The Blog

Dr. Jon LaPook: How To Save Billions in Health Costs Starting Now

2009-11-12T23:59:43Z

President Obama has stressed the importance of "bending the cost curve" in order to put the brakes on galloping health care expenses that total 2.5 trillion dollars a year and are increasing at 6% a year. The fastest way to do this is shockingly simple: carefully explain to patients the known risks and benefits of procedures.

Dr. Elliott S. Fisher, Director of Dartmouth's Center for Health Policy Research, estimates that thirty to forty percent of elective procedures are unnecessary. This includes elective angioplasty ($16,000), spinal fusion ($22,300), knee replacement ($14,400), and hip replacement ($15,700).

And it's not just costly procedures that are ballooning our health tab; the annual price for diagnostic imaging studies such at CT's and MRI's is about 100 billion dollars, roughly 35% of which is estimated to be wasted.

A prime example of an overused procedure is angioplasty, which opens up clogged arteries in the heart. Over a million are performed every year in the United States. Most patients believe it will prevent a heart attack and prolong life. But that's only true if the procedure is performed when a patient is actually showing signs of a heart attack. In elective cases which, according to the American College of Cardiology's National Cardiovascular Data Registry, account for 37% of angioplasties, it has not been shown either to prevent heart attack or prolong life. For a segment that aired last June on the CBS Evening News with Katie Couric, cardiologist Dr. Steven Nissen of the Cleveland Clinic told me, "Cardiovascular interventional procedures are big money makers for hospitals and for practitioners." For a lot of doctors, "it's tough to walk away from that."

Our fee-for-service payment system certainly creates perverse incentives for doctors, a major reason for the spiraling cost of health care. But there is another factor that is more insidious: the reluctance of physicians to accept new evidence about the medicine they practice. For example, doctors have been taught for many years that an open artery is always better than a closed one. Despite convincing data showing that this simply isn't true, many physicians remain unconvinced and refuse to change their behavior.

When I interviewed President Obama about health care in July, I asked him about unnecessary elective angioplasties and the friction between what a physician believes to be true and what is supported by evidence-based medicine. He replied, "I have enormous faith in doctors. I think they always want to do the right thing for patients. But I also think, if we're honest, doctors, right now, have disincentives to making the better choices in the situations you talked about. If you are getting paid more for the angioplasty, then that subconsciously even might make you think the angioplasty is the better route to take. And so if we're reimbursing the physician not on the basis of how many procedures you're performing but rather how are you caring for the patient overall - what are the outcomes - then I think you start seeing some different choices."

Trying to figure out which medical interventions actually work is the whole point of the so-called "comparative effectiveness" studies for which Congress has budgeted 1.1 billion dollars. There has already been good progress in this kind of research. Aside from data showing that elective angioplasties don't save lives, a recent study found that vertebroplasty, a common procedure to treat pain from back fractures, was no better than a placebo treatment with a shot to temporarily numb the area.

Ultimately, insurers will try to change behavior by refusing to cover services that have performed poorly in comparative effectiveness research. That strategy will likely take years to implement and will be complicated by the fact that medicine is both an art and a science and will never be able to be reduced to perfectly predictable algorithms. Clinical judgment and even what has recently become a politically incorrect term - intuition - will always play an important role.

So how do we save billions starting now? By doctors and patients agreeing to discuss carefully whether procedures and tests are worth it.

This will have to involve consent forms. A review of hundreds of these forms at more than 150 hospitals found them to be of "limited value."

They are loaded with confusing language, often omit specific risks and benefits, and are generally not well explained by doctors. Patients often sign the forms minutes before a procedure without even reading them. Experts such as Dr. Fisher say that 30-40% of unnecessary procedures could be eliminated through proper informed consent - what is increasing being called "informed patient choice" to emphasize that doing the suggested procedure is not a foregone conclusion.

Gerry O'Connor, PhD, Associate Dean for Health Policy and Clinical Practice at the Dartmouth Hitchcock Medical Center, has implemented a pilot program that personalizes the consent process. In the case of angioplasty, the physician collects detailed medical information about a patient, then searches a database of angiogram results to estimate individual risks and benefits by finding out what happened to similar patients who had the same procedure.

"It's not generic," he told me. "It's for people like you. If we get that right, we'll create a better informed consent."

Ultimately, electronic medical records will connect with electronic medical knowledge, including comparative effectiveness results, to give doctors and patients information - so-called "decision support" - at the moment a test or procedure is electronically ordered. But until then, and starting immediately, doctors and patients can try the low-tech solution of setting aside enough time to weigh adequately the pros and cons of medical options - not just for procedures but for other treatments and diagnostic studies. Of course, this is more easily said than done in a system that reimburses far better for doing things to patients than for communicating with them. That must change.

Mehmet Oz, M.D.: Real Health Care Reform: What's Next?

2009-11-12T23:27:54Z

On a recent episode of my show, I met a woman named Sandi. Her eyes streamed with tears as she told me about how she binged on food every night after her children were asleep. She was at her wit's end. She was suffering with complications from obesity -- borderline diabetes, hypertension, fatigue and most importantly, depression and anxiety. To modern medicine, she was a simple math equation -- her BMI needed to be under 30, her blood sugar around 100 and blood pressure around 120/70. There are any number of useful drugs that could help. But they would by no means deal with the cause of her problems or bring her to wellness.

Sandi isn't just a math equation that I can fix with drugs or surgery. She is a person, plain and simple. To treat her properly I need to understand every aspect of her life -- her food cravings that she likens to getting a crack hit, her feelings of defeat as she gives in night after night, her feelings of powerlessness and isolation. I need to look at her family; her life circumstances; her mental and spiritual health; her relationships; her daily routine; where she lives and how she gets to work each day. I need to provide to her with a comprehensive list of additional resources -- therapists, counselors, nutritionists, exercise trainers, spiritual counselors, her personal "go to" team to buttress every corner of her personhood.

Sandi will go to a long-term rehabilitative facility that treats patients with chronic eating disorders by addressing the physical and emotional components that make up the distress I witnessed at her intervention. The list of factors is lengthy, but each of them is deeply embedded in every tear that rolls down her cheek as she shares her story. And Sandi's tears are a call to action.

As I write this, the news is that the House passed the health care reform bill which will now move to the Senate. As government does its part to grapple with the economics of coverage, we the care providers and we the people have an enormous part to play. All of us must work together to create the change we need so that all Americans can experience a culture of health and well-being. Health care reform is not just about who pays. It must also address what we are paying for. And we have to start paying for health rather than treating sickness.

We need to create a culture of health and wellness that fosters a nationwide understanding that personal behaviors are a major factor in health and well-being. And at the same time, we need to make the necessary societal changes so that all individuals are supported in making the correct choices. We need to make it easier to do the right thing.

