One of the reasons that intellectuals do so poorly in the face of propaganda is that we intellectualize it.  We can either be “troubled by the facts put forth,” or we dismiss it as nonsense which no thinking person could tolerate.  Those approaches are instinctive responses of the intelligent, and they are ineffective.  The masters of propaganda have learned this certainty, and are playing to it.

What were the problems that the American people wanted to be addressed in the 1990’s, what were the problems discussed in To Err Is Human, the IOM publication in 1999?

  • Lack of predictability in the payment system.
  • Vulnerability to financial ruin from serious illness.
  • Fragmentation of the healthcare system and the potential for consequent error.
  • Lack of a single longstanding primary care provider.
  • Lack of time to discuss medical issues.
  • Healthcare having an overly-weighted focus on drugs and procedures.
  • Failure of medical information technology to keep up with its advances in other fields.

It is twenty years later.  How have we progressed on solving these issues?  It seems to me that there has been an accelerated worsening of every aspect where the American public wanted improvement, and the IOM study pointed out as a concern – the fragmentation of connectivity in the medical establishment.

If you have a patient in the hospital, you may never round on her/him; nor will you be informed in any way when they went in, when they left, or what was done for them.  Today, they are tracked into fragmented silos of medical care.  Nobody knows what is going on.  Is this improvement over 20 years ago?

“Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient safety researchers provides some context.”

How frequently do surgeons remove the wrong body parts, and is that mistake part of the massive trend of error that the authors report?  It is nonsense, and everyone knows it.  But the Washington Post has no reservations about putting it forth in a “news” column, and the BMJ has no problem with putting it forth with its stamp of scientific approval.  If a publication is issued for the clear goal of propaganda, it must be propaganda, no matter how opaque the truth is to the intellectual classes.

The purpose of this “sales pitch” is to propose that 10% of all deaths are due to medical errors, and that the problem is at the dimension of heart disease and cancer.  Yet, it is not being improved upon due to the selfish and malign purposes of the independent doctors.  Therefore, the independent practice and freethinking doctor must be stamped out.

When the war is going badly, the attention of the people must be controlled and directed, lest a civil war erupt.  Good propaganda can control people.

The first assumption that must be impressed upon the people is that their impressions and opinions are fallible and incorrect.  They ought not think for themselves.  The Direct Primary Care movement is a great threat to the modern Industrial Retail Medicine structures, as it centers care in the doctor/patient dyad – the one thing that the movement has been so effective in destroying.

Next, one must detach the individual from any perception of control over the strategic leadership in the matter.  They must remain apathetic and cynical, and key only off the voice of “leadership.”  We distort, you deride, says a play on words for one of the great media network’s slogans.  People should not think, they should throw rocks at the identified enemy.

Intellectuals are surprisingly helpless in the face of propaganda.  We seem to struggle with the question, “is this true, or is it utter rubbish?”  As doctors, we live in the medical profession.  Do we see this sort of butchery on a wide scale?  Do you see lethal medical errors as often as diabetes or pulmonary disease?  If not, why are we afraid to reject the proposition?

When we intellectuals see propaganda, we confuse ourselves by imagining that the propagandist is naïve and genuine, but poorly informed.  Surely, if we were to give her or him the correct facts, they would suddenly recant their harebrained position, and apologize for being wrong.  Does that happen?

Here is a lovely primer on how to use propaganda, written by one of its masters, to cover the general principles of propaganda.  Read it through, and ask what the goal of the revolutionaries overthrowing modern medicine are.

  1. Propagandist must have access to intelligence concerning events and public opinion.
  2. Propaganda must be planned and executed by only one authority.
  3. The propaganda consequences of an action must be considered in planning that action.
  4. Propaganda must affect the enemy’s policy and action.
  5. Declassified, operational information must be available to implement a propaganda campaign
  6. To be perceived, propaganda must evoke the interest of an audience and must be transmitted through an attention-getting communications medium.
  7. Credibility alone must determine whether propaganda output should be true or false.
  8. The purpose, content and effectiveness of enemy propaganda; the strength and effects of an expose; and the nature of current propaganda campaigns determine whether enemy propaganda should be ignored or refuted.
  9. Credibility, intelligence, and the possible effects of communicating determine whether (enemy) propaganda materials should be censored.
  10. Material from enemy propaganda may be utilized in operations when it helps diminish that enemy’s prestige or lends support to the propagandist’s own objective.
  11. Black rather than white propaganda may be employed when the latter is less credible or produces undesirable effects.
  12. Propaganda may be facilitated by leaders with prestige.
  13. Propaganda must be carefully timed.
  14. Propaganda must label events and people with distinctive phrases or slogans.
  15. Propaganda to the home front must prevent the raising of false hopes which can be blasted by future events.
  16. Propaganda to the home front must create an optimum anxiety level.
  17. Propaganda to the home front must diminish the impact of frustration.
  18. Propaganda must facilitate the displacement of aggression by specifying the targets for hatred.
  19. Propaganda cannot immediately affect strong counter-tendencies; instead it must offer some form of action or diversion, or both.

Dr. Goebbels went on and on a bit; he was deeply rooted in the German intellectual tradition, but became one of the best and most famous propagandists in history (so far.)  He clearly was very insightful and honest in his description of how to market propaganda.  Good job, Smokin’ Joe!

The balance between fascism and democracy is an unending plebiscite on the questions:

  • Am I able to think for myself?
  • What are the consequences of doing so?
  • If I understand that something is to be done, can I cause it to be done, or not?

People who fear the onset of fascism are merely watching the polls.  Sometimes governments are democratic, sometimes fascist, depending on the results.  I am pessimistic about ours, today.

I note that people fear that Donald Trump or Hillary Clinton may not be effective as the Wise Father or Wise Mother that should control the United States for the next few years.  That fear alone shows the depth of trouble we are in.  The President and the Congress do not have to be wise, benevolent nobles who will guide the herd to prosperity.  The country was never built on such a premise.  Why now?