Musing this morning about the process we all go through to help us make "informed" decisions. That process is one of evaluation - of weighing the pro's and the con's. In my professional life as a pharmacist, I am constantly asked to interpret the risk of medication use versus the benefit. All medicines carry the risk of side effects, and most often, people will look up the "laundry list" of adverse events and not know how to interpret them in light of their own personal use. Patient Package Inserts (PPI's) are not written in a way that makes the information useful to most people, including most healthcare professionals.
How does one then evaluate the risk of a given treatment? Not surprisingly, people go to patient chat rooms to get their information. While I'm all for the "e-patient" movement and for people to become more empowered in their approach to their health and to management of their disease(s), the caveat must be re-inforced that "one person's experience is one person's experience"! Each human is an individual with unique genetic predispositions. We are now coming to understand that these genetic predispositions matter in all aspects of health and disease and in medication use. We do not, however, have the ability to predict an individual's response to a given drug, or to the combination of drugs that many are asked to take.
Evaluation of risk, therefore, comes down to personal experience and post-marketing reporting. Most of the time, medications are FDA approved on the experience of a few thousand individuals (some times a few hundred). Statistically speaking, when compared to the 300+ million persons in the U.S., and billions of persons worldwide, the experience of even 10,000 persons is not predictive of how things are going to go with a drug when it is used broadly. Experience over the last 25 years has taught me to be careful when adopting new drugs for this very reason. Side effect profiles often look very different after 100,000 persons have taken it in the non-controlled "real world", than it did in the controlled environment of a research trial.
Advocacy and informed decision making require that we evaluate things differently than we have in the past. Medicines come to market with less and less investigation. More and more "information" is posted on internet sites without adequate explanation. Marketing machines are wound up earlier and earlier, leaking information to people hungry for the next big breakthrough (including the financial markets) and this drives use. Where can the average person turn for information that is useful and meaningful and unbiased? One place is Possibilities Journey, Inc, (www.possjrny.org) and the other is your local pharmacist. Your pharmacist is the best resource to help you evaluate what is happening in your life, to advocate for your health, to help you stay consistent and persistent in your medication use, and to maximize the benefit from the medicine.
So this week, stop by to see your pharmacist - or drop us a note with questions. Understand that your local pharmacist is busy, but if you make an appointment and pay the person for their time, you will get their undivided attention and some useful information. Remember to bring a list of all the drugs you are using (herbals, homeopathy, over-the-counter) as well as prescription. Paying a dollar a minute for face-to-face consultation is a good rule of thumb.
Peace and health,
Dan
Thursday, July 28, 2011
Monday, July 25, 2011
Frozen in Place
Today's post is brought to you from a sermon I preached yesterday entitled, "Get Going!" based on Psalm 1 and 1 Corinthians 1:23-39. I've been preaching monthly to a Latino congregation on issues of spirituality and health and the intersection between the two. Overall, Latinos are in poor health compared to age matched peer groups and are in need of good health information and intervention.
Preparing the sermon got me thinking about my own health journey and the ups and downs that has taken. I started a walking program about 2 months ago after a long struggle with inertia. I have put on an extra 25 pounds and I really needed to find something that could help me get going again. I'm not a health club/gym person, nor do I have the extra cash for that (running a cash-strapped public charity). I've never been a runner as I always develop shin splints and other leg issues. It finally hit me that I could just walk, and that walking was every bit as good as other forms of exercise (yes, I am a slow learner). ;-) So, 6 mornings each week I walk up and down the hills around my home at a reasonably brisk pace. I'm toning up and some weight is leaving, but the most interesting thing is the change in my attitude about other healthy choices in my life. I am adjusting my diet to aid in my walking program. I'm walking instead of driving on many errands.
It is true that once a healthy life choice is made and committed to, other healthy choices follow. The folks at "Small Step" understand this (www.smallstep.gov). A governmental website that promotes doing little things to get started and to build from those successes. They have a wealth of information and tips, an e-newsletter, tips on healthy eating and reasonable goal setting. A very practical website, and by my estimation, the best one that you've never heard of.
