Commonweal Newsletters
December 1, 2004
Dear Commonweal Board Members and Friends:
I hope this Fall Commonweal Letter finds you well. I write to you on a beautiful coastal morning. The air is so pure and sweet I just want to stand in the morning sun and breathe. I bicycle out to Commonweal along Mesa Road. A bird in a fir tree scolds me. A buck ambles insolently down a driveway. A dog trots officiously by on a mission. A grey cat crouches watching me in the lee of a blackberry bush. Near Waz Thomas's house, one of Bill Niman's cows tries to scratch her ear with her hind hoof. I sit back on the bike and glide down the driveway toward Commonweal. The Farallon Islands stand clear out on the horizon.
One of the special joys for me of working at Commonweal these days is that Charlotte Brody has now been Commonweal's new Executive Director for a year. She is still commuting from Washington, D.C., but we only have another six months before she will be in residence at Commonweal. The whole place has begun to reflect her skillful touch.
Charlotte writes:
Let me start with my most recent Commonweal experience: The weekend before Thanksgiving, Commonweal hosted a Health Care Without Harm sponsored meeting on food and health care. The purpose of the 2-day, 22-person discussion was to create a plan to bring sustainably grown, fresh, healthy and local foods into health care settings and to make these improvements in ways that will build a larger market for such food nationally.
I facilitated the meeting along with my Health Care Without Harm colleague, Jamie Harvie. And, once again, I got to witness the Commonweal magic: Health care system food service managers and anti-GMO food activists pushing through the conventional curtains we all hang around us, in an effort to protect and define ourselves. With the curtains out of the way, people really listened to each other; really tried to understand each other's concerns and limits. At the end of the food and health care meeting, we have a phenomenally ambitious but do-able plan with every participant taking on a piece of the work.
I think all of us were amazed at what we accomplished in our short time together, especially since most of us had never met before and we came from such different backgrounds. Our successful start came, in part, from Jenepher Stowell's grace and welcoming warmth and Claire Heart's amazing food: pumpkin soup served from a beautiful, dark orange pumpkin; vibrantly colored platters of steamed, locally grown, organic vegetables. But I also think that the food meeting, like every Commonweal meeting, was blessed by the presence of all the people with cancer who have sat in a circle in the same chairs, eaten at the same tables, walked the same path out from Pacific House to look at the ocean one more time before dark. Commonweal is a place of personal and social healing - repairing, restoring, reconciling, and making whole. I feel very lucky to be a part of it.
As Michael wrote, it's been almost a year that I've been flying back and forth, serving both as Executive Director of Commonweal and Health Care Without Harm. The stress of having two sets of responsibilities on two coasts and a family has been a little overwhelming. But it's also been pretty wonderful. I've learned a lot about Commonweal and the community we serve. I've met many extraordinary people. And I've gotten some good things done while transitioning away from my duties as an Executive Director of a campaign that I helped to found and dearly love. In January, I will hand over the role of HCWH Co-Executive Director to Anna Gilmore Hall, formerly of the American Nurses Association. But I'll stay involved with the Health Care Without Harm as co-leader of the Purchasing Workgroup and as a member of the Steering Committee.
Starting in January, I'll work more from home. I look forward to watching my youngest son prepare for college and getting ready for the sale of the house and the Big Move West in June. We still have no idea of where we'll find a place to live, but I'm not spending too much time worrying about that. Instead, I've been mulling over the outcome of the November 2nd election and what environmental health goals we could win if we only focus on urban areas and blue states like California. And thinking about how we might achieve those objectives in a way that will help us to build a new majority vision of responsibility and protection for our country. A new publication from the Collaborative on Health and the Environment: Our Health and the Health of the Environment: How Are They Connected and What Can We Do To Improve Both? describes a variety of consumer campaigns and local and state policy initiatives that can win incremental, healing change. The CHE office at Commonweal would be happy to send you a copy or copies of the CHE Policy Primer or you can download it from the website: www.healthandenvironment.org
In this first year as half time Executive Director, I've deeply enjoyed getting to know the Commonweal staff and making a few changes around the edges of a wonderfully healthy organization. There is a newly designed website and new internet access, both the accomplishments of our newly hired Office Manager, Cynthia Loebig; new and extraordinary directors of the Garden, Penny Livingston-Stark and James Stark; a new budget format; new personnel policies; a new Coordinator of CHE, Eleni Sotos, while keeping the important involvement of the former CHE Coordinator, Jeanette Swafford; new victories in the Campaign for Safe Cosmetics; a new plan for the redesign and expansion of Commonweal's office space with architect Jim Hutton; and the beginnings of a new Commonweal Biomonitoring Resource Center with Sharyle Patton and Davis Baltz. Much of this work is described in more detail below. I welcome your thoughts and your questions on how we can continue Commonweal's work in the world.
Steve Lerner's Account of the Norco Struggle in Bookstores This Month
Commonweal Research Director Steve Lerner's book Norco: A Struggle for Environmental Justice, from MIT Press, will be in bookstores this month. Steve tells the story of one of the great environmental justice struggles in the American South of this decade, in which Margie Richard, the leader of Concerned Citizens of Norco, led the African-American neighborhood of Diamond to victory in winning the right to relocate away from a Shell chemical plant and refinery complex. Margie became the first African-American woman to win the Goldman Environmental Prize for her role in the Norco struggle.
Commonweal, as readers of this Letter know, was deeply engaged in the Norco struggle. Commonweal worked to build bridges between Concerned Citizens of Norco and Royal Dutch Shell. Steve has written what will surely be the definitive account of the Norco struggle, interviewing dozens of local residents, both African-American and white, as well as Shell officials and a wide range of the activists who engaged with the struggle. Norco is a remarkable book, and I hope you get a copy, consider asking your bookstore to carry it or give a copy as a gift.
Steve will be doing book-parties over the course of the spring in New Orleans, New York, Boston, San Francisco and Washington. If you want to be on his list for an invitation, please drop him a note, SDLerner@aol.com.
Susan Halpern on the Etiquette of Illness; and Rebecca Katz on "One Bite at a Time."
