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.
Sunday, February 11, 2018
Sunday, January 14, 2018
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.
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.
Sunday, December 10, 2017
The Truth about Big Tobacco
There was some big, big news recently that you probably haven’t heard. After years of legal wrangling, the tobacco industry has not only been found guilty of fraud, conspiracy, and racketeering, but they have been ordered to run television and newspaper ads admitting the truth that they fought so hard to suppress for decades.
Let’s go back to the beginning. It was more than 50 years ago, in 1964, when Luther Terry, the 9th Surgeon General of the United States, issued a landmark report linking smoking to lung cancer and a host of other diseases. Since that time, Big Tobacco lied, deceived, and in every way engaged in a no-holds-barred battle against every attempt to regulate or curtail the sale of tobacco products. In the meantime, tens of millions of U.S. citizens have died prematurely from tobacco use.
In 1999, the Department of Justice took on Philip Morris and other tobacco giants under the Racketeer Influenced and Corrupt Organizations Act (RICO), alleging that the tobacco companies had engaged in a decades-long conspiracy to (1) mislead the public about the risks of smoking; (2) mislead the public about the danger of secondhand smoke; (3) misrepresent the addictiveness of nicotine; (4) manipulate the nicotine delivery of cigarettes; (5) deceptively market cigarettes characterized as “light” or “low tar,” while knowing that those cigarettes were at least as hazardous as full flavored cigarettes; (6) target the youth market; and (7) not produce safer cigarettes.
Seven years later, in 2006, Federal District Court Judge Judy Kessler ruled that Philip Morris and other tobacco companies engaged in fraud, conspiracy and racketeering – all to deliberately deceive the American public about the health risks of smoking and secondhand smoke. Her ruling noted that Big Tobacco had “marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.” Judge Kessler ordered that these companies admit their guilt publically by running newspaper and television ads detailing their deception.
It took eleven more years – and a lengthy appeal process – for Big Tobacco to finally agree to any sort of public mea culpa about the health effects of smoking and their role in addicting hundreds of millions of people. Their watered-down admissions of guilt (known in legal parlance as “corrective statements”) will appear in about 50 newspapers and for a year on major television networks. One startlingly honest (and obvious) fact that must be publicized is that Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA intentionally designed cigarettes to make them more addictive.
Think about that. At a time when we rightly are criticizing pharmaceutical companies for how they market pain medications (which actually have a therapeutic use), we still give a pass to the companies that market the most addictive, useless, and deadly product around. At least Big Tobacco now must admit publically that “More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol combined.”
Other statements you may see are, “Many smokers switch to low tar and light cigarettes rather than quitting because they think low tar and light cigarettes are less harmful. They are not,” and “There is no safe level of exposure to secondhand smoke.” Sadly, we have known all of this for years. No, decades.
These ads started on November 26, but I have yet to see one myself. I wonder if anyone who needs to see them will see them. Major newspapers and even television are not the way our vulnerable youth consume media these days. I am sure Big Tobacco is counting on that.
In the meantime, tobacco sales continue at a brisk pace. A Wall Street Journal article in April of this year noted that revenues for U.S. tobacco companies hit $117 billion in 2016, up from $78 billion in 2001, despite lawsuits, rising taxes and declining smoking rates. Americans spent more than $90 billion on cigarettes in retail stores last year.
Stores that sell tobacco products today are complicit in the very deception that Big Tobacco is guilty of. The retail markup of tobacco products, according to the Wall Street Journal, is 17%, higher than that on groceries. No wonder grocery and convenience store chains put tobacco products front and center in their stores – or even out in front of their stores. Easy money. Dirty money.
The conservative/libertarian argument about supply and demand and “personal choice” is, pardon the pun, smoke and mirrors when people are knowingly addicted to the product in question. Cigarettes are not sugar water. I don’t mind companies making a profit – even obscene profits – as long as it isn’t by addicting us and killing us.
If nothing else comes from this mea culpa – these “corrective statements” – I hope tobacco and related products become so regulated and so taxed that not only is it not possible to become addicted, but it is too expensive for our youth to even consider starting. Nothing short of a world without tobacco will do. Perhaps that is a pipe dream, but our kids are worth it.
Let’s go back to the beginning. It was more than 50 years ago, in 1964, when Luther Terry, the 9th Surgeon General of the United States, issued a landmark report linking smoking to lung cancer and a host of other diseases. Since that time, Big Tobacco lied, deceived, and in every way engaged in a no-holds-barred battle against every attempt to regulate or curtail the sale of tobacco products. In the meantime, tens of millions of U.S. citizens have died prematurely from tobacco use.
