County Health: Where Do We Begin?

First, let me say that the title implies that we are not doing anything for community health, which is certainly not true. The Angelina County & Cities Health District does amazing work, day in and day out, to provide primary care, immunizations, preventive services, and much more. Our two hospitals – and the physicians, nurses, and other personnel who staff them – are monumental institutions of care, providing both emergency and specialty services (like heart surgery, neurosurgery, neonatal care, and cancer treatment) that many towns our size could only dream of. Our city and county governments help in their own way, with everything from parks, sidewalks and public transportation to smoking ordinances that, together, form a net of support for any broad public health initiative.

But now what? Last month, I wrote of our poor county health ranking (as determined by the Robert Wood Johnson Foundation) and the fact that Angelina County is dead last in Health Behaviors, which includes adult smoking, adult obesity, physical inactivity and access to exercise opportunities, excessive drinking and alcohol-impaired driving deaths, sexually transmitted infections, teen births, and food environment index. Collectively, we’ve got to do more to improve the health of the residents of Angelina County.

As President and CEO of the Episcopal Health Foundation Elena Marks loves to say, health is not healthcare. We cannot spend our way to health by doing more medical procedures writing more prescriptions for illnesses. Once people reach the healthcare system (emergency room or hospital, for example), so much of what determines true health has already been ignored.

What are the determinants of health? Dr. Paul McGaha, formerly with the Texas Department of State Health Services and now Chair of the Department of Community Health in the School of Community and Rural Health at UT Health Science Center in Tyler, describes four broad categories that determine a community’s health. First are social and economic factors, which are 40% of health determinants. These factors include education level, employment, income, family and social support, and community safety. Health behaviors, such as tobacco use, diet and exercise, alcohol and drug use, and sexual activity, accounts for 30% of a community’s health. Our physical environment, such as air and water quality and housing and transit availability, are responsible for 10% of our health. That leaves only 20% for what most people think is actually responsible for a community’s health, and that is actual access to and quality of healthcare. Unfortunately, healthcare expenditures nationwide are so unbalanced that 97.5% of spending – a staggering $3.3 trillion – is for that clinical care which only accounts for 20% of health. In other words, only 2.5% of healthcare spending goes to 80% of what determines our health as a community.

The facts are that US healthcare spending – dollars spent on actual care – far exceed other countries, and US spending on “social services” – including education, parks, public safety, transit, public health, etc. – is significantly less than other countries. What do we get for all that healthcare spending? Worse outcomes and lower life expectancy. Yet spending on healthcare continues to rise.

If we are to improve our county health rankings, we must attack determinants of health on all fronts. Much of that attack must come from outside the healthcare community, though those of us in healthcare need to both inform and encourage that discussion. We must consider the community health needs and ramifications in everything we do. How do we affect overall community health by curriculum choices in the schools, choice of grocery store displays (not to mention availability of fresh, healthy groceries), availability of parks and sidewalks, public safety, welfare, public health spending?

To that end, DETCOG has an opportunity to work with the Episcopal Health Foundation to access county by county data on healthcare and social services spending (analyzed by health economist J. Mac McCullough, PhD, MPH) so that we can learn how spending decisions impact the health and well-being of our residents. From that, we can explore opportunities to impact the health of our entire community by allocating our precious city and county funds for the biggest bang for the buck. Along with possible school-based initiatives mentioned last month, we must continue to look outside the box of traditional healthcare spending for ways to actually improve community health. As they say, it isn’t brain surgery. And that’s the point.

We can’t afford to pay for all the healthcare we are currently providing and projected to need in the future. The beautiful thing is, by wisely directing our resources now, we will be healthier and less of a burden to care for in the long run. That, my friends, is a win-win!

A Health Problem We Can’t Ignore

On Thursday, the Chamber of Commerce hosted the 11th annual Salute to Healthcare Banquet, where we recognized the importance of the healthcare sector and its role in the local economy as well as celebrated four great individuals for their contributions to our local healthcare community.

Amber Warner received the Nurse of the Year award for her work as a certified hospice and palliative nurse at Hospice in the Pines and her volunteer work in the community; Pat Todd was honored as Individual of Merit for her advocacy for suicide awareness and prevention; Sharon Shaw got the Healthcare Professional of the Year nod for her tireless work on behalf of the uninsured and underinsured at the Angelina County & Cities Health District; and Dr. Tom Willis was honored with the Lifetime Achievement Award for 30-plus years as an internist in Lufkin as well as his civic and charitable contributions. It was a wonderful night of celebration.

It was also a night of sober education about the poor state of health in our schools and our community at large. Dr. Jeremy Lyon, a retired Frisco ISD superintendent who has a passion for healthy kids and schools, presented a compelling talk titled, “Strong Kids in Healthy Communities: Creating Our Future.”
Angelina County is not healthy. That unfortunate fact is supported by data used to rank counties nationwide and compiled by the Robert Wood Johnson Foundation. These rankings are available for anyone to review at http://www.countyhealthrankings.org.

In Texas, Angelina County is in the lowest 20% for the state for Health Outcomes. Sadly, for Health Behaviors we rank dead last. Eighteen percent of adults smoke, compared with 14% for the state at large (and may states smoke much less than that). One-third of Angelina County residents are physically inactive. And fully 40% of Angelina County citizens are obese! On average in Texas, 28% are obese, with some counties as low as 21% - nearly half of where we are in Angelina County. Finally, life expectancy in Angelina County is almost 2 years and 9 months shorter than for the US as a whole.

All of these factors can be traced back to habits and behaviors we pick up as kids. In 1982, The Dallas-based Cooper Institute launched FitnessGram, a health-related fitness assessment used annually in tens of thousands of schools, reaching over 10 million children across the United States. But even with FitnessGram assessments in our schools, we are not changing behaviors.