Speaking of books from the Commonweal community, Commonweal Advisory Board Member Susan Halpern has published a wonderful new book on The Etiquette of Illness, featured in Oprah Winfrey's O Magazine and in Vogue as well. Susan's intent is to help people know how best to respond when a friend is ill. Susan has been a co-leader and staff member of both the Commonweal and Smith Farm Cancer Help Programs. Rebecca Katz is one of the two senior chefs on the Commonweal Cancer Help Program, along with Claire Heart. Rebecca's new book, One Bite at a Time, is designed as a cookbook for people with cancer and their families, but can be recommended as a visual and sensory delight to anyone interested in exquisitely tasty food.
NewBiomonitoring Resource Center Will Tell the Story of "Pollution in People"
One of the most exciting new projects that Charlotte Brody has brought to Commonweal is the Commonweal Biomonitoring Resource Center. The Center was recently funded with initial support from the John Merck Fund and the New York Community Trust. The Center will be directed by Sharyle Patton and by Davis Baltz, Associate Director.
One central goal of the Center this year will be to conduct biomonitoring of a cross-section of Californians and other notables in support of new California biomonitoring legislation. This year, California Senate Bill 1168 (Ortiz), the Healthy Californians Biomonitoring Program, passed in the Senate but ultimately failed in the Assembly in its first attempt to make it through the legislative process. Commonweal, The Breast Cancer Fund, and other coalition members learned much of what we need to do to build public support for the concept of a state biomonitoring program. Biomonitoring of a small but significant group of Californians and other notables will be a central piece of our education and advocacy aimed at building support for the reintroduction of the bill.
Sharyle writes:
Body burden assessment or biological monitoring ("biomonitoring") is the simultaneous measurement of the presence and concentration of chemical compounds in human biospecimens like blood, urine, breastmilk, adipose tissue, hair, saliva, and meconium that, apart from occupational exposure or other special circumstances, usually are found at levels beneath those of traditional toxicological concern. A new framework is emerging in toxicology, however, that emphasizes the importance of exposures to complex mixtures of chemicals, even at low levels of exposure, and the timing of exposure at critical periods of development.
This new framework says we need to be concerned about large populations exposed to low levels, and not strictly focused on small populations exposed to unusual large exposures. Furthermore, it recognizes that we are all exposed and carry within us a multitude of chemicals rather than one single chemical. The new paradigm incorporates all these new dimensions of toxicology, based on what we have learned from biomonitoring.
By documenting the ubiquity and complexity of exposures that ordinary people are experiencing every day, body burden measurements shine a spotlight on the failures of current chemical regulations, and they highlight how improvements in standards can contribute positively to protecting public health. Because of the wide array of health conditions now plausibly linked by scientific research to exposure to different contaminants, body burden measurements also create an opportunity to attract new constituencies into public health advocacy.
In 2002, Commonweal, in partnership with the Mt. Sinai School of Medicine and the Environmental Working Group, released the first body burden study of identified participants. You can see what chemicals Commonweal staff Charlotte Brody, Davis Baltz, Lexi Rome, Michael Lerner and I had in our bodies at www.bodyburden.org, the remarkable Environmental Working Group website. The site also shows the body burdens of Commonweal friends Monique Harden, Lucy Waletzky, Bill Moyers, and the late Andrea Martin, founder of The Breast Cancer Fund. The body burdens of the Commonweal cohort and the larger, statistically significant but anonymous, body burden studies reported by the Centers for Disease Control [CDC] in 2001 and 2003, examined exposure to many chemicals simultaneously. These studies have produced compelling new information and have captured the attention of a variety of community groups and particular populations who want to learn more about body burdens, who want to be tested, and who want to understand the relationship between chemical body burdens and the health of their families and communities.
The central purpose of the Commonweal Biomonitoring Resource Center is to help Americans develop a new science-based way of talking about chemicals and health. Charlotte Brody writes:
The old story about toxic chemicals was about toxic waste sites in someone else's backyard, and that only high levels matter. Toxic chemicals were not linked to health impacts, unless you happened to live next to a Superfund site or were exposed occupationally. The new story is that we are all exposed to complex mixtures of chemicals all the time and, unexpectedly, they are capable of interfering with normal biological processes even at low levels of exposure. They aren't toxins or poisons in the traditional sense, in that they may not be acutely toxic at the time of exposure or very soon thereafter.
Rather, the chemicals that make up our body burdens form an internal reservoir of toxicity capable of delivering small amounts of toxic insult on an ongoing basis. For individuals exposed very young, the effects of chemicals may be more severe, but such effects may not appear for decades after the initial exposure. Toxic chemicals are contaminants hijacking control of biological processes, especially endocrine-disrupting chemicals freely crossing the placental barrier and entering the fetus.
We need to talk about these new ideas in ways that don't scare people but support them in personal and political actions. We need to make clear that it doesn't need to be this way. Alternatives exist that will help future generations live without toxic trespass.
Davis Baltz explains further how biomonitoring is a key element in a precautionary chemical policy designed to let us live toxic-free:
Biomonitoring points us toward a new approach to protecting our health. Many of the contaminants that are linked by modern science to different disease endpoints are not persistent. Reducing exposure pathways-eliminating unnecessary uses, finding safer substitutes-can quickly lead to their elimination. And for those that are persistent, we know from 40 years of experience with phase-outs of compounds like persistent organic pollutants (POPs) and organochlorine pesticides, that a committed society can change course and achieve significant exposure reductions.
Body burden testing produces data that supports a framework challenging the existing paradigm while creating a vision of the next. Thoughtful studies with powerful results that are integrated effectively into ongoing market and policy campaigns can provide continuing opportunities to engage with the press, the public, and policy makers about that next vision.
