Prostate Cancer, Finasteride, PSA, Prevention part2

Yasterday I talked about the confusion that exists for men in deciding what to do about prostate cancer prevention. The American Urological Association (AUA) and the American Society of Clinical Oncology have recommended the use of finasteride (brand name Proscar) for prevention of prostate cancer in healthy asymptomatic men who get regular blood test screening by evauation of the prostate-specific-antigen (PSA) . At the same time the AUA and other groups continue to remain on the fence about whether or not there should be routine screening, hedging by saying that men should discuss this question with their physician. It's confusing to begin with and now even more so.


Finasteride is a medication that has been around since 1992 and is FDA approved for treatment of urinary symptoms in men with enlarged prostates. Finasteride works by decreasing dihydrotestosterone in the blood and prostate gland which essentially shrinks the prostate. Like all medications it has some side effects and finasteride can cause decreased sexual drive and erectile dysfunction. The findings come from the Prostate Cancer Prevention Trial (PCPT) which began in 1993. This study enrolled 18,882 men and randomized half to placebo and half to the active drug. The study sample was 92% white males, 4% black males, and 4% other ethnic groups. For prostate cancer this is not a true representative sample as black men suffer disproportionally from this disease. The trial was stopped in 2003 because it clearly was effective and ethical concerns made it unreasonable to continue to give some men the placebo.

So the AUA is recommending that men who are screened with the PSA should take medication but they are not recommending routine PSA screening in the first place?!

Why is this? It has to do with the characteristic that many prostate cancers (but not all - mine wasn't) are slow growing and it might take from 6-8 years before a small cancer will penetrate the prostate capsule and infiltrate local structures. Once this happens though there is no cure. Because the PSA screening test has been around awhile it hasn't been used in a widespread fashion until the past 6-8 years so no one has shown conclusively that PSA screening saves lives. In the meantime 30,00 American men are dying each year.

I will discuss more of this next week.

Thought for the day

"Compassion leads to courage".

Lao-tzu

Unacknowledged Loss and Grief

Recently I noticed an article in the opinion section of our local newspaper written by the syndicated columnist Leonard J. Pitts, Jr. It caught my interest because of the subject matter. The title is: There's Nothing Moral About Hating Gays. I agree with the sentiments expressed by Mr. Pitts but something else in the column struck a chord.

In the article he described a situation where a lesbian couple went on a cruise with their children. One of the partners had an aneurysm and was taken to a hospital. The other spouse, who is an emergency room social worker, was told by the hospital social worker "I need you to know that you are in an anti-gay city and state and you won't get to know about Lisa's condition or see her." The social worker then walked away. Janice, the worried spouse, spent 8 hours in the waiting room and did not get to see Lisa until the priest was administering last rites. Lisa spent all that time without the benefit of a partner of twenty years being at her bedside.

Ken Doka (1989), in his book Disenfranchised Grief, describes this phenomena as situations when the loss cannot be openly acknowledged, socially sanctioned or publicly shared. The story of Lisa and Janice is a prime example of a relationship not being recognized. In pursuit of one's personal code and opinions those who practice a different lifestyle are subjected to cruelty. The loss of a life partner is devastating enough with out being complicated by callousness and dismissal. My reaction to the story was outrage and sadness because I know this is not an isolated case.

In my capacity as grief counselor at Cottonwood de Tucson I have been given the privilege to support grievers in the expression and processing of a variety of losses. I am grateful that I work for an organization that recognizes the humanity of our patients without exception. It is my hope that people will become more educated regarding more appropriate ways to support those in pain.

Dan Stone LCSW, LISAC, CT
Marketing Representative
Cottonwood de Tucson
4110 West Sweetwater Drive
Tucson, AZ 85745
Toll Free (800) 877-4520

http://www.cottonwoodrecovery.com/

Prostate Cancer, Finasteride, Prevention, PSA

What is a man to do? The confusing world of prostate cancer screening and treatment just got more confusing. New joint guidelines produced by the American Society of Clinical Oncology and the American Urological Association has recommended a certain medication (finasteride) for the prevention of prostate cancer in healthy asymptomatic men. Why is this confusing? Isn't prevention a good thing? I want to talk a bit about prostate cancer and the conundrums associated with it.