Dr. Lyon presented factors in our culture that contribute to negative youth health outcomes as well as barriers and opportunities to improve youth health outcomes within schools and communities. One model - the Center for Disease Control’s (CDC) Whole School, Whole Community, Whole Child (WSCC) model, developed in cooperation with the Association for Supervision and Curriculum Development (ASCD) - is designed to improve learning and health in our nation’s schools. That model starts with the premise that every child in every school deserves to be healthy, safe, engaged, supported, and challenged. The CDC and ASCD understand that health and learning are inextricably intertwined.

The Texas Forest Country Partnership, the Chamber, the Angelina County & Cities Health District, Angelina College, LISD, and hospital and community leaders have already had an information-gathering meeting with Dr. Lyon to consider what steps we may take in Angelina County to improve our county health rankings. Goodness knows, they can’t get much worse. This will require a long-term, coordinated, multi-institutional approach to health and wellness with the entire community providing support.

Together, we can - we must - move the needle toward a healthier Angelina County. Literally, our children’s lives depend on it.

It Started With Kindergarten

It started with kindergarten graduation. However cute this photo op may be, it is symptomatic of a much larger problem in our society. We think – no, we demand – that our kids live in Lake Wobegon, the fictional town of Prairie Home Companion fame “where all the women are strong, all the men are good looking, and all the children are above average.” We refuse to admit that our children might be normal, so we turn every event into a hyped up ceremony.

I applaud the idea of giving our kids a healthy sense of identity, confidence, and purpose. But taken to extreme, all the pomp and circumstance paradoxically promotes selfishness and entitlement as opposed to a healthy sense of self in relation to others. We have created a self-centered ethos where everything is “all about me”, to be documented on Instagram, Facebook and Snapchat. This breeds a false self-confidence and self-identity apart from a true community.

We now have “promposals” where students elaborately stage and photograph asking a date to prom. To equate an invitation to a prom – already fraught with teenage angst and FOMO (fear of missing out) – with a wedding proposal is the height of high school self-promotion, if not self-deception.

Marriage proposals, too, are now destination events attended by families, videographers and drones – or even 100,000 of your closest football fans watching on the giant screen – turning a private, intimate declaration of love and commitment into an all-about-me reality TV event. Let’s not forget the expensive destination bachelor and bachelorette weekends and destination weddings that are increasingly leaving the traditional community behind. It is not a coincidence that we now have the term “bridezilla” to describe the selfish behavior of some brides. Consider the recent story of “Susan”, whose wedding was “ruined” because her invited guests wouldn’t write a check for $1,500 each so that she could have the Kardashian-for-a-day wedding of her dreams.

A new generation of kids, whose sex was announced by ever more elaborate gender reveal parties (including one in Arizona that caused a 47,000-acre wildfire), is being raised in a radically individualistic society, where one is encouraged to drink Diet Coke “Because I Can” and where we are urged to “Just Do You” when what advertisers really mean is, “Forget everyone else; you are the only one that matters.”

Fun fact: The number of emotional-support animals brought on airplanes increased by 74% from 2016 to 2017. I find it ironic that our Lake Wobegon above-average, perfect-at-everything-they-do kids grow up so insecure that they feel not only the need, but the entitlement, to take a live animal with them on a flight, or need a safe space because they can’t handle differences of opinion.

Our churches are not exempt from these worrisome trends. Do we only go to a church service to watch a performance and be entertained, and only if the performance is the music we like? Do we change churches like Sunday clothes? The church – the ekklesia, or assembly – is not about the individual any more than is society at large.

Any society is a group of people living and interacting with each other. It’s a give and take. Any community requires individuals to give up a part of themselves, not just with taxes (or tithes), or time, but also some of their preferences or needs or identity (i.e., their “self”-ish individuality) for the benefit and success of the whole.

Don’t get me wrong. I don’t long for a mythical 1950s time and place where WASP America demanded conformity to a non-existent ideal. I love the diversity in our communities, churches, and country. I celebrate the true individuality of people. But radical individualism destroys not only the community, but the individual soul as well.

No man is an island. John Donne (1572-1631), an English poet and cleric, penned that phrase almost 400 years ago. It is worth reading the entire poem:

No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend's were.
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.

We are all part of mankind, the human race, and part of one another. When one hurts, we all hurt. When one dies, a little piece of each of us is gone.

As individuals, we aren’t all exceptional, and that’s ok. We are, however, all different, and that’s ok, too. But let’s not bow to the false god of everyone selfishly doing their own thing without regard for our fellow man. Living and working together with respect, cooperation, and a healthy self-sacrifice – putting others above self – we can be extraordinary. Now, that is something to teach in kindergarten.

The True Power of Community

I have been reminded lately how wonderful our community of Lufkin is! I use the word community intentionally, for Lufkin is more than a city and more than just voting districts or neighborhoods or individual churches, organizations, or professions. All of these terms tend to identify us in division - as in separateness, not conflict - as opposed to unity.

Not that these markers of identity (such as Rotarian, Church of God in Christ, nurse, Episcopalian, etc.) don’t carry significance or meaning. But community implies (indeed, demands) unity. In fact, the word unity is part of root meaning of community. And unity is our source of strength. When we all – individuals, organizations – have common goals, we can accomplish much.

Sometimes our community rallies around a common athletic team such as the Lufkin Panthers or – the last two years – our Little League players. When a sports team is made up of upstanding individual players, such as the Thundering 13 or the Fierce 14, their victories became our victories. Our pride is not only in their outstanding team play and championships, but in their character, which we not so secretly claimed was a reflection of our city’s character. After all, they are “our” kids.

At other times, our community comes together for important work caring for our own. Two shining examples are the annual Thanksgiving Community Food Drive and The Junior League of Lufkin’s Back to School Bonanza (B2SB). Both events are often seen as “one day” events and get great press when they happen. But the events themselves are the tip of their respective icebergs when it comes to the organization and fundraising that precede them. The real testament to community for each of these events, however, is the number of people involved and purpose of each event.