Burr Heneman's Ocean Policy Program Promotes Model Fisheries Management
While the Biomonitoring Resource Center is building new tools to help us reverse the pollution in people, Commonweal Co-Founder Burr Heneman continues his remarkable work to make California ocean management a model for ocean management worldwide. Burr writes:
"Agreement is growing that fishery management must go beyond its traditional single-species focus to incorporate ecosystem considerations in deciding how many fish may safely be caught by a fishery. The goal is a sustainable relationship between man and the sea. This approach, in which ecological integrity is given greater importance than short-term benefits to the human enterprise, has come to be called ecosystem-based management. That term seeks to imply an understanding that humans can manage only human activities, not ecosystems, but that we must take the health of ecosystems into consideration as best we can as we manage our activities.
"Ecosystem-based management for fisheries has been endorsed by the European Union, the United Nations Food and Agriculture Organization, the National Research Council, the National Marine Fisheries Service, the Pew Oceans Commission, and, this year, the President's National Commission on Ocean Policy. Now we are down to the details of making EBM work.
"Commonweal has been designing and helping establish ecosystem-based ocean resource management approaches in California since 1997. Our efforts and those of our colleagues have met with considerable success. Commonweal associate Les Kaufman of Boston University and Ocean Policy Program director Burr Heneman, along with Tom Barnes of the California Department of Fish and Game and Rod Fujita of Environmental Defense, drafted the country's first ecosystem-based fishery management plan, adopted by California in 2002. It provides a blueprint for moving from highly risk-averse management in circumstances in which managers know very little about the ecosystem effects of a fishery to more informed, less precautionary management as ecosystem relationships become better understood and incorporated into management decisions.
"We presented that plan in a paper to an international symposium on ecosystem-based fishery management at the Mote Marine Laboratory in Sarasota later that year. In September of this year, that paper was published in the Bulletin of Marine Science (Kaufman, L., B. Heneman, J.T. Barnes, and R. Fujita. 2004. Transition from low to high data richness: an experiment in ecosystem-based fishery management from California. Bulletin of Marine Science 74:3:693-726).
"A year ago, based on California's leadership in this field, I joined an international group of fisheries experts and marine ecologists that co-authored a paper published in Science in July urging that we need to move from talking about ecosystem-based management to applying it (Pikitch, E.K., C. Santora, E. A. Babcock, A. Bakun, R. Bonfil, D. O. Conover, P. Dayton, P. Doukakis, D. Fluharty, B. Heneman, E. D. Houde, J. Link, P. A. Livingston, M. Mangel, M. K. McAllister, J. Pope, K. J. Sainsbury. 2004. Ecosystem-Based Fishery Management. Science 305:346-347). Key sections of the paper use the California model that Commonweal has championed as a prototype of how to shift from traditional to ecosystem-based fisheries management.
"As I reported in our last letter, the President's National Commission on Ocean Policy strongly endorsed the approach to coastal ocean observing programs that the Commonweal Ocean Policy Program has been promoting successfully in California. Most notably, Commonweal is the recipient of a significant grant from our partner, the State Coastal Conservancy, to help the Conservancy initiate the $21 million Coastal Ocean Currents Monitoring Program (for more information, go to www.cocmp.org).
"On the shores of Monterey Bay in October, Governor Schwarzenegger explicitly called attention to the Coastal Ocean Currents Monitoring Program, placing it third on the list of key elements for his Ocean Action Plan."
Good News: Permaculture in the Commonweal Garden
One of the developments that has lifted my spirits most this year has been the rebirth of the Commonweal Garden as a vital center of permaculture design, education, training, and demonstration. The two remarkable people behind this rebirth are Penny Livingston-Stark and James Stark. Penny and James are two of the leading practitioners of permaculture in North America. Penny, a visionary permaculture educator, is a lifelong Marin resident. James, a man of deep experience and practice, grew up on a family farm in Canada that his Scottish great-grandparents settled on in the 1840s. He tells the poignant story of how his great-grandfather and grandfather could make a living on the farm, but that his father had to work at the GM plant in town in order to make ends meet. By the time his generation inherited the farm, it was no longer economically viable. Permaculture helped James recover a vision of community farming in the 21st century. I had heard Penny talk about permaculture at the Bioneers Conference in Marin, a subject to which I will return. She and two colleagues gave a workshop that I attended. What I came to understand is that permaculture is not just a way of gardening. It is a life philosophy of regenerative design of how human beings can live on earth. It is an applied design art. James and Penny are both deeply inspiring senior members of the international permaculture community. They attract students, interns, and colleagues from across the country who want nothing more than to come, be part of their practice of living sustainably on the earth. This letter from Penny and James gives you a sense of who they are and of what this means in practice:
We would like to first of all acknowledge what a privilege it is to have the opportunity to make the Commonweal Garden our home and the center of our work in the world. At the end of each day of preparing the site for the day we can actually move into the Garden House, we find it so hard to leave. The Garden is such a magnificent piece of our earth.
As you know, we have lived in our home on our one-acre permaculture site in Pt. Reyes Station [the town just North of Bolinas] which we developed over the last ten years to include the permaculture garden, solar power, gray water treatment, ponds, water catchment, a wood-fired oven, and earth and straw buildings utilizing sustainable non-toxic materials. We have also converted our two cars to run on pure vegetable oil. However, our six-year search for a farm site in Marin has finally been fulfilled with our move to the Commonweal Garden.
Now we will be able to demonstrate a broader range of ways of living in harmony with the earth. Our dream for the Garden is that it will be a place of healing for visitors as we restore the site as a place of abundance and beauty. Even though we have not moved in yet, we have already hosted a wilderness awareness program for the last three weeks. The participants have been doing their "sit spots" in the Garden and tracking and mapping the community of life on the site. So, the dream is already becoming a reality.
We have purchased a night camera that we will be setting up in the Garden to put together a family album of the animals that call the Garden home. The project to document with video the next three years of the development of the Garden has already begun. With the generous support of two donors, we are documenting with a broadcast-quality video camera the site as it undergoes its transformation.
Over the last few weeks we have been occupied with clearing the site of debris that has mounted up over the years and removing the wildlife that had moved into the buildings. We have almost completed this clean-up stage and are now in the midst of the creative part of the restoration.
We will be moving into the garden by December 1, and hope to have a housewarming and blessing sometime before the end of the year. We have already put in place our first program that will be offered starting in January. It will be a four seasons permaculture course with wilderness awareness woven in. The program will take place one Sunday a month. We won't go into details here, but you can get more information from our web site www.permacultureinstitute.com.