In 1999, the Department of Justice took on Philip Morris and other tobacco giants under the Racketeer Influenced and Corrupt Organizations Act (RICO), alleging that the tobacco companies had engaged in a decades-long conspiracy to (1) mislead the public about the risks of smoking; (2) mislead the public about the danger of secondhand smoke; (3) misrepresent the addictiveness of nicotine; (4) manipulate the nicotine delivery of cigarettes; (5) deceptively market cigarettes characterized as “light” or “low tar,” while knowing that those cigarettes were at least as hazardous as full flavored cigarettes; (6) target the youth market; and (7) not produce safer cigarettes.
Seven years later, in 2006, Federal District Court Judge Judy Kessler ruled that Philip Morris and other tobacco companies engaged in fraud, conspiracy and racketeering – all to deliberately deceive the American public about the health risks of smoking and secondhand smoke. Her ruling noted that Big Tobacco had “marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.” Judge Kessler ordered that these companies admit their guilt publically by running newspaper and television ads detailing their deception.
It took eleven more years – and a lengthy appeal process – for Big Tobacco to finally agree to any sort of public mea culpa about the health effects of smoking and their role in addicting hundreds of millions of people. Their watered-down admissions of guilt (known in legal parlance as “corrective statements”) will appear in about 50 newspapers and for a year on major television networks. One startlingly honest (and obvious) fact that must be publicized is that Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA intentionally designed cigarettes to make them more addictive.
Think about that. At a time when we rightly are criticizing pharmaceutical companies for how they market pain medications (which actually have a therapeutic use), we still give a pass to the companies that market the most addictive, useless, and deadly product around. At least Big Tobacco now must admit publically that “More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol combined.”
Other statements you may see are, “Many smokers switch to low tar and light cigarettes rather than quitting because they think low tar and light cigarettes are less harmful. They are not,” and “There is no safe level of exposure to secondhand smoke.” Sadly, we have known all of this for years. No, decades.
These ads started on November 26, but I have yet to see one myself. I wonder if anyone who needs to see them will see them. Major newspapers and even television are not the way our vulnerable youth consume media these days. I am sure Big Tobacco is counting on that.
In the meantime, tobacco sales continue at a brisk pace. A Wall Street Journal article in April of this year noted that revenues for U.S. tobacco companies hit $117 billion in 2016, up from $78 billion in 2001, despite lawsuits, rising taxes and declining smoking rates. Americans spent more than $90 billion on cigarettes in retail stores last year.
Stores that sell tobacco products today are complicit in the very deception that Big Tobacco is guilty of. The retail markup of tobacco products, according to the Wall Street Journal, is 17%, higher than that on groceries. No wonder grocery and convenience store chains put tobacco products front and center in their stores – or even out in front of their stores. Easy money. Dirty money.
The conservative/libertarian argument about supply and demand and “personal choice” is, pardon the pun, smoke and mirrors when people are knowingly addicted to the product in question. Cigarettes are not sugar water. I don’t mind companies making a profit – even obscene profits – as long as it isn’t by addicting us and killing us.
If nothing else comes from this mea culpa – these “corrective statements” – I hope tobacco and related products become so regulated and so taxed that not only is it not possible to become addicted, but it is too expensive for our youth to even consider starting. Nothing short of a world without tobacco will do. Perhaps that is a pipe dream, but our kids are worth it.
Sunday, November 12, 2017
Why I Shout about Being a Cancer Doctor
A prestigious oncology journal recently published an opinion piece titled, “Why I Keep Quiet about Being a Cancer Doctor.” I was depressed after reading it, because the author self-identified as “someone who deals with the onslaught of disease and despair day in and day out.” If that is his true outlook, no wonder he keeps quiet! He seemed to have difficulty answering the question, “How do you do this every day?” When he managed to reflect poetically about the nuances and minefields of daily practice, it was almost apologetically.
Let me just say, I love being asked what I do. Maybe that’s because I love what I do!
I love my patients, for one thing, and I try hard not fall into the easy trap of judging people based on lifestyle or insurance status. Whether their cancer was self-inflicted or environmental, genetically-linked or totally random, I find there is always something in everyone worthy of compassion and care. Cancer is a journey, and cancer patients need to trust that their physician is committed to going on the journey with them. I do that, honestly, out of respect for the dignity of each individual. It doesn’t hurt that I am constantly aware that my time may come, and I, too, want to be treated with compassion and respect.
