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November 2011

A Compelling, Compassionate, Critique of Conservative Extremism by David Frum

NewYorkMagazine_20111128_politicscvr_150the [Republican] party is getting the big questions disastrously wrong

[David Frum on the GOP’s Lost Sense of Reality (New York Magazine, 20 November 2011)]

David Frum, former economics speechwriter for former U.S. President George W. Bush, offers a sharp critique of the Republican Party in an interview with NPR's Steve Innskeep yesterday, David Frum asks "When did the GOP lose touch?". The interview was prompted by Frum's recent article in the current issue of New York Magazine, which is impressive in its breadth and depth ... and, I would argue, its compassion.

I often feel incensed at some of the things I hear and read conservatives saying and writing. Frum's article helps provide some context for some of the perspectives presumably felt and sometimes articulated by some conservatives, but does so largely without being condescending. I'm reminded of one of the central tenets of non-violent communication: communication designed to induce fear, shame and/or guilt in a listener often arises from conscious or unconscious fear, shame and/or guilt on the part of the speaker. I'm also uncomfortably reminded of my own tendencies toward projection and rejection ... which are [also] reflected in the subtitle of Frum's article:

Some of my Republican friends ask if I’ve gone crazy. I say: Look in the mirror.

I highly recommend reading the entire article, and its complementary companion article by Jonathan Chait, who until recently was senior editor at The New Republic, How Did Liberals Become So Unreasonable (although frankly, I did not find Chait's article as compelling ... or compassionate). Here, I wanted share a few excerpts highlighting some key observations Frum makes regarding the rightward GOP shift(s).

  • On Fiscal Austerity and Economic Stagnation:
    ... the big winners in the American fiscal system are the rich, the old, the rural, and veterans—typically conservative constituencies. ... Any serious move to balance the budget, or even just reduce the deficit a little, must inevitably cut programs conservative voters do like: Medicare for current beneficiaries, farm subsidies, veterans’ benefits, and big tax loopholes like the mortgage-interest deduction and employer-provided health benefits. The rank and file of the GOP are therefore caught between their interests and their ideology—intensifying their suspicion that shadowy Washington elites are playing dirty tricks upon them.
  • On Ethnic Competition:
    [In a National Journal article based on a Gallup poll of Republican voters, Second Verse, Same as the First, Ron Brownstein reports that] "... noncollege whites are the gloomiest: Just one-third of them think their kids will live better than they do; an equal number think their children won’t even match their living standard. No other group is nearly that negative." Those fears are not irrational. ... It is precisely these disaffected whites—especially those who didn’t go to college—who form the Republican voting base.
  • On Fox News and Talk Radio:
    Extremism and conflict make for bad politics but great TV. Over the past two decades, conservatism has evolved from a political philosophy into a market segment. An industry has grown up to serve that segment—and its stars have become the true thought leaders of the conservative world. The business model of the conservative media is built on two elements: provoking the audience into a fever of indignation (to keep them watching) and fomenting mistrust of all other information sources (so that they never change the channel).
  • On [what I would call] unenlightened self-interest:
    We used to say “You’re entitled to your own opinion, but not to your own facts.” Now we are all entitled to our own facts, and conservative media use this right to immerse their audience in a total environment of pseudo-facts and pretend information. ... [sinister GOP] billionaires do exist, and some do indeed attempt to influence the political process. ... Yet, for the most part, these Republican billionaires are not acting cynically. They watch Fox News too, and they’re gripped by the same apocalyptic fears as the Republican base. In funding the tea-party movement, they are ­actually acting against their own longer-term interests, for it is the richest who have the most interest in political stability, which depends upon broad societal agreement that the existing distribution of rewards is fair and reasonable. If the social order comes to seem unjust to large numbers of people, what happens next will make Occupy Wall Street look like a street fair.
  • "a going-out-of-business sale for the baby-boom generation":
    Some call this the closing of the conservative mind. Alas, the conservative mind has proved itself only too open, these past years, to all manner of intellectual pollen. Call it instead the drying up of conservative creativity. ... In the aftershock of 2008, large numbers of Americans feel exploited and abused. Rather than workable solutions, my party is offering low taxes for the currently rich and high spending for the currently old, to be followed by who-knows-what and who-the-hell-cares. This isn’t conservatism; it’s a going-out-of-business sale for the baby-boom generation.