Finally, it was great to see and hear you at the Bioneers last weekend [More about this later in this Letter]. It was so inspiring to experience all the accomplishment that the emerging earth society is creating together. What particularly inspired us was seeing how all the aspects of wellness, social justice, peace, and the regeneration of the earth are all coming together. It is in that spirit that we look forward to developing our relationship with you and Commonweal and to manifest in the Garden an inspiring place of peace and love - a beacon of light for human beings returning to living in harmony with the earth.
Thank you for the great contribution Commonweal is making in the world and thank you again for inviting us into your family.
Penny and James
Rachel Naomi Remen's Healer's Art Course Now in 35 Medical Schools
Rachel Naomi Remen's Institute for the Study of Health and Illness at Commonweal (ISHI) continues its quiet path of exceptional national impact. ISHI Administrator Cristina Tucker writes:
"The Healer's Art course at the University of California, San Francisco, School of Medicine, now in its thirteenth year, was voted the best elective course of 2004 by the medical students. ISHI's most recent Faculty Development training in September brought together faculty and medical school deans from Mayo Medical School, Case Western Reserve, University of Virginia, Ohio State, and other medical schools. This brings the number of medical schools offering The Healer's Art in 2005 to 35. There are 15 more medical schools waiting in the wings.
"Three newly developed large professional workshops were completed between June and September and all were well attended. The most gratifying part of our work is the response that we get from students and physicians. One exercise in the Healer's Art training and in various workshops enables each person to write a personal mission statement, or Hippocratic Oath. Here is the Hippocratic Oath of a physician in one of our recent workshops:
Let me be still like the heart of the oak;
steady even when the storm whips its branches.
May I stand tall and strong, without effort,
creating a natural place of refuge.
Let my roots run deep into the heart of the earth,
Bringing a flow of energy through me,
Into the world.
And here is the Hippocratic Oath of a hospice nurse:
Help me to see the beauty in others
Help me to love unconditionally
Help me to enjoy the process and not hurry it
Help me
to be me
"In conjunction with two researchers at UCSF, Dr. Michael Rabow and Judith Wrubel, Rachel and her ISHI colleagues have gathered evaluations from twenty-five medical schools that offered The Healer's Art course in 2004. They are now compiling the data for a research paper about the impact of that course nationally.
"The ISHI physician outreach program, Finding Meaning in Medicine, continues to grow nationally and internationally, with several hundred participants who have registered at ISHI's online site. The online FMM discussions are active, and provide physicians a place to discuss some of the deepest issues regarding their service in medicine. Rachel anticipates extending access to FMM discussions to medical students and other health care professionals in the coming year."
Collaborative on Health and the Environment - "Science for the Disease Tribes"
The wonderful experiment of the Collaborative on Health and the Environment continues to unfold, providing a fascinating experience for over a thousand CHE Partners across the country. CHE, founded two and a half years ago, is a national partnership of over 1,200 individuals and organizations dedicated to raising the level of public and professional dialogue on the relationship of the environment to human and ecosystem health. CHE is, I often say, "science for the disease tribes" - providing a space for a wide range of different patient, health professional, environmental, and community-based organizations, to learn about the exploding science linking the environment to health, and to explore what common work they may want to undertake.
CHE now has active working or discussion groups on cancer, led by Jeanette Swafford; on learning and developmental disabilities, led by Elise Miller; on infertility and pregnancy compromise, led by Alison Carlson; and on electromagnetic fields, led by Nancy Evans. A new working group on respiratory disease is likely to emerge from a recent Partner conference call on how particulate matter affects a wide range of health outcomes, and a working group on labor and health is in formation.
CHE also has spawned a growing number of vibrant regional CHEs. The first was CHE Northwest in Seattle, co-founded by Elise Miller of the Institute for Children's Environmental Health on Whidbey Island and Commonweal friend Roger Rosenblatt, M.D., M.P.H. Now there is an equally dynamic CHE-Pennsylvania under formation in Pittsburgh with the support of the Vira Heinz Endowment there. CHE-Oregon will emerge from a conference in Portland next Spring. CHE-Florida is still a little shaky, but has not died on the vine, and we are nursing it along. CHE-Texas is in the planning stage and a founding conference is anticipated in Austin.
CHE recently conducted several workshops at the Bioneers Conference in Marin County, including a day-long training on Ecological Medicine organized by Charlotte Brody. Many of the core CHE Partners spoke at Bioneers, to a very energized audience of health professionals, patients, and concerned citizens. Charlotte also created a new Policy Primer for CHE, outlining a range of "CHE-friendly policy options" for CHE Partners to consider.
The most involved Commonweal staff working on CHE are Eleni Sotos, Jeanette Swafford, Frieda Nixdorf, Sharyle Patton, Steve Heilig, Alison Carlson, Charlotte Brody, and me. Add to the list Commonweal Senior Associate Pete Myers, Ted Schettler of the Science and Environmental Health Network, and Elise Miller of the Institute for Children's Environmental Health, and you have the list of those presently most engaged with CHE.
The model of CHE is the essence of simplicity. You join free, you receive no more than two emails a month, and you are invited to participate in a crisp, hour-long monthly Partner Call, where national experts provide brief synopses of the science on a health condition, a specific environmental agent, or a policy issue of shared concern. Then, if you are interested, you can join one of the working groups or regional groups and get more engaged. We truly welcome readers of the Commonweal Letter to join CHE. It is a great way to learn and to engage at the interface of personal and planetary health.