We need to create a culture of health and well-being in our country that teaches a new vision -- that true health involves being well in body, mind, and spirit in the context of one's community. We need to change the idea that health is simply the absence of disease. It isn't. It is much more than that. Health provides for a vital state of engagement with life.

Americans pay far more for health care than the citizens of any other nation, and these costs are escalating every year. In fact, spending on health care related expenses now consumes more than one out of every six dollars we earn. Yet we experience greater incidence of disease and the World Health Organization's analysis of healthy nation indicators puts our life expectancy near the very bottom of the top 40 nations.

How can this be?

The problem sits at the very core of how we approach health care.

American health care does not help people become or stay healthy and does not make it easy for people who are seeking prevention. We have a disease management system based on the episodic care of illness or trauma, which means we treat symptoms instead of causes. In essence, we can operate on Sandi, but we can't give her a comprehensive pathway to wellness after her surgery. True healing can only begin when we correctly diagnose the problem and treat the root cause.

When we treat body parts without caring for the whole patient, it means that we are leaving out one of the strongest healing forces available -- YOU, the person with the ailment.

We know from research that the digestive system is controlled by the mind and anxiety, depression, and fear affect its functioning. Social and psychological stress can aggravate a wide variety of diseases, such as diabetes mellitus, high blood pressure, and migraine headaches. Emotions affect heart rate, blood pressure, sleep patterns, stomach acid secretion, and elimination processes. Treating Sandi isn't about the biology of what caused her weight problem -- it's about understanding and addressing those dark hours at night where she finds herself in that vortex of anxiety, defeat and feelings of helplessness. That's a complex understanding that has taken me a lifetime to learn. We can't afford to ignore these connections when we treat people. We can't leave the person out of the equation.

Currently, the majority of our health care dollars are spent after a person is in crisis -- like when I have to bring in an interventionist and watch them go through an emotional catharsis. It costs the most to intervene when the possibilities for full recovery are the slimmest. Think about it. Last year, $2.1 trillion dollars were spent in this country on medical care, or roughly $12,000 per family, and 95 cents of every dollar were spent to treat diseases after they had already occurred.

The fact is -- it is much easier to prevent a disease from developing than it is to cure it once the problem has reached a critical stage.

Let's look at chronic disease as an example. More than half of Americans suffer from one or more chronic diseases and we know that conditions such as heart disease, cancer, and diabetes are not only the leading causes of death and disability in the United States, they drive more than half of the health care expenditures of the nation.

But we also know that seven of the most common chronic diseases -- cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental disorders -- have been linked to behavioral and environmental risk factors that can be addressed. They might even be prevented altogether if people were helped and encouraged to make better choices. By this I mean eating nutritionally sound food, adopting healthy habits such as not-smoking, building healthy relationships, living and working in non-toxic environments, being purposefully engaged in life, practicing stress reduction activities, and staying fit through exercise.

People often have a hard time believing that something as simple as the choices we make about our daily lives can be as powerful as drugs and surgery. But they are.

The World Health Organization just released a report revealing that global life expectancy could be increased by nearly five years and millions of lives could be saved annually by addressing 24 factors affecting health. The list includes a mixture of environmental, behavioral and physiological factors, such as air pollution, tobacco use and poor nutrition.

In a recent study published in the Archives of Internal Medicine, CDC researchers found that individuals who adhered to four healthy lifestyle habits had a 78 percent lower risk for chronic disease, including diabetes, stroke, heart disease, and cancer. The four factors were never having smoked, having a body mass index (BMI) less than 30, exercising for at least 3.5 hours per week, and eating healthfully.

The Lifestyle Heart Trial published in the Lancet showed that people with severe coronary heart disease were able to stop or reverse it without drugs or surgery by simply making intensive lifestyle changes.

A trial published in the Journal of Urology by my colleague Dean Ornish showed that lifestyle changes can slow, stop, or even reverse the progression of early-stage prostate cancer.

You get the point. Or do you? This isn't theory. These aren't utopian pipe dreams. This isn't idealism. This is evidence-based peer reviewed science that even the most methodical and empirically minded individual can understand.

Said differently, the science suggests that the reason lifestyle change programs work so well is because the combined interventions affect gene expression, turning on genes that prevent disease and turning off genes that promote heart disease, prostate cancer, breast cancer, and other illnesses.

When you look at the big picture, improving the health of all Americans cannot be achieved by addressing the health care system in isolation from the rest of society. We have to change our entire culture. That's not as daunting as it sounds. It's simply a matter of how we look at things. The steps themselves are simple, but they require a social choreography and a new outlook. On a positive note, in all my years in medicine, I have never felt we were at such a critical mass as we are now for these ideas to take root and grow. Regardless of the outcome of the health care reform debate, the national discussion has created a turning point for the way we see and prioritize health.

We have to make the promotion of health part of what we do in our homes and in our places of work. This could range from reducing the amount of toxic chemicals we use for cleaning -- to planning nutritional meals for our families -- to demanding smoke-free work environments -- to making time in our schedules for exercise -- to adopting corporate wellness programs that reward healthy behaviors.

Being health conscious involves monitoring what food we grow and how we manufacture it, which includes anything from supporting local farmers -- to buying organic foods -- to regulating how our food is genetically altered -- to asking major food processing companies to remove trans fats and reduce sugar content in their products.

Our cultural emphasis on health must involve improving the quality of our air and water. This could mean planting more trees, placing stricter demands on automobile emissions, eliminating contamination sources flowing into our lakes and oceans, and creating riparian buffers along our rivers.

City planning and health departments need shared goals. Having health as a priority in community design would mean creating more bicycle and walking paths, establishing a network of green rooftops, creating community gardens and ensuring that all residents have access to fresh food.

Health promotion has to be part of the educational process of our children. This would include teaching nutrition and stress reduction in elementary and middle schools, ensuring that food served in cafeterias is healthy and nutritious, banning the sale of soda and candy on school premises, and demanding that recess and physical education classes are never cut from the school day.

Our focus on health has to be part of the work processes of our corporations, which means helping employees in their pursuit of better health, eliminating toxins from the manufacturing process, and creating products that leave smaller footprints or -- in the case of medicines -- produce less side effects.

And it has to be part of our everyday culture. This can mean anything from having access to calorie counts for restaurant items -- to encouraging our friends to make better choices -- to ensuring that insurance companies reimburse for prevention.

When we do all this, not only will each individual benefit, so will the whole country. An investment in health and wellness is an investment in our future prosperity and the strength of our nation.

We are so close, and I hold great hope. Lets do it.