I love being a provider of hope. That’s not limited just to hope for cure, as much of a desired goal that may be. Sometimes my most grateful patients have been the ones I have told are dying. They usually knew it, but nobody would talk to them about it (not to mention they were afraid to ask). Giving them hope - of comfort, of peace, of relief of pain - is very gratifying. Their care is no less important than the wonderful cures we prefer to celebrate.
Of course, I love sharing the news of success in oncology. In the more than twenty five years I have been in practice, the cure rate of all cancers combined increased from 50% to 70%. That is a remarkable improvement! Many cancers have 5-year survival rates well above 90%. Last month – Breast Cancer Awareness Month – we celebrated the fact that the breast cancer death rate has dropped 40% over the same period of time.
Yes, the oncologist writer rightly pointed out how demanding (and emotionally exhausting) it can sometimes be to be a cancer doctor. We don’t cure pancreatic cancer often at all. And it is frustrating that the cancer that kills more people than any other – lung cancer – is almost entirely preventable. And we’ve all known that for more than 50 years.
I do tire of dealing with the cancer conspiracy theories that inevitably come up, like, “Drug companies have a cure; they are just keeping it from us.” But rather than ignore or avoid opportunities to both dispel myths and celebrate research triumphs, I relish the chance to advocate not only for my specialty, but for organizations like the American Cancer Society and movements like hospice care, which help us with everything from research, prevention and early detection, treatment support and survivorship, to palliative and end of life care where needed.
Above all, being a physician (and specifically an oncologist) is for me a sacred calling. How can I keep quiet about what I love and am called to do? I can’t suppress talking or writing about my passion any more than a bird can stop chirping in the spring. That’s worth shouting about!
Let me just say, I love being asked what I do. Maybe that’s because I love what I do!
I love my patients, for one thing, and I try hard not fall into the easy trap of judging people based on lifestyle or insurance status. Whether their cancer was self-inflicted or environmental, genetically-linked or totally random, I find there is always something in everyone worthy of compassion and care. Cancer is a journey, and cancer patients need to trust that their physician is committed to going on the journey with them. I do that, honestly, out of respect for the dignity of each individual. It doesn’t hurt that I am constantly aware that my time may come, and I, too, want to be treated with compassion and respect.
I love being a provider of hope. That’s not limited just to hope for cure, as much of a desired goal that may be. Sometimes my most grateful patients have been the ones I have told are dying. They usually knew it, but nobody would talk to them about it (not to mention they were afraid to ask). Giving them hope - of comfort, of peace, of relief of pain - is very gratifying. Their care is no less important than the wonderful cures we prefer to celebrate.
Of course, I love sharing the news of success in oncology. In the more than twenty five years I have been in practice, the cure rate of all cancers combined increased from 50% to 70%. That is a remarkable improvement! Many cancers have 5-year survival rates well above 90%. Last month – Breast Cancer Awareness Month – we celebrated the fact that the breast cancer death rate has dropped 40% over the same period of time.
Yes, the oncologist writer rightly pointed out how demanding (and emotionally exhausting) it can sometimes be to be a cancer doctor. We don’t cure pancreatic cancer often at all. And it is frustrating that the cancer that kills more people than any other – lung cancer – is almost entirely preventable. And we’ve all known that for more than 50 years.
I do tire of dealing with the cancer conspiracy theories that inevitably come up, like, “Drug companies have a cure; they are just keeping it from us.” But rather than ignore or avoid opportunities to both dispel myths and celebrate research triumphs, I relish the chance to advocate not only for my specialty, but for organizations like the American Cancer Society and movements like hospice care, which help us with everything from research, prevention and early detection, treatment support and survivorship, to palliative and end of life care where needed.
Above all, being a physician (and specifically an oncologist) is for me a sacred calling. How can I keep quiet about what I love and am called to do? I can’t suppress talking or writing about my passion any more than a bird can stop chirping in the spring. That’s worth shouting about!
Sunday, October 8, 2017
Palliative Care: Something We All Want
As a hospice physician – in addition to my role as a doctor who treats cancer – much of my focus is on comfort care. Part of my motivation to study medicine stems from my childhood concept of who a physician was and should be: a healer and comforter. The physician of yesteryear came to the bedside to care for and comfort the sick (and yes, the dying). I love that the Latin root for comforter is confortare, meaning, “to strengthen much.” In Christianity, the Holy Spirit is also called the Comforter.
