Forgive for good

A proven presciption for health and happiness

by Frederic Luskin, Ph.D.

I AM A SENIOR consultant for the Vaden Health Center at Stanford University where I teach people ways to manage their stress and to live lives of greater satisfaction. I do this to reduce their risk of disease and to help their bodies and minds remain strong and resilient. A funny thing happened to me in the midst of doing this work. I started to research the effect that forgiveness had on physical and emotional well being. Towards that end, I developed a simple process of teaching people to let go of the grudges and grievances they carried around. As I started to teach forgiveness, I discovered that an unexpectedly large number of people responded to this work with fascination, confusion, enthusiasm and mistrust. Almost no one knew for certain exactly what forgiveness was and why it might be useful to study.

My work as director of the Stanford Forgiveness Projects has shown that learning to forgive helps people hurt less, experience less anger, feel less stress and suffer less depression. My research also shows that, as people learn to forgive, they become more hopeful, optimistic and compassionate. As people learn to forgive, they become more forgiving in general, not just towards one particular person who did them wrong. Our research has also shown that forgiveness has physical health benefits.

People who learn to forgive report significantly fewer symptoms of stress, such as backache, muscle tension, dizziness, headaches and upset stomachs. In addition, people report improvements in appetite, sleep patterns, energy and general well being. Finally, one research project showed that angry people with high blood pressure showed a decrease in both anger and blood pressure when they learned to forgive.

If forgiveness is so good for us, why do so few of us choose to forgive when people hurt us? First, no one has taught us how to forgive. The religious traditions usually tell us to forgive, but do not offer the practical steps as to how. We live in a culture that prizes the expression of anger and resentment more than the peace of forgiveness. And most people are confused about what forgiveness is and what it is not. Because of this, too many do not take the opportunity to heal themselves, sometimes from great emotional pain and the physical consequences that result.

First, forgiving an offence such as an adulterous affair does not mean you condone the affair. I am reminded often that we can only forgive that which we know to be wrong. Your partner’s affair was wrong, but you do not have to suffer indefinitely because you were betrayed. Secondly, forgiveness in no way means you have to reconcile with someone who treated you badly. If you were the recipient of childhood abuse or are in a harsh relationship, you can forgive the offender and, as part of that choice, make the decision to end or limit contact. Forgiveness is primarily for creating your peace of mind. It is to create healing in your life and return you to a state where you can live capable again of love and trust.

Another misconception about forgiveness is that it depends on whether or not the abuser or lying person apologizes, wants you back or changes his/her ways. If another person’s poor behaviour was the determinant for your healing then the unkind and selfish people in your life would retain power over you indefinitely. Finally, you can forgive you ex-spouse for their insulting speech and even for abandoning you and your children… but forgiveness in no way means you do not take the ex to court to make sure your children get the support payments to which they are entitled. Forgiveness and justice are not the same. Forgiveness and reconciliation are not the same. Forgiveness and condoning are not the same.

What I have seen time and time again is that people have the capacity to make peace with their past. They regain their ability to trust and love and stop blaming other people for their emotional distress. They take more time to count their blessings and less to complain about what went wrong. They understand they need to look more at who they are becoming and less at what has happened. They grasp that each day they wake up with a fresh start no matter what happened to them yesterday. They learn to forgive and heal in both body and mind.

Nine steps to forgiveness
Forgive for Good

1. Know exactly how you feel about what happened and be able to articulate what about the situation is not OK. Then, tell a couple of trusted people about your experience.

2. Make a commitment to yourself to do what you have to do to feel better. Forgiveness is for you and not for anyone else. No one else even has to know about your decision.

3. Understand your goal. Forgiveness does not necessarily mean reconciliation with the person that upset you or condoning their action. What you are after is to find peace. Forgiveness can be defined as the “peace and understanding that come from blaming that which has hurt you less, taking the life experience less personally and changing your grievance story.”

4. Get the right perspective on what is happening. Recognize that your primary distress is coming from the hurt feelings, thoughts and physical upset you are suffering now, not what offended you or hurt you two minutes – or 10 years – ago.

5. At the moment you feel upset, practise the Positive Emotion Refocusing Technique, a simple stress management technique to soothe your body’s flight or fight response.

6. Give up expecting things from other people, or your life, that they do not choose to give you. Recognize the “unenforceable rules” you have for your health or how you or other people must behave. Remind yourself that you can hope for health, love, friendship and prosperity and work hard to get them. However, you will suffer if you demand these things occur when you do not have the power to make them happen.

7. Put your energy into looking for another way to get your positive goals met [other] than through the experience that has hurt you. I call this step finding your positive intention. Instead of mentally replaying your hurt, seek out new ways to get what you want.

8. Remember that a life well lived is your best revenge. Instead of focusing on your wounded feelings, and thereby giving the person who caused you pain power over you, learn to look for the love, beauty and kindness around you.

9. Amend your grievance story to remind you of the power you have to create a better story, one where you can let go of the need to be a victim.

Dr. Fred Luskin is the director of the Stanford University Forgiveness Projects, a renowned researcher, author and expert in forgiveness. He presents “Forgive for Good: 9 Steps to Forgiveness” at the Justice Institute of British Columbia (Theatre), New Westminster, BC, March 26, 9AM-3:30PM. Call 604-528-5590 or 1-877-528-5591to register

Back room drug deals

 

DRUG BUST Alan Cassels

“The very word ‘secrecy’ is repugnant in a free and open society and we are, as a people, inherently and historically opposed to secret societies, to secret oaths and to secret proceedings. ”

– John F. Kennedy

ARE YOU familiar with the line, “If you’ve nothing to hide, you have nothing to fear?” That’s the slogan often used to attack those who express concern about personal privacy – the ones who say they’re worried about the proliferation of surveillance cameras, databases and other data-collection devices that track us like bloodhounds, recording our every encounter with the legal, commercial, educational and medical systems. Where is all that information kept? How correct is it? Who is using it? Can it be used for purposes for other than which it was intended? Will it ever come back to haunt us even if we have “nothing to hide?” Scary thoughts indeed.

While personal privacy is an issue that gets a lot of attention, leading to a growing level of public concern about exactly how personal data are being used, there’s another side to the secrecy issue. And that’s the fact that many decisions, especially vital decisions that affect healthcare, are made in secret, not open to the sunlight of public scrutiny. Most people would find it astounding that, in Canada, millions are spent on healthcare decisions made behind closed doors. Even if these decisions are being made by well-meaning policy makers fully preoccupied with advancing the public interest, secretive decision-making, by its very nature, means there is no way for third parties to verify whether or not the public interest is best served.