Sherman Yellen: In Praise of Bad Cooking and Good Mothers: A Thanksgiving Memory

2009-11-12T21:58:19Z

I've never been a big fan of Halloween -- I don't scare easy and I don't believe in ghosts, not the spooky kind. Ah, but Thanksgiving! My favorite holiday; one filled with the real ghosts of my childhood. My mother Lilly -- movie star beautiful, generous, kindly -- would roll up the sleeves of her floral printed housedress, put on a clean ironed apron and meet this holiday as her great culinary challenge: that awesome and awful Thanksgiving dinner. And I would watch her in wonder during my childhood in the nineteen thirties and forties.

The first order of business was dealing with the turkey from hell, sent to us live in New York City in a crate by my mother's crazy joker of a younger brother, Albert, who lived upstate near the Canadian border. Less a gift than a curse, the bird was exiled to our bathtub for a week, clucking away, fed birdseed and always on the verge of becoming a pet rather than a feast before being snuck out of our house by my father to meet his fate at the local butcher. When finally presented at the feast the creature was so overcooked by my mother, who didn't believe in timing her cooking, that it had become mummified enough to be worthy of an archeological exhibition. The corpse was surrounded with a neat row of sliced canned cranberry slabs, a culinary sarcophagus. A pile of store bought soft sugary rolls nestled nearby. Sweet potatoes with half melted marshmallows inside were passed about, and wintery-pale pink sliced tomatoes resting on a cold crunch of iceberg lettuce were offered as sides, while a dish of defrosted Birds Eye creamed spinach (be still my heart) was followed at last by scoops of Rushmeyer's ice-cream fit for any hungry pilgrim.

There was not a dish or a pot in our home that was not used in making that meal. Each contributed to the creation of the overcooked and the underdone. My mother, a truly marvelous woman, was, as I have suggested, an awful cook. And I dare say that was a small part of what made her so marvelous. She knew what really mattered and for her -- unlike the foodies of today -- life wasn't cooking. When she died in an accident years later I discovered that her Fanny Farmer Cookbook (subtitled The Way to A Man's Heart) a wedding gift when she married in 1926, was in pristine condition, not a gravy stain to be found on it, not a earmarked page or a check mark against any recipe. If that was the culinary bible of the time my mother was an agnostic.

Her Thanksgiving was a meal to die for but we survived it. Conversation often concerned the relative virtues of the dark as opposed to the light meat, which was sweeter, who wanted the drumstick to gnaw upon, and what mystery spices were in the glutinous raisin and bread stuffing. Not the stuff of a Noel Coward play, but it worked for us. The guests included what was then called a maiden lady, the lonely book-keeper Miss Zaro who looked much like a turkey herself with a reddish beak of a nose and a sack of loose flesh under her non-existent chin where her neck was meant to be. Anyone who lacked a family within wailing distance of our place was welcomed to Thanksgiving at the Yellen's. After dinner, my father would read a story about the Pilgrims and the Indians and how they made their peace together. A noisy, loving, but quarrelsome man, my father was very big on peace, something he cherished but rarely gave to anyone. Like most true pacifists he was often quite angry. As a young boy I always identified with the Indians; still do, who could resist their feathered head-dress and bows and arrows? And who would want to be a sanctimonious God toting Pilgrim in tight black stocking with pursed lips and buckled shoes? Essentially, we considered my mother's cooking the original Plymouth Rock meal and felt we were as much a part of an historical recreation as any pageant in Colonial Williamsburg.

Growing up in the Depression years it was not odd for a boy to have such a mother and believe that this Thanksgiving meal was comprised of delicious food. Cooking was about basic nutrition, not gourmandizing; our cuisinart was the can opener, it was all about sitting down together at the table with salt and pepper, mustard and ketchup to conceal the culinary crime -- I call it innocence -- on our plates, something we did nightly -- and it was about a family grateful for being alive in American in Hitler's world, employed for another year, healthy without the miracle drugs and vaccines of today, loving each other, fighting fiercely and making up and eating all of our evening meals together.

Today my side dish is corn -- so you can stop reading if you can't take it off the blog. People don't know how good badly prepared food was when it was offered with so much love. I half suspect that some of this modern attention to gourmet cooking is an effort to make up for the loss of family life in recent years; culinary art replacing plain, hearty meals, families often divided by divorce and the Diaspora of American life where daughters and sons go off to find work where they can and crowded airports are as much a symbol of Thanksgiving as Norman Rockwell's famous dinner. Family has so often been disparaged in films and on TV that dysfunctional is the modifier for family, replacing loving in most discussions.

I know that if my mother was alive today (she would be 106) the elegant Thanksgiving recipes in the New York Times would seem another language to her -- and if she understood that language she would respond "What's wrong with them? What a waste of time." She might admire a Martha Stewart as a hard worker, but all those home baked cookies? It would seem a foolish expenditure of a woman's energy when there was an inexpensive bakery nearby with good Hungarian strudel and cookies, and people who needed your help more than your fresh baked pastry. She had clothes to mend, friends to call, charity to give, children to help with their homework, and most of all relatives whose woes required listening and comfort. It was the Depression and we were all natural ecologists. Nobody wasted anything -- even a broken marriage could be mended, reused, refitted, with the lesson of endurance passed on to the next generation. My magnificent electric train set was bought cheap at auction by my father, and after I played with it until the wheels came loose, it would be passed on to my younger cousins. My sister's Baldwin piano was also bought second hand. Only fools spent money needlessly when there was so much good stuff, old stuff, around for reuse. Not that we didn't enjoy new clothes and nice toys -- you can bet we did -- but everything was made to last, bought with the idea that it would be passed on, reused, until the last drop of good or fun was squeezed from it. This was as true of Thanksgiving meals that had a way of being recycled over a week as a sandwich or a snack, each transformation taking it down the food-scale a peg but rarely ending in stomach-ache or food poisoning. Nobody had heard of E. coli (or wanted to).

Now I am not a bad food snob, honoring only the overcooked and underdone. I am a great appreciator of the Thanksgiving meal that my daughter-in-law Lise and my son Chris prepare for us in their house -- it puts Julia and Ruth and Martha to shame with its magical transformations of common squash and plain vegetables into food for the gods, and they do it without waving a flag filled with Michelin stars, without braggadocio; two amateur cooks who have had great fun in putting it all together, even with their one and a half year old twin daughters tugging at their aprons. My mother would have loved their cooking, forgiven it for being as tasty as it is because it lacks all snobbery and competitiveness, and bespeaks family love. My son Nick and his four-year-old daughter will be sharing the holiday with us, as well as other family and friends -- and it's a great mix of ages and lifestyles. It will be noisy, giddy, and attended by four cats and Sam, a large chocolate Labrador retriever who will stretch out on the sofa and take up room for four. Most of all it will remind me how blessed I am to have such a family.

