Know What It Means To Be ‘On the Flagpole’?

Catherine Hollander

You don’t have to work on Capitol Hill too long to realize the place has its own language. Lawmakers become “members.” A short-term legislative solution becomes a “patch.” And issues get their own shorthand, from the “doc fix” to “net neutrality.”

Ever wonder how all this lingo takes root?

For answers, one might look to Sen. Lamar Alexander, R-Tenn., whose pet phrase “on the flagpole” appears to be gaining traction, at least among a small subset of Hill staffers, lawmakers, lobbyists, and officials.

The expression may puzzle you, especially if you’re not familiar with the debate surrounding pharmaceutical compounding, where it is most often—or even exclusively—used. You may feel the urge to e-mail a colleague who has covered health care issues for years to see if it’s a pharmaceutical term of art. It’s not. It’s an Alexanderism used to describe the person or agency responsible for something.

A fatal fungal-meningitis outbreak last fall—the result of tainted steroid injections—has spurred proposed legislation to tighten restrictions on the type of pharmacies that mix custom drugs, a process known as compounding. Alexander, the ranking member on the Senate Health, Education, Labor, and Pensions Committee, wants to make sure someone is accountable for overseeing those facilities—or, as he says, to make clear who is “on the flagpole.”

Alexander has been using the phrase for more than 30 years. “My experience in life is that if it’s clear who’s on the flagpole, the job usually gets done,” he told National Journal Daily.

He traces its origins to his time as governor of Tennessee. “In my first Cabinet meetings I would say, ‘Why don’t we do X?’ Everyone would agree, ‘Let’s all do X.’ A month later, X wasn’t done. I learned the hard way that everybody does nothing,” Alexander recalled in a 1986 memoir of his governorship, Steps Along the Way. “I developed a new procedure. When something was important, someone went ‘up the flagpole.’ ”

Alexander brought the phrase to Capitol Hill during the recent discussions on pharmaceutical compounding, using—and defining it—in several printed editorials that have run in Tennessee newspapers (one 484-word piece cited the term four times).

It’s catching on, as these things tend to do.

“We had advised that any compounding manufacturer would also have to hold a pharmacy license in the state in which they were located. And I understand the reason for not doing that was to make the flagpole clear,” said Janet Woodcock, director of the Food and Drug Administration’s Center for Drug Evaluation and Research, at a May hearing.

Carmen Catizone, executive director of the National Association of Boards of Pharmacy, said at the same hearing, “We are concerned … that allowing the FDA access to pharmacy records for activities that are regulated by the states could create a confusing situation, could take people off the flagpole.”

Joseph Hill, director of federal legislative affairs for the American Society of Health-System Pharmacists, first heard the phrase at a HELP Committee hearing last year. “This regulatory gray area or legal gray area has been around for quite some time, so as soon as [Alexander] mentioned the phrase ‘on the flagpole, who is it going to be?’ I understood exactly what he was saying, because that’s been the problem,” he said. Now, ASHP uses the phrase internally, Hill says.

The popularization of the phrase among staffers and others gives Alexander hope. “I appreciate the fact that staff members listened to senators, and that senators were listening to each other and that the FDA was listening, too, and so maybe we’ll find the principle of accountability—well, it is the central feature of this solution to a really terrible public health tragedy,” he said.

But despite its spread, the neologism conjures different images among those who use it.

“I wasn’t sure whether it meant, frankly, like who’s on the flagpole—like someone’s sitting on top of the flagpole looking for something—or someone’s responsible for raising a flag, like flagpole duty,” said David Ball, president of Ball Consulting Group, which works with the International Academy of Compounding Pharmacists on media relations. “Growing up at school, there was always someone [on] flagpole duty.”

Hill had a different image in mind: “I kind of picture, you know, someone who didn’t do their job being tarred and feathered and tied to a string, and they raise this person up the flagpole for all to see they didn’t do their job,” he said.

Alexander pictures “somebody flapping in the wind, so it’s absolutely clear whose job it is to get it done.”