One example on my radar, although details are sketchy, is the way different provincial drug plans cut deals with drug companies about listing their drugs. These so-called product listing agreements allow companies to get their new drugs on the formulary – the list of drugs the province will pay for – without having to reveal how much or how little they are paying the government. They also don’t have to reveal how much more patients and private insurers may have to pay outside the government plan for the same drug. The public may be getting a real steal on a certain product, which just might be providing incredible value for taxpayer money, but the name of the game is secrecy; no one is supposed to know.

Let’s say a company wants its new drug listed on the Ontario Drug Plan and it asks the Ontario government for a certain price. After negotiations about the number of doses and the number of patients likely to use the drug, the product will be listed. If the company sells more of the drug than it projected, it might be required to pay back some of those additional costs to government. These agreements may have research requirements built into them to better monitor how the drug is being used in the general population. This is all conjecture, of course, because the deals are made in secret. What actually happens within a product listing agreement is a big, black box and no one, except the government negotiators and the manufacturer, knows what kind of money the drug is costing the taxpayer or the consumers who are not covered by provincial plans.

Are these fair agreements? Should they be made in the open? That’s my default opinion, but without knowing the specifics of these deals, it’s necessary to withhold judgement. Hopefully, given all the pressure exerted on governments to keep costs down, such secret deals are actually resulting in maximum value for the dollar.

Let’s broaden this question and ask ourselves if we’d welcome governments secretly negotiating on our behalf for other public goods. Would we allow the building of a new Port Mann Bridge or a new Sea-to-Sky Highway to be negotiated in secret? What would we say if prospective builders got together with government officials and hammered out financial deals where the public couldn’t know how much money is changing hands?

Some say the secrecy is necessary because of the way the drug industry and the different public pharmacare programs are structured in Canada. For instance, Quebec has a “most favoured nation” clause that requires manufacturers to provide the Quebec government with the lowest price among all the provincial plans. Maybe doing deals in secret is the only way any other province can get the fairest price. It’s hard to tell, but a recent paper published by Aidan Hollis, an economist in Alberta, found that BC carried out a sole-sourcing contract with a drug company that involved secret rebates to Pharmacare. The problem he saw was that the alleged price reductions for Pharmacare recipients meant higher prices for everyone else not covered by Pharmacare. Hollis concluded: “A tendering process with secret rebates is not transparent, nor is it fair to impose high costs on those patients whose purchases are not covered by Pharmacare.”

“Transparent.” That’s the word that seems most antithetical to the word “secrecy” and one that pharmaceutical companies absolutely love to fling at governments for being secretive. In fact, if you’ve been listening to the comments from drug lobbyists and their favourite disease groups about public agencies that critically evaluate drugs – Canada’s Common Drug Review and UBC’s Therapeutics Initiative, for example – the word “transparency” is thrown down like a gauntlet. Why aren’t these organizations more “transparent” they ask?

Am I the only one to notice the faint whiff of hypocrisy when drug companies are cutting secret deals with provincial governments to list their drugs, even as they publicly demand transparency in government-sponsored analyses of new drugs?

The drug companies’ version of the word transparency is simple: these groups want to know who’s at the table and they want to know the name, rank and serial number of the key lobbying targets. They want to know which levers to work, hence demanding greater and greater transparency around the decisions governments make about drugs because the more opaque the decision-making process, the less chance the drug companies have of influencing governments’ decisions.

Fair enough, right? Yet these demands from the pharmaceutical industry lead to some hard questions regarding the industry’s offerings in terms of their own transparency. Sure, they are companies and companies need to keep secrets – proprietary information, ya know – and I can accept that. However, we in the public know almost nothing about what the industry is doing to influence healthcare decisions, such as how much they spend to influence physician prescribing.

Dr. Joel Lexchin, a Canadian expert in pharmaceutical policy and author of one of the best books on the drug industry in Canada –The Real Pushers, New Star Books, 1984 – has estimated that the drug industry in Canada today spends about $50,000 per doctor, per year, marketing its products to physicians, but we don’t know for sure. (With 6,000 practising doctors in BC, that’s about $300 million per year.) Do we know how the money is spent or to what extent it influences prescribing decisions? Of course not. All of that information is confidential, secret and non-transparent.

Another worrisome aspect of transparency relates to the way Health Canada respects drug manufacturers’ requests for confidentiality of unpublished data – that is, the company’s clinical data our regulator examines before it allows a drug to be sold in Canada. We researchers who are interested in what those data show –especially in terms of drug safety – can’t get them. That information is considered confidential and we can only see summaries of the data that support the approval of a drug.

Data on drug safety, data on what provinces pay for drugs and data on drug company spending to influence prescribing are certainly on my menu of what I think needs to be brought into the light of day under the banner of greater transparency.

Yet even while governments in Canada jump to satisfy the industry’s strident desire for greater transparency, they tend not to demand, in return, greater transparency for those things obviously in the public interest. At the very least, we would hope they would strike a balance so that the glare of transparency can shine on both public and private matters. However, the way the companies and governments currently deal with transparency issues reminds me of the slogan used to describe the recent spate of bailouts of private banks in the economic slowdown: “The privatization of benefits and socialization of costs and risks.”

Maybe our democratically elected governments need to say this to the drug companies: “We’ll give you transparency of our decision making processes when you provide us equal clarity on your business decisions. You can’t have us working in a glass house while you work in a batcave.”

Alan Cassels is a drug policy researcher at the University of Victoria and author of The ABCs of Disease Mongering: An epidemic in 26 Letters.

cassels@uivic.ca

 

Veggies for vitality

NUTRISPEAK by Vesanto Melina

The scrumptious aroma of potatoes baking in the oven on a winter afternoon. Minestrone soup simmering, bringing an invitation from onion, garlic and herbs. The vibrant reds, greens and purples of a rainbow-hued salad. The explosion of flavour when you bite into an avocado and tomato sandwich.

If the word “vegetables” doesn’t conjure in your mind sensations of colour, fragrance, delicious flavour and bountiful health, it’s time to update your attitude about these amazing foods. When we have a savoury soup and salad for lunch, and build our dinner around veggies, we consume a wealth of vitamins, minerals and other nutritious compounds.