Governor Backs Law Suit Requiring Oversight for California Youth Authority
There is more than a passing chance that Governor Arnold Schwarzenegger may be the next President of the United States. His supporters are exploring the legal remedies that would make him eligible to be a candidate. His support a year after his inauguration remains high in California, and his moderate combination of pro-choice, pro-environment, and pro-business positions may well appeal to both Republican and independent voters. He would still have a long way to go to impress those concerned with social justice. But what is less appreciated across the country is that the "Governator" has made criminal and juvenile justice reform a significant part of his agenda. First, he appointed the reform-oriented Warden of San Quentin prison as the new chief of the California Department of Corrections. Then, last week, he did what no governor has done in twenty years: appear at a news conference to announce the settlement of a lawsuit against the California Youth Authority, the largest youth prison system in the world. Schwarzenegger told the assembled press that the state had "made mistakes" with the Youth Authority, and that he fully supported the consent decree in the suit-one that will reduce violence, improve conditions, and upgrade programs at the Youth Authority.
David Steinhart, Director of the Commonweal Juvenile Justice Program, worked closely with the Prison Law Office (which filed the lawsuit), with the Governor's staff and with lawmakers this year on the issues addressed in the lawsuit. He has been impressed by the Governor's willingness to engage in open discussion about juvenile justice reform-though he would like to see more progress (beyond the CYA lawsuit) in the time ahead. David has also focused this Fall on improving mental health services for children in the California juvenile justice system. He writes:
"A strong focus of the Juvenile Justice program in recent months has been the issue of mental health for children in the juvenile justice system. There is increasing evidence, nationally and in California, that juvenile halls and other locked youth facilities have become dumping grounds for children with sometimes serious mental disorders. Earlier this year, experts in a pending lawsuit against the California Youth Authority issued a scathing report on mental health conditions in the CYA - including high rates of violence, poor training of mental health staff, and inept controls on the use of psychotropic drugs.
"We invested a good deal of time this year on attempts to improve mental health services for arrested and incarcerated juveniles, in both state and local facilities. We worked closely, for example, with Darrell Steinberg - the 2004 Assembly Budget Chairman and a leading advocate of child mental health reforms in California - on drafts of AB 2019, a bill that would have given Juvenile Courts new tools for the assessment and treatment of children with mental and developmental disabilities.
"That bill failed, in a mire of concerns about cost and local service mandates. Meanwhile, Steinberg was also the prime force behind Proposition 63, the California ballot measure that would raise about $700 million per year for community mental health services, from a one percent tax on individual incomes over $1 million. With the passage of Proposition 63 (53-47%), several opportunities to improve mental health services for incarcerated children are now presented, and we will work to realize them this year.
"We owe thanks to the California Endowment and the California Wellness Foundation for supporting our efforts in this area. Thanks also to former Commonweal associate, Dr. David Arredondo, for his truly helpful insights into the needs of this population.
"As always, we face the challenge of raising funds to sustain the work of the Juvenile Justice Program. Most of the grants supporting the Juvenile Justice program expire at the end of 2004. Our work is especially hard to fund because we are at the tough end of the fundraising spectrum - due to our focus on public policy, and to the target clientele of children whose behaviors run from careless to severely criminal. Even with these challenges, we have decent prospects for new, smaller grants from several sources. And these prospects are enhanced by our standing as experts and advisors to key leaders in the California Legislature and in the Schwarzenegger Administration."
Passings: Shannon McGowan, Cancer Help Program Co-Leader
At the heart of the Commonweal Cancer Help Program is a small group of psychotherapists who alternate co-leading the week-long Cancer Help Program retreats. The co-leader must be a consummately skilled small-group leader familiar with the special world of cancer. Rachel Naomi Remen, M.D., Lenore Lefer, Stewart Horance and Shannon McGowan have been the principal co-leaders of the Cancer Help Program for many years.
Shannon McGowan died November 7 at 4:30 p.m. at her home in Pt. Richmond, California, after a long struggle with lung cancer. A tall, slender, red-haired, elegant woman, Shannon had survived an earlier bout with cancer when she was 36. That experience 25 years ago led her to co-found The Wellness Community with Harold Benjamin. The Wellness Community became one of the nation's largest and most successful models of psychosocial support for people with cancer. Ten years ago, Shannon became a co-leader of the Commonweal Cancer Help Program. She then decided to start an East Bay Wellness Community, a tremendous undertaking financially and organizationally that became a major center for Bay Area cancer patients.
Four years ago Shannon developed a life-threatening lung cancer. Her HMO told her there was nothing that could be done to help her, but Shannon was having none of it. She turned to two close Commonweal friends, Mark Renneker, M.D., and Keith Block, M.D. Together, Mark and Keith helped Shannon find a series of medical treatments that put her cancer in remission and allowed her to return to her work with Commonweal and with her private clients. Shannon sued her HMO and collected payments for the alternative treatments she had sought, winning an important victory for herself and for others. She then undertook a determined effort to bring Keith Block's innovative cancer treatment program from Evanston, Illinois, to the Bay Area. Others are continuing that effort in her memory. This year, the cancer returned. Shannon fought it with the same single-minded determination with which she had fought it before. The Commonweal community joins hundreds of Shannon's friends across the country in prayer and loving memory of this wonderful woman.
The Birth of Commonheart: The Commonweal Heart Group
For me personally, one of the loveliest developments at Commonweal this Fall has been the birth of the Commonweal Heart Support Group. Commonweal Co-Founder Burr Heneman and I started the group together since we have both experienced heart "events" (as they are called in the heart community). Maria Straatmann, a new Commonweal volunteer staff member who has also been working with us in the Cancer Help Program, offered to coordinate the group. We call the group Commonheart. It has about sixteen members, all but one from West Marin. It meets monthly at Commonweal.
We started Commonheart primarily because there is good evidence that support groups, along with diet, exercise, and stress reduction, contribute to sustaining good health for people who live with heart conditions. Beyond that, I was deeply interested in whether it was possible to create a free monthly heart support group that met a local need and that was truly of high quality. Since the group is bound by confidentiality, I cannot discuss specifics or describe the remarkable people who were drawn to do this together. Suffice it to say that it is a vibrant and profound experience of community-based healing work.