There are some things that we do know. Prostate cancer is the second leading cause of cancer death in men after lung cancer. It occupies the same place as breast cancer does in women. More people die of colorectal cancer than either prostate or breast cancer but that is referring to men and women together. Approximately 186,000 men in the United States are diagnosed with prostate cancer each year and in that year approximately 30, 000 men will die of it. Prostate cancer dispropotionally affects black men more that whites or other ethnic groups. Prostate cancer is a disease of middle aged to old men usually first diagnosed in those over 50 years old although there a a number of cases in men in their 40's, again dispropotionally more often in black men. Prostate cancer does have a genetic component sometimes but most of the time the causes are unknown. Prostate cancer is curable either by surgery or radiation in the early stages but once locally advanced beyond the wall of the prostate gland is universally fatal as there is no effective chemotherapy. There are treatments, but they are only palliative, not curable

A recommendation for preventive chemotherapy then is big news. But there is till controversy about screening for prostate cancer. The American Urological Association (AUA) has now recommended this preventive treatment but this recommendation comes with a caveat. It is only for those men who have been screened by a blood test for prostate - specific - antigen (PSA) which is a tumor marker and is used for detecting and diagnosing prostate cancer. The new guidelines are for men whose PSA value is 3.0ng/ml or lower. Yet the American Urological Association has not come out with a clear recommendation for men to be screened in the first place! No major cancer group or physician group has come out and actually made a recommendation for routine prostate cancer screening and like the others the AUA is still sitting on the fence despite the high numbers of prostate cancer deaths per year. Confusing?
I will explain more tomorrow.

Thought for the day

"One prostate cancer death per year is one death too many".

The National Prostate Cancer Coalition

Alcohol, Breast Cancer, Million Women Study, UK

We all know that alcohol use is associated with a variety of health risks. We are also told however that low use of alcohol(one to two drinks per day) gives some cardiac protection and can lower the risk of heart disease. Recent findings from the Million Women Study in the United Kingdom show that there are other adverse effects that we need to be aware of.

1.3 million women, average age 55, have been followed for the past seven years and it is clear that alcohol use, even mild can increase the risk of cancer, particularly breast cancer. The study found that the risk exists even with one drink per day and increases with increasing use. It is estimated that 1 drink per day resulted in an increase of 15 cancers per 1000 women and that two drinks per day caused 30 more new cancer cases per 1000 women. This might not seem like a lot but translates into approximately 13% of all new cancer cases in women may be directly attributable to alcohol. In addition to breast cancer there was an increase in rectal and liver cancers and in women who smoked esophageal and oral cancers as well.

This is a reminder to me that sweeping recommendations such as drink a little to reduce heart disease have to be balanced by other factors and that we need to look at overall health in evaluating any forms of prevention and treatment.

Thought for the day

"Fools despise wisdom and instruction".

The book of Proverbs

American Neuropsychiatric Association Conference

I got back last night from attending the annual meeting of the American Neuropsychiatric Association which was held in San Antonio, Texas this year. San Antonio is a great city to visit and I was especially happy to be able to spend sometime with my niece and her husband who live there. As I mentioned before this meeting has become my favorite to attend because it is a mixture of psychiatrists, neurologists, and neuropsychologists all interested in psychiatric aspects of neurologic disorders and neurologic aspects of psychiatric disorders. It is a conference where brain meets behavior and is a mixture of some aspect basic neuroanatomy review, research findings and clinical issues. This year topics included the brainstem, psychiatric aspects of the right hemisphere, glial cells (which are the cells in the brain that support neurons), the brain and the law, new research in gene therapy and modulation, and the role of estrogen in neuropyschiatric disorders. I learned a lot and may share some information on these topics in upcoming posts.

The last day was devoted to clinical presentations and I was struck by two things. The first was to again be reminded how difficult real life situations of our patients are. No one has the answers to many of our questions but it is nice to hear how other practicioners deal with very difficult problems. I particularly enjoyed a presentation of two cases where a physician discussed the difficulties in assisting the severely intellectually disabled. He encouraged us all to approach our work with a spirit of humility and and attitude of listening, empathy, and open mindedness. The other thing that stuck me was the relative lack of attention payed to addiction or possible addictions in these very tough neuropsychiatric dilemmas. We still have a long way to go in educating physicians about the pervasive effects of alcoholism and other addictions.

Thought for the day

May I approach my work in a spirit of humility and an attitude of listening, open mindedness and empathy.

American Neuropsychiatric Association Conference

I will be "off blog" for a few days. I will be attending the annual meeting of the American Neuropsychiatric Association. This is always my favorite meeting because of my interest in neuroscience. This organization consists primarily of neurologists interested in psychiatric disorders and psychiatrists interested in neurological disorders. It makes for a good combination and a lot of free discussion on new ideas and findings in both fields.