More than any other group of foods, vegetables have proven their worth as cancer fighters and as our powerful protectors. This is a great time to make the acquaintance of new members of this family of plant foods and also to discover what powerful allies they can be in supporting your health.

One of the best things that veggies have going for them is an abundance of protective phytochemicals (plant chemicals). These substances provide many of the colours that make the produce aisles so attractive and vibrant. Veggies also give you more bang for your buck, in terms of providing vitamins, minerals and protection against disease, per calorie and per mouthful, compared with any other group of foods.

The recipe shown is from our newest book, The Raw Food Revolution Diet*. This bean-free hummus has all the flavour of traditional Middle Eastern hummus and is full of nutrients, including bone-strengthening calcium. It’s tasty with raw veggies. To expand your horizons about which veggies you can eat raw, here are a few ideas: asparagus tips, broccoli florets, carrot sticks, cauliflower florets, celery sticks, cherry tomatoes, cucumber discs, green onions, green pea pods, jicama sticks, parsnip sticks, peppers (red, yellow and green), snow peas, zucchini strips or circles.

The Raw Food Diet Revolution

A trend that is sweeping North America is the raw foods movement. Some people are motivated by a concern about their bulging waistlines, others by the abundance of protective antioxidants and phytochemicals in plant foods. Many are inspired to increase their intake of uncooked veggies and fruits without adhering to an entirely raw diet. Are raw diets nutritionally adequate? What are the potential pitfalls? Are they good for children? Can a raw or mainly raw diet form the basis for a successful weight loss plan? I will be delivering a seminar entitled The Raw Food Diet Revolution at The Wellness Show. See information below.

Vesanto Melina delivers The Raw Food Diet Revolution seminar at The Wellness Show, Vancouver Convention & Exhibition Ctr, 999 Canada Place, Sun. Feb. 8, 12:30pm. Drop by the Book Publishing Company booth (620) and say hello.

www.thewellnessshow.com 
www.nutrispeak.com
*Authors: Cherie Soria, Brenda Davis and Vesanto Melina (The Book Publishing Company, 2008.)

Attend a free presentation by Vesanto, “Rx for Healthy Eating” in Langley’s Walnut Grove Library, Wed. Feb. 11 at 7 pm


Zucchini Hummus

Makes 1-2/3 cups (5 servings)
Serve hummus with raw veggies or as “Romaine Boats” on the inner leaves of a head of Romaine lettuce, topped with diced tomatoes and alfalfa sprouts.

1 small zucchini, peeled and chopped (1 cup/250 mL, firmly packed)
3 1/2 Tbsp. lemon juice
1 Tbsp. flaxseed oil or olive oil
1-4 cloves garlic
1 tsp. paprika
1 tsp. salt
1/4 tsp. ground cumin (optional)
1/8 tsp. cayenne
1/2 cup sesame tahini
1/3 cup sesame seeds, soaked 4 hours and drained

Place in a blender the zucchini, lemon juice, oil, garlic, paprika, salt, cumin (if using) and cayenne. Purée. Add tahini and sesame seeds and purée until perfectly smooth and creamy. Store in a glass jar or other covered container, refrigerated, for up to four days.

Note: This recipe can be made in a food processor, although the mixture will contain whole sesame seeds, rather than being smooth. Alternatively, you can replace the seeds with 1/3 cup more tahini plus a little water.

Vesanto Melina is a BC-registered dietitian and co-author of the following nutrition classics: Becoming Vegan, the Food Allergy Survival Guide andRaising Vegetarian Children
www.nutrispeak.com

Five-year food security plan

ON THE GARDEN PATH by Carolyn Herriot

I spent a full year searching for a property where I could grow as much of my own food as possible. From the moment I stepped foot on the land we bought, I started visualizing my new garden 10 years down the road. Amazingly, it only took five years to achieve year-round self-sufficiency in fruits and vegetables. Now I know that urban gardeners on Vancouver Island could achieve food security with their own five-year plan. It could look something like this:

Year one: edible landscaping. Year two: fruit and vegetable gardening. Year three: winter food gardening. Year four: seed saving for future harvests. Year five: four-season production using local seed banks.

We are beginning the ninth year on our property so I thought I’d share what we did on The Garden Path with you:

Amending the soil: With 15 feet of clay fill to work with, this was a no-brainer! How to change a cracked substrate with no earthworms into a fertile organic loam in a few months? First, Maverick Excavating came to break up the clay and then we mulched like mad, with what I refer to as “The Four Secrets of Successful Soil Building” – compost, manure, leaves and seaweed. By adding six-inch layers of these organic amendments in the fall, we were able to turn compacted clay into friable soil, with good tilth and teaming with earthworms by April the following year.

The best part is these organic soil amendments are free and freely available and are often regarded as waste. If urban gardeners linked with rural farmers and used their manure, we could easily solve a big waste disposal problem. If gardeners kept their leaves and fed them back to the soil, we would save a lot of money by the city not having to pick them up and we wouldn’t have to drive to the works yard to buy the leaves back as mulch. There’s a good joke here.

Building a greenhouse: I chose a glass and metal frame model, but there are other options. Due to erratic weather, I now grow seedlings for transplanting whenever possible. If you don’t have the luxury of a greenhouse, you can improvise with cold frames and cloches.

Designing the garden: Maverick Excavating dug up a 50 sq. ft. area, which was divided into four quadrants with a circular bed in the middle. This layout works well for crop rotations, which break the lifecycle of pests and diseases.

We grow food year round in the main garden because in our temperate climate there’s no need to leave beds empty from October to April; there are 50 varieties of different vegetables that can be harvested throughout winter.

The “Berry Walk”: I planted a 50-foot-long border with raspberries, blackcurrants, redcurrants, gooseberries and Josta berries, all of which were under-planted with “Totem” June-bearing strawberries. They thrive in the same conditions.

The fruit orchard: A small orchard of 10 trees was planted in the second year. Dwarf and semi-dwarf saplings of apple, pear, cherry and plum trees were planted 15-feet apart in two rows of five because I visualized an avenue of trees with a canopy of fruit, providing shade for summer banquets.

The arbour: In year three, we scoured the forest to build a 50-foot-long arbour for kiwis, grapes, climbing berries and thornless blackberries. The berries are very ornamental as they ripen from red to black.