Sadly my mother was killed in her early Eighties on a New York street while delivering store food to a poor, sick woman; the victim of a careless driver who ran her down on a sidewalk. But this is not what I think about on Thanksgiving: not how she died but how she lived. On the surface times have so changed between my childhood seventy years ago and today, and yet the changes are superficial to me. So much of life is luck, and so much of luck is being born into a good and caring family.

Today, just as the resources of this world -- clean air and clean water -- are at risk, it's helpful to look to the past rather than to the futurists for answers. Cliché's can contain some saving truths. "Waste not -- want not" is not the creed of the miser; it is the wisdom of the good mother who wants her children to make a decent life in the world. It means don't give up easy, don't squander your talents, don't look to "things" to replace feelings, and don't find obsolescence in everything you own. Most important, don't worry about how long the turkey has been in the oven if you can spend the time laughing with your children and entertaining lonely friends. So I give thanks for my family, the one who raised me, and the one I have today. Happy Thanksgiving to all; and yes, dark meat, like long ago memories, is so much sweeter.

Tina Traster: A Meatless Thanksgiving

2009-11-12T21:15:38Z

When we moved into our renovated house in late October 2005 I said to my husband, "We should host Thanksgiving this year." We finally had a real dining room after living in our shoebox on the Upper West Side.

"No one will come," he said.

I knew he was right. No one wants a turkey-less Thanksgiving. I resigned myself to a meal at someone else's house, cringing at the sight of a gravy-dripping bird proudly displayed in the center of a dining room table.

It was either that or dinner for three, which my husband, daughter and I did one year.

This year there's a twist in the family drama. Various dysfunctions among siblings, parents and even a friend prevent others from hosting. My dining room will be christened for Thanksgiving. What I'm most grateful for is the chance to gather nearly a dozen people for a meat-less harvest meal.

I stopped eating meat 30 years ago, the day I arrived at college. The decision was not borne of some great moral struggle, though I've always had a deep, abiding love for animals. I eat cheese and eggs. I never saw vegetarianism as a movement or something to broadcast, much less proselytize about.

Now I do.

Now I know far too much to hope only my husband (a vegetarian since we got together a decade ago) and my seven-year-old daughter will follow my lead. Now I hope to convince as many humans as I can to think about the connection between what they eat and how it was raised. I want to do whatever I'm able to connect the dots between E-coli and factory farming. I'm urging everyone I come in contact with to watch the documentary "Food Inc," even though I spent a good portion of it crouching behind the seat, cupping my ears.

Food Inc. showed me I had work to do. I hadn't made the connection that cheese I'd been buying at stores like Whole Foods might be made with milk from factory-farm cows. That next Thursday, I found a local cheese artisan, Shepherd Valley of New Jersey, at my town's farm market. During the weekend, my family visited this amazing sheep farm that is responsible for the most delicious, grass-fed cheese. The butter I bought at their farm store showed me I had no idea what real butter tastes like.

I read egg cartons as carefully as I read bank statements. I know free-range and cage-free and all that marketing hullabaloo does not insure laying hens are living a humane existence. I try my best. Sometimes the twee farmy name on the cartoon makes me reach for a particular brand. Until I stop procrastinating and raise chickens (which I've been swearing to do since I moved to a big piece of land in suburbia) I will not be satisfied that I'm eating ethically-grown eggs.

We live with so many disconnects. So much about how we live and what we're exposed to makes us feel powerless. Eating is an exception. Eating is the great equalizer. I can be conscious about every food I choose or reject. With every trip to the health food store or farm market or the farm out yonder I can teach my daughter she never ever has to set foot in an A&P. Or more importantly, what she eats has a story. And every story has something to do with dirt or a tree or an animal. And she has a place in this cycle of life.

I'm already anticipating a few wise cracks over the dinner table on Thanksgiving. Just for sport, you know. I could launch into a lecture on how turkeys have been so genetically modified that they are incapable of natural reproduction. Or I can cook up a harvest feast of my husband's home-made breads, creamy potato leek soup, sweet potato fries, fresh salads and other vegetables dishes that will leave everyone just as stuffed and overfed as they would otherwise be.

If I'm really lucky, right before we gather around the table before dusk, someone will notice the sound of crunching leaves outside the window. The kids will run over first and squeal with delight at the brood of wild turkeys pecking at the lawn. The rest of us will not be able to resist watching these iridescent feathery creatures pursuing subsistence.

I love these birds. They are always a great source of pleasure and humor. But on Thanksgiving, I will raise my glass to them and whisper "lucky you."

Therese Borchard: Writing "Beyond Blue": Keeping My End of the Bargain

2009-11-12T21:08:34Z

I'm a tad over hearing about how depression and other mood disorders are yuppie diseases for folks with the time and resources to ruminate and obsess. I could do without all the advice on how to transform my thoughts into happy campers, even as I try every mindfulness strategy and cognitive-behavioral trick in the book. And I'd like to, one day, be able to tell family and friends the truth when they ask the predicable question, "How are you?"

We need to understand something important.

Depression kills.

It killed my godmother--my mom's younger sister--at the tender age of 43. It kills approximately 800,000 people across the globe every year. Suicide takes more lives than traffic accidents, lung disease, and AIDs, and it is the second leading cause of death in females aged 15 to 40. By 2020, depression is expected to be the second most debilitating disease worldwide.

But if you don't care about those stats, let me tell you this: Depression nearly killed me. For two years after the birth of my youngest child, I was a suicidal mess. The worst part about it? Unlike a cancer victim, I had to keep it all to myself. I wasn't able to utter a word to the outside world.

Because I had already been judged plenty.

Well-intentioned people said I wasn't eating organically, that I wasn't doing the right yoga, that I should be praying harder, and that my meditation attempts were lame. They told me to get over my childhood crap and move on, to buck up like the rest of the population. So I continued to fall into my cereal bowl every morning, to carry with me a paper bag for imminent panic attacks, to lock myself and my kids into the restroom of a Starbucks until my meltdown subsided, and to pull over onto the side of the road whenever I started to shake.

After trying 23 medication combinations, working with 7 psychiatrists, participating in two inpatient hospital psychiatric programs, and attempting every alternative therapy out there, I made a bargain with God.

"I will dedicate the rest of my life to helping people who suffer from mood disorders," I promised, "if I ever wake up and want to be alive."

Miraculously that day did come... the morning I woke up and thought about coffee.

So here I am. With my mission: to educate folks about mental illness and to offer support to those who, like myself, suffer from mood disorders.

That's why I wrote "Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes."

So that others might find a seed of hope in my story, and be able to hang on for one day longer. So that anyone who struggles with anxiety or depression--even in the slightest way--might find a companion in me, some consolation in the incredibly personal details of my story, and a bit of hope to lighten and often dark and lonely place.

It's about my end of the bargain.