The more I look at heart disease, the more impressed I am by the depth of the controversies about almost every aspect of the treatment of this disease. Two weeks ago, I went into the Emergency Room at Marin General Hospital with acute nausea, which turned out to be liver toxicity stemming from a combination of the Lipitor I was taking and Niaspan. Lipitor is the best-selling statin drug. Niaspan is a time-released form of niacin. Several physicians have told me they have seen more and more liver problems with people using this combination. Serendipitously, a physician named John Abrahamson came to visit last week. He has written an important new book, Overdosed America, that makes a strong case that statin drugs are being too widely used. A recent article in the Journal of the Royal Society of Medicine, "The case for statins: has it really been made?" echoes Abrahamson's critique:
The statin trials found an absolute difference of less than 1% to a maximum of 3.3% in all-cause mortality between control and treatment groups, and from 1.1% to 4.7% in the most standard combined event, fatal and nonfatal MI. These are not impressive results. But there is a way to make them look impressive - namely by expressing the results as a relative difference rather than an absolute difference. Take the LIPID trial. It involved only patients with CHD (i.e., it was a secondary prevention trial). The difference between the deaths in the statin group and the placebo group was 3.1% (14.1% of the placebo group died and 11% of the statin group). But the impact of these results can be much magnified by expressing them as relative differences: "The statin drug lowered the risk of death by 22%" (11 is 22% lower than 14.1).
Another serious problem with the way the results are presented is that the reader is often not told the number needed to treat (NNT) for one patient to benefit. The NNTs range from around 30 in the 4S and LIPID trials to over 100 in the primary prevention trials. But this is not information the patients are likely to be given; instead, they are told that they will reduce their risk of death by about 30%. Presenting information to patients in the form of relative risk will much increase their receptiveness to taking the drug.
Now let us look at the cost of preventing CHD by using statins. The simplest, minimum-assumption, calculation is based on three factors - the cost of the drug per year, the NNT, and the length of the trials. The two secondary prevention trials indicate an NNT of about 30 to postpone one death. Using this figure and a conservative estimate of the cost of the statin drugs per year of $500, we arrive at the cost of postponing one death of $85,000 (500 x 30 x 5.7).
But that figure becomes much higher when we use data from the primary prevention trials, as the NNTs are much higher. This becomes especially relevant because the latest NCEP III guidelines have considerably lowered the eligibility requirements for using statin drugs. According to a detailed analysis it was estimated that the new guidelines have the effect of expanding the number of people in the USA who are eligible for lipid lowering by drug therapy, which in most cases means statins, from 15 million to 36 million, a jump of 140% at a stroke. It is noteworthy that the chair of the committee that wrote these guidelines as well as 5 of the 13 members of the committee have received drug company funding.
The effect of widening the net for the use of statins means that millions of people at only modest risk of CHD will be eligible. For such people, the cost will be exceedingly high for the benefit achieved. For people at that risk level, the cost of statins translates to more than $300,000 to prevent a major CHD event.
If there is a still-underground debate about the role of statins in heart disease, the recommendations in complementary approaches to heart disease are equally diverse. While I have stayed on the very low-fat diet recommended by my friend and colleague Dean Ornish, M.D., opinion among cardiologists with an integrative medicine approach varies as to whether the low-fat diet or the Mediterranean diet is best not only for preventing, but also for reversing, Coronary Artery Disease.
Sadly, there are no randomized controlled trials comparing the low fat and Mediterranean Diets. Moreover, while Ornish has conducted RCTs demonstrating the reversal of coronary artery disease using his diet, the Mediterranean Diet enthusiasts can point only to the Lyons study, which shows significantly reduced mortality associated with the Mediterranean Diet compared to the control group, but did not assess whether the coronary arteries opened. Opinion on which supplements to take with heart disease is even more varied. What consensus there is in integrative cardiology focuses on the benefits of a diet somewhere between the low fat and Mediterranean Diet, and on exercise and support groups. Exercise enjoys the most support of all these modalities.
Thoughts on the Election: Is the Moral Center Shifting Toward Europe?
As for the election, I continue Commonweal's tradition of nonpartisan comment, focused on our values, not on party affiliations. This has been a challenging election cycle for all those who share the views we hold on health, the environment, and justice. I want to focus these comments on some long-term and fundamental questions that the election evokes.
Peter Goldmark, the past president of the Rockefeller Foundation and former publisher of The International Herald-Tribune, remarked at a Global Leadership Network conference at Commonweal a few months ago that the moral center of gravity in the world may well be shifting from the United States to Europe.
Goldmark's observation fits with the view I have described in this Letter before. The United States can be seen as behaving in a way characteristic of declining hegemonic powers. Historically, hegemons often come to power representing the perceived collective interest of a community of nations. The United States represented the shared values of a community of nations as it shaped international institutions at the end of World War II. As hegemons enter the arc of their decline, they wield power increasingly in what they perceive to be their narrow self-interest. This abandonment of international action based on shared values erodes what Harvard political theorist Joseph Nye calls their "soft power" of moral suasion. They are then left to rely on their "hard power," which they typically misuse. They often spend themselves into bankruptcy in foreign adventures. After a time, a new hegemon emerges.
Does The Arc of the Moral Universe Bends Toward Justice?
Of all the emails I have seen circulating since the election, this excerpt of a speech from Martin Luther King resonates for me most. "In March, 1965," the email begins, " Dr. King spoke in Montgomery, Alabama, about his frustration with an incredibly horrible present and his hopes for the future. He said:
"I know you are asking today, 'How long will it take?' Somebody's asking, 'How long will prejudice blind the visions of men, darken their understanding, and drive bright-eyed wisdom from her sacred throne?' Somebody's asking, 'When will wounded justice, lying prostrate on the streets of Selma and Birmingham and communities all over the South, be lifted from this dust of shame to reign supreme among the children of men?' How long will justice be crucified, and truth bear it?'
"I come to say to you this afternoon, however difficult the moment, however frustrating the hour, it will not be long, because 'truth crushed to earth will rise again.' How long? Not long, because 'no lie can live forever.'
"How long? Not long, because 'you shall reap what you sow...'
"How long? Not long, because the arc of the moral universe is long, but it bends toward justice."