Seed saving: Over the years, more garden beds were added for seed saving. Plants adapt to the conditions in which they grow, which is why using organic seed is best when you are an organic gardener. Local seeds also have an edge in that they become adapted to the local climate conditions.

Willows and bamboos: These are useful, renewable resources for the garden. In future years, the bamboos and willows I have been planting will provide material for obelisks, arbours, trellises, screens, fences and teepees.

The native edible plant walk: next on the list – I’ll keep you posted.

Carolyn Herriot is author of A Year on the Garden Path: A 52-Week Organic Gardening Guide. She grows her certified organic “Seeds of Victoria” at The Garden Path Centre where she blogs The New Victory Garden online.

Big pharma breaks the law and pays up

DRUG BUST Alan Cassels

“Drastic action is essential to preserve the integrity of medical science and practice and to justify public trust.”

– Journal of the American Medical Association

You can learn a lot about the effects of drugs and the actions of drug manufacturers by peering into a courtroom. When you hear what the companies themselves have to say, in sworn testimony, about their drugs or their marketing tactics, you realize that we in the general public really only have an iceberg tip’s worth of information about any drug on the market.

You can’t deny that courts of law can get at a certain purity of truth, which emerges from the wringer of the legal system.

Exhibit A to support this argument is a major lawsuit settled last month in the US against drug giant Eli Lilly. The company was ordered to pay $1.42-billion (US) to settle criminal and civil investigations. These charges stem from the way the drug manufacturer marketed its antipsychotic drug Zyprexa, (generic name olanzapine). Lilly executives explained that the key charge centred on how Lilly was advertising Zyprexa for ailments for which it was not approved.

A company trying to license its drug will come to the regulator with a series of claims of what its drug can do. It is only those claims deemed to be supported by sufficient evidence that get approved by the FDA or Health Canada. However, while drugs are licensed only to treat certain specific conditions, our doctors are free to prescribe any drug for any patient for whatever reason they see fit, approved or not approved. The issue of “approval” is important because a company can only market its drug for “approved” uses. In other words, if your drug is approved to treat toenail fungus, the sales reps can’t go pushing the drug for erectile dysfunction. That’s against the law.

Zyprexa belongs to a relatively new class of antipsychotic drugs approved to treat people suffering from schizophrenia and bipolar disorder. I thought, OK, there can’t be that many schizophrenics or people with bipolar out in society so antipsychotic drugs like Zyprexa wouldn’t have much of a market. I was wrong. Lilly has sold nearly $40 billion (US) worth of Zyprexa since it was approved in 1996, making it, in fact, one of the biggest-selling drugs in the world.

Many of us had sensed there had to be something illegal about the way the drug was being marketed, but we had to wait until the court documents revealed what was actually happening.

A huge blockbuster drug, approved only for the treatment of relatively uncommon diseases, was obviously being taken by millions of people – despite its known and fearful side effects (mainly weight gain and diabetes) and its documented life-threatening severe adverse effects, (heart attacks and strokes). So why was an antipsychotic like Zyprexa so widely used?

The answer is what we call “off-label promotion.” According to documents filed in U.S. District Court in Philadelphia, Lilly said it promoted Zyprexa for elderly people in the treatment of dementia, which is a use strictly not approved by Health Canada or the US Food and Drug Administration. The US attorney handling the case told a press conference, “Lilly completely ignored the law,” making “hundred of millions of dollars” from illegally promoting Zyprexa.

Here’s the main kicker: not only is the drug not approved to treat dementia in the elderly, but Health Canada has said that prescribing this drug to elderly people is something that should emphatically not be done due to the risk of strokes. Yet if you were to wander the halls of the average seniors home in Canada, you’d find as many as a quarter of the residents taking these drugs.

Exhibit B in my argument that the law courts are great places to look to expand our knowledge about drugs is the drug Neurontin (gabapentin). This drug will go down in the history books as being off the scale in terms of its off-label promotion. Neurontin was approved in the mid-1990s as an “add-on” therapy for what they call “partial complex seizures.” A small market, right? I mean, how many people suffer seizures and would therefore need drugs like Neurontin? Seems like a lot. By 2004, nearly $3 billion worth of the drug was being sold.

David Franklin, a whistleblower from Parke-Davis (later bought out by Pfizer, which marketed the drug), set the wheels in motion for a huge lawsuit that followed. The result was public access to some of the most complete court documents ever assembled around the aggressive, off-label marketing of a drug. In the passage below, Franklin relates what a Parke-Davis executive said to him and his fellow sales people:

“I want you out there every day selling Neurontin… We all know Neurontin’s not growing for adjunctive therapy, besides that’s not where the money is. Pain management, now that’s money. Monotherapy [for epilepsy], that’s money… We can’t wait for [physicians] to ask, we need [to] get out there and tell them up front. Dinner programs, CME [continuing medical education] programs, consultantships all work great but don’t forget the one-on-one. That’s where we need to be, holding their hand and whispering in their ear, Neurontin for pain, Neurontin for monotherapy, Neurontin for bipolar, Neurontin for everything. I don’t want to see a single patient coming off Neurontin before they’ve been up to at least 4800 mg/day. I don’t want to hear that safety crap either, have you tried Neurontin, every one of you should take one just to see there is nothing, it’s a great drug.” (From The Neurontin Legacy: Marketing through Misinformation and Manipulation by C. Seth Landefeld, M.D. and Michael A. Steinman, M.D., published in the New England Journal of Medicine, Jan. 9, 2009.)

It would become the mother of all court actions against illegal marketing by a company; the payouts were almost a billion dollars, at that time the biggest legal action ever taken against a drug company. The court documents reveal the whole gamut of tricks used to manipulate information: suppressing publications, training and using local doctors to serve as paid speakers for the drug, cultivating “thought leaders,” influencing academics with research grants, appointing people to “advisory boards” that worked to launder payments to physicians and lots and lots of “unrestricted educational grants” to do what was needed to sell this drug.

In an article in December’s New England Journal of Medicine, it was noted that the marketing of Neurontin was based on “the systematic use of deception and misinformation to create a biased evidence base and manipulate physicians’ beliefs and prescribing behaviours.”