Toan Lam: Cancer: Big C To Little c (VIDEO)

2009-11-12T19:57:23Z

Many of us have lost a loved one from the big C. I lost my father, aunt and friends to Cancer.

And while it's not a fun topic to talk about and in many cases and cultures - taboo -- talking about it could save your life or the life of someone you care about. I've experienced that the hard way.

I come from a typical Asian family that isn't encouraged to be inquisitive, outspoken or to make a big fuss about anything for that matter. At home, it wasn't ok to speak up about what was on my mind - a "don't ask, don't tell" environment. (So it's liberating that I've found a passion/career path through www.GoInspireGo.com to share inspirational stories and essentially be the voice for the voiceless.) I vividly remember the moment as clear as the bright fall colors. One crisp autumn day, I nervously asked my Aunt Hong if she got checked for cancer, specifically if she's ever had a mammogram. I don't recollect what actually compelled me to (gulp) ask that question, but what I do recall was being very embarrassed to even bring up a question of that nature. (Or any other questions for that matter, especially to my elders). I wasn't raised to question my "authorities," not to mention, talking about breasts. Viscerally, I just felt like urging her to go to the doctor. She looked at me, stunned. She answered with a gesture. (Just a nod of the head) I don't think she ever followed through and got a checkup.

Unfortunately, the conversation ended there. So did her life just a few years after I posed that question. My mother's sister died of breast cancer at age 48. I don't know if she ever got checked. I do, however, know that that year alone in 2000, I lost my father to stomach cancer and Auntie, in just a few short months--and no one really talked about cancer itself or how we were affected by it. Our feelings were shoved underneath the imaginary rug. Losing Auntie Hong was harder on me and my family than losing others family members, including my own father. Not that you can tangibly, philosophically and emotionally categorize which death was more difficult to deal with. I think the sorrow or raw sense of sadness lingered not only because she was too young to die, her job wasn't done on this earth.

Auntie Hong left behind a fourteen-year-old son, Thomas, whom my siblings and I treat like a younger brother. "Are you afraid?" I remember asking him. A blank stare ensued. I tried comforting him as he blinked back tears. "It's ok to be scared and to cry." I assured him. "You are like a brother to us. We are here for you. Your mom asked us to watch after you after she passed and to make sure you grow up all right." I took the first step in breaking the silence by talking to Thomas - the lack of communication and being quiet was what caused more confusion and fear about cancer and other topics like sex.

Though my experiences with losing people to cancer, I've realized that this disease does not discriminate, age, sex, creed or class. I also learned that many people are totally in the dark when it comes to cancer facts and myths. Being hush hush about cancer can be deadly.

George Lin, my friend who was the San Diego Asian Film Foundation's Program Director died at age 37 of Pheochromocytoma, a rare tumor of the adrenal gland. I remember meeting George, at the festival. One year he was a young, healthy and funny. I remember George cracking jokes as we ate Korean food at a hole-in-the-wall restaurant. The next year, when I came to volunteer at the San Diego Asian Film Festival, I saw a totally different George. He looked gaunt, feeble and ill. He didn't explain the change. He didn't crack jokes like he usually did with me. And I didn't ask. I just knew that something was wrong.

This year marked the 10th anniversary of the San Diego Asian Film Foundation/Festival. While many people were excited to converge in San Diego to celebrate film, there was a somber feeling - as though something was missing from the festival. Many volunteers and festival goers say they could feel that George was there in spirit, I certainly did. George inspired this year's festival theme: Cancer Awareness. Lee Ann Kim, the festival's Executive Director recently told me that after George's death, she became obsessed with researching cancer and cancer awareness. "After talking with so many people, I realized that so many people didn't want to talk about cancer," Kim said. "Like many people who have cancer, George didn't tell many people about his illness. But I knew, I was his boss." It seems many people are still very afraid to talk about cancer, especially the Asian American and Asian community. As we all know too well, that could be a tragic mistake.

In the spirit of those we've all lost to cancer, I am urging you, begging you, to please talk about it. Awareness and Early Detection could save lives.

I'm inviting you to break the silence -- talk about it.

Rest in peace Dad, Aunt Hong and George. I hope his story inspires everyone to be aware and share. PLEASE SHARE THIS STORY (and video) WITH AT LEAST ONE PERSON. Be inspired to do something so that talking about the BIG C won't be that big of a deal to talk about anymore. Let's get it out in the open, and talk about cancer - so it will no longer be taboo, I hope and believe that one day, that the CAPITAL C - will be replaced with a little c. So please, talk about cancer. Be aware. And share. It may save the life of a loved one. It may save your life.

***

You can find out more about Toan Lam at http://www.goinspirego.com. Click on the YouTube link and check out the stories his team created, and videos created by viewers.
Contact Toan at: toanlam@goinspirego.com

Kim Stagliano: Will Democrats Scuttle Healthcare Because Of Abortion?

2009-11-12T19:43:57Z

Does Spanx make an asbestos undergarment for HuffPo bloggers about to set themselves on fire?

I'm wondering if some Democrats are going to use abortion against the healthcare plan the way Republicans have used it (and gay marriage) to scuttle elections for years. This concerns me.

I am a pro-choice voter. I used to say I was politically pro-choice but personally pro-life, meaning I would never consider having an abortion. That was until I was faced with the choice of carrying a baby to term myself.

In November of 1999, my two daughters were diagnosed with autism. Mark and I agreed we would not have any more children. Alas, someone forgot to clue in the sperm and the egg. On New Year's Eve, we partied like it was 1999, because it was. In January 2000, when I found myself guzzling cartons of milk and stuffing bagels into my face at Panera while watching the clock to see if Taco Bell was open so I could get the burrito that was demanding my attention, I realized I might be pregnant. Mark formally announced my pregnancy. "Holy sh*t, Kim, you're pregnant. Look at your chest!" he declared, eyes agog, as I stepped out of the shower one chilly February morning. Lo and behold, he was right. I had that glorious chest that was my pride (and his joy) for the couple of weeks before the belly outpaced the boobs. I really should have taken a boudoir shot during one of my pregnancies to remember the chest that appeared so magically.

My obstetrician was a terrific doctor and a good man. He had a son with severe ADHD and he knew what I was facing at home with my newly diagnosed girls. Mark and I were pretty naive about the challenges of autism. Dr. P said to me, "You know, Kim. You have choices. You do not have to have this baby." He said this with great kindness and concern. He was not pressuring me. I chose to have the baby, and Bella was born.

Fast forward nine years.. My husband lost his job three times before finally striking out on his own. We sold our home before we got into mortgage trouble. We've moved four times in six years. We have one car. We've cut our budget so close to the bone I can smell the marrow.

One of our biggest worries since 2003 has been health insurance.

