m as mad as hell, and I’m not going to take this anymore!” Preaching to the choir!
So what’s the message? It is simple.
This publication is distributed to more than 40,000 clinicians. Each clinician interacts with hundreds of patients, family members, nurses and support staff every day.
If — as physicians — we exercise some of the values of yesteryear and resume our roles as valued and respected community leaders, we can potentially influence a substantial proportion of the electorate to take the trouble to understand the important problems facing us, evaluate the candidates critically, and stand up against conflation of unrelated threats and issues.
Even more important, perhaps we can dissuade potential voters from becoming automatons that support their political parties unquestioningly, and encourage them actually to leverage their vote in a meaningful way.
Maybe we can remind patients that global warming is a physical reality supported by data and will eventually have biological and clinical implications. We could note the unacceptable unique death rate in our nation from guns and similar arms and comment that the founding fathers gave us the right to bear arms, not to bear weapons of mass destruction.
The bolder among us might even note that politicians should not be above the law, and should not be allowed to commit vast errors of judgment without penalties, nor should the community accept rhetoric, fabrication and lies as being acceptable alternatives to truth and principle.
We face a crucial election for the future of democratic society. History will judge us harshly if we allow chaos to emerge and expand further. Somehow we find ourselves in a dystopia, in which traditional values have been lost, anarchy among the great unwashed is gaining traction and harming those of us who contribute effort and ideas to the nation, pay taxes and obey the rule of law.
I entreat each clinician reader of this commentary to become an active agent for reason, logic and common sense, and to take the extra few moments to talk to your patients and refuse to put up with this nonsense.
The alternative is to move into the world of The Hunger Games.
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Carolinas HealthCare System. He can be reached at derek.raghavan@carolinashealthcare.org.
Disclosure: Raghavan reports no relevant financial disclosures.