The 8,000 pages of corporate documents now in the public domain reveal the tactics used by a company to create a multibillion-dollar blockbuster out of a drug that should have gone nowhere. These documents are available in a searchable digital library at the University of California in San Francisco. (www.dida.library.ucsf.edu). The class-action suit which followed also generated detailed testimony, searchable through the US Federal Judiciary’s Public Access to Court Electronic Records Service Center.

How much off-label prescribing happens? About 20 percent of drugs in the US are written to treat a condition for which the drug was not approved, according to a 2006 study published in the Archives of Internal Medicine.

What’s a patient to do in all of this? For starters, ask your doctor, “Is this drug you are about to prescribe me actually “approved” for the condition or disease for which I would take it? It might be best to first try the proven, standard and “approved” therapies.”

Clearly, we shouldn’t have to wait for the courts to tell us what is happening behind the scenes about how drugs are being used. Better research and regulation on how drugs are actually being used in the market (and what kinds of effects they have) are needed.

In Canada, a group of academics and health policymakers have been trying for several years to make the case that Canada needed better ways to research and assess the safety and effectiveness of drugs as they are used in the “real world.” In mid-January, Canada’s new Health Minister Leona Aglukkaq announced that the government was committing $32 million over four years to create a research network to “enhance national capacity for research on the safety and effectiveness of drugs used by Canadians.” This is about the best news on the drug safety front we’ve seen in a long time.

We shouldn’t have to rely on the courts to provide independent, unbiased evidence to help answer important questions about the drugs we take every day. Publicly funded research that is free from pharmaceutical industry influences will help a lot. The new $32 million is hardly what you’d calldrastic action on the drug safety front, seeing as this represents about 1/1,000th of Canada’s annual drug bill, but it could be a step in the right direction. There is no doubt that the time has come to start creating systems to ensure safe and effective use of drugs in Canada.

There is no use waiting until the courts have their say.

Alan Cassels is a drug policy researcher at the University of Victoria.

He uncovers the world of cancer screening in a two-part radio documentary, You are Pre-Diseased, airing on CBC IDEAS at 9:05 pm, February 12 and 19. Mark your calendars.

cassels@uivic.ca

The heights of the fall

by Shakti Mhi

Dedicated to Daniel, who was there for me with his whole being.

My body was in motion, falling 30 feet down. As I fell, time didn’t slow down; it simply stopped. Maybe because I fell at the speed of light, or when you take off from your usual orbit, the laws of nature cease to exist.

As I was in the air, I was very clear and relaxed. I thought, “Is this going to be the end?” I felt a bit disappointed as I was in the middle of teaching a yoga teacher training program and I had a few things to do in my life. I didn’t resist the fall with my body; I let my body fall like a heavy pillow and I hit the rock on the ground. The impact was incredible; bones and flesh hitting the ground at a speed that is only meant for diving birds. I lost my breath but not my consciousness. I watched my body in its stillness; no air moved in or out. I knew at this moment I was entering a new era of my existence, but I wasn’t sure if it was in the form of death or a new kind of life.

I wondered if the reason I was not breathing was because one of my ribs had pierced my lung. I decided to gather all the energy that was left in my broken body and force a deep inhale into my shocked lungs. There is a good reason why in Zen it says, “If you are aware of your breath, you are aware of the moment.” I guess the last time I had been forced to inhale so intensely was when I was born. I felt so much joy when my lungs started to move, vacuuming the air in.

The aftermath

I knew my spine was broken and my next thought was, “Am I paralyzed?” I searched for my toes, but it wasn’t easy to map them in my brain. I was determined to find the group of muscles responsible for moving my toes. I did and when they moved, I was in bliss. I checked my legs and was thrilled to feel them moving. My left hand was lying beside me with no life in it. Broken bones were exposed to the air covered with a jungle of dark mud. I thought of the long journey before me. I was on a small island off the main coast of Thailand that had no medical facilities and the only way back was on a tiny boat on a stormy ocean. Honouring my practice, I knew there was only one way for me to go through the ordeal: being in the moment.

Lying on the ground, waiting for an emergency team to arrive, I had to restrain my mind from leaving the moment and wildly galloping into the unbounded desert of fears, doubts, worries and the replay of moments that had past. I needed to be 100 percent focused, tuned in and crystal clear. I couldn’t afford to lose any energy by letting my mind wander outside of the moment.

People carried me from the jungle to the beach and the pain was unbearable. I knew if I identified with the pain it would swallow me alive and I would lose consciousness. So I started to say loudly, “I am not this body and this pain is not me.” I kept repeating it as a mantra until I established a state were I was fully able to watch the pain, knowing it was in my body and knowing that it was not me. It helped me to manage the pain as a separate thing from my self. When I was informed that it would take some time for the speedboat to arrive, I started to chant like there would be no tomorrow. I chanted so loudly that people started to move towards the beach thinking maybe there was a Satsang going on. I couldn’t understand where this powerful voice came from in my broken, bleeding body. But I didn’t care; my intense chanting established life in my injured body by evoking Prana and circulating it in my physical and energy bodies.

And the journey began – endless moments of awareness, bliss and gratitude for being alive. When I arrived at the hospital a few hours later, I was informed that it would take another six hours for the surgeon to fly in from Bangkok. I asked Daniel to remove the big clock from the wall across from my bed, as I needed to bend time to my own terms to survive the long wait. The next thing I heard was the surgeon explaining how serious the injury was. He suggested surgery for my spine. I went within my self and came back with an assertive command not to touch my spine, just to care for my hand. They respected my wish, but didn’t support it.

What made this experience so powerful and spiritual is that I was forced to immerse fully into the moment and move beyond space and time, move beyond all concepts of pain and pleasure, of good and bad. I experienced each moment as it was.

Another significant aspect of my injury was watching the power of the mind when it was guided with intuition

Illustration © Mahesh14

and cleared of all fears. My mind and I decided not to let any predictable diagnoses and bad news from the medical staff stop us from being creative in our dance of healing. Meditation, visualization, loud affirmations and tons of humour were my yoga practice, day and night. I was talking to my body and guiding it gently as it found its way back to a place of balance and health. I refused to remain on morphine and instead exercised changing the concept of pain into pleasure; after all, it is only a concept.

