Fixing the Potholes in the American Healthcare System

You know it’s a slow news day when the Wall Street Journal runs a story on potholes in British roads. Not just potholes, but people posting silly photos of potholes on social media. There turned out to be a deeper purpose to the article, though. These were people shaming their local governments into addressing a basic need, specifically fixing the holes in roads that represent a serious threat to motorists ($700M in automobile damage across the UK last year), not to mention cyclists. The photo above comes from James Coxall, a resident of a town near Cambridge. According to the article, Coxall had been complaining to his local council for eight months about a particularly deep and dangerous hole on a nearby road, but without success. He and his wife put jeans and trainers (Brit-speak for sneakers) on two wooden boards, placed the fake legs shoe-end up in the water-filled hole, and posted photos on his Facebook page. It promptly went viral. Then, lo and behold, the hole got fixed. Now Coxall gets requests from people around the country to make legs for their potholes as well.

What is it about humor that makes it an effective force in social change? And how can we tap into this to fix healthcare?

This article in the journal Humor (yes, there’s an academic journal devoted to humor research) says that humor serves multiple functions: attracting attention, persuasion, offering a way into complex issues, dissolving social barriers, and encouraging message sharing.

Personally, I think of humor as taking the principle of nonviolence one step further. The impulse to react to injustice by attacking people or property is understandable. But while it can sometimes force social change under specific circumstances, it raises obvious moral problems, and it’s often counterproductive. Like when Luigi Mangione turned a rapacious insurance CEO into a sympathetic murder victim leaving behind a wife and two kids. Violence hardens ideologic positions and invites escalation. Nonviolent protest, on the other hand, works in part because it promotes sympathy for the cause. Humorous protest takes this idea even further, into what I would describe as emotional antiviolence.

Consider the following two cases: A couple years ago, environmental protesters from Extinction Rebellion threw cans of soup at the Van Gogh Sunflowers painting on display in London’s National Gallery. From the protesters’ perspective this was a classic nonviolent action. They knew the painting was covered in glass and they thought their "performance art" would bring positive attention to their cause. But to me it felt emotionally wrong. I love Van Gogh’s art, and I love that the National Gallery makes a massive world-class art collection free to the public. So choosing them as objects of protest left me feeling less sympathy toward Extinction Rebellion rather than more. (If they feel they have to throw cans of soup, they should throw them at the Shell Oil headquarters, not Sunflowers.)

Now, contrast that with this chant by Australian schoolchildren protesting climate change in a government office: “We have kazoos and we’re not afraid to use them!” The silliness makes the protest more effective. It also distracts from the fact that the kids are ditching school and trespassing.

In the healthcare justice space, John Oliver’s news comedy show Last Week Tonight (HBO) has done a number of hard-hitting pieces. My two personal favorites were this skewering of Davita for putting profits ahead of kidney dialysis patients, and when he ripped apart the Sackler family for their court fight to retain the billions they made by fanning the flames of the opioid epidemic. Oliver explained in this NYTimes interview how his show deals with dark themes. He confessed that sometimes the writers have come back to him and his producer to say that a topic was too depressing and they just couldn’t come up with any way to add jokes. But most of the time they’re able to find mockable elements of absurdity in the people and corporations they cover. 

My favorite healthcare humorist, though, is Dr. Glaucomflecken, aka Dr. Will Flanary. Flanary graduated from the only medical school in the country named after Dr. Seuss and now practices ophthalmology in Clackamas County, Oregon. He had dabbled in standup comedy during high school and college, then later during residency began posting short comedy videos on social media. These days he has a huge following on LinkedIn (which is where I see his content) as well as Facebook and YouTube. Many Glaucomflecken pieces are based on classic medical tropes such as the orthropod bro or the safety-obsessed pediatrician.

But recently he’s been posting vicious bits about healthcare profiteering. Like this one where he sends his 5 year old daughter to collections for an unpaid bill following splinter removal by “Dr. Daddy.” Or this one about an executive from United Hellthcare (note the spelling) bragging about their denial rates. And here's his version of a PBM executive explaining to a pharmacist how kickbacks from drug companies work.

Why don’t more doctors (or nurses, or pharmacists) do comedy? Maybe because it takes a lot of practice before you’re any good at it, and over-educated professionals who are used to being the smartest people in the room might be uncomfortable putting themselves out there. I also wonder whether our science-centric culture teaches us that medicine and healthcare are serious subjects that deserve a serious tone.

Regardless: We need more Dr. Glaucomfleckens in the fight for medical justice.