Frankly, all physicians should practice comfort care. We know we aren’t to harm our patients. That obligation not to inflict harm intentionally is the ethical principle of nonmaleficence. It is summed up in the Latin phrase Primum non nocere – First, do no harm. The Hippocratic Oath states, in part, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.” That oath – to help the sick – expresses our obligation to do good (the ethical principle of beneficence). Though the actual oath used in various medical schools has changed over time, the overarching mandate to help the sick – and, at a minimum, not to harm them – is universal.
What does it mean to help the sick? That seems, on the surface, like an obvious question. “To cure, of course!” we would say in the 21st century. But curing disease is a quite modern concept. For most of medical history, comfort care was the primary goal. Modern technology and the emphasis on cure got us advanced cardiac care, open heart surgery, amazing innovations in cancer treatment, and so much more. But by 1980, most people died in the hospital. This was rare just a generation or two prior to that, when nearly everyone died at home (or on the battlefield).
Since 1980, the number of people dying in the hospital has declined somewhat, thanks in part to better end of life care (including hospice care). However, 7 out of 10 Americans still die in a hospital, nursing home or long-term care facility when 7 out of 10 of us say we want to die at home (only 25% of Americans actually do die at home). Utilization of hospice care at the end of life is still woefully low.
But, what about those in the hospital who aren’t expected to die, who want a better, more “comfortable” hospital care experience overall? “Cure sometimes, treat often, comfort always,” is a wonderful mantra attributed to the 19th century tuberculosis physician Dr. Edward Trudeau. This phrase sums up a newer movement in medicine called palliative care.
Palliative care focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing any serious illness. To palliate means to relieve – literally, to cloak – with the focus being on symptoms. Symptom management obviously should not be limited to end of life care.
As an example, for an ICU patient suffering from an acute exacerbation of lung disease, probably on a ventilator for a short period of time (but expected to recover), the physician historically has been paying attention to oxygen and carbon dioxide measurements, volumes of air going in and out, the acidity of the blood, and other “numbers” that paint a picture of how the patient is doing. But not how the patient or family is feeling. Shortness of breath? Anxiety? Nausea? Pain? Dealing with prognosis and potential end-of-life decision-making? Social and spiritual support? These are issues that might benefit from a palliative care consult.
Every hospitalization (whether ICU or not) has the potential for needing some degree of palliative, or comfort, care in addition to and alongside the acute medical needs that precipitated the admission in the first place. Often, the treating physician can and should address these needs. Quality metrics such as patient satisfaction, length of stay, and even cost of hospitalization are improved with good symptom management.
And, believe it or not, sometimes patients live longer with good comfort care! In my field of oncology, randomized trials have shown improved quality of life and even improved survival with early use of palliative care. The American Society of Clinical Oncology (ASCO) recommends the integration of palliative care with conventional oncology treatment, and the American Society for Radiation Oncology (ASTRO) has urged early palliative care referral when cure is not expected, even if death is not imminent and treatment still is ongoing.
CHI St. Luke’s Health Memorial in Lufkin will be starting a new palliative care consult service later this fall. A team consisting of a physician, nurse, and social worker all certified in palliative care will be available to consult with and advise physicians on any patient with difficult to manage symptoms, regardless of whether or not the patient has a terminal prognosis.
As we learn more about palliative care, we remember the Golden Rule: “So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets (Matthew 7:12, NIV).”
Comfort always.
Frankly, all physicians should practice comfort care. We know we aren’t to harm our patients. That obligation not to inflict harm intentionally is the ethical principle of nonmaleficence. It is summed up in the Latin phrase Primum non nocere – First, do no harm. The Hippocratic Oath states, in part, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.” That oath – to help the sick – expresses our obligation to do good (the ethical principle of beneficence). Though the actual oath used in various medical schools has changed over time, the overarching mandate to help the sick – and, at a minimum, not to harm them – is universal.
What does it mean to help the sick? That seems, on the surface, like an obvious question. “To cure, of course!” we would say in the 21st century. But curing disease is a quite modern concept. For most of medical history, comfort care was the primary goal. Modern technology and the emphasis on cure got us advanced cardiac care, open heart surgery, amazing innovations in cancer treatment, and so much more. But by 1980, most people died in the hospital. This was rare just a generation or two prior to that, when nearly everyone died at home (or on the battlefield).
Since 1980, the number of people dying in the hospital has declined somewhat, thanks in part to better end of life care (including hospice care). However, 7 out of 10 Americans still die in a hospital, nursing home or long-term care facility when 7 out of 10 of us say we want to die at home (only 25% of Americans actually do die at home). Utilization of hospice care at the end of life is still woefully low.