The first time Mark lost his job we paid over $20,000 into COBRA. The second time, he found another job quickly, and we went right onto another company sponsored health plan. But the insurance cost $1000 out of pocket per month. Money we could ill afford. The third time, we were just plain tapped out financially and COBRA was not an option at close to $1200 a month. My girls were denied private insurance coverage because autism is a pre-existing condition, so they went onto the state plan.

I need healthcare now for my family. I don't have the luxury of waiting for the perfect plan that pleases everyone. And as much I believe every woman should have access to safe reproductive healthcare, I'm not willing to deny healthcare coverage to millions, including my own family, because one medical procedure might not be covered.

If the plan ensures easy and affordable access to birth control, that would help women. Perhaps an astute reader can tell us if access to regular healthcare results in fewer abortions. Certainly access to birth control could.

Are Democrats going to scuttle their President's promise to deliver healthcare reform because of abortion? That seems like a page from the Republican playbook. I'd like to have the choice of healthcare.

And now, feel free to flame away.

Stefan Aschan: How To Lift More Weight And Prevent Lower Back Injuries

2009-11-12T19:30:56Z

The following question from Gail B. came in my mailbox. Gail writes:

The first time I gave birth did a number on my pelvic floor. Although my mom has the same thing, and actually my sister too. So maybe there's some genetic weakness tendency there. And anticipating a possible question from you - no, I have never worked hard and consistently with Kegel exercises to see how much it would help!

Kegels are a must in any kind of exercise program. For men and woman alike. The pelvic floor acts like the stirring wheel for your body. It gives you support and stability with any kind of movement you do.

One specific muscle weakness in a healthy individual is very rare. You can train muscles to make them stronger and to perform correctly. Yes, there are genetic differences between women and men, which need to be considered in an exercise program. Yet, genetically, singular muscle group weakness, such as the pelvic girdle is rare. Rather, weakness can be caused from inactivity.

To strengthen the pelvic girdle, perform the Kegel exercise by doing the following: remember what happens during urination. Relaxed muscles allow a free flow of fluid and when you contract the muscle you can feel how your pelvic girdle activates. No? Try it again. Start and stop and pay attention to what is happening as you do it. Those controlled muscle contractions are referred to as Kegels. You can do them anytime, even now while you are sitting and reading this.

This is just one part that is important. Your head, arms and legs need a stable working foundation that you accomplish by building up your core. When I refer to the core I refer to the transverses abdominis, your diaphragm, your back extensions [Multifidus] and your pelvic floor. Without proper core strength you are not working from a strong platform, to push more weight and to prevent yourself from injuries.

Research has shown that when you body functions correctly, 30 milliseconds before arm movements and 110 milliseconds before leg movements the core, your inner unite, turns on. If your body does not function correctly, find a highly educated personal trainer who can go through tests and evaluation and give you a program to recondition your recruitment patterns.

Stay focused.

Stefan

To sign up for your FREE easy and simple weight loss solutions and updates go to www.stefanaschan.com.

Birgitta Lauren: What is Driving the Surge in US Premature Births? $$?

2009-11-12T18:35:02Z

Last week the CDC published yet again a scathing report card for moms and their yet again higher premature delivery rate, the reason the US infant mortality rate is worse than most developed countries both in Europe and Asia. Twenty-one countries rate better than the US.

Premature delivery is blamed on deficient prenatal care, obesity, smoking, early C-section, induced labor and fertility treatments. Even though that’s not the whole story, and all of these are preventable, at least to a degree. Moms low on the socioeconomic scale do not get enough prenatal care. This could be minimized if health insurance coverage for maternity care was more affordable. Obesity: absolutely preventable if women exercised more and ate healthier foods. Obesity also starts in the womb for the child if mom eats too much or too little while pregnant. Smoking: definitely preventable! No woman in this day and age should be smoking. No man should be smoking near a pregnant woman. Early C-sections for any other reason than medical necessity should be banned. Induced labor for any reason other than medical necessity should be banned.

Fertility treatments are a necessity for many women and makes focusing on maternal health so much more important, especially if mom is carrying multiple babies. It is not necessarily the fertility treatments that cause premature birth; it is the lack of good health habits in the mother. However, no woman should be allowed to carry more than three, as the health problems created for the babies are too great. Moms are having a tough enough time carrying one healthy baby, 4 or more is impossible. Our number one priority must be that of the health of the babies.

However, even “high risk” moms can have full term pregnancies if proper care is taken to exercise and eat right. In 17 years, I’ve seen many “high risk” moms deliver full term; twins, placenta previa, incompetent cervix, diabetes, hypertension, sever obesity, etc….with proper exercise and nutrition.

With the preemie rate now at almost 13% and rising, we need to focus on the “Lifestyle Factors” of women to prevent premature babies. A healthy vaginal full term delivery cost about $1,500, a C-section can cost $5,000-15,000. The first year of a healthy child costs about $5,000, and the first year of a preemie can cost up to $1.5 million. Not counting food, clothing, diapers etc…

In the last week, several articles were published on how micronutrients reduce prematurity and infant mortality (micronutrient: all individual vitamins and minerals, macronutrient: carbs, protein and fats) , omega fatty acid fish oils are needed for a healthy baby, Vitamin C, D and B vitamins are needed while pregnant, moms veggie rich diet helps baby prevent diabetes, prenatal exercise prevents premature delivery, and even the American Psychological Association came out with “A little know epidemic”: Stress may account for many preterm births.

Stress can be a big problem in pregnancy and can be minimized with exercise, meditation and proper eating and sunning habits. Exercise, meditation, B vitamins, vitamin D (sunshine) and Omega fish oils all improve stress and possible depression levels. Both stress and nutrient deficiencies are major causes of preeclampsia and prematurity, and must be addressed. Moms must exercise, eat better and take good complete, prenatal supplements. Unfortunately most women take prescription vitamins that only contain half of the needed nutrients and in synthetic form rather than natural forms as the synthetic versions are less expensive. Many moms are unduly scared of fish and therefore deficient in omega fatty acids needed for a healthy baby. Vegan sources of DHA are not as good for baby’s development as fish sources that also contain the important EPA’s.

Processed foods, fried foods, artificial sweeteners, sugar and white carbohydrate foods, rob women and their babies of vital nutrition and harm metabolically, increasing the likely hood of gestational diabetes and hypertension. Personally I would ban all things sugar, fried and cola sodas as they are pure poison for pregnant moms and their growing babies.

Other issues that can be detrimental to the health of a growing baby are environmental toxins, but even with those, getting enough B vitamins like Folate and B6, and Selenium can counteract harmful effects of unfortunate exposure of the chemicals BPA from plastics and/or mercury. Other consumed toxins can be medications. Such as commonly prescribed anti-nausea drugs, that has a side effect that prohibits absorption of Folate….the most important nutrient during pregnancy.