So this week, just get going. Start small like I did with a walking program or other endeavor that you commit to doing for the next month. Try to do this new thing at least 5 days each week. You may have to get up a bit earlier, or adjust your "normal" routine, but it will pay off. Set reasonable goals - for example: you didn't get overweight in a week, so don't expect the extra weight to come off in a week. Settle in for the long haul, but look at that long haul one day at a time. In this way, you'll avoid being frozen in place by the size of the task. Inertia really is a very strong force - but it is also a physical reality that bodies in motion tend to stay in motion.
Peace for the journey!
Dan
Preparing the sermon got me thinking about my own health journey and the ups and downs that has taken. I started a walking program about 2 months ago after a long struggle with inertia. I have put on an extra 25 pounds and I really needed to find something that could help me get going again. I'm not a health club/gym person, nor do I have the extra cash for that (running a cash-strapped public charity). I've never been a runner as I always develop shin splints and other leg issues. It finally hit me that I could just walk, and that walking was every bit as good as other forms of exercise (yes, I am a slow learner). ;-) So, 6 mornings each week I walk up and down the hills around my home at a reasonably brisk pace. I'm toning up and some weight is leaving, but the most interesting thing is the change in my attitude about other healthy choices in my life. I am adjusting my diet to aid in my walking program. I'm walking instead of driving on many errands.
It is true that once a healthy life choice is made and committed to, other healthy choices follow. The folks at "Small Step" understand this (www.smallstep.gov). A governmental website that promotes doing little things to get started and to build from those successes. They have a wealth of information and tips, an e-newsletter, tips on healthy eating and reasonable goal setting. A very practical website, and by my estimation, the best one that you've never heard of.
So this week, just get going. Start small like I did with a walking program or other endeavor that you commit to doing for the next month. Try to do this new thing at least 5 days each week. You may have to get up a bit earlier, or adjust your "normal" routine, but it will pay off. Set reasonable goals - for example: you didn't get overweight in a week, so don't expect the extra weight to come off in a week. Settle in for the long haul, but look at that long haul one day at a time. In this way, you'll avoid being frozen in place by the size of the task. Inertia really is a very strong force - but it is also a physical reality that bodies in motion tend to stay in motion.
Peace for the journey!
Dan
Thursday, July 21, 2011
Decisions and our HW2
Today's post is brought to you as an outflow of my interaction with a certain 14 year old in my house. Tough time in personal development, overall he's a solid kid, but going through that time in life where decision making is not leading him where he needs to go. It's to be expected, he's still developing his frontal lobe, he is challenged by ADD and associated issues, he's a boy, and the testosterone surge is making him crazy.
It made me wonder, however, what has gone wrong with our overall health, wellness and wholeness (HW2)? Certainly, fourteen year olds grow up (or at least get older). How come non-teenagers can't make good decisions when it comes to their HW2? I know for a fact that one of the problems with my son is the worldly inputs that he accesses. His worldview is skewed to the narrative that it's all about him - no matter what. This is where we find ourselves as a community and a Nation. When it's all about an individual's need, then nothing else is as important. This is understandable (to an extent) when one is stuck in the lowest level of Maslow's heirarchy - but most Americans are not there.
Choices, decisions, narratives, worldviews...all of this determines how we move through our lives and how our lives affect those around us. It also affects our HW2 - just look at the cost of healthcare in the U.S. The majority of the cost incurred is from consequences of preventable disease. More than 1/3 of all adults are obese (2/3 are overwieght or obese)- 40% of all adults engage in no physical exercise; a large percent of the population has not received recommended vaccinations (approx 40%); 21% of adult Americans still smoke cigarettes; 23% of all adults had 5 or more alcohol containing drinks in the last year; 33% of all adults have high blood pressure; deaths from heart disease, stroke and cancer are most common. (See FASTSTATS form CDC.gov)
These are staggering stastistics, but behind the majority of them are choices. There is a great website that can help make people healthier, it's called "Small Steps" (www.smallsteps.gov). This website aids people to understand that they can make really minor changes to their life styles and have it pay off for their health. The issue is, however, they need to make those changes. How can faith communities specifically, and all communities in general, get involved in each other's lives to help make us all healthier? This is what Possibilities Journey, Inc is all about. It's not "rocket science", but it does take committment, support and the proper choices.
This week and weekend, try making one small change in your life to promote a healthier you. Go to Smallsteps.gov and see waht you can do today and everyday to improve your HW2.
