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Mehmet Oz, a Republican candidate for U.S. Senate in Pennsylvania, takes part in a Republican Jewish Coalition event in Philadelphia on Aug. 17.Matt Rourke/The Associated Press

James Rohr moved to Pittsburgh 50 years ago and worked his way up to become chairman and CEO of PNC Financial Services Group, the sixth-biggest bank in the United States. He was chairman of the board of the city’s Carnegie Mellon University, headed Pittsburgh’s 250th anniversary celebration and was named Pittsburgher of the Year a decade ago. Then the city named a downtown street for him. “After all these years,” he said this week, “everyone still knows I’m from Cleveland.”

No wonder the celebrity doctor Mehmet Oz – with regular appearances on The Oprah Winfrey Show, with his own medical television show and with the endorsement of former president Donald Trump – is having trouble in his campaign to win a Senate seat from Pennsylvania in this fall’s midterm elections. He’s also from Cleveland and, as his Democratic rival in the campaign repeatedly points out, has lived in New Jersey for years.

Thus a lesson in American politics and American culture.

The United States may be a giant continental country of 332 million people with an influence that extends far beyond its borders, but it retains intensely parochial political values. The late speaker of the House of Representatives Thomas (Tip) O’Neill Jr., the product of an enclave of Cambridge, Mass., known as Barry’s Corner, had perhaps the greatest insight in American politics when he declared “all politics is local.”

Dr. Oz is learning that every day here. He’s not local.

In one of the most competitive Senate races in the country – in one of the few states where Democrats have a good chance of capturing a Republican seat in the evenly divided chamber – the conversation is only glancingly about inflation, abortion, immigration, taxes, the federal budget or who controls what is taught in schools. It’s primarily about whether the Republican candidate for a body that has the power of confirming judges and presidential appointments is sufficiently a Pennsylvanian.

John Fetterman, the state Lieutenant-Governor who is the Democratic nominee for Senate, is running a relentlessly local campaign. Not only is he stressing his record as mayor of financially distressed Braddock (population 1,885), he also is ceaselessly pounding Dr. Oz for not being from Pennsylvania. He is pressing the theme in television ads, billboards, videos, social media postings and even on a banner that trailed an airplane flying over the New Jersey shore carrying a banner mocking Dr. Oz by declaring, “Welcome home to N.J.”

This summer Mr. Fetterman’s campaign released a video starring Nicole LaValle, widely known as Snooki from MTV’s Jersey Shore. “I heard that you moved from New Jersey to Pennsylvania to look for a new job,” she said. “I know you’re away from home and you’re in a new place, but Jersey will not forget you.”

The Fetterman fusillade has put Dr. Oz so much on the defensive that Mr. Trump is swooping into the state Saturday to help refocus the campaign from where the doctor lives to whom the doctor resembles, with the former president sure to say that he sees himself in Dr. Oz. Both have University of Pennsylvania degrees, but Dr. Oz otherwise has little in common with his sponsor besides being a celebrity and arguing that the 2020 election was stolen.

In truth, Dr. Oz is not alone in being from someplace else.

Over the past half-century, two-thirds of candidates for the Senate have been from out of state. Hillary Rodham Clinton was less of a New Yorker than the Rangers’ Mark Messier (Edmonton) and Theoren Fleury (Oxbow, Sask.), but she won an Empire State seat in 2000, an echo of how Robert F. Kennedy – less of a New Yorker than the Yankees’ Mickey Mantle (Oklahoma) and Roger Maris (Minnesota) – won a New York race in 1964. Members of the New York-based Rockefeller family became governors of Arkansas (1966) and West Virginia (1976). One of the Senate’s most colourful and influential figures, Daniel Webster, was born in New Hampshire but entered the Senate in 1827 from Massachusetts.

“Not being from Pennsylvania has become a big liability for Oz,” said Charles Hunt, a Boise State University political scientist whose Home Field Advantage: Roots, Reelection, and Representation in the Modern Congress is being released next week. “It has played into the narrative that the Fetterman campaign is trying to tell about him. There’s no way Oz can really rebut the fact that he is not a long-term Pennsylvanian.”

This would matter less in, for example, Arizona, where the Republican candidate for the Senate, Blake Masters, was born in Colorado and where the Democrat, incumbent Senator Mark Kelly, was born in New Jersey. (The 52 days Mr. Kelly spent in space as an astronaut might account for about the amount of time Dr. Oz spent in Pennsylvania before joining the Senate race.) But Arizona, stuffed with retirees and immigrants, is a state accustomed to outsiders and Pennsylvania is not. One measure: Immigrants comprise only 7 per cent of Pennsylvanians.

American campaigns often are remembered for one telling moment. Gerald Ford lost the White House in 1976 in large measure when he said that “there is no Soviet domination of Eastern Europe” when it was clear there was. Ronald Reagan won the White House four years later largely on the strength of asking “Are you better off than you were four years ago?” when most Americans thought they weren’t.

If Mr. Fetterman wins the Pennsylvania Senate seat, his campaign will be remembered for the video in which Steven Van Zandt, the star of The Sopranos and Bruce Springsteen’s E Street Band who moved to New Jersey at 7, asked Dr. Oz: “Whad’ya doin’ in Pennsylvania?” And then said, “Trust me. You’re a little outta your league. Nobody wants to see you get embarrassed. So come on back to Jersey where you belong and we’ll have some fun, eh? We’ll go to the beach, we’ll go surfing, come on.”