Long distance healing

Because we are all connected to each other on the energy level, healing from a distance works powerfully. Immediately following my event, many people in Thailand, including teachers, students, yogis and friends, meditated and sent me powerful energy to encourage rapid healing. The news travelled quickly from India to Vancouver and beyond and wonderful people sent me more and more energy. Lying in my hospital room, I felt strong vibrations moving along my spine, aware of a beautiful gold colour, healing my broken bones. Even though I was isolated, I felt connected to an ocean of high frequency vibrations. I could physically feel streams of energy entering my body. I owe my rapid healing to all the people that sent this wonderful, loving energy. Sometimes the energy felt so intense, I burst into tears of bliss and gratitude. Thank you all.

Shakti Mhi is the author of The Enigma of Self-Realization and founder of Prana Yoga College International.

www.pranayoga.com

Less is more: make it your new mantra

DRUG BUST Alan Cassels

If you listen closely to the pleas of health advocates and patient groups, those who push for better treatments for specific diseases, such as Alzheimer’s, cancer, arthritis or heart disease, there is a common refrain. That refrain, summed up in a word, is “More.”

We need more drugs. We need more CT or MRI machines. We need more doctors. We need more specialists. We need more access to everything. More. More. More.

And then add the requests for more of everything that supports a decent quality of life. Advocates for the homeless make pleas for more affordable rental housing. AIDs advocates make a very strong case for government-supported safe injection sites. Seniors advocates make demands for more assisted living complexes to support seniors in their frail years. More. More. More. The advocates often feel like their pleas are mere cries in the wilderness.

If you are a health bureaucrat, policymaker or politician, you probably spend a lot of time listening to the competing groups stating their case for More, More, More. You may spend much of your workday trying to satisfy the needs of those who are asking for more. And choosing to make more of one thing accessible to one group inevitably means money that is not going towards a competing claim. After all, there is a limited supply of tax dollars to go around.

The sense of a limited supply of money brings a level of discipline to the way government doles out our collective wealth. Yet I believe it’s occasionally worth putting aside those decisions for a moment and stepping back to take a look at the big picture at the way we manage all our collective resources, of which healthcare is only a single slice.

At the beginning of the year, let’s ask ourselves, “What kind of show are we humans running here on this planet?” Our planet consists of nearly unimaginable health extremes. The poorest billion people on Earth live on less than a dollar a day, a level of deprivation that necessitates being dominated by the issue of survival. More than 25,000 children under five die every day from the most easily preventable diseases: diarrhoea, parasites, malnutrition and malaria. This one billion people lack even the most basic components of health and improving their chances of survival depends on their getting more of almost everything: clean water, decent clothing, adequate shelter, basic healthcare, income, peace and democracy. Even a little more of any of these simple things would produce a huge impact on the lives of these people.

At the other end of the spectrum, where the majority of Canadians live, are another billion or so people for whom survival is almost a foreign concept. These people can easily think of more ways to spend our collective wealth. Nearly half of our provincial budgets are allocated for healthcare and still there is a belief in scarcity – a belief that we need more drugs, more machines, more specialists and more doctors to solve our woes.

That’s not to say that a lot of our collective health spending couldn’t be better managed. There’s good evidence that the way we organize healthcare is so chaotic and irrational that we overspend and underspend in areas that have nothing to do with rationality and equity. What I see at this extreme rich end of the rich spectrum is an absurd level of obsession with avoidance of death at any cost and a collective self-absorption to fight an unwinnable war. Supporting this war is a belief that prophylactic medicine – medicine at any cost, and often against the dictates of evidence, rationality or even common sense – presents nothing but positive contributions to our health. Here we see people plunking down $2,500 to buy a full body CT scan, convinced that it’ll give them the edge they need to save them from the inevitable. Many more get tested and treated, poked and prodded, diagnosed, medicated, swabbed, jabbed, cut and eviscerated, to an extent that sometimes seems quite laughable if it wasn’t so regrettable.

Some beliefs are decidedly bad for your health. Let’s examine some of the more absurd of those beliefs, shall we?

Brand name means better healthcare: How about the belief that brand name drugs are always better than generic drugs? This singular idiocy means that we Canadians collectively spend $2 billion more on drugs than is necessary every year. Don’t tell me we can’t afford to meet even the most minimal levels of foreign aid befitting of a developed country when we allow this lunacy to continue. Buying a patent-protected drug when a cheaper generic exists is a tax on the uninformed. If you believe that a patented treatment always infers some kind of clinical advantage over the unpatented stuff, you should probably be forced to pay for your beliefs. And please don’t expect the taxpayer to pay for your foolishness.

Screen early, screen often: Another absurd belief that many of us have is that it’s a great idea to screen healthy people for disease. Yet screening healthy people can involve insidious and uncounted harms and it is expensive and often terribly unnecessary. There may be dozens of cancer screening programs out there, but only three – count’em three – types of screening programs for cancer have sufficient scientific evidence for authorities to recommend them for the whole population. What are they? Breast screening (mammography) for women over 50, cervical cancer screening (the pap test) and colorectal cancer screening (fecal occult blood test). All the others that we hear about – full body screening, lung cancer screening, PSA or prostate screening, other organ screening, heart screening, (angiography) etc, etc. – are not recommended even though they are heavily marketed and promoted through both the media and private clinics.

Government is protecting us from drug marketing and screening scams:Sadly, that one is wrong too. In Canada, despite all the marketing of both screening and drugs, there is minimal consumer protection from the blatant fear-mongering advertisements you see asking you to take a drug or come on down to the local private clinic for a full body or heart or lung scan. Colleges of Physicians, Health Canada regulators and other professional organizations point at each other when asked who should be minding the store. Even if you believe in minimal government control over your life, you could not disagree with the need for some state involvement overlooking the advertising and marketing of health care products and devices that could hurt you.

Screening and newer drugs are always of incredible benefit: Sadly, this is wrong too. Both the provision of new drugs and preventative health screening are highly controversial because the actual benefit for most people is very small. A new cholesterol-lowering drug might prevent one percent of people taking it from having a heart attack in the next five years. With mammography screening, we’d have to screen 1,000 women with X-ray mammograms every two years for 10 years to prevent about three deaths (compared to a similar group of women not screened). This level of screening will cause about 200 women to experience further investigation (because something suspicious was “found” on their mammogram) or a biopsy. Those women would face the anxiety of having a diagnosis of breast cancer that turned out to be false. It’s very hard to counter the “look early, act early” mantra when it comes to cancer screening, the underlying thought being that if you can find it early, you have a better chance of living.