But, what about those in the hospital who aren’t expected to die, who want a better, more “comfortable” hospital care experience overall? “Cure sometimes, treat often, comfort always,” is a wonderful mantra attributed to the 19th century tuberculosis physician Dr. Edward Trudeau. This phrase sums up a newer movement in medicine called palliative care.
Palliative care focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing any serious illness. To palliate means to relieve – literally, to cloak – with the focus being on symptoms. Symptom management obviously should not be limited to end of life care.
As an example, for an ICU patient suffering from an acute exacerbation of lung disease, probably on a ventilator for a short period of time (but expected to recover), the physician historically has been paying attention to oxygen and carbon dioxide measurements, volumes of air going in and out, the acidity of the blood, and other “numbers” that paint a picture of how the patient is doing. But not how the patient or family is feeling. Shortness of breath? Anxiety? Nausea? Pain? Dealing with prognosis and potential end-of-life decision-making? Social and spiritual support? These are issues that might benefit from a palliative care consult.
Every hospitalization (whether ICU or not) has the potential for needing some degree of palliative, or comfort, care in addition to and alongside the acute medical needs that precipitated the admission in the first place. Often, the treating physician can and should address these needs. Quality metrics such as patient satisfaction, length of stay, and even cost of hospitalization are improved with good symptom management.
And, believe it or not, sometimes patients live longer with good comfort care! In my field of oncology, randomized trials have shown improved quality of life and even improved survival with early use of palliative care. The American Society of Clinical Oncology (ASCO) recommends the integration of palliative care with conventional oncology treatment, and the American Society for Radiation Oncology (ASTRO) has urged early palliative care referral when cure is not expected, even if death is not imminent and treatment still is ongoing.
CHI St. Luke’s Health Memorial in Lufkin will be starting a new palliative care consult service later this fall. A team consisting of a physician, nurse, and social worker all certified in palliative care will be available to consult with and advise physicians on any patient with difficult to manage symptoms, regardless of whether or not the patient has a terminal prognosis.
As we learn more about palliative care, we remember the Golden Rule: “So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets (Matthew 7:12, NIV).”
Comfort always.
Sunday, September 10, 2017
The Demise of Polite Conversation
When did the art of pleasant conversation and open dialogue end? Every national new item – it seems – sparks vitriol that demands an alignment in one political camp or the other, one race or the other, or one sexual orientation or the other. I am afraid we have lost the ability to exchange ideas, to communicate freely, to learn from one another. To celebrate our differences rather than condemn them. Passionate speech and polite speech are not incompatible.
But I am afraid to speak, for fear my words are misinterpreted. I am afraid to write, lest my writing not encourage the thoughtful conversation I intended, but provoke a hateful backlash. Is it no longer possible to have civil discourse?
I am afraid to laugh, for fear my laughter is misconstrued. Can’t I both laugh at Tina Fay’s Saturday Night Live sheet-caking stunt, for example, as well as at Chad Prather’s “Unapologetically Southern” YouTube videos? At political cartoons of both the Wall Street Journal and the New York Times? Or is humor no longer funny, only hateful? Can’t we laugh at ourselves anymore, at our own hypocrisies? We all have them. I’m afraid we no longer recognize that; we are blinded by our self-interest.
I am afraid of social media. Facebook has unfortunately turned into a forum where, other than the annual birthday wish or mundane vacation photo, posts are filled with inflammatory opinions and commentary-as-fact with the self-righteous, ignorant replies that follow. Mob mentality sets in and people post things they would never say to your face. Hurtful – hateful – things.
Free speech is not the same thing as kind speech, uplifting speech, or frankly, intelligent speech. Nor should honest disagreement be labeled hate speech. Unfortunately, much speech today is designed to shut down the conversation by labeling one’s opponent –are they really an opponent? – a bigot, or by declaring they have no moral standing even to join the conversation. That is coercion, intimidation, and bullying no matter which side is doing it. That makes me very afraid.
I am afraid when I see fellow Christians deciding that following politics is more important than following the Ten Commandments. When they opt for strict party affiliation over and above "Thou shalt love thy neighbour as thyself" (Mark 12:31, KJV). And when they decide it is expedient to legislate hate, discrimination, and economic disparity while ignoring inconvenient moral issues like poverty and healthcare. What happened to being Jesus to those around us?
Rod Dreher, in his timely book The Benedict Option, notes that political victory does not vitiate the vice of hypocrisy. The socially liberal churches are just as guilty of blindly aligning with the Democratic Party as the fundamentalists are with the Republican Party. Could it be that Jesus understood this when he said, “Render therefore unto Caesar the things which are Caesar’s; and unto God the things that are God’s” (Matthew 22:21, KJV)?
