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Saturday, April 10, 2010

The wow factor and tachyphylaxis

I have come to realize that my medical education  has more relevance to non-medical contexts  than I could ever have imagined. In today's NYT, Gail Collins published a piece entitled "The curse of the wow factor". In it she laments that -
The problem is that they’re all wow and no substance....... There’s a feeling abroad that politicians can only get attention by sounding a little nutty. 
In order for any given politician to generate support, they need to attract attention in a world where they are competing for attention. That is an increasingly challenging task to accomplish in a world with some many inputs and increasing volume of each of these inputs. This is classic pharmacology.  Place a cell is a quiescent state and it becomes primed to respond to a very nominal stimulus. You don't need much ligand to get a response. Keep a cell in an environment where it is bathed in stimuli and it adjusts by downregulating receptors and becoming responsive only to the most robust of stimuli.

The public has become less responsive to what might be considered "normal" political stimulation because we have downregulated our political receptors. As it stands now, those politicians who can get through the first wave of selection for major candidacy MUST significantly activate a portion of the party faithful to generate specific responses;

1) showing up for public appearances and generating motivated crowds
2) Check writing behaviors
3) Foregoing other activities to be involved in campaign activities.  

 The question is what stimulus in needed to get this response in sufficient numbers of people over time to keep a campaign energized? It ultimately depends upon how much other stimulus people are getting and how much their receptors for political stimuli have been downregulated.

I am reminded of the similarity of this scenario to entertainment and prime time TV. When the TV series ER first aired, it was novel and widely acclaimed. Over time, the writers needed to find novel scenarios (stimuli) which they had not yet exposed their audience to since prior exposure meant that the appropriate TV receptors had already been downregulated or otherwise rendered non-responsive. They ended up requiring increasingly outrageous circumstances to happen each week in order to hold the audiences attention. Like the politicians described by Gail Collins, the characters had to become nuttier and nuttier in order to hold the audiences attention.

How do you restore the appropriate responsiveness to stimuli once tachyphylaxis has happened? In the world of pharmacology, you need to withdraw the drug. When the writers of ER could no longer dream up story lines which could titillate the public sufficiently, audiences melted away seeking their fixes by watching Nip Tuck or House, thus finding alternative sources of stimulation. They simply found a different stimulant whose receptors were still active, at least for a while.

At least part of the reason we have gotten to this point is that we have no consensus on what job politicians are actually vying to do. Is their primary role to serve the county, to serve their constituency, to protect the constitution, to be fiscally responsible, the protect the weak, to be leaders or follows. Ask five people and you will get five different answers. We could try to have a discussion about what their job should be but that would simply not be stimulating. Politicians could try to take on a leadership role and tell voters what they thought their job should.  I strongly suspect that would be an extremely ineffective vote garnering exercise. Absent a defined job for them to accomplish, there is no other approach to garnering votes than to "wow" the voters with ploys ever more out there.

Given the ground rules and the new avenues for pursuing the wow factor, there is no reason not to assume that politicians will get progressively nuttier and nuttier and the impassioned faithful will become even more emotionally and less cerebrally motivated. Politics may very well become the province of the drug crazed until there is sufficient sentiment to follow the old Nancy Regan principle of "Just say no".

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