Even hygiene and especially dental hygiene can have tremendous effect on the health of a pregnancy. Gum disease has been shown to cause premature delivery.

With all this information at our disposal why is the preemie rate increasing in the US? Why is the US number 22 on the infant mortality rate list of developed countries with more than double the mortality rate than most European countries? Why are moms not taking better care of themselves in the US?

Last week, a premature infant summit was held in Los Angeles by MedImmune for doctors, NICU nurses, charity organizations, government entities and other health care professionals in the maternity field. My first concern was that it was FREE. From Valet parking, to breakfast, snacks, lunch and presentation… all my past conferences needed payment….Listening to presentation after presentation of statistic after statistic on our detrimental prematurity rate and talk of the need for more money to care for these infants without a single hint to the prevention of this problem, I not only got suspicious, I got angry. What was the point of wasting a whole day with all this we already knew…? Without a solution…. Could all these people that care for preemies deliberately wanting to keep the preemie rate up to stay in business?

A professor of a very well regarded CA University raised his hand and voice for the need of prevention and helping moms to be healthier during pregnancy. He was ignored, subject changed…. I raised my hand and voice for more effort on prevention and was met with the same treatment. During the breaks between sessions, several other like-minded health professionals met with me with the same concerns. Halfway through, I had enough, left and decided to check out MedImmune. It was not an organization, but a drug company that makes drugs for preemie babies…..with no vested interest in reducing the preemie rate. This drug apparently reduces RSV, a respiratory virus that may happen to preemies. Preemies may need this drug, but I’d prefer if there were less preemies…. The drug’s side effects are: respiratory infections, ear infections, fever, sinus problems, abnormal heart rhythms, anaphylaxis, bruising, skin reactions etc…. or generally compromise the immune system of these children, leaving them vulnerable to flu’s and cancer later. But wait…the same company also makes flu vaccine and cancer drugs…..

With all this talk about the need for lower cost health care, our babies need to be born healthier, to reduce health cost of the future. This starts in utero. Create healthier children and all of our costs will go down.

With drug companies spending 45% of their budget on advertising and the above type of “meetings”, (never did I think I would end up in one), drug prices could be almost halved if drug promotions were banned. Don’t let drug companies fool you with their R&D expense. Apparently they only spend 14% of their budget on R&D, as 90% of all drug research is done by medical schools, private research and the government that the drug companies then buys and sells…

Women, moms, whether pregnant or contemplating pregnancy, for a healthier baby your lifestyle is of utmost importance. Everything you do or don’t do, will affect the health of your baby. For fertility and a full term pregnancy and the healthiest baby; exercise, eat healthy, take your vitamins, avoid all chemicals and toxins possible, drink lots of water, get plenty of rest and sleep. Don’t worry, be happy!

Yours in health, Birgitta Lauren www.expectingfitness.com

Resources: American Psychological Association; Prenatal-health.com ; Mercola.com; Health Day News; Nutra Ingredients Europe; The Truth about the drug companies. By Marcia Angell.

Deborah Calla: Death And Dying: Nature Is Selfish, Get Over It

2009-11-12T18:33:23Z

I have always thought when people passed away that the ones left behind cried for the fact they would not have the person they loved in their lives any longer. The truth is we cry for not having that person but we also cry for all they will never get to do and to experience; new presidents, newborns, love, restaurants, films, political and social changes etc.

I once read that nature is selfish -- a powerful but truthful statement. Nature doesn’t stop for anyone or anything. No matter what is happening in our lives people still rush to work, fight wars, make love, waste time and the world goes through tsunamis, global warming, sunsets and sunrises.

It is so brutally shocking when our lives are falling apart and the rest of the world does not seem to notice. The first time I really experienced this was when my husband was lying in a hospital bed fighting for his life and I went for a walk around the hospital. I needed air and sunlight after spending three days locked up in his room without leaving.

As my body walked my mind was still tied back to what was happening in that hospital room, but all the people walking by me didn’t seem to notice or care. They laughed and carried on like nothing was happening. I wanted to stop and tell them “Don’t you know what’s happening? My husband is fighting for his life. How can you just carry on? ” But of course I couldn’t do that. The truth is that everyone has their drama, small and big, at different times in their lives and nature doesn’t care and it doesn’t stop. But that is how life is; it has its own force.

It is so important to live life for what we think is important and brings us the greatest amount of happiness and satisfaction and not fall victim of any type of fictional or social interpretation of what life should be or look like.

Life is what it is and it’s to be lived to the fullest at every moment because things can change on a dime. This is by no means a gloom and doom statement. It is actually beautiful and powerful and it can be simple to live by making every day count and being in the moment. If the moment is talking to a friend, then let’s dedicate the time to the friend. Let’s not think about what we need to do after we leave our friend. Let’s be in the moment. If the moment is making love, let’s not think about what happened before and what will happen after. Let’s be in the moment and try to let our body and mind experience every feeling and sensation.

We are so often in a hurry that we miss out on fully experiencing what happens to us until something tragic happens and we realize that we have rushed through too much and now have much to regret.

So while nature is selfish and life will continue on no matter what happens to each one of us, we can make our own lives count by dedicating our journey to ourselves. Our best friend lives within us, and it is actually ourselves. We are the only ones who will never leave and will always hear our thoughts and feelings and know everything that there is to know about US. So why not give our best friend the best life possible by letting ourselves truly experience life by being in the moment? Think about it.

Dr. Alex Benzer: 9 Reasons Why Dating Actors is a Bad Idea

2009-11-12T18:13:34Z

One of the most common romantic fantasies that men and women in this country tend to have is to date an actor. The men all want an Angelina Jolie, and all the women want a Brad Pitt.

And why not (besides the mildly inconvenient fact of those two being married to each other)? Actors are famous, influential, loved by all, make oodles of money and look good on your arm. And your friends will be mightily impressed.

Now I’ve been living in Los Angeles for some years, and for better or for worse have gone out with enough actresses to know what it’s really like. So if you're seeking a fulfilling relationship, here I present to you why dating an actor is a Bad Idea. My experience is with the females, but the generalizations below being of the vast variety, they apply regardless of gender:

1. Actors are financially unstable.

The number of actors who are making a decent living out there is vanishingly small. There are a few dozen household names; the rest are mostly struggling. They sling drinks and wait tables, waiting for their big break.

One of my mentors put it bluntly: “If you’re hungry, you’ll forget about love. And if you need to pee, you’ll forget about the hunger, too.” Maslow’s hierarchy of needs says that base-level needs like shelter, security, employment and resources supersede higher ones.