King's quote raises for me one of the most fundamental questions of the whole election experience. Do we indeed live in a "moral universe," as King believed? Or was the great naturalist E.O. Wilson right when he asked in his famous essay, "Is mankind suicidal?" Wilson opined that the primate neurological structure was a dicey one on which to build a wisdom society, since primates are designed to think short-term about the well-being of their small family group, not long-term about the whole earth. The world might well have been better off, entomologist Wilson impishly proposed, if the contest for hegemony had been won by a species of intelligent ants.
I do not know whether King meant that the arc of the moral universe bending toward justice means that justice on earth is preordained, or simply that God wants it to work out that way. The latter view was espoused by Abraham Joshua Heschel, to my mind the greatest of the 20th century Jewish theologians. Heschel believed that the universe is indeed theocentric, but that the coming of justice to earth is by no means assured, and rests on our capacity to co-create a world that lives in harmony with all life.
The beauty of moral philosophy is that these great questions are never definitively answered. Religion affirms certain answers. Moral philosophy poses essential questions. Which we prefer depends on our temperament. But the answers we choose shape our lives.
What we are today comes from our thoughts of yesterday
And our present thoughts build our lives of tomorrow.
Our life is the creation of our mind.
If a man thinks or acts with an impure mind,
Suffering follows him as the wheel of the cart follows the ox that draws the
cart.
What we are today comes from our thoughts of yesterday
And our present thoughts build our lives of tomorrow.
Our life is the creation of our mind.
If a man thinks or acts with a pure mind,
Joy follows him as his own shadow.
Those words of the Buddha were spoken in that awesome epoch of human history when so many of our greatest Teachers appeared to guide human consciousness. They are recorded in one of the greatest Buddhist texts, The Dhammapada. Over two thousand years later, in the travails of World War II, Carl Jung wrote his last and greatest book, Mysterium Coniunctionis, a study of the light that alchemy might shed on the human process of individuation. Jung argued that alchemy offered profound insights into both the collective and individual unfolding of the human psyche:
The shy and delicate youth stands for everything that is winged in the psyche or that would like to sprout wings. But [he] dies from the poison of organizational thinking and mass statistics; the individual succumbs to the madness that sooner or later overtakes every mass - the death instinct of the lemmings. In the political sphere the name for this is war...The goal of the winged youth is a higher one than the fulfillment of collective ideals, which are all nothing but makeshifts and conditions for bare existence. Since [collective ideals are] the absolute foundation, no one will deny their importance, but collective ideals are not by a long way the breath of life which a man needs in order to live. If his soul does not live nothing can save him from stultification. His life is the soil in which his soul can and must develop. He has only the mystery of his living soul to set against the overwhelming might and brutality of collective convictions.
The ancient Chinese sages had clear ideas about living in times when so many denizens of mass society march lemming-like on what appears so self-destructive a course. The sages were, as all good sages should be, nuanced, balancing a continuing willingness to contribute to the social good with a recognition that there are times to cultivate the inner sphere. They continued to seek opportunities for public service even as they prudently moved (or were banished to) the fastness of their mountain retreats. Commonweal cannot retreat from its central commitments to health, the environment, and justice. But we can, and do, regard the cultivation of the inner life as both remedy and solace in times like these. The last few days I have been reading (speaking of Chinese sages) W.B. Yeats' great poem "Lapis Lazuli."
I have heard that hysterical women say
They are tired of the palette and fiddle-bow,
Of poets that are always gay,
For everyone knows or else should know
That if nothing drastic is done
Aeroplane and Zeppelin will come out
Pitch like King Billy bomb-balls in
Until the town lies beaten flat.
All perform their tragic play,
There struts Hamlet, there is Lear,
That's Ophelia, that Cordelia;
Yet they, should the last scene be there,
The great stage curtain about to drop,
If worthy their prominent part in the play,
Do not break up their lines to weep.
They know that Hamlet and Lear are gay;
Gaiety transfiguring all that dread
Two Chinamen, behind them a third,
Are carved in lapis lazuli.
Over them flies a long-legged bird,
A symbol of longevity
Every discoloration of the stone,
Every accidental crack or dent,
Seems a water course or an avalanche,
Or lofty slope where it still snows
Though doubtless plum or cherry branch
Sweetens the little half-way house
Those Chinamen climb towards, and I
Delight to imagine them seated there;
There on the mountain and the sky,
On all the tragic scene they stare.
One asks for mournful melodies;
Accomplished fingers begin to play.
Their eyes, mid many wrinkles their eyes,
Their ancient glittering eyes are gay.
These lines from King, from Jung, from the Buddha and from Yeats, offer me refuge and solace in these difficult times.
Cancer Help Program Enters Twentieth Year
The year 2005 marks the twentieth year of the Commonweal Cancer Help Program. Of the many remarkable things about the CHP, the continuity of the staff is among the most notable. What is perhaps most striking to me is the depth and resonance of the healing community that the staff has created collectively. After twenty years, we still love to come together to do these week-long retreats. We are also deeply fond of each other. That love for what we do, and our fondness for each other, is part of what participants in the Cancer Help Program experience. The participants find themselves embraced by a caring community that accepts them, as we accept each other, just as we are, warts and all.
It is hard to convey what this experience is like unless you have experienced it. Participating in the Cancer Help Program helps many people change their lives in lasting ways. The Cancer Help Program helps people find a way to live better and fuller lives in the face of a cancer diagnosis. It is also possible that the CHP helps some people find a way to live longer lives, although this is impossible to demonstrate.
One other thing is certain: the power of the Cancer Help Program manifests in the steadfastness of the CHP alumni community. This community gathers twice a year at CHP Alumni Days at Commonweal, and also at the Jenifer Altman Lecture, which this year was brilliantly given by Keith Block, M.D., who described the integrative oncology program he has developed in Evanston, Illinois. But CHP alumni are also to be found across the country and around the world. They write us, call us, email us, and stayin touch in many ways. Finally, CHP alumni are among the most devoted of contributors to Commonweal each year. Their contributions are the gifts that allow us to continue the Cancer Help Program year after year.