I am afraid our clumsy, partisan involvement has resulted in a political environment increasingly hostile to the very real – and very Christian – charitable work of the Church. We must redirect our gaze outside our church walls and into our increasingly diverse and desperate communities. Putting our faith to work on the ground speaks volumes and accomplishes so much more than legislating selective moral conformity.
It often takes a crisis – a disaster? – to bring the country together to work for the common good. Perhaps Hurricane Harvey will accomplish that. It appears to be doing so; I just hope it lasts.
Dreher wrote, "The state will not be able to care for all human needs in the future, especially if the current projections of growing economic inequality prove accurate.” Christians need to rediscover an ethic that marries personal responsibility with intentional charity and corporate love and respect. I fear we may have drifted too far to do so.
But I am afraid not to try.
But I am afraid to speak, for fear my words are misinterpreted. I am afraid to write, lest my writing not encourage the thoughtful conversation I intended, but provoke a hateful backlash. Is it no longer possible to have civil discourse?
I am afraid to laugh, for fear my laughter is misconstrued. Can’t I both laugh at Tina Fay’s Saturday Night Live sheet-caking stunt, for example, as well as at Chad Prather’s “Unapologetically Southern” YouTube videos? At political cartoons of both the Wall Street Journal and the New York Times? Or is humor no longer funny, only hateful? Can’t we laugh at ourselves anymore, at our own hypocrisies? We all have them. I’m afraid we no longer recognize that; we are blinded by our self-interest.
I am afraid of social media. Facebook has unfortunately turned into a forum where, other than the annual birthday wish or mundane vacation photo, posts are filled with inflammatory opinions and commentary-as-fact with the self-righteous, ignorant replies that follow. Mob mentality sets in and people post things they would never say to your face. Hurtful – hateful – things.
Free speech is not the same thing as kind speech, uplifting speech, or frankly, intelligent speech. Nor should honest disagreement be labeled hate speech. Unfortunately, much speech today is designed to shut down the conversation by labeling one’s opponent –are they really an opponent? – a bigot, or by declaring they have no moral standing even to join the conversation. That is coercion, intimidation, and bullying no matter which side is doing it. That makes me very afraid.
I am afraid when I see fellow Christians deciding that following politics is more important than following the Ten Commandments. When they opt for strict party affiliation over and above "Thou shalt love thy neighbour as thyself" (Mark 12:31, KJV). And when they decide it is expedient to legislate hate, discrimination, and economic disparity while ignoring inconvenient moral issues like poverty and healthcare. What happened to being Jesus to those around us?
Rod Dreher, in his timely book The Benedict Option, notes that political victory does not vitiate the vice of hypocrisy. The socially liberal churches are just as guilty of blindly aligning with the Democratic Party as the fundamentalists are with the Republican Party. Could it be that Jesus understood this when he said, “Render therefore unto Caesar the things which are Caesar’s; and unto God the things that are God’s” (Matthew 22:21, KJV)?
I am afraid our clumsy, partisan involvement has resulted in a political environment increasingly hostile to the very real – and very Christian – charitable work of the Church. We must redirect our gaze outside our church walls and into our increasingly diverse and desperate communities. Putting our faith to work on the ground speaks volumes and accomplishes so much more than legislating selective moral conformity.
It often takes a crisis – a disaster? – to bring the country together to work for the common good. Perhaps Hurricane Harvey will accomplish that. It appears to be doing so; I just hope it lasts.
Dreher wrote, "The state will not be able to care for all human needs in the future, especially if the current projections of growing economic inequality prove accurate.” Christians need to rediscover an ethic that marries personal responsibility with intentional charity and corporate love and respect. I fear we may have drifted too far to do so.
But I am afraid not to try.
Sunday, August 13, 2017
Moving the Needle on Health in Angelina County
Back in January, I wrote about the abysmal county health rankings in Deep East Texas and the fact that Angelina County has been named the county with the highest obesity rate in Texas. Almost four out of ten of us aren't merely overweight, we are downright obese. Let’s just admit it; we’re fat. And that fatness is a major factor in the development of high blood pressure, diabetes, heart disease, and many cancers, among other illnesses.
Obesity is a two-edged sword that is both killing us early and costing us a lot in terms of ongoing healthcare expenditures and lost productivity. Smoking is, of course, another huge factor in our high cost of healthcare and poorer health outcomes. We must do better.