The Thanksgiving Community Food Drive was started by the late Reverend Bettie Kennedy more than 25 years ago, who hand-delivered Thanksgiving meal boxes to needy families in North Lufkin. Bruce Love joined the work in 1999. That year, they delivered 50 boxes. Over the years, as eyes were opened to the even larger need in the community, the volunteer base and money raised grew and grew. Last year, $27,500 was raised - all for food - and 500 volunteers met at Brookshire Brothers’ White’s warehouse to pack and deliver 2,000 boxes of food for families in need. This is a true community event.

The Back to School Bonanza is another great program with broad community support. The junior League of Lufkin headed that effort, providing $60,000 - on top of $20,000 raised in the community - and leadership to over 60 organizations, churches, businesses, and foundations along with more than 500 community volunteers to provide a staggering amount of help for needy school kids to get the school year started off right. This wasn’t just a backpack drive, either! Yes, nearly 2,200 backpacks filled with grade-specific school supplies were handed out (with most of the supplies purchased from Brookshire Brothers). In addition, 1,100 breakfast sandwiches, 1,000 granola bars, and 1,000 bottles of water were handed out, 3,000 health kits were donated, 958 head checks were performed (and 88 lice kits given out). Over 4,200 uniform pieces were collected along with 2,300 pairs of shoes and 2,500 pairs of socks and $5,000 worth of underwear! One hundred forty haircuts were given. Even 1,500 children’s books were given out. Sixteen vendor booths were set up as well. The first person was in line at 1:20 AM!

Want more examples? Impact Lufkin just purchased the old Lufkin Country Club 170-acre tract of land to be used as a “site where the community will sow the seeds of opportunity,” according to Dr. Patricia McKenzie, Vice President of Impact Lufkin’s Board of Directors. “We have been blessed with a unique venue to carry out our mission as a community-driven organization that connects resources with responsible partners, agencies and programs to serve as a catalyst for sustainable community empowerment, revitalization and enrichment.”

Angelina College has also had significant announcements lately, including the launch of the Early College High School program with Lufkin ISD and with support from the TLL Temple Foundation. LISD Superintendent Lynn Torres noted to the Lufkin News that “this partnership allows students to not only take enough classes for an associate degree, but to also have the additional support from college instructors, teachers and counselors.” In addition, Angelina College – also with the help of the TLL Temple Foundation – is expanding staff capacity of the Small Business Development Center to focus on North Lufkin. These efforts are a demonstration of the power of partnership and collaboration – in a word, community.

A healthy community like ours is evidenced by a unifying spirit of cooperation, trust, and respect across party, racial, and religious affiliations. The danger, though, in any living, breathing community is that division in the body can kill. Much like cancer, seeds of complaint and discontent do not benefit the body; they can grow, take over, and destroy it. We can have differences of opinion about how to support our community and provide assistance to our fellow citizens. But we must voice those opinions in constructive ways while seeking the common good.

Our community is not perfect; no community is. But we are pretty darn close! Lufkin is known for being a giving community. That reputation is well-deserved, but we cannot rest on reputation. We each have different gifts and different roles to play. But none of us are unnecessary; we each need to do our part. Only when we all contribute can we truly support our educational institutions, improve community health, combat poverty, and sustain the many wonderful quality of life organizations and events in our area.

The work continues. What can you give? Time? Money? Expertise? Get plugged in, work together, and give! For WE – together, in unity – are the true power of community.

There's Something About a Sabbatical

As this column is printed, I will be three weeks into a four week sabbatical. Since I am writing ahead of time, I obviously can’t have predicted how it is going. I can say what I hope it will be, at least to some extent.

I am a Type A personality and part of me – as I write this – wanted to plan out every moment of this break from my daily routine. I even made a list ahead of time of what the sabbatical is and isn’t (for me, mind you). High on that list is that I should not feel guilty if I don’t accomplish certain things that my Type A personality thinks I should. That I should just let it be what it will be. That’s hard for me.

People often ask me – when they find out I am a cancer and hospice physician – how I can do what I do without staying depressed. “Isn’t it hard?” they ask. My pat answer is that I love what I do, so how could it be hard? When I am doing what I believe God has gifted me to do, it is the easiest job in the world!

But that simple answer obscures that fact that burnout is a real possibility, even for me. Even though I love my job, frustrations arise. Not every patient is pleasant or easy to work with. Stress happens. We all need a break sometimes.

There are different ways to get away, and how we go about it may depend on where we are in life. During the routine work year, breaks can come in all shapes and sizes, from the afternoon off to a three day weekend or a more substantial week or more off for a vacation. These standard breaks rejuvenate us and help us stay focused when we are back at work.

A sabbatical is something altogether different.

The word sabbatical has at its root what we recognize as Sabbath – rest – which has a deeply spiritual meaning of both rest and worship in Judeo-Christian theology. The idea of an extended rest from work has a long history in the academic setting, where professors are given time off from teaching to travel, write a book, or study. But I never hear of doctors taking a sabbatical.

Doctors need it. Physician burnout is, according to some, is at epidemic levels. Others call it a crisis. Whatever. Let’s just say, burnout among physicians is far too common. The specialty of emergency medicine reportedly has rates of burnout at nearly 60% with many other specialties at 50% or higher. Burnout is basically severe, chronic stress characterized by emotional exhaustion and lack of empathy for patients along with a cynical or negative attitude and a sense that you are spinning your wheels in your career and not getting anywhere. Does that describe any physician(s) you know? I guarantee it does. I don’t want it to describe me.

Why physician burnout exists (and is increasing) is not the subject of this essay. But if you talk to doctors, government bureaucracy, electronic health records, insurance companies, and declining reimbursement despite longer work hours are almost always going to come up.
Doctors need a break. More than just a scheduled afternoon off or periodic vacation. I would argue that at some point in a physician’s career – if they want to stay the course for the long haul – they need to take a sabbatical.