I have no laptop so I will be back at this site on Monday 2-23.

Thought for the day

"Encourage the fainthearted, help the weak, be patient with everyone".

Philosophy, Personal Achievement, and Hard Work

I was going to write about some recent news articles regarding neural pathways for addiction but have to pause to share some good news. Over the weekend we received a call from our older daughter, Amy (that is her on the right), who informed us that she had been admitted to the doctoral program in philosophy at Notre Dame. This was great news as she had wanted this for the past four years and with the degree of competition for so few spots available was unsure of her chances. She is currently in a Master's Degree program at Northern Illinois University which she will finish in May. She has worked very hard for this accomplishment and as her father, I certainly think she is worthy of this personal achievement!

Notre Dame is a Catholic university. We are not Catholic but the program there, as expected, takes seriously the possibility of God and how that might guide our philosophical considerations and discussions. She particularly wanted to work with two professors who are well known for their work, Dr. Alvin Plantinga and Dr. Peter van Inwagen. Dr. Plantinga has written a series of books on what he calls Warranted ChristianBelief in which he outlines his thoughts as to why belief in God can be taken seriously and rationally by philosophers. Dr. van Inwagen has written The Problem of Evil in which he discusses the age old question of how do we reconcile the idea of a loving God with so much evil and suffering in our world. I am very happy that Amy will be able to work with professors of such caliber.

So, I am very proud of Amy, for her hard work, perseverance and dedication and am very happy that this has been rewarded. Amy - you deserve it!

Thought for the day

" A little philosophy inclineth man's mind to atheism; but depth in philosophy bringeth men's minds about to religion".

Francis Bacon

Addiction, Recovery, Higher Power, Choice, and Community

I mentioned yesterday that I would say a few things more about free choice. I think that much of our lives are predetermined or certainly out of our control but we always have the gift of free choice in how we respond to circumstances, face moral dilemmas, and cope with our weaknesses. This certainly applies to addiction and recovery. The genetic tendency towards alcoholism is predetermined, the ability to stop at one drink is beyond the alcoholic's own power, the chances of relapse high and yet there are numerous choices in recovery to be made that affect whether or not one will pick up that first drink. Does one stay in community, obtain a sponsor, keep away from high risk situations, call someone for help in time of need, etc.? These are free choices that one can make that will greatly infuence what will happen.

Yet at the same time I believe that on our own we are unable to consistently make the right choices. This applies to all of us, not just those in recovery. We will continue to do the things we don't want to do and won't do the things we ought. This is our predetermined state. Alone we are incapable. We must appeal to a higher power to enable us to continue to do right and steer us back on track when we go wrong.I also think that whether or not one believes in God, that that higher power must include participation in a community of those who recognize that we are all in the same boat and that it takes the community to help us survive. So of all the choices we make I believe that most important one is the choice to belong to a community of those who are attempting to live how we would like to live, whether that community is AA, church, a men's group, women's group etc.

Thought for the day

" God is not willing to do everything, and thus take away our free will and that share of glory which belongs to us".

Free Will, Neuroscience, Determinism, and Choice

Do we have free will or is our fate predetermined? This question has been debated for thousands of years. Joining the debate now are neuroscientists who are tending to land on the side of determinism based upon the increasing knowledge we are gaining about how the central nervous system operates. One example is the question of who or what is doing the acting when I move? For instance when I move my arm the transmission from the neocortex (where I do my thinking) actually comes after, not before the arm has moved. Another example is in the case of those who have antisocial or criminal tendencies. We are learning through neuroimaging that their brains are different than a normal brain in terms of how emotions are processed. The argument is that if their brains are different how can they act otherwise and on what basis do we hold them accountable for their actions? These are just a couple of examples.

When I think about the issue I think about how much is predetermined. I have no say as to when I am born, where I am born, my parents, my genetic makeup, the environment that I grow up in, my intelligence level, my socioeconomic class, whether I live in a free country or under a dictator, natural events such as floods and earthquakes, illness or health, how my brain is wired, etc. So I have to admit that I don't have complete free will. I think the better way to put it from my perspective is that while much is predetermined for me I retain the gift of free choice. Throughout each day I am presented with choices to make, the most remarkable to me is how I respond to events, how I respond to adversity, how I respond to good fortune, how I treat my family and loved ones, and how I respond when faced with moral dilemmas. I believe that this power of choice resides in me, that circumstances may be predetermined, but that what I do with these circumstances makes all the difference. So while neuroscience can tell us much about how the brain operates neuroscience without philosophy cannot answer the question of determinism vs. free will.

