What makes a meme effective -- be it verbal, visual or the combination -- is repetition.
And then, an astute reader at BAGnewsNotes pointed out how the sham-scholarship here is telegraphed by the author's name and degree superseding the title. (Plus, as far as I know, the "h" in Ph.D. is not supposed) to be capitalized. Plus, note the employment of capitalization, even on the small letters, to typographically heighten the stature and professional degree of the man behind this slander.
Finally, credit to Richard Silverstein (via a post at Metafilter) for calling out the linguistic manipulation married to the visual. Intone the title in you head and the man you see in this otherwise-thoughtful pose rings as an abomination.
For a deeper treatment of the MSM's racial and religious stereotyping of Obama, check out ObamaPhobia, an audio slideshow of my recent presentation at NetrootsNation.