Peace for the journey,
Dan
It made me wonder, however, what has gone wrong with our overall health, wellness and wholeness (HW2)? Certainly, fourteen year olds grow up (or at least get older). How come non-teenagers can't make good decisions when it comes to their HW2? I know for a fact that one of the problems with my son is the worldly inputs that he accesses. His worldview is skewed to the narrative that it's all about him - no matter what. This is where we find ourselves as a community and a Nation. When it's all about an individual's need, then nothing else is as important. This is understandable (to an extent) when one is stuck in the lowest level of Maslow's heirarchy - but most Americans are not there.
Choices, decisions, narratives, worldviews...all of this determines how we move through our lives and how our lives affect those around us. It also affects our HW2 - just look at the cost of healthcare in the U.S. The majority of the cost incurred is from consequences of preventable disease. More than 1/3 of all adults are obese (2/3 are overwieght or obese)- 40% of all adults engage in no physical exercise; a large percent of the population has not received recommended vaccinations (approx 40%); 21% of adult Americans still smoke cigarettes; 23% of all adults had 5 or more alcohol containing drinks in the last year; 33% of all adults have high blood pressure; deaths from heart disease, stroke and cancer are most common. (See FASTSTATS form CDC.gov)
These are staggering stastistics, but behind the majority of them are choices. There is a great website that can help make people healthier, it's called "Small Steps" (www.smallsteps.gov). This website aids people to understand that they can make really minor changes to their life styles and have it pay off for their health. The issue is, however, they need to make those changes. How can faith communities specifically, and all communities in general, get involved in each other's lives to help make us all healthier? This is what Possibilities Journey, Inc is all about. It's not "rocket science", but it does take committment, support and the proper choices.
This week and weekend, try making one small change in your life to promote a healthier you. Go to Smallsteps.gov and see waht you can do today and everyday to improve your HW2.
Peace for the journey,
Dan
Monday, July 18, 2011
Out of Context...
Talking with my sister-in-law just now and made the statement, "It's really hard to know what's going on when you don't know the whole story." How true, and this is true also of our overall health, wellness and wholeness (HW2). Our lives often get taken out of context as we encounter the health care system (or as I like to call it, the "Episodic Intervention Portal"). Think about it, when's the last time you had a real heart-to-heart with a medical provider? Better yet, when's the last time you had a medical provider that knew you for more than a brief time of your life and understood how you see the world and make your decisions?
Context...understanding life and how we interpret it is a major factor in our HW2. We learn as we grow to filter information and contextualize it. It is how we make sense of the world around us - how we relate to the world and vice versa. Spirituality and religion offer alternative narratives to that of the secular world - and the secular world is contantly banging on our doors to be heard and understood. Context gives meaning to our lives and to the information that is presented to us everyday. Laboratory data when given to non-clinicians are just numbers - high or low or "normal". We need someone to interpret those numbers to tell us if we are doing well or about to be in trouble.
Context and HW2 - the truly difficult part of solving the dilemma of healthcare. When HW2 is seen only in the light of physiologic variables, then we are either overweight or underweight, "normal" or "abnormal", "ok" or "not ok". When our spiritual selves are discounted (because they are not easily defined or described - and don't fit into a 10 minute office visit) then it is not surprising that we don't trust the person who is speaking to us. Without trust and relationship, I have no reason to follow through with instructions, or to even pay attention to what is being said. I've already made up my mind that I will or won't actively participate in whatever is being proposed.
Healthcare reform will never be fully realized until we address the lack of meaning in our current delivery of "care". We at Possibilities Journey, Inc (www.possjrny.org) believe that by re-integrating faith communities and their congregants into the public health system we can bring back relationships and meaning into health. We believe that wholeness can return and that context can be given. When that happens, we will truly be delivering and receiving care. This week, seek context for your HW2 - know that we're here to help.
Peace,
Dan
Context...understanding life and how we interpret it is a major factor in our HW2. We learn as we grow to filter information and contextualize it. It is how we make sense of the world around us - how we relate to the world and vice versa. Spirituality and religion offer alternative narratives to that of the secular world - and the secular world is contantly banging on our doors to be heard and understood. Context gives meaning to our lives and to the information that is presented to us everyday. Laboratory data when given to non-clinicians are just numbers - high or low or "normal". We need someone to interpret those numbers to tell us if we are doing well or about to be in trouble.