What does a sabbatical look like? It depends on the person. My advice for those considering a sabbatical is to keep in mind three key components: time, distance, and purpose.

Time is important in order to distinguish a sabbatical from a vacation. Two weeks, for example, is not long enough to truly get away from work. You spend the first week just beginning to unwind and the second week worrying about the hell you are going to pay when you get back to the office. Four weeks is a minimum for a true sabbatical.

Distance is important as well – certainly physical distance, in that you want to avoid the temptation to check in on work. Get out of town. Out of the country, even. In this digital age, electronic distance is also important. Are you still going to be tied to Facebook? Instagram? Twitter? Or worse, to your electronic health record? Emotional distance is key as well. Let go of the thought that only you can do what you do.

Finally, consider if there are things you’ve always wanted to do – books to read (or write), goals to accomplish – but you’ve never had the time to do them. Be creative; think outside the box.

Avoid the temptation simply to travel, where you feel obligated to visit every cathedral and museum from A to Z. That’s a vacation. A sabbatical is about you. Be careful, though, that you don’t set unrealistic goals for your sabbatical, and that you don’t come back feeling guilty that you didn’t accomplish all that you set out to do. Remember, the definition of sabbatical is rest. Be still. Listen. Be open. Don’t just “do”! Find out more about who you are apart from medicine.

Personally, I’m taking my cue from two Biblical imperatives that guide my thinking about life in general. The first, Romans 12:2 (NIV), states, “Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will.” And the second is from Philippians 4:8 (NIV): “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things.” I will be reading German theologian Dietrich Bonhoeffer’s profound book, The Cost of Discipleship. But I am not going to feel guilty if I don’t finish it. I’m resting, after all.

Fewer Women Need Chemotherapy for Breast Cancer

Less is more. When we find examples of that in medicine, we celebrate. In oncology – at least in fields like early breast cancer, where cure rates are high – the goal is to treat better, smarter – less – while maintaining high cure rates. In radiation oncology, strong scientific evidence has led to the widespread adoption of breast conserving surgery and radiation (less surgery) over mastectomy. Now, we have solid data that fewer women need chemotherapy as well.

It has taken a long time for that chemotherapy pendulum to swing back. In the 1980s, the prevailing mantra was high-dose chemotherapy for most women with breast cancer. Women even demanded and lobbied for the “right” to receive bone marrow transplants for aggressive breast cancers. My mother-in-law received a bone marrow transplant at an academic medical center in Lubbock, Texas. She stayed in the hospital for 30 days, much of that in the ICU, and nearly died from the treatment. Unfortunately, after recovering from the transplant she died from her cancer anyway. In retrospect, bone marrow transplant treatment for breast cancer can only be described as excessive, ineffective, and highly toxic. The scientific evidence just wasn’t there yet to support it.

Even putting aside bone marrow transplants, the promise of more and more chemotherapy that started around 1975 resulted in almost every woman with a cancer larger than a centimeter – not even a half inch – being recommended to get chemotherapy. That meant a lot of women were being treated with undeniably toxic chemotherapy who didn’t need it.

Thankfully, many advances along the way have helped determine who may or may not benefit from chemotherapy. Identification of receptors on an individual woman’s cancer for estrogen, progesterone, and HER2, for example, can guide certain treatment recommendations. In our modern era of often over-hyped personalized medicine, a test called Oncotype DX (developed in 2003) has actually revolutionized the way we decide for many women who gets chemotherapy and who doesn’t.

Oncotype DX is a 21-gene assay of a patient’s tumor that evaluates risk of recurrence with and without chemotherapy for women with early stage estrogen receptor-positive and HER2-negative breast cancer. The resultant individualized score quantifies the 10-year risk of distant recurrence and, therefore, the likelihood of chemotherapy benefit for that particular patient. Physicians receive a report indicating their patient is in a low risk, intermediate risk, or high risk group for recurrence. The practice until recently has been to offer chemotherapy in the high risk group and to consider it in the intermediate risk group as well.

On June 3, 2018, the prestigious New England Journal of Medicine published a practice-changing article that will have tens of thousands of women in the intermediate risk group celebrating each year, because they, too, won’t have to have chemotherapy. This is one of those game-changer moments when the news hype is real. The test is anticipated to spare nearly 70% of women from having to have chemotherapy who probably would have been recommended for it previously. One of the study’s authors estimated that around 60,000 women with breast cancer will benefit each year by not having to have chemotherapy.

In the US alone this year, about 266,000 new cases of breast cancer will be diagnosed in women, and there will be about 41,000 deaths. The 5-year relative survival for localized breast cancer is 99%! But women who won’t die from breast cancer don’t want to suffer through treatment they don’t need.

Breast cancer treatment remains quite complicated. There is not – and never will be – a one size fits all approach. Many women do need chemotherapy for breast cancer. Screening and early detection with mammography remain critically important to finding breast cancers earlier, when less aggressive treatments are much more likely to be recommended. Breast cancer treatment is an example where less can, indeed, be more.

New Colorectal Cancer Screening Guidelines

In what has been described as a game-changing recommendation, on May 30, 2018, the American Cancer Society released a new colorectal cancer screening guideline that recommends most adults start regular screening at age 45, as opposed to where it has been at age 50. Why is this so important?

Colorectal cancer is the third most common cancer in both men and women, as well as the third leading cause of cancer death overall. Prostate and breast cancer are the most common cancers in men and women, respectively, with lung cancer second in incidence in both sexes. Lung cancer, however, is the leading cause of cancer death in both sexes, pushing prostate and breast cancers to second place. Colorectal cancer strikes more than 140,000 people in the United States every year. More than 50,000 will die from it each year.