The rhetoric on the national stage is all about the skyrocketing cost of health insurance and how to tweak (or get rid of) Obamacare, as if that would solve our healthcare problems. The government can’t do it for us, folks. Regardless of what happens with healthcare reform, we need to collectively get off our fat behinds and take more responsibility for our own health. We need to do this individually, yes, but we also need to work on this as a community.
I mentioned in January the groundwork being laid by the Texas Forest Country Partnership. They hosted a series of strategic planning sessions to set goals for growth across a broad spectrum of our regional economy, from forestry and tourism to manufacturing and healthcare. Part of their healthcare recommendation was to raise our county health rankings in the region.
Since then, the $1 billion Episcopal Health Foundation, whose goal is to improve the health of the 10 million people living throughout the 57-county region served by the Episcopal Diocese of Texas, hosted a community meeting in Nacogdoches specifically to deepen their relationship with organizations working to improve community health in this area. Other foundations have expressed a similar interest.
But let’s be very clear: no foundation or partnership is going to do the work for us. We all have to be involved. The amazing thing about Angelina County is the number of resources we already have, along with the incredible people behind them! These resources need to intentionally focus on both individual and community health and work in a coordinated effort to put the pieces of our health puzzle together.
Hospitals must strengthen community outreach, especially with diabetes, heart disease, stroke, and cancer education. Physicians must expand care for the indigent in our communities. It is our duty. The Angelina County & Cities Health District deserves our full support for the incredible care they already provide, but they can and must do more. That requires funding, whether from grant support, state government, or from within Angelina County. Their primary care outreach is crucial to the health of our county.
Organizations like the American Cancer Society, The Coalition, ADAC, and the Burke Center must expand outreach and education about healthy lifestyles and disease prevention, cancer screening, smoking cessation, and immunizations. Women’s Special Services at CHI St. Luke’s Health Memorial will continue to apply for grants for low income women to get breast and cervical cancer screening.
Lufkin went smoke free years ago and is better off for it. What about other cities? Diboll? Angelina County? Texas? Our state legislators need to use that proposed bathroom bill as toilet paper and instead pass smoke free legislation, which we know will both improve the health of our communities and save taxpayer dollars.
Chamber businesses need to provide or strengthen wellness programs for their employees, encouraging healthier lifestyles, diet, exercise, and smoking cessation. Maybe if people had to climb two flights of stairs to buy their cigarettes rather than drive through a barn or stop at a convenience store, fewer people would smoke. And they’d lose weight while they were at it! Is it just as easy for us to shop for healthy foods as it is tobacco and junk food? How do we encourage and facilitate healthy eating?
Our educational institutions from elementary school through college should have comprehensive, intentional programs to promote health and exercise. It is discouraging when I see employees at both our local hospitals riding the elevator to go up one floor when taking the stairs is much more beneficial.
Active events like the Neches River Rendezvous, Pineywoods Purgatory and Relay for Life are fantastic. What other events can we organize that will involve an even larger and broader swath of people year round? Find a reason to get outside. Participate in a fun run, even if you simply walk a mile or two. A stroll around the zoo can be good exercise and lots of fun. Or, spend an hour or two hiking the trails at Kit McConnico Park. It’ll do your heart and soul good!
City sidewalks have been a great addition in recent years. Use them! Our Parks and Recreation Department has a website with programs and classes as well. Do we have a master plan for parks and recreation activities? If not, maybe we should.
I have a dream of a coordinated community effort where healthy living concepts infuse everything we do. Will Angelina County catch the vision to join in this effort? Lifestyle changes are hard. Nothing happens overnight. Changes in community health are measured over years - decades, even. We cannot get discouraged. Slow, meaningful progress over time will make a difference.
One early step coming up is the Texas Forest Country Partnership Economic Summit November 7-8, 2017 at the Pitser Garrison Convention Center. Included in that Summit will be a Rural Healthcare Symposium. Though it will address more than just Angelina County healthcare, it will be an important venue to discuss and brainstorm together. The Texas Forest Country Partnership should continue to take the lead in bringing groups together, applying for and administering grants, and monitoring progress and effectiveness.
As we plan for a healthy new direction in Angelina County, I encourage everyone to get involved. Be prepared to work! Come up with concrete ideas that you (or your business or organization) are willing to implement. Where philanthropic support is necessary, we will approach local, regional, and national foundations for assistance.
We must become the change we want to see and move the needle on health in Angelina County out of the red zone and into the green. Who’s with me?
Obesity is a two-edged sword that is both killing us early and costing us a lot in terms of ongoing healthcare expenditures and lost productivity. Smoking is, of course, another huge factor in our high cost of healthcare and poorer health outcomes. We must do better.
