To bridge gaps and solve hard problems, Kansans should moderate their rhetoric

June 23, 2021 3:33 am

A man wears an “I Do Not Comply” pin at a protest against masks, vaccines, and vaccine passports outside the headquarters of the Centers for Disease Control on March 13, 2021, in Atlanta, Georgia. As of that date, more than 534,000 people had died from COVID-19 in the U.S. (Elijah Nouvelage/Getty Images)

The Kansas Reflector welcomes opinion pieces from writers who share our goal of widening the conversation about how public policies affect the day-to-day lives of people throughout our state. Doug Iliff has been in the private practice of family medicine in Topeka for 35 years.

In my 45 years as a Kansas family physician, I’ve never been through anything like the COVID-19 pandemic, professionally or personally. On one hand, I know a perfectly competent and rational provider who purchased a personal ventilator in the first month after the alarm was sounded. On the other, I’ve got two intelligent sons in Los Angeles who think the disease has been fabricated or imported for political reasons, that masks spread disease rather than inhibit it, and that vaccines are a nefarious plot.

Anybody else have that sort of experience? Thought so. Confused about conflicting recommendations from experts? Me too, and I’m supposed to be one of them.

Rhetoric is an ancient art, not much taught today, but its practice is ubiquitous. We can’t escape it, because the choice of words and the definition of terms sometimes frames an argument in persuasive ways, whether consciously or not. This would be a good time to chill the rhetoric.

The abortion debate is shopworn by now, but one could almost certainly discern an opinion by the choice of terms. A person who claims to be pro-choice does not want to be cast as pro-abortion; and someone pro-life avoids description as anti-abortion.

“Mandate” has become one of those minefields. I’d be willing to bet that Anthony Fauci wished he had never used the word, because it is dripping with coercive connotation. After initially proclaiming masks unnecessary, mandating their use was bound to cause conflicts. “Recommendation” would have been more nuanced, might have saved the jobs of many a county or state health officer and perhaps obviated the need for Kansas health secretary Lee Norman to accept bodyguards.

Arnold Kling describes the “three languages of politics” as follows: progressives tend to see the world as a struggle between oppressors and oppressed; for conservatives, it is civilization vs. barbarism; and libertarians are concerned with the consequences of liberty against coercion. It’s the libertarians with their hackles up in the pandemic, and who could blame them?

We moderates can’t make up our mind, or we see different issues through different lenses. We all know there is a time for mandates. Vetted ID before boarding an airplane or driving a car? Check. No problem. Voting without that mandated ID, or appearing in church without a mandated mask? Them’s fightin’ words.

The pandemic mandates have been problematic for a number of reasons. “Following the science” has become something of a joke, because the disease was novel, scientific studies gave different results, and scientists disagreed — unless your information sources were carefully siloed. Therefore our views often depended more on our political “language” than a dispassionate view of a complicated subject.

Even in a profession like medicine, the mandates speak with forked tongue. I don’t deliver babies any more or see patients in the hospital, but to maintain my hospital staff affiliation I must periodically get a TB skin test and annually receive a flu shot. Yet COVID-19 vaccination, so far, is not mandated. The result is that a third of hospital employees have refused vaccination, even though COVID is a far more serious issue than TB or influenza.

“Social determinants of health” is another term which frames an issue carelessly. It was invented by a commission of the World Health Organization in 2005, which could not explain it without using weasel words like “influences,” or “leads to.” Because, of course, nothing “determines” our health, with the possible exceptions of genetics or genocide.

“Food deserts” are a problem that would be good to solve. Still, I have lots of fat patients who live in oases of luxury, and skinny ones who live in poor neighborhoods. The Dillons in central Topeka, abandoned as a grocery store and now the site of GraceMed, was where the family shopped when my kids were young. Then panhandling became a neighborhood problem, and two police officers were killed in the parking lot.

As a result, the ensuing food desert was turned into a health oasis.

The rhetorical advantage of “determinants” is its power. If I am “determined” to end up in poverty, ill health, or deprived of the finer things in life, the show is over. No use trying to improve myself by education or exercise; what I require is salvation from an outside agency.

I can’t imagine a more crippling message to send to someone in challenging circumstances. Perhaps rhetorical moderation would be helpful in bridging opinion gaps and solving hard problems.

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Doug Iliff
Doug Iliff

Doug Iliff has been in the private practice of family medicine in Topeka for 35 years. He was also a family physician at Ft. Bragg in North Carolina for five years and an emergency physician at Stormont-Vail in Topeka for six years.