The overall incidence of colorectal cancer is actually decreasing, attributable in large part to success in getting people screened. You might wonder, then, with all the success, why the change in the screening recommendation? After all, it wasn’t that long ago that the American Cancer Society got some grief for loosening screening recommendations for breast cancer.

It turns out, recent data from the American Cancer Society research team shows a 51% increase in colorectal cancer since 1994 among those under age 50. Adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born around 1950. That means my kids - all in their 20s - have a much higher risk of colorectal cancer over their lifetime than I do.

The reasons for this increase have not been well-identified. But according to Otis Brawley, MD, the Chief Medical Officer of the American Cancer Society, that increasing risk of colorectal cancer (which, by the way, is increasing for every generation born since the 1950s) is likely due to what he describes as a complex relationship between colorectal cancer and obesity, an unhealthy diet, and lack of physical activity.

Because of this increasing risk among younger individuals, the American Cancer Society believes that by lowering the age of screening to 45, many more lives can be saved. And they have modeling data that strongly supports that recommendation.

Making a recommendation is a far cry from making it happen, though. Someone has to pay for the extra screening for those who are age 45 to 49. Currently, the Affordable Care Act requires insurance coverage based on recommendations issued by the United States Preventive Services Task Force (USPSTF). Their current recommendation is that colorectal cancer screening start at age 50. This will be an area where the American Cancer Society and their political arm, the American Cancer Society Cancer Action Network (ACS CAN), will be working to change the law to expand insurance coverage to those in the 45 to 49 age range (which, according to the New York Times, could be an additional 22 million US residents).

As alarming as the increased incidence of colorectal cancer in people under age 50 sounds, the good news is that colorectal cancer remains highly preventable with screening, because polyps can be found and removed before they develop into cancer. If colorectal cancer develops, cure rates are also high if it is caught early. For example, those with localized colorectal cancer are cured 90% of the time, whereas the overall cure rate is only about two out of three (because not everyone is getting screened).

There are many tests that can be used for screening. The screening most linked with the decreasing incidence of colorectal cancer is colonoscopy (again, because polyps, if present, can be removed before they turn into cancer). When negative, colonoscopy only needs to be done every ten years. Other tests like the fecal immunochemical test (FIT) may need to be done every year.

The most important thing is to get screened, no matter which test you choose. Talk with your doctor about it and also check with your insurance about what they cover. Check out the American Cancer Society’s website cancer.org for more information as well. People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.

It’s not just about screening, though. What else can you do? The American Cancer Society believes you can lower your risk of colorectal cancer by eating lots of vegetables, fruits, and whole grains and less red meat (beef, pork, or lamb) and processed meats (hot dogs and some luncheon meats), getting regular exercise, watching your weight, avoiding tobacco, and limiting alcohol to no more than 2 drinks a day for men and 1 drink a day for women.

Guess what? These lifestyle and dietary changes help us is so many other ways, too, from lowering our risk of heart and lung disease or diabetes, lessening the risk of getting many types of cancer, and basically improving our overall quality and quantity of life. Now, that’s a game changer!

Reflections From the May 5th Election

On May 5, 2018, the citizens of Angelina County had the opportunity to participate in what is arguably the bedrock activity of our democracy: a free and fair election. This election was not, some might argue, as significant as one involving state or national representatives. And voter turnout was certainly less than would be expected for those elections. However, approving a $70 million bond issue and electing leaders of multiple educational institutions – with combined budgets of well over $100M and employing nearly 3,000 people – is not insignificant.

The various independent school districts in Angelina County are quite used to running elections. Angelina College, on the other hand, had not had a contested election for 22 years. They pulled it off admirably. But let’s be honest. This set of elections was not perfect. There are things we can do better next time.

One criticism that was leveled at both the LISD bond and Angelina College elections was a lack of transparency. I suppose this allegation is leveled during every election, especially the national ones. Whether or not voters have not only adequate information but honest information about the issues (or people) involved is always in question. With the LISD bond vote, some voiced there was not enough lead time between the announcement of the bond proposition and the actual vote, and not enough information about how that overall decision-making process came about. However, I strongly feel the LISD board, administration, and others did a great job of educating the voters about the needs. You couldn’t live in Lufkin and not be aware that the bond issue was on the ballot. And you certainly couldn’t have had a child at the Middle School in the last 20 years and not been aware of the critical state of that campus.

The transparency criticism of Angelina College was more vague. I did hear it rumored that Angelina College wanted to become a 4-year university (and the implication was that by doing so the needs of the local population would be ignored). Nothing could be further from the truth! Angelina College has amazingly broad educational offerings for students from all walks of life. That is not about to change. But where rumors exist, there is an opportunity for education. 

One recent example may serve as a model for the future. Angelina College welcomed a number of people who came to one of our board meetings (which are always open to the public) when the board toured the Technology Workforce Building. Board members and visitors alike were very impressed with the quality and number of programs offered. This type of “open house” may be a good way to showcase periodically what Angelina College has to offer to our community. 

Another idea brought up during the election during a town hall meeting in North Lufkin was to have town hall-type meetings from time to time as a way to gather community input and to keep the community informed about what is happening at Angelina College. That is not a bad idea.

Angelina College President Dr. Michael Simon has become well known and quite visible in the community and has made inroads and contacts throughout the county. This visibility and approachability – not just of the AC President, but also of the Board – is key to maintaining strong community relationships as well as a vital way to address questions about the direction of the college.

By far, however, the biggest complaint about the election process this year was about lack of publicity, whether TV or newspaper, especially in the days leading up to the election. It seems everyone was looking for last minute information about where to vote. Examples abound of people who voted early in one election but still needed to vote in another, and where do they go? To the LISD Administration building? Slack? Angelina College? To another school district altogether? And early voting in two different locations with different hours of operation was confusing as well. Voters were counting on the local news media to make sense of a very confusing, complicated election. The news media largely failed. 