Context and HW2 - the truly difficult part of solving the dilemma of healthcare. When HW2 is seen only in the light of physiologic variables, then we are either overweight or underweight, "normal" or "abnormal", "ok" or "not ok". When our spiritual selves are discounted (because they are not easily defined or described - and don't fit into a 10 minute office visit) then it is not surprising that we don't trust the person who is speaking to us. Without trust and relationship, I have no reason to follow through with instructions, or to even pay attention to what is being said. I've already made up my mind that I will or won't actively participate in whatever is being proposed.
Healthcare reform will never be fully realized until we address the lack of meaning in our current delivery of "care". We at Possibilities Journey, Inc (www.possjrny.org) believe that by re-integrating faith communities and their congregants into the public health system we can bring back relationships and meaning into health. We believe that wholeness can return and that context can be given. When that happens, we will truly be delivering and receiving care. This week, seek context for your HW2 - know that we're here to help.
Peace,
Dan
Monday, July 11, 2011
Words and Their Effect on Health...
Yesterday I delivered a sermon that was based on Psalm 119 and Matthew 13. In both of these passages, words, especially those sent by God, play a very important role in our ability to find our way in the world. It got me thinking about the importance of words and our health. There are a lot of words written daily about health and disease and how to get the former and prevent the latter. There are so many words, in fact, that it is quite overwhelming to the average person (truth be told, it's overwhelming to health professionals too).
Words convey facts, opinions, transfer knowledge, engage us in debate, and they can lead us to the introspection that may eventually result in wisdom. One of the most difficult aspects of words is that when they are written it is often difficult to discern whether what is written is fact or opinion. While opinions can be valuable when there are no good data on a subject, they can be misleading and ultimately harmful when taken out of context. One thing that I know after more than 20 years of healthcare practice is that one person's experience is one person's experience. Each human body is uniquely created and operates on its own set of plans. Extrapolating one person's experience can quickly lead to disaster.
Be cautious when using chat rooms and public opinion portals. Even use of "professional" sites with on-line health practitioners is a gamble as they can not know you to the extent they need to in order to render a thorough opinion. Talk with people who know you and who know what is important to you when making decisions. Remember to consult with writings that address the spiritual needs in your life. Understanding the nuances of medical literature, statistics, research design and reporting are all difficult aspects of becoming informed. Take your time and find people that you trust to support you on your journey. Always remember, things that sound too good are never useful and are often harmful.
Deciphering health literature is what Possibilities Journey, Inc, is all about. We work daily to develop relationships with people in order to help them idenitfy and use the words that are available in making well informed decisions on health, wellness and wholeness. You can see what we're up to at: www.possjrny.org. This week I wish you all well as you wade through the words that are presented to you. If we can be of help, drop us a note.
Peace,
Dan
Words convey facts, opinions, transfer knowledge, engage us in debate, and they can lead us to the introspection that may eventually result in wisdom. One of the most difficult aspects of words is that when they are written it is often difficult to discern whether what is written is fact or opinion. While opinions can be valuable when there are no good data on a subject, they can be misleading and ultimately harmful when taken out of context. One thing that I know after more than 20 years of healthcare practice is that one person's experience is one person's experience. Each human body is uniquely created and operates on its own set of plans. Extrapolating one person's experience can quickly lead to disaster.
Be cautious when using chat rooms and public opinion portals. Even use of "professional" sites with on-line health practitioners is a gamble as they can not know you to the extent they need to in order to render a thorough opinion. Talk with people who know you and who know what is important to you when making decisions. Remember to consult with writings that address the spiritual needs in your life. Understanding the nuances of medical literature, statistics, research design and reporting are all difficult aspects of becoming informed. Take your time and find people that you trust to support you on your journey. Always remember, things that sound too good are never useful and are often harmful.
Deciphering health literature is what Possibilities Journey, Inc, is all about. We work daily to develop relationships with people in order to help them idenitfy and use the words that are available in making well informed decisions on health, wellness and wholeness. You can see what we're up to at: www.possjrny.org. This week I wish you all well as you wade through the words that are presented to you. If we can be of help, drop us a note.
Peace,
Dan
Thursday, July 7, 2011
Health in a World of Possibility...
