Well, I voted for them so I'll take partial credit.
Nashville is an oasis of blue in a red state... But I suppose that describes all big cities in red states these days.
Don't get all pissy about it, it works great!
Robert Picardo directed a lot of those episodes, so I'm sure he could have written in that recognition...but preferred the tension of having talent and ability mixed with a personality that made him unbearable. His character recognized this at times but never really grew. One of the better jokes was that all the other EMRs of him were so toxic that they were decommissioned as doctors and put to work piloting garbage transports.
Everybody is taking a guess but the meme really came from a legal situation (i forget which state) where incest could not be portrayed in porn but was precisely defined as a blood relative. By mentioning the male was a "step brother" somewhere it ensured the video could not be classified as incest in legal terms (while still appealing to....that crowd). It was used enough combined with awkward acting that it became a meme in general... And the Internet ran with it like it does. So it just sorta implies a porn situation now
Also famously an early lgbt ally. Before the term gay existed in the 20s and 30s the polite way of asking if a man was homosexual was if they were a friend of Dorothy.