Yes, this newspaper provided some voter education about the candidates several weeks prior to the election, but the mechanics of the election itself were largely ignored. One article on Tuesday, April 24, 2018 mentioned that early voting was underway, and discussed where early voting for various races was taking place. Beyond that, and especially close to the election, there was nothing. Television coverage was conspicuously absent as well.

That being said, the number of voters participating – nearly 3,000 voted in the LISD bond election and nearly 2,100 in the Angelina College election – shows that off-year, local elections are important to the citizens of Angelina County. Compare that to the Nacogdoches ISD board election, where one candidate won by a vote of 246 to 104.

Going forward, we must not take our democracy for granted, even in the “less significant” or off-year elections. The voters of Angelina County have every right to expect that a free press in a democracy will beat the drum of voter education and voter turnout as loudly as they can. When the next off-year election happens, the news media must step up to their role to educate the public about the complexity and details of multiple different and simultaneous polling locations. Our democracy is too precious to ignore.

Angelina College: 50 Years and Going Strong

Angelina College opened its doors to students in the fall of 1968, a momentous year in modern history. The Smithsonian called 1968 the Year that Shattered America. North Vietnamese Communists launched the Tet Offensive, deadly college riots were taking place, race relations were at an all-time low, Martin Luther King, Jr. and Robert F. Kennedy were assassinated, and Apollo 8 orbited the moon. 

According to the Texas State Historical Association’s Handbook of Texas Online, Angelina College began as a project of the Angelina County Chamber of Commerce. In the early 1960s the chamber appointed a steering committee whose purpose was to gain support from area individuals, business, and industry for the construction of a two-year public community college. The efforts of this committee resulted in the Angelina County Junior College District, the sale of bonds for building purposes, a maintenance tax, and a seven-member board of trustees. In its first semester the college enrolled 660 students in both credit and noncredit programs. Dr. Jack Hudgins was the first president of Angelina College. He served until 1991 and was followed by Dr. Larry Phillips, who served until 2015. Current president Dr. Michael Simon is only the third president in the college’s 50 year existence. 

Angelina College, accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC), has grown over the last 50 years to have an operating budget of nearly $23 million and more than 250 faculty on a campus of 230 acres with more than 20 buildings. Angelina College is not only one of the major employers in the county, its influence is widespread and long lasting. More than 5,300 students, including many high school dual-credit students, attend classes either on site or online at any given time, obtaining the education and skills necessary to join or advance in the workforce in Angelina County and beyond. 

President Simon notes on the AC website that AC offers associate degrees and certificates in Business, Fine Arts, Science and Mathematics, Liberal Arts, Technology and Workforce, and Health Careers academic divisions. AC also offers customized workforce training, adult basic education, police and fire academies, and personal enrichment courses through our Community Services division. 

As you can see, Angelina College is so much more than just high school graduates taking college courses on the Lufkin campus, although that remains a core component of what AC provides. AC’s college transfer core curriculum and associate degrees prepare students to transition to four-year universities and beyond. 

Angelina College has an impressively broad catalog of course offerings. Both visual and performing arts classes and opportunities are available at AC, and the availability of the Temple Theater (and AC’s close collaboration with Angelina Arts Alliance to bring world-class performances to Lufkin) is a huge benefit to both AC and the deep East Texas region. 

Sports programs are an important component of the AC experience, with basketball, baseball, softball, and now soccer available.  In 2014, the Lady Roadrunner softball team captured the NJCAA Division I national championship after winning the World Series in St. George, Utah, becoming the first Texas team to earn the title since the Series' inception in 1977. 

The Division of Health Careers is an especially strong part of Angelina College, offering programs in Nursing, Pharmacy Tech, Radiography and Ultrasonography, EMS, and Surgical Tech, among others. Texas A&M’s College of Nursing provides a seamless track for students in Lufkin to get their nursing degree, with AC being one of A&M’s off-site locations for training. 

The Division of Technology and Workforce offers more than thirty certificate and licensure programs in areas from Automotive Technology and Fluid Power Technology to Criminal Justice, HVAC and Welding. 

Want to start a new business? The Angelina College Small Business Development Center assists new business owners and existing businesses raise capital to start and expand businesses with expertise in financial analysis of business ideas, bank presentations, business plans, accounting and marketing. 

Angelina College is not just about Lufkin. Distance learning opportunities are available throughout our 12-county deep East Texas region, and online options are an increasingly important offering for many students, both traditional college students and those seeking adult workforce education. Very soon, we will see international students coming to Lufkin for a valuable education in the United States. 

Angelina County has always been a very generous county, supporting many non-profit and educational initiatives. That is seen in how we help our AC students as well. Government Pell Grants are certainly an important part of educational funding at AC and are given to over 2,700 students a year. But nearly 600 students receive academic scholarships, and with the Angelina Challenge Award, all public high school graduates in Angelina County who do not qualify for more than $1,000 in any other financial aid may receive up to $1,000 for tuition for one year. The total amount of financial aid awarded at AC is over $13 million annually. 

For a half century now, Angelina College has provided a solid educational foundation for the citizens of deep East Texas. Keep an eye out this year for special events related to Angelina College’s 50th Anniversary. It is a great time to be a Roadrunner and a great time to support Angelina College! 

The Seduction of Technology

For Christmas, my wife gave me and my daughter an Apple TV 4K. Billed as a device to “watch select shows and movies in stunning 4K HDR,” this tiny little box-like contraption – which measures less than four inches square and is just 1.4 inches tall – caused a gargantuan amount of change at our house over the last 2 months. And for something that is priced at only $179, the true cost incurred to make it functional was at least an order of magnitude more.