Frum finishes off the article with a call for conservative moderates to speak up:

I refuse to believe that I am the only Republican who feels this way. If CNN’s most recent polling is correct, only half of us sympathize with the tea party. However, moderate-minded people dislike conflict—and thus tend to lose to people who relish conflict. The most extreme voices in the GOP now denounce everybody else as Republicans in Name Only. But who elected them as the GOP’s membership committee?

Silent majority_for_peaceDuring this period of increasing protests against inequality and injustice - on Wall Street and other streets in America, as well as on streets and squares in Egypt and elsewhere around the world -  I'm reminded of earlier widespread protests against the Vietnam War ... and former Republican President Richard Nixon's claims during that period to be the spokesperson for what he called the silent majority, and his largely successful efforts to divide and polarize the American people ... and claims made by the more recently self-appointed Republican spokespeople of real Americans.

However, harking back to that earlier period of protest also reminds me of the wisdom of an inspiring liberal who, like Frum, [also] called for moderation in words and actions in the cause of promoting change: Dr. Martin Luther King, Jr:

History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.

Although Frum and King espouse different perspectives on the types of changes that are likely to lead to a greater Good, a vigorous, non-violent debate seems like the most likely course to lead toward improvements in politics and society.


Usability and confusability in Health IT: doctor-computer interaction vs. doctor-human interaction

20111109_doctor_hospital_electronic_35A segment on the Marketplace Tech Report, Health care providers having trouble with new technology, caught my ear yesterday. The story included health and safety concerns raised by one of the authors of a 197-page report, Health IT and Patient Safety: Building Safer Systems for Better Care, published by the Institute of Medicine this week:

Dr. Ashish Jha, a professor at Harvard's School of Public Health and an author of this report as well says, "One of things that happened in Pittsburgh, in the pediatric ICU was that when the electronic system was put in, it really changed the way doctors and nurses interacted and the way they worked together. Physicians started spending a lot less time at the bedside and they were spending a lot more time staring at the computer screen, and interacting less with nurses and interacting less with patients. And there's a lot of information you pick up when you speak directly with people that when you go to purely electronic communication, you miss."

Two diametrically opposed possible explanations for the increased inattention of doctors to their human colleagues and customers (aka patients) came to mind:

  • the health information technology (HealthIT) systems are so well designed that doctors are becoming engrossed in the wealth of information newly available to them
  • the new HealthIT systems are so poorly designed that doctors are being needlessly distracted by confusing and unintuitive interfaces that require significant attention to navigate effectively.

HealthITandPatientSafety_coverAfter downloading and skimming the report [a pre-publication version of which is available as a free PDF], it appears that the latter explanation is most on point. Chapter 4 of the report, Opportunities to Build a Safer System for Health IT, includes observations, analysis and recommendations for usability, workflow and other human-computer interaction (HCI) issues involved in the design of effective Health IT systems. The report includes chapters on other topics involving information and technology (many of which incorporate elements of HCI), but it is encouraging to see such a strong human-centered focus on what is, by definition, a very human-centered domain.

SaferSystemsForHealthIT_Fig_4_1

Among the observations shared by the committee who authored the report is a strident call for usability as a mission-critical factor:

The committee expressed concerns that poor [Health IT] usability ... is one of the single greatest threats to patient safety. On the other hand, once improved, it can be an effective promoter of patient safety. [emphasis added]

Among the relevant references they recommend for improving usability:

Unfortunately, I don't currently have the time to dig more deeply into the report or the wealth of references it cites (I have 75 midterm Operating Systems exams to grade in the next 36 hours). However, in my [re]new[ed] role as educator, I will be teaching a class on HCI next quarter and am pondering how I might indulge my increasing interest in computer supported cooperative healthcare and find ways of focusing on healthcare issues as a stimulating and worthwhile problem domain for undergraduate students learning about HCI.

Having recently read a compelling NYTimes article on Why Science Majors Change Their Minds (It's Just So Darn Hard) - which emphasized the increasing importance of design, projects, problem solving and social service to motivate students studying Science, Technology, Engineering and Math (STEM) - I'm eager to put some of these ideas into practice.

[Update: The New York Times has a related article on doctor-computer interaction, which focuses on the distraction caused by highly engaging IT devices and services that are not designed specifically for healthcare: As Doctors Use More Devices, Potential for Distraction Grows (found via a post on Distraction at Josephine Ensign's "Medical Margins" Blog).]