I'm reading my way through a new book. This one is entitled, "Welcome to the Wisdom of the World" by Joan Chittister. It is a wonderful read from a nun who has thought deeply about her spirituality and how it fits into this world of ours. The book is a reflection on different faith traditions and the wisdom that they offer to us as we all seek to understand our world and our place in it. She begins the book with a walk through Hindu wisdom and I was struck by the thought (not for the first time) of how unhealthy possibilities can be.
A dear friend of mine is an ICU physician and we were e-mailing the other day. She was supposed to attend a meeting that I was facilitating, but got caught in the hospital by a very difficult case. She was frustrated by the case because it was a major surgery in a very frail person. The surgery was difficult and it was somewhat of a miracle that the person arrived in the ICU from the operating room. Subsequently, during a long night of high intensity care, the person died. My friend remarked that "there is always something we can do, we don't often consider long enough whether we should do." How right she is - and how much a part of our communal dis-ease this thinking has become.
Possibilities, free will, choices, opportunities, breakthroughs, miracles, rampant individualism...it is all a part of our world. However, possibilities without the ability to make wise choices, often leads us down a path to ever worsening outcomes. I have seen the following scenario hundreds of times over 25 years...Well Meaning Doctor (WMD): "Of course we can do that, it's really quite easy." Well Meaning Person (WMP): "OK, let's go ahead then, since it's so easy." The problem being, that it is technically "easy" for a highly trained WMD to do most anything, the difficulty comes in the time after the "easy" procedure is done. Very little discussion goes into the after care portion, and WMD's aren't a part of that daily process. That daily grind falls to WMP's who are caring for the person affected. This is the world of spiraling health care costs.
Welcome to our broken healthcare system. A system with seemingly limitless possibility ungoverned by the wisdom to set reasonable limits. Much more time needs to be spent discussing whether something "should" be done rather than whether it is possible to do something or not. This is where the missing piece of communal wisdom needs to come into the discussion. This is where re-integrating faith communities and their wisdom can lead us out of the morass we are in. This is what Possibilities Journey, Inc (www.possjrny.org) is all about. Bringing the wisdom of the community back into a healthcare system that is in great need of that input.
This week, consider the possibility that some wisdom is lacking in your life and enter into a faith community near you. It could be a transformational event - and I pray that it is. Consider also the choices you have in front of you or your loved ones and evaluate what is possible versus what is wise.
Peace,
Dan
A dear friend of mine is an ICU physician and we were e-mailing the other day. She was supposed to attend a meeting that I was facilitating, but got caught in the hospital by a very difficult case. She was frustrated by the case because it was a major surgery in a very frail person. The surgery was difficult and it was somewhat of a miracle that the person arrived in the ICU from the operating room. Subsequently, during a long night of high intensity care, the person died. My friend remarked that "there is always something we can do, we don't often consider long enough whether we should do." How right she is - and how much a part of our communal dis-ease this thinking has become.
Possibilities, free will, choices, opportunities, breakthroughs, miracles, rampant individualism...it is all a part of our world. However, possibilities without the ability to make wise choices, often leads us down a path to ever worsening outcomes. I have seen the following scenario hundreds of times over 25 years...Well Meaning Doctor (WMD): "Of course we can do that, it's really quite easy." Well Meaning Person (WMP): "OK, let's go ahead then, since it's so easy." The problem being, that it is technically "easy" for a highly trained WMD to do most anything, the difficulty comes in the time after the "easy" procedure is done. Very little discussion goes into the after care portion, and WMD's aren't a part of that daily process. That daily grind falls to WMP's who are caring for the person affected. This is the world of spiraling health care costs.
Welcome to our broken healthcare system. A system with seemingly limitless possibility ungoverned by the wisdom to set reasonable limits. Much more time needs to be spent discussing whether something "should" be done rather than whether it is possible to do something or not. This is where the missing piece of communal wisdom needs to come into the discussion. This is where re-integrating faith communities and their wisdom can lead us out of the morass we are in. This is what Possibilities Journey, Inc (www.possjrny.org) is all about. Bringing the wisdom of the community back into a healthcare system that is in great need of that input.
This week, consider the possibility that some wisdom is lacking in your life and enter into a faith community near you. It could be a transformational event - and I pray that it is. Consider also the choices you have in front of you or your loved ones and evaluate what is possible versus what is wise.