More on this tomorrow.

Thought for the day

" Be a philosopher; but amidst all your philosophy, be still a man'.

David Hume

Adolescents, Mental Health Treatment and Disparity

I have been thinking lately about the disparity between the need for adolescent mental health services and the relative lack of available treatment programs to address our current situation. We spend a lot of money on pediatric medical services for children and adolescents. We build Children's Hospitals, Children's Service in general hospitals, Cancer Centers, and Burn Centers. Many non profit organizations raise tremendous amounts of money for pediatric research and treatments. This is fantastic and has allowed more and more children and adolescents to have advanced state of the art treatment. We have made great strides in reducing morbidity and mortality from infectious diseases, cancers, heart problems, genetic diseases, neurologic diseases, and others. But the fact remains that we ignore the most widespread problems that are faced in this age group.

Morbidity and mortality from disorders that have a mental and behavioral component outweigh that of all other causes combined. The three major causes of death in pediatrics are accidents, murders, and suicide all of which have behavioral aspects. Complications of child abuse, substance abuse, and depression are more widespread than any other pediatric diseases. Sexually transmitted diseases and teen pregnancies are the two main gynecologic problems for our young people. What a disparity between the needs and the services available! In Tucson all funding for both inpatient and outpatient treatment programs have been cut and each year there are less available treatment options than the year before. There are fewer major non profit organizations that are raising money for more research and treatment as there are for other medical illnesses.

What is the answer? I don't know but I believe that we must bring more awareness to our society about this great disparity before we will make any changes. I hope that the Mental Health Parity Act that was recently signed into law will help move us in the right direction.

Thought for the day

Our children are our future.

FDA, Opioids, and Risk Evaluation and Mitigation Strategies

I noticed in the news today that the Food and Drug Administration (FDA) has plans to increase regulation of certain narcotic prescription pain medications, including OxyContin and morphine and Fentanyl patches. The FDA already regulates these medications as Schedule II narcotics but has not had the ability or authority to do more than make recommendations and monitor prescribing patterns. In 2007 a law was passed, the Risk Evaluation and Mitigation Strategies (REMS), that allows the FDA greater authority in it's ability to require both manufacturers of these drugs and prescribing physicians to follow certain guidelines.

The FDA is responding to a significant problem in that these medications, while successfully treating pain in cancer patients and chronic pain patients, are increasingly becoming drugs of misuse, abuse, diversion, and addiction. Prescription pain medications are now the number one abused substance after nicotine and alcohol. Pain medications have overtaken marijuana as the most commonly used drug in teenagers and their use is increasing. Here at Cottonwood abuse of these medications are the most commonly presenting addiction after alcoholism. Again, after alcoholism the addiction and misprescribing of these medications are the second most common reason for disciplinary actions of state boards of medicine. In addition to the addiction potential these medications are dangerous in overdoses and have been responsible for many deaths. These drugs can be lethal when mixed with certain sedatives and are believed to have been responsible for the tragic death of actor Heath Ledger last year.

Something clearly needs to be done about this problem. I support the FDA in taking a stronger stance on this issue. It is unclear what the new regulations will be but I am sure will include required additional training for physicians who wish to prescribe certain opioid pain medications. My support comes with some trepidation however. This will be the first regulatory action that will affect physician autonomy in prescribing. While necessary in this case I do have some concerns that REMS can be used in the future to limit physician autonomy in other areas of prescribing such as use of psychophamacologic medications in which proposed restrictions are motivated more by an ideological and political agenda rather than based upon science. We will have to wait and see.

Thought for the day

Change brings both opportunity and risk.

Elisabeth Kubler-Ross, Life Lessons, and Relationships

Not too long ago a friend recommended that I read the book Life Lessons by Elisabeth Kubler-Ross. As experts on death and dying she and co-author David Kessler write about their views on how to life life based upon the lessons they have learned in working with those who are dying. I have to say that I was at first put off by the book. I was thinking that it was full of trite sayings. Then I realized that this book was written while Kubler-Ross herself was dying and that she was trying to pack in as much wisdom that she had gained over the years and wanted to share before she herself died. Then I began to see the book as a treasure full of knowledge that I need to pay attention to.