Board and Staff Changes at Commonweal
Nadine Parker, our long-time bookkeeper/administrative assistant at Commonweal, retired this year after more than 21 years of service. The wife of Executive Vice President David Parker, Nadine also served as my assistant for many years. She has been a dedicated and very able contributor to the Commonweal community. We wish her all the best. Rob Fowler has taken Nadine's place as bookkeeper. He comes to Commonweal from a career in computer software and journalism.
We bid a deeply grateful farewell to longtime Commonweal Board Member Winifred Mauzy of Kentfield, who is retiring from the Board after sixteen years of service. Win has been a truly invaluable contributor to the Commonweal community.
Finally, our beloved colleague Mimi Mindel is stepping down after a decade as Art Curator for Commonweal. Mimi's last show, a ten-year retrospective of all 26 of the artists who have had exhibits in the Commonweal Gallery, is on the walls right now. Mimi is, I am grateful to say, staying on as the Cancer Help Program Resource Director. In that role, Mimi keeps the voluminous files of treatment options that we maintain, as well as the CanServe Database, which helps callers from across the country find health resources in their own communities.
Please Consider Supporting Commonweal
Commonweal Friends support Commonweal throughout the year, but the holiday season is an especially important time for us. Grants support many Commonweal programs. But it is individual contributions that provide the critical "glue" that enables us to hold all of Commonweal together and, especially, to continue the work of the Cancer Help Program.
Among those who have contributed to Commonweal since I last wrote to you are:
Lynda Abdoo, Carolyn Anderson, Rita Arditti, Peter Barnes, Lindy and Timothy Bartels, Carl Bellini, Walter N. Bieneman, Georgian Branigan, Anne Maiden Brown, Jody Bush, Maria H. Carlos, Wayne Cochran, John Colla-Negri, Emanuel & Elaine Crystal, Barry Custer, Margaret A. Dale, Thomas and Gun Denhart, Mia Dodson, Barbara Duchon, Edith Eddy, Hilarie Faberman, Lois A. Fairley, Nan Feagin, Monique Ferris, Howard Gardner, Deborah J. Gerner, Terri and Jeffrey Goldberg, Amnon Goodman, AnneKathryn Goodman, Peter Goyton, Sally & Gil Gradinger, Lindy Rose Graham, Sadja Greenwood, Jan Guthrie, Charles And Susan Halpern, Jane F. Irvine Henderson, Evangeline Hermanson, Dan Hogan, Connie Holmes. Karen Johnson Levitt, Marty Johnson, M.F.C.C., Karen Jurgens, Monica Kaufer, Kathi J. Kemper, M.D., Roy F. and Mildred Knudsen, Maxine Kraemer, Cynthia G. Kreger, Alyse Laemmle, Phil Lee, Hayden Jon & Faith Lee, Cara Beth Lee, Lenore Lefer, M.S., M.F.C.C., Marianna Leuschel, Barbara Lipkin-Luther, Erika Bast Little, Madeline Littlefield, Kenderton S. & Francis S. Lynch II, Mrs. Winifred Lynn, Iona Main, Idelisse Malav/(c), Betty Joan Maly, Esther Marks, Joan Martin, Margaret McNamara, Martha A. Mejia, James S. Miller, Debbie Morrison, Fitzhugh Mullan, M.D., Mary Louise Myers, George S. and Penny L Nann, Marion Nestle, Nancy and James Osborn, Gail Paradise, Stephen R. Perry, Jack & Eve Petajan, Julien and Diane Phillips, Betty Jane and Robert Phillips, Edith Piltch , Jeanne Rizzo, Roger A. Rosenblatt, Dr. A. Harvey and Sally Salans , Earl de Fremery & Kathryn Sawyer, Anore M. Shaw, Sidney And Margaret Silver, Jay Simoneaux, Eva H. Slinker, Robin Smith, Patricia Stewart, Barbara & Hugo Swan, Anne Symens-Bucher, Steve Tempest, Karen Thompson, Jennifer H. Valentine, Shirley Ward Deininger, Harold and Laura Ware, Marjan Wazeka, Catherine G. West, MD, Matthew B. Zwerling
We are profoundly grateful for your support, and thank each of you again for these contributions.
Grants in Support of Commonweal
Among the foundations that provide major program support to Commonweal are:
Alan and Nancy Baer Foundation, Alberta S. Kimball Foundation, Bank of America Foundation, Beldon Fund, Bernard Osher Foundation, Boyce Charitable Fund, Breast Cancer Fund, California Endowment, California Wellness Foundation, Cedar Tree Foundation, Collective Heritage Institute, Compton Foundation, Dallas Jewish Community Foundation, David L. Klein Foundation, Donald Magnin Family Fund, Emmett Family Ltd Partnership, Fine Family Foundation, Flow Fund, French American Charitable Trust, George Family Foundation, Health Care Without Harm, Louise Gartner Philanthropic Fund, J & R Herman Support Foundation, Jenifer Altman Foundation, Jewish Federation of Greater Dallas, John Merck Fund, Katz-Snyder Fund, Maisel Family Philanthropic Fund, Marin Community Foundation, Marisla Foundation, McCarthy Family Fund, Nancy and James Osborn Fund, Nathan Cummings Foundation, New York Community Trust, Panta Rhea Foundation, Peninsula Community Foundation, Ruth Hennig Fund, San Francisco Foundation, Seven Springs Foundation, State Coastal Conservancy, Stuart Four Square Fund, Szekeley Family Fund, Tides Center Foundation, Triangle Community Foundation, UCSF, Walter S. Johnson Foundation, and the Zellerbach Family Fund.
We are deeply grateful to each of the foundations that make Commonweal's work possible.
In Closing
That is the news from Commonweal, friends. This new year, 2005, marks Commonweal's thirtieth anniversary, if you count our birthday from the year we moved onto the site. For those of us who have been here through all or most of the past thirty years, one of the greatest gifts is to see the emergence of a whole new generation of Commonweal staff and Commonweal friends. They have emerged to continue the work, to shape the direction we take over the next decades. It is a joy to work alongside them.
Thanks for believing in our work. Thanks for continuing to support our work, if you can. And may the holy days bring peace and good will to all the peoples of the earth, and to all life on earth.
With warm best wishes,
Michael Lerner President