I think it is time we re-examine our healthcare beliefs. Maybe we need to make a pledge to consider a “less is more” mantra towards health spending. We only need look at the level of per capita health spending in the US, which is more than twice the rate of other industrialized countries, to remind ourselves it’s how we organize healthcare that counts, not how much we spend.

Major advances in world health could be achieved if we collectively took care of everyone’s basic needs – why not start with homelessness in our own cities? – and then worked to ensure we don’t let our collective and irrational health beliefs hold us hostage.

The reason that over-treatment and over-diagnosis are such important subjects to us rich one billion is not just because the excesses of medicine can adversely affect our health, but because such appalling excesses leave so many of our fellow citizens behind.

A civilized society is measured not by how well it takes care of its most privileged citizens, but how well it takes care of those who have nothing. Why not pledge that in this New Year, we work to create a rising tide that lifts all boats, not just those of us who live on yachts?

Alan Cassels is a drug policy researcher at the University of Victoria.

He uncovers the world of cancer screening in a two-part radio documentary, You are Pre-Diseased, airing on CBC IDEAS at 9:05 pm, February 12 and 19. Mark your calendars.

cassels@uivic.ca

Healthy holidays

NUTRISPEAK by Vesanto Melina

Are you planning any festive gatherings that will include food? Beyond the traditional fare, do you wonder how to nourish the range of dietary choices among your circle of friends and family? Does your group include vegetarians, vegans, raw foods enthusiasts or someone whose health concerns require that they eat healthier food instead of just loading up on cholesterol, fat and sugar?

Here are a few tips along with two vegan, cholesterol-free, no-sugar-added recipes that are suitable for many people with food sensitivities (apart from nuts). The delicious cookies are entirely raw.

When you serve appetizers at events, include one or more packages of the seasoned types of hummus that are widely available in supermarket coolers. These protein-rich dips help many vegetarians fare well at festive events; they can be served with raw veggies, crackers and slices of fresh bread.

If your group is considering a restaurant, check out www.happycow.net orwww.vegdining.com and type in your location.

Vesanto Melina is a BC-registered dietitian and co-author of the following nutrition classics: Becoming Vegan, the Food Allergy Survival Guide andRaising Vegetarian Children
www.nutrispeak.com


Here are two vegan, cholesterol-free, no-sugar-added recipes that are suitable for many people with food sensitivities (apart from nuts). The delicious cookies are entirely raw.

Cashew and Vegetable Stir Fry

From Becoming Vegetarian by Vesanto Melina and Brenda Davis (Wiley Canada, 2003).

For this stir fry, we suggested specific vegetables, however, you can try others such as asparagus, cauliflower, Chinese greens, daikon radish, mung bean sprouts and mushrooms. For appealing textures in a stir fry, add the denser vegetables at the beginning for longer cooking. Add the more leafy vegetables at the end. Chinese or Thai chili garlic sauces (available at Oriental stores and many supermarkets) can be hot, so use more or less, as you prefer. Makes 4 cups (two servings). Recipe can be doubled.

Sauce:

2 tbsp cashew butter or peanut butter

1-2 tbsp Chinese, Thai or other chili garlic sauce

1 tbsp tamari, Bragg Liquid Soy or soy sauce

1 tbsp water

Stir Fry:

1/4 cup or more cashews 1 large red or white onion, sliced

2 tsp olive oil 1 large carrot, sliced diagonally

1 cup broccoli florets, chopped

1 red pepper, diced

1 cup bok choy or Chinese cabbage, chopped

1 cup snow pea pods

In small bowl, stir together cashew butter, chili garlic sauce, tamari and water to make a smooth paste. In a preheated hot wok or pan, cook onion in oil over high heat for 3 minutes or until beginning to brown. Add carrot and cook for 1 minute; add broccoli and cook for another 30 seconds; then add red pepper, bok choy and snow peas, cooking just long enough to heat through. Add sauce, stir to combine, sprinkle with cashews and serve over brown rice.

 

Sweet Nut’ins

 

From The Raw Food Revolution Diet by Cherie Soria, Brenda Davis and Vesanto Melina (Book Publishing Company, 2008).

Sweet Nut’ins are a perfect holiday cookie for all ages. Soaking improves the mouth feel and mineral availability of nuts. For dried fruit, use chopped, pitted dates or try any combination of dates, dried apricots, blueberries, cranberries, cherries and figs (with stems removed).

Makes about 2 dozen cookies

2 cups almonds, soaked for 8 hours, rinsed and drained

1 cup walnuts, soaked for 8 hours, rinsed and drained

3 cups dried fruit

1 tsp almond extract or 2 tsp orange zest (minced orange peel)

In a food processor outfitted with the “S” blade, grind the almonds and walnuts until coarsely chopped. Add the dried fruit and almond extract or zest; process until ingredients are thoroughly mixed. Using a tablespoon, form small balls and flatten these with your hand, making cookies about 1/2 inch thick and 2 inches in diameter. Enjoy these soft, chewy cookies immediately or store them in an airtight container in the refrigerator or freezer.

Variation: If you have a dehydrator, you can place the formed cookies on a tray lined with a non-stick sheet and dehydrate the cookies at 105 degrees F/40 C for 12 to 24 hours, depending on how crunchy you want them. These healthy treats make excellent gifts that can be safely mailed. They also freeze well.

Support the food declaration

ON THE GARDEN PATH by Carolyn Herriot

I never thought I’d see the day when one man could make such an enormous difference to the planet. We have just begun a new era of politics where, out of necessity, the people will now drive the agenda. The most powerful nation in the world – the one that contributes most to climate change and war – now has an administration willing to listen and respond to the needs of the people. There’s really only one thing left for the people to do: to decide what the future looks like so we may move there smoothly and easily.

A brilliant start can be found at www.fooddeclaration.org, a US website that has initiated a Declaration for Healthy Food and Agriculture. Will you sign up? The Declaration follows:

We, the undersigned, believe that a healthy food system is necessary to meet the urgent challenges of our time. Behind us stands a half-century of industrial food production, underwritten by cheap fossil fuels, abundant land and water resources and a drive to maximize the global harvest of cheap calories. Ahead lie rising energy and food costs, a changing climate, declining water supplies, a growing population and the paradox of widespread hunger and obesity.