In her chapter on relationships she talks about how all our encounters, however brief, are relationships and important for learning how to love. In this I think about my wife to whom no one is a stranger. She makes friends with everyone she meets and builds relationships with those people such as grocery clerks, librarians, postal workers, and others with whom she meets just once or sees on a regular basis. She sees each person as important and each encounter as more important than any task she happens to be trying to accomplish. Almost always we are some of the last people to leave church or events because there are too many people to encounter. I used to get irritated by this but have realized that I have much to learn from her. I have tended to focus on the task at hand and get preoccupied by thinking of the next task. To her the person is more important.By watching her I am slowly learning to focus my attention and to be mindful in my encounters with people.

So I am enjoying the book so far and recommend Life Lessons to anyone trying to live a fuller and more meaningful life.

Thought for the day

"The common denominator in all your relationships is you".

Elisabeth Kubler-Ross

Pets, Addiction , Therapy, and Recovery

It is Friday so I thought I would provide another personal update. I haven't said much about my dog, Buddy. Buddy is 11 years old. He is a black and brown shepherd mix of some sort. That is Buddy on the left. The other dog is Labbie who passed away last year. I never can get Buddy to sit still for a picture. He always runs straight towards me when he sees the camera!

I found Buddy as an abandoned puppy. He was all mangy and my wife nursed him back to health. At the time we already had three dogs so we had no intention of keeping him. We wanted to find a good home for him. We didn't want to name him so we would not become attached to him so we just referred to him as Buddy or little Buddy. Well, we didn't look that hard for a home for him and after awhile we knew he was with us to stay. Although he is getting older he still has the energy and playfulness of a puppy. He has had to adjust to some loneliness as his two cohorts, Labbie and Muffin (both 14) died this past year. I am not one who can deal with grief by immediately going out and getting a new dog so we still have not decided whether or not to get another one.

He still doesn't know what to make of Pounce the cat who avoids him at all costs.

Thought for the day

" Toward what end am I now making use of my soul? Each day question and cross examine yourself".

Marcus Aurelius

Obama, Cabinet Picks, and Apology

I usually don't comment on political matters but I thought I would today. There is usually so much divisiveness over politics that it is a subject I like to stay away from generally except with my closest of friends. The problem with political discussions is that they too often become heated and we unfortunately begin to make value judgements on those who disagree with us. I try as much as possible to stay away from these topics at Cottonwood. My hope and goal is that no one here even knows my political leanings. My thought is that most all of us whether Republicans, Democrats, or Independents want basically the same things - a strong and safe country, a working economy, and the right balance between government protection and individual freedoms. We simply have different ideas on how to achieve these goals.

It bothered me though that President Obama felt he needed to apologize for some of the problems that were coming out about some of his Cabinet picks. Every President has had this difficulty. How can you know everything about the men and women chosen in advance? I don't think you can even though you try to find out as much as you are able. So to President Obama- no apology needed. Let's get on with business.

Thought for the day

Nobody is perfect.

Addiction, Recovery, Guilt, Shame, and Remorse

Every day in my work I deal with those who are struggling with overcoming addictions who are also suffering from guilt, shame, and remorse for their actions and consequences of behaviors engaged in while under the influence of alcohol and drugs. These emotions can be a barrier to recovery and need to be dealt with effectively for healing to occur. While many times we think about guilt and shame as being the same thing I see them as two different emotions that must be addressed differently.

In my view guilt is a healthy emotion and shame a negative one. To me guilt is the awareness of having done something that causes harm to someone else for which we are deeply sorry, wished we hadn't done what we did, would want to take it back, and want to not engage in the harmful behavior again. Guilt I see as best dealt with by openly acknowledging what we have done and experiencing the painful grief of remorse. I think of it as a positive emotion as it provides both the desire and motivation to make the changes that we need to make.

Shame I think of as an unhealthy emotion and one that is best dealt with by getting rid of it entirely. I view shame as that aspect of ourselves which wishes to hide our failings yet at the same time engage in self criticism and beating ourselves up. This emotion is toxic as it leads to no significant change in our behavior. We stay stuck in a cycle of self focus and do not turn ourselves away from ourselves to others. In a way it is a selfish and self centered emotion. To deal with shame and to rid ourselves of it I think we need to fully acknowledge our failings and then refuse to spend time in self criticism.

By recognizing the difference between these emotions we can then move more quickly to a healing place and recovery.

Thought for the day

" Admitted to God, to ourselves, and to another human being the exact nature of our wrongs".