Our largest TV up until now was a perfectly reasonable 42” screen. When we constructed our house 20 years ago, no one imagined the truly massive screens sold today. The built-in cabinetry where our TV sits certainly wasn’t made for big screens. Even our meager 42” TV didn’t fit well, with the side edges having to hide behind the frame opening of the cabinet. We don’t watch much TV, and it suited our needs. At least, I thought it did.

My wife was tired of paying exorbitant monthly fees for cable service that we didn’t really use, and she thought streaming was the way to go. Hence, the Apple TV 4K. But she didn’t realize that first we needed to get a 4K TV. One that fits into our predetermined and unchangeable space. Because I was certainly not allowed to rebuild the cabinets. And we were not going to rearrange furniture in order to have a big monster screen on a wall. Our 42” TV used to be considered big; now, you can hardly find anything that small! Some of the newer OLED TVs aren’t made in anything less than 55”. Finding a TV that fit our space and still had a 4K screen was a challenge. 

And did I mention Ultra High Definition? Because you need that, too. And to really take advantage of the technology, you need the Blu-ray player that plays 4K Ultra HD discs. Oh, and the receiver equipment must be compatible with all of these technologies or you won’t be able to tie in your surround sound with the TV and Blu-ray. (Luckily, I did not have to replace any speakers, as they were good enough.) Next, none of my prior HDMI cables that connect all of these components together were compatible with the 4K Ultra HD technology. Let me tell you, these new HDMI cables are expensive! And you need several!

Finally, we couldn’t stream 4K Ultra HD content at the internet speeds we were currently paying for, so we needed to upgrade the speed of our internet service and replace the internet modem and router as well. (On that subject, I am a little pissed that we are offered “speeds up to 1 Gb” in our Lufkin market when in reality only 400 MB download speed is achievable. Frankly, neither Suddenlink nor AT&T deliver on what they advertise locally. After years of complaining, I still don’t have a decent signal inside my house. Our market is just not that important to these guys.)

This last week, we got it all set up and watched our first 4K Ultra HD movie – Interstellar with Matthew McConaughey and Anne Hathaway. The sound and picture are, indeed, incredible! But my question is, do I enjoy it an order of magnitude more than when I first saw it? Is the quality of picture that much better to warrant the upgrade in technology? Does the technology emperor have any clothes?

Healthcare gave in to the seduction of technology years ago while seeking the holy grail of patient safety. Our own local hospitals have spent tens of millions of dollars each on computer hardware and software, and the annual maintenance spend is in the multimillions. I can’t say the corpulent healthcare technology emperor has absolutely no clothes, but he is not covered by much more than a Speedo. It ain’t a pretty sight. 

The promise of improved patient safety and better outcomes is, frankly, difficult to prove. That’s not to say that technological advances in cancer treatment and heart disease haven’t lengthened life expectancy. But how much does the average patient admitted to the hospital benefit from technology that constantly pulls the nurse’s attention away from bedside care?

All technology – not just in healthcare – needs to be evaluated both for its potential benefit as well as its often hidden effects and costs. The price we pay is not just in dollars and cents. Are any of us better humans with the distraction of smart phones and the life-sucking pull of their ever-present dementors known as Facebook, Instagram, Twitter, and Snapchat? What about our 4K Ultra HD TVs? Ultra HD 4K garbage is still garbage, just in vivid detail. Let’s make sure we use technology to improve who we are as relational people and not let technology distract us, rule us, or as is increasingly the case, divide us. That would be worth an upgrade.

The Importance of Spirituality in Healing

Spirituality has gotten a bad rap. This is understandable, given the watering down of and movement away from organized religion in the late 20th century through today. The use of the term spirituality to describe any inclination beyond the purely physical – often based solely on “it feels right” – makes it difficult to assign any validity to the term. Add to that the oft-accompanying rejection of organized religion (most especially Christianity), and the term spirituality becomes as ethereal as the east wind.

I don’t believe this type of spirituality – this vague notion of otherworldliness or mysticism – has any particular benefit. I doubt it does much harm, either. It is just there. However, a spirituality that equates to magical thinking is not benign; it can be quite harmful. Spirituality is not a golden ticket to physical healing. 

Those who “claim” physical healing based on the strength of a person’s faith or the perceived closeness of a person’s relationship with God are gnostic charlatans peddling a vile snake oil that insinuates that those who are not healed are spiritually inferior and somehow less worthy than those who are. I have had the honor of participating in the cure of thousands of cancer patients over my career. Some of those cases have been so remarkable or unusual as to be “a miracle”, but I have never actually observed a truly miraculous healing. Any such healings that might occur must be ascribed to God and God alone, and God is not a lifeless puppet manipulated by human prayers.

I wish everyone would be cured, but that is not the world we live in. I have also had the privilege of caring for thousands of dying patients in my career, and providing comfort through the dying process is every bit as important – and rewarding – as the curative treatment I provide.

Ultimately, healing is more than just a physical event, as much as we strive for that. Dame Cicely Saunders, founder of the modern hospice movement, famously coined the phrase “total pain” to include not just physical pain, but also the emotional, social, and spiritual components of pain. That holistic concept translates to the overall healing process as well. I might cure a patient’s cancer, but their persistent financial distress, guilt, broken family relationships, and spiritual angst can result in no actual relief of suffering.

Anecdotally, I get a strong sense that patients who have a more than superficial faith cope better with the suffering associated with illness and death than those who do not. There is data showing that faith and religious practices do help patients not only cope with their illnesses but have a better quality of life.

Patients who continue to suffer spiritually despite good medical care often seem to fit in one of two categories: those who have no belief in a hereafter (and worry they have not accomplished enough in this life), or more commonly, those who fear death and eternal punishment for not having lived a good enough life. Either way, they worry they haven’t been “good enough” and it’s kind of late in the ballgame to turn things around. 

On the other hand, orthodox Christian faith starts with that very acknowledgement that none of us are “good enough”. Comfort – the healing of our spiritual pain and suffering, if you will – comes from accepting that God loves us anyway. Further, our suffering ironically can have meaning. That is not to say, as many well-meaning people too often do, “God meant it for good,” or worse yet, “What sin in your life have you not confessed that caused this to happen?”