These realities call for a radically different approach to food and agriculture. We believe that the food system must be reorganized on a foundation of health: for our communities, for people, for animals and for the natural world. The quality of food, and not just its quantity, ought to guide our agriculture. The ways we grow, distribute and prepare food should celebrate our various cultures and our shared humanity, providing not only sustenance, but justice, beauty and pleasure.

Governments have a duty to protect people from malnutrition, unsafe food and exploitation, and to protect the land and water on which we depend from degradation. Individuals, producers and organizations have a duty to create regional systems that can provide healthy food for their communities. We all have a duty to respect and honour the labourers of the land without whom we could not survive. The changes we call for here have begun, but the time has come to accelerate the transformation of our food and agriculture and make its benefits available to all.

We believe that the following twelve principles should frame food and agriculture policy, to ensure that it will contribute to the health and wealth of the nation and the world. A healthy food and agriculture policy:

1. Forms the foundation of secure and prosperous societies, healthy communities and healthy people.

2. Provides access to affordable, nutritious food to everyone.

3. Prevents the exploitation of farmers, workers and natural resources; the domination of genomes and markets; and the cruel treatment of animals, by any nation, corporation or individual.

4. Upholds the dignity, safety and quality of life for all who work to feed us.

5. Commits resources to teach children the skills and knowledge essential to food production, preparation, nutrition and enjoyment.

6. Protects the finite resources of productive soils, fresh water and biological diversity.

7. Strives to remove fossil fuel from every link in the food chain and replace it with renewable resources and energy.

8. Originates from a biological rather than an industrial framework.

9. Fosters diversity in all its relevant forms: diversity of domestic and wild species; diversity of foods, flavours and traditions; diversity of ownership.

10. Requires a national dialogue concerning technologies used in production and allows regions to adopt their own respective guidelines on such matters.

11. Enforces transparency so that citizens know how their food is produced, where it comes from and what it contains.

12. Promotes economic structures and supports programs to nurture the development of just and sustainable regional farm and food networks.

Our pursuit of healthy food and agriculture unites us as people and as communities, across geographic boundaries and social and economic lines. We pledge our votes, our purchases, our creativity and our energies to this urgent cause.

Carolyn Herriot is author of A Year on the Garden Path: A 52-Week Organic Gardening Guide. She grows her certified organic “Seeds of Victoria” a

The gift of sight

by Heather Wardle

 

In a small corner of a district hospital in Tibet, 12-year-old Datso sat crying. She was blind from bilateral cataracts, the clouding of the eye’s natural lens. Datso’s short life had been miserable and lonely. “I am blind and don’t deserve any friends,” she sobbed. “I am not capable of doing anything but sitting in my home with my grandparents all the time. Nobody is willing to play with me. I can’t see now and I am afraid that I won’t see ever again in my life.”

Thanks to the kindness of strangers in Canada, Datso received sight-restoring cataract surgery at a Seva Canada-sponsored eye camp in Tibet. Seva Canada is an international, non-governmental organization in Vancouver whose mission is the elimination of preventable and treatable blindness.

In Sanskrit, seva means “service” or “compassion in action.” For more than 26 years, Seva has been helping poor countries help themselves by creating sustainable eye care systems. Seva now works in seven countries – Tibet, Nepal, India, Tanzania, Guatemala, Cambodia and Egypt – training local eye-care specialists.

Datso is one of 314 million people worldwide with serious vision impairment. Of these, 45 million are blind and 124 million have low vision. Yet 75 percent of this blindness is either preventable or treatable. Often, a 15-minute cataract surgery that costs only $50 will restore sight and completely transform someone’s life.

Drew Luyall, SEVAs youngest donor

After her two eye surgeries, Datso was a changed girl. She was free to lead a normal life, see her loved ones, play with friends, go to school and be happy. “I feel like doing everything now,” she said laughing, “but first of all, I need to see my one-month-old brother at home!”

One kind Canadian who has given many gifts of sight is a remarkable 10-year-old boy named Drew Lyall from Kimberley, BC. Drew first heard about Seva Canada’s sight restoration and blindness prevention work in 2006 when he saw a Seva multimedia show in Kimberley. Since then, Drew has raised more than $1,500 for Seva Canada to fund eye surgeries and training in Asia and Africa.

To raise money, Drew has collected thousands of cans and bottles for recycling, often dragging them on his toboggan through the winter snows. Now that his local bottle depot has burned down, Drew is fundraising through local craft fairs and school talks. Drew has a heart of gold. He is full of compassion for those who are blind and he is tireless in his fundraising efforts. He’s paid for a Tibetan eye surgeon to get specialist training in Nepal, funded sight restoration for a child in Tanzania and introduced Seva to many people.

Dr. Lloyd Axworthy, former Minister of Foreign Affairs, is an Honourable Patron of Seva Canada. “During the last 26 years, Seva has helped to restore the sight of many thousands of people who suffer needlessly from blindness that is both preventable and treatable,” says Dr. Axworthy. “I am exceptionally proud to be associated with the work of Seva Canada.”

Heather Wardle is the development director of Seva Canada Society. 
www.seva.ca.


Saving sight on the roof of the world

Tibetan eye camps are miraculous events. Hundreds of blind patients are brought by their families, sometimes travelling for days. They are led-in blind and after a 15-minute surgery costing about $50 can see again.

Tibet has one of the highest rates of blindness in the world, primarily caused by cataracts. Seva Canada is the leading eye-care provider in Tibet, responsible for two-thirds of the cataract surgeries.

“Cataract surgery in adults is just wonderful. It’s the best bang for your buck operation in the world,” says ophthalmologist and Seva board member Dr. Peter Nash.

Mobile eye camps provide a way to reach the blind in remote areas. Each year, Seva runs as many as 25 eye camps, costing around $12,500 each. Each camp screens hundreds of people of all ages and performs up to 400 sight-restoring cataract surgeries.

Dekyi, a blind woman with six children to care for, received the gift of sight in October at a Seva eye camp in Chamdo. “For the first time in my life, I am happy,” she told the doctors. “Please tell all the people at Seva. They are the ones who have helped me end my bad karma and bring a glimpse of light to my life!”

This holiday season, choose to give the gift of sight. Visitwww.seva.ca or call 604-713-6622 for information and to request a copy of Seva’s Gift of Sight catalogue, an alternative giving guide. You can give the gift of sight on behalf of family members, friends and business associates. With each gift, Seva will send a card describing your gift to the person you wish to honour.