Peace,
Dan
Monday, July 4, 2011
The Health/Place Relationship...
Today's post is a reflection on a concept termed the "theology of place". No matter where we humans are, we take formless space (think bare office cubicle or desk) and make it our own. We add pictures of important people or events, we beautify it with plants or art work, we litter it with our personal detritus. The space becomes "ours" whether it is a rental, a lease or we own it. Whether it is a space just big enough for us and a laptop, or many thousands of acres, we interact with that space to create a relationship. We also exist in it and create memories - and it is both the relationship and the memories that confer something sacred or at least special to that place.
Over time, we develop a "way" of interacting with new spaces in our lives. Thus unknowingly we develop a theology of place which confers meaning to the spaces we occupy. Obviously, depending upon what happens within those spaces, the meaning for us can be positive or negative. Additionally, the space can be healthy or unhealthy. Case in point, if you occupy a space in a high stress and low reward job, it is likely that you will be highly stressed and frustrated (and less healthy). If however, you occupy a space that treats you as an important part of a team and that rewards your efforts, you will reflect a much more positive outlook (and likely be healthier).
We now understand that place and health are inter-related. Spaces which help us to explore meaning in our lives and helps us grow not only in our chosen fields but in our humanity, confer health benefits far beyond what would be expected. This type of work life used to be common place. Real community existed where people knew each other and understood where they fit into the ethos of the place they occupied. There was a peace of mind that allowed people the opportunity to grow into the person they chose to be. People were healthier overall, because they were connected to each other and to a place. (see any of the books by Wendell Berry)
In today's world we rush ever faster into the future, demanding more and more "efficiency" and using up resources (human and earthly) at an alarming pace. We see places as acquisitions to be bought and sold, not to be retained and treasured. Even "vacation" places are purchased only to be used every now and then - they are purchased with an eye on the return-on-investment (ROI) much more so than for their aesthetic value. We have lost the theology of place - and we wonder why we aren't able to settle down and be at peace. We wonder why we aren't able to be healthier and more whole. We wonder and we ponder and we don't know what to do!
I write this on a national holiday where we are celebrating the creation of a nation. All Americans identify (positively or negatively) with this country. Those who have traveled know what it means to live here and how blessed we are. Today and all this week I'd like to encourage you to consider your theology of place and evaluate how your places add or detract from your sense of health and well being. How can you change your theology of place to create an environment that leads you to health, wellness and wholeness?
Peace and joy,
Dan
Over time, we develop a "way" of interacting with new spaces in our lives. Thus unknowingly we develop a theology of place which confers meaning to the spaces we occupy. Obviously, depending upon what happens within those spaces, the meaning for us can be positive or negative. Additionally, the space can be healthy or unhealthy. Case in point, if you occupy a space in a high stress and low reward job, it is likely that you will be highly stressed and frustrated (and less healthy). If however, you occupy a space that treats you as an important part of a team and that rewards your efforts, you will reflect a much more positive outlook (and likely be healthier).
We now understand that place and health are inter-related. Spaces which help us to explore meaning in our lives and helps us grow not only in our chosen fields but in our humanity, confer health benefits far beyond what would be expected. This type of work life used to be common place. Real community existed where people knew each other and understood where they fit into the ethos of the place they occupied. There was a peace of mind that allowed people the opportunity to grow into the person they chose to be. People were healthier overall, because they were connected to each other and to a place. (see any of the books by Wendell Berry)
In today's world we rush ever faster into the future, demanding more and more "efficiency" and using up resources (human and earthly) at an alarming pace. We see places as acquisitions to be bought and sold, not to be retained and treasured. Even "vacation" places are purchased only to be used every now and then - they are purchased with an eye on the return-on-investment (ROI) much more so than for their aesthetic value. We have lost the theology of place - and we wonder why we aren't able to settle down and be at peace. We wonder why we aren't able to be healthier and more whole. We wonder and we ponder and we don't know what to do!
I write this on a national holiday where we are celebrating the creation of a nation. All Americans identify (positively or negatively) with this country. Those who have traveled know what it means to live here and how blessed we are. Today and all this week I'd like to encourage you to consider your theology of place and evaluate how your places add or detract from your sense of health and well being. How can you change your theology of place to create an environment that leads you to health, wellness and wholeness?
Peace and joy,
Dan
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