The Christian faith – more so than any other – speaks volumes about the significance of suffering. Others may teach suffering is something to be overcome by quashing our desires, or that suffering is just a test from God (or worse, always a punishment). Biblical Christianity teaches not only the universality of suffering but the provision of comfort in and through suffering, whatever the cause.

Having a major illness is expensive, stressful, and often all-consuming. Without a comprehensive approach to care for the total person, we will never truly heal. That means more than doctors and nurses need to be involved in the healing process. We must include social workers, chaplains, and frankly, the entire community.

We need to recognize the spiritual struggles that attend our illnesses and the importance of spirituality in promoting comfort and healing. We can do this by sharing our stories with one another, listening without judging, and by mending and strengthening relationships within families, our houses of worship, and the broader community. And, yes, we need to pray for healing and comfort, not as a magical spell compelling some god to act on our command, but as a partner with the one true God who knows what it is to suffer. Let the healing begin.

The Anti-Vaccination Movement is Fake – and Dangerous – News

Most vaccine-preventable diseases of childhood are at or near record lows. Vaccines prevent the deaths of about 2.5 million children worldwide every year. Yet some highly contagious diseases like measles and whooping cough still pop up where enough people are unvaccinated.

In the United States, compliance with childhood vaccinations remains quite high overall. At least 90 percent of children are getting the recommended vaccinations on time for many diseases – but not all, and not in all locales. Maintaining a high percentage of children vaccinated is important. Herd immunity occurs when a certain threshold percent of a community (such as a school) is vaccinated, reducing the probability that those who are not immune will come into contact with an infectious individual. For highly infectious diseases like measles, 90 to 95 percent of a community needs to be vaccinated to provide herd immunity. That is why vaccinations are required for our schoolchildren.

According to the Texas Department of State Health Services, students are required to have seven vaccinations in order to attend a public or private elementary or secondary school in Texas: Diphtheria/Tetanus/Pertussis (DTaP/DTP/DT/Td/Tdap), Polio, Measles, Mumps, and Rubella (MMR), Hepatitis B, Varicella (chicken pox), Meningococcal (MCV4), and Hepatitis A. Texas law allows physicians to write medical exemptions if they feel the vaccine(s) would be “medically harmful or injurious to the health and well-being of the child or household member.” All well and good.  Texas law also allows – ill-advisedly – “parents/guardians to choose an exemption from immunization requirements for reasons of conscience, including a religious belief.” The “belief” of the anti-vaccination movement is based on lies and is only “religious” in its cult-like following of a dangerous (and discredited) Pied Piper, Andrew Wakefield.

A 2017 Washington Post article states, “A leading conspiracy theorist is Andrew Wakefield, author of the 1998 study that needlessly triggered the first fears. (The medical journal BMJ, in a 2011 review of the debacle, described the paper as “fatally flawed both scientifically and ethically.”) Wakefield’s Twitter handle identifies him as a doctor, but his medical license has been revoked. The British native now lives in Austin, where he is active in the state and national anti-vaccine movement.”

The political noise made by these charlatan zealots has been difficult for legislators to ignore. This disturbing movement has been gaining traction especially in certain private schools in Texas. In one such school, the Austin Waldorf School, reportedly more than 40 percent of the school’s 158 students are unvaccinated. This is mindboggling ignorance in a “school” where tuition ranges from $11,450 to $17,147 a year.

Baylor College of Medicine professor Peter J. Hotez, MD, PhD, Founding Dean of the National School of Tropical Medicine and Director of the Texas Children's Hospital Center for Vaccine Development is truly on the front lines of the battle being waged by the anti-vaccination movement. The fact that Dr. Hotez is both a world authority on infectious disease and a parent of an autistic child hasn’t stopped the anti-vaccination movement from attacking him. It does, however, make their attacks even more sad; they have no facts to back up their case, so they just get mean (for example, saying he is in denial that vaccination caused his daughter’s autism).

This insidious – and disproven – idea that vaccines are linked to autism continues to rear its ugly, dangerous head, despite what Dr. Hotez calls “rock-solid proof” to the contrary published in peer-review journals like the New England Journal of Medicine, JAMA (the Journal of the American Medical Association), the British Medical Journal, and by organizations like the Institute of Medicine and the American Academy of Pediatrics. The data that originally was claimed to show a link between vaccines and autism was later found to be falsified. In other words, the anti-vaccine crowd is fueled by conspiracy theories and truly fake news. (Though not known with certainty, it is believed genetics and environmental exposure during early pregnancy may play a role in development of autism.)

The problem with conspiracy theories is that facts don’t matter. Those who try to argue based on facts are automatically considered part of the conspiracy. Unfortunately, President Trump was rumored early in his presidency to favor a proponent of this ‘vaccines cause autism’ theory to chair a new commission on vaccines, lending credence to the lies. Thankfully, those commission efforts appear to have stalled.

Some argue against vaccinations on the basis of parental rights. I’m so sorry, but you do not have the “right” to endanger others’ children. It is a time-honored role of government to provide a safe, healthy environment for its citizens. Just look at the public health disaster in Flint, Michigan, where the government abdicated its responsibility.

Texas needs to stop allowing nonmedical “conscientious” exemptions in our schools. Your “right” to ignorantly and dangerously keep your child from receiving vaccinations stops at the schoolhouse door. California made it tougher for parents to opt out of vaccination compliance and vaccination rates increased. Texas should do the same.

In this New Year and upcoming legislative session, may the Texas Legislature resolve to pass legislation limiting nonmedical exemptions. Here’s hoping they can ignore the cacophony of lies and claims of “rights” of those who try to stop them. Those liars endanger all our children, and that is not a right they should have.