Alcoholics Anonymous

Michael Phelps, Marijuana, Drug Use and Ambivalence

A reader asked me to comment on Michael Phelps and wanted to know what I thought about him being caught smoking marijuana. At first I was reluctant to do so. So many people have already weighed in on this issue. But the reader pressed me, saying he really wanted my opinion on this matter so I thought I would share a few thoughts.

The most striking thing to me about his marijuana smoking has been the mixed public reaction which has ranged from excoriating him to an attitude of leniency. I believe that this ambivalence reflects America's ambivalence about marijuana itself. Is marijuana addictive? Is it a "harmeless" drug or a gateway drug to more serious drug abuse? Should it be legalized? Should marijuana be allowed for medical purposes? As a society we have not yet come to terms with marijuana and how and if it should be used.

I believe that all discussion about marijuana should be taken in the broader context that the two most commonly used, dangerous and destructive drugs are both legal, alcohol and nicotine. The harm caused by these drugs far outweighs all the harm created by all other drugs combined. I think we forget this in the often passionate debate over marijuana.

So what is the truth? What do we need to know in order to have more informed opinions on marijuana? In no particular order I will indicate some of the facts that are clear. Marijuana is an addictive drug. While most people who use try marijuana or use occassionaly do not become addicted there is a group of people who are highly addicted and whose lives are torn apart by marijuana use. At Cottonwood I see patients whose use of marijuana has been casual despite their addictions to other drugs and I also see patients who are addicted to marijuana alone and have been unable to function effectively in life due to this addiction. While most people who use marijuana do not go on to other drug abuse there are hardly any other drug users who have not used tobacco and marijuana first. Tobacco though is the main "gateway" drug. Marijuana is no longer the main drug of abuse among teens after tobacco and alcohol. Prescription pain pill use has overtaken marijuana use among youth and is increasing while marijuana use has been decreasing. The marijuana used to today is much more potent and has much higher content of THC (the active drug) than the marijuana used in the 1960' and 70's. Chronic marijuana use can lead to psychosis in a subset of people who may be more genetically prone to developing a psychotic disorder. Marijuana is currently calssified by the Federal Drug Enforcement Agency as a schedule I drug, a drug that has no medicinal use. We know however that it does have medicinal use and can be particularly effective for the nausea often induced by chemotherapeutic treatments for cancer. Medical use of marijuana has been legalized in several states including our own Arizona but the Federal government restrictions overide state law.

So I don't have the answer to the question of marijuana use but I do think we should base our opinions upon the knowledge we have rather than just uninformed opinions.
As for Michael Phelps? My thought for the day is

"Let him who is without sin cast the first stone".

Jesus of Nazareth

Sprituality, Religion, Recovery, Community and Outreach

Working in addictions and recovery I often hear what I believe to be a false dichotomy between the concepts of spirituality and religion. A statement that I have heard repeatedly goes something like this "Religion is for those who fear going to hell. Spirituality is for those who have already been there". I beieve that this statement not only doesn't reflect the universality of pain and suffering but also represents a fundamental misunderstanding of what religion is. Religion is not just a series of rules and restrictions or dogma but is the very means by which spirituality is experienced communnaly. My spiritual life is individual but my religion is a joining in community together with other people to strengthen me in a way I cannot be strengthened on my own or with just my own personal relationship between myself and God or my higher power. This gathering together is the very essence of religion and compltetes, not competes, with my spirituality.

Another positive aspect of religion is that it assists me in moving from beyond my own internal spiritual life to a focus outside just myself. The religious community is able to do far more to make the world a better place than I can do by myself. I was reminded of this again this weekend. About 80 middle schoolers and high schoolers from my church participated in a 30 hour famine to focus their and our awareness of the challenges many people face in just obtaining basic necessities. In addition to learning more about what is going on in the world they participated, cooked and worked with a local organization that feeds not only the homeless but the very poor as well. Through the weekend they also raised money to support other projects. Last year they collected enough money to build a well for a village in Zambia that had never before had clean and safe drinking water. I do not know what they are using the money for this year but it will probably be somthing similar. These youth have also been stirred to want to be more involved in local outreach programs to the poor here in Tucson. Individually these youth would not be able to do much to make a difference but by joining with and participating in their religious community they have a significant impact.

I believe that we should see spirituality and religion as facets that together bring about positive change not only for myself but for the broader community as well.

Thought for the day

"True religion is this, to visit the widows and orphans in their distress"

St. James