The rhetoric on the national stage is all about the skyrocketing cost of health insurance and how to tweak (or get rid of) Obamacare, as if that would solve our healthcare problems. The government can’t do it for us, folks. Regardless of what happens with healthcare reform, we need to collectively get off our fat behinds and take more responsibility for our own health. We need to do this individually, yes, but we also need to work on this as a community.
I mentioned in January the groundwork being laid by the Texas Forest Country Partnership. They hosted a series of strategic planning sessions to set goals for growth across a broad spectrum of our regional economy, from forestry and tourism to manufacturing and healthcare. Part of their healthcare recommendation was to raise our county health rankings in the region.
Since then, the $1 billion Episcopal Health Foundation, whose goal is to improve the health of the 10 million people living throughout the 57-county region served by the Episcopal Diocese of Texas, hosted a community meeting in Nacogdoches specifically to deepen their relationship with organizations working to improve community health in this area. Other foundations have expressed a similar interest.
But let’s be very clear: no foundation or partnership is going to do the work for us. We all have to be involved. The amazing thing about Angelina County is the number of resources we already have, along with the incredible people behind them! These resources need to intentionally focus on both individual and community health and work in a coordinated effort to put the pieces of our health puzzle together.
Hospitals must strengthen community outreach, especially with diabetes, heart disease, stroke, and cancer education. Physicians must expand care for the indigent in our communities. It is our duty. The Angelina County & Cities Health District deserves our full support for the incredible care they already provide, but they can and must do more. That requires funding, whether from grant support, state government, or from within Angelina County. Their primary care outreach is crucial to the health of our county.
Organizations like the American Cancer Society, The Coalition, ADAC, and the Burke Center must expand outreach and education about healthy lifestyles and disease prevention, cancer screening, smoking cessation, and immunizations. Women’s Special Services at CHI St. Luke’s Health Memorial will continue to apply for grants for low income women to get breast and cervical cancer screening.
Lufkin went smoke free years ago and is better off for it. What about other cities? Diboll? Angelina County? Texas? Our state legislators need to use that proposed bathroom bill as toilet paper and instead pass smoke free legislation, which we know will both improve the health of our communities and save taxpayer dollars.
Chamber businesses need to provide or strengthen wellness programs for their employees, encouraging healthier lifestyles, diet, exercise, and smoking cessation. Maybe if people had to climb two flights of stairs to buy their cigarettes rather than drive through a barn or stop at a convenience store, fewer people would smoke. And they’d lose weight while they were at it! Is it just as easy for us to shop for healthy foods as it is tobacco and junk food? How do we encourage and facilitate healthy eating?
Our educational institutions from elementary school through college should have comprehensive, intentional programs to promote health and exercise. It is discouraging when I see employees at both our local hospitals riding the elevator to go up one floor when taking the stairs is much more beneficial.
Active events like the Neches River Rendezvous, Pineywoods Purgatory and Relay for Life are fantastic. What other events can we organize that will involve an even larger and broader swath of people year round? Find a reason to get outside. Participate in a fun run, even if you simply walk a mile or two. A stroll around the zoo can be good exercise and lots of fun. Or, spend an hour or two hiking the trails at Kit McConnico Park. It’ll do your heart and soul good!
City sidewalks have been a great addition in recent years. Use them! Our Parks and Recreation Department has a website with programs and classes as well. Do we have a master plan for parks and recreation activities? If not, maybe we should.
I have a dream of a coordinated community effort where healthy living concepts infuse everything we do. Will Angelina County catch the vision to join in this effort? Lifestyle changes are hard. Nothing happens overnight. Changes in community health are measured over years - decades, even. We cannot get discouraged. Slow, meaningful progress over time will make a difference.
One early step coming up is the Texas Forest Country Partnership Economic Summit November 7-8, 2017 at the Pitser Garrison Convention Center. Included in that Summit will be a Rural Healthcare Symposium. Though it will address more than just Angelina County healthcare, it will be an important venue to discuss and brainstorm together. The Texas Forest Country Partnership should continue to take the lead in bringing groups together, applying for and administering grants, and monitoring progress and effectiveness.
As we plan for a healthy new direction in Angelina County, I encourage everyone to get involved. Be prepared to work! Come up with concrete ideas that you (or your business or organization) are willing to implement. Where philanthropic support is necessary, we will approach local, regional, and national foundations for assistance.
We must become the change we want to see and move the needle on health in Angelina County out of the red zone and into the green. Who’s with me?
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