If scarcity prevents fulfillment of those basic needs, you don’t get to rise to the higher ones involving love, esteem and self-actualization. So someone who’s struggling with making ends meet doesn’t just lack time for love but may not be in a position to offer (or receive) love at all.

2. Actors are in a state of perpetual emergency.

Here comes the next audition! Next callback! And another! Every call and meeting with producers and agents is an emergency. Even though there’s a less than 10% chance of anything coming out of any given audition, she never knows which one’s going to be the big one, so she has to show up every day.

If you’re dating her, you try to be supportive the first few times. But after she cancels on you for an audition for a Charmin' ad again, you start wondering whether being left high and dry is your idea of fun. Which contributes to the next problem…

3. Actors have funny schedules.

In addition to the sudden-death auditions and callbacks that usually happen on weekends when you’re trying to get together, actors also have paying gigs that happen at inconvenient times for workaday mortals.

If she’s in a theater production, she may not be available on any weekend evening for months. Film shoots happen at midnight; callbacks pop up out of nowhere. And if she lands a really big job that shoots on location, she could be gone for 3 months.

So you can go out for dinner or to your friend’s birthday party – just not with her. If companionship is an essential part of your fulfillment in a relationship, then you’re not going to be fulfilled.

4. They are constantly exposed to rejection, hurting their self-esteem.

I once accompanied a girlfriend to an audition for a commercial, just to see how the other half lives. What I saw was quite enlightening: a roomful of preposterously good-looking folks, all vying for 2 roles in an advertisement. The chances of any one of them landing the job was well under 5%.

So day in, day out, actors walk into situations with a 95% chance of rejection – often for reasons they can’t control, like height, complexion or butt size.

You can imagine that this could wreak silent havoc with the self-esteem of anyone not made of stone. The dating problem arises because psychologists have found a phenomenon called the marriage shift: in a long-term relationship, someone with low self-esteem will eventually come to disbelieve her partner’s kindness (“Why would he want me? He must be lying or crazy”), think him a fraud and walk out. That doesn't sound like a party to me.

5. They are in constant danger of being criticized publicly and therefore feel insecure.

If you have a regular job, chances are that you receive your periodic work review in private behind closed doors.

But there are a few jobs out there whose job reviews comes out in public – in a newspaper article or worse, on a magazine cover. Tabloids go further and include the actor’s private life, too – it’s all fair game. So actors never know when they’re going to be swiped at by some unaccountable miscreant who endangers their self-esteem and mood.

6. Their self-absorption leaves little room in their lives for others.

The work of a good actor involves total focus on the physical self so it becomes an instrument of expression. Because of this self-absorption and the aforementioned perpetual state of emergency, she will call on you to be understanding and be patient.

However, she will not have the time and energy to be understanding and patient in return. It’s not her fault – the nature of the business simply precludes it. In the meantime, there’s no one to support you in your time of need.

7. They are incapable of sustained, deep happiness.

One of the characteristics of meaningful work is that it gets rewarded. For the reward to register in the human brain, it has to arrive immediately after the completion of a task – within seconds to minutes.

For film and TV actors, the reward of their work – applause or good reviews – comes weeks to months after the work is complete. So their neural reward circuit never really gets lit up, and at a deep level, they never feel truly gratified, even when they do their best work. So you’re stuck with someone whose life work is incapable of making her truly happy, and there’s not much you can do about that. If you like her, that’s bound to affect you as well.

8. Their satisfaction is externally determined.

If you were to summarize all the thinking of the ages about happiness and living the good life, it may come down to this: if you can generate your own good feelings from within, you win. If you depend on the outside world to generate good feelings for you, you lose.

Like all art, acting has no absolute value other than that conferred upon it by public opinion. So the actor’s happiness is perpetually determined from the outside: the opinions of casting directors, producers, reviewers, and their audience. As Lao Tzu said in Chapter 9 of the Tao Te Ching, “Care about people's approval, and you will be their prisoner.” And a prisoner’s not all that fun to hang around.

Also, an actor’s whole way of existence is about expression rather than introspection. As my friend the author and producer Adam Gilad pointed out, “The Oracle of Delphi’s gate inscription didn’t say ‘Express thyself’ – it said ‘Know thyself.’” There’s a big difference between the two.

9. They inhabit a perceived state of permanent decline

I’ll never forget when my friend Anna told me on her 24^th birthday without a hint of irony, “Omigod – I’m so old.” Forget that Anna is accident-causingly beautiful. She already sees herself as over the hill, knows she’s not getting any younger, and checks for wrinkles and other supposed defects every day.

So you’re the one thinking she’s a piece of heavenly perfection, but she’s convinced she’s turning into Quasimodo. Eventually, you’ll get tired of your compliments going nowhere, she will think you a fraud (see #4) and things unravel from there.

Of course, my dear reader, you will still be attracted to actors in spite of all of this, and you may still date one of them someday. If so, perhaps by knowing what you’re getting yourself into, you’ll be the one who bucks the trend. But just knowing it’s raining outside won’t keep you from getting soaked, so proceed with caution still.

Further smart dating tips in the Tao of Dating book for women and Tao of Dating book for men

Visit the blog: www.TaoOfDating.com

Join me on Facebook

Write to me: DrAlex(at)TaoOfDating.com

Gretchen Rubin: Balanced Life -- 11 Myths Of De-Cluttering.

2009-11-12T18:11:49Z

One of my great realizations about happiness (and a point oddly under-emphasized by positive psychologists) is that outer order contributes to inner calm.

But as much as most of us want to keep our home, office, car, etc. in reasonable order, it's tough. Here's a list of some myths of de-cluttering that make it harder to get rid of stuff.

Myths of Cluttering:
1. "I need to get organized." No! Don't get organized is your first step.

2. "I need to be hyper-organized." I fully appreciate the pleasure of having a place for everything, and perhaps counter-intuitively, I believe it's easier to put things away in an exact place, rather than a general place ("the third shelf of the coat closet," not "a closet.") However, this impulse can become destructive. If you're spending a lot of time alphabetizing your spices, organizing your shoes according to heel height, creating eighty categories for your home files, etc., consider whether you need to be quite so precisely organized. I find this particularly true with toys - I've spent hours sorting pretend food, Polly Pockets pieces, and tea sets, only to find everything a jumble the next day.

3. "I need some more inventive storage containers." See #1. If you get rid of everything you don't need, you may not need any fancy containers.

4. "I need to find the perfect recipient for everything I'm getting rid of." It's easier to get rid of things when you know that you'll be giving them to someone who can use them, but don't let this kind intention become a source of clutter, itself. I have a friend who has multiple piles all over her house, each lovingly destined for a particular recipient. This is generous and thoughtful, but it contributes mightily to clutter. Try to find one or two good recipients, or if you really want to move your ex-stuff in multiple directions, create some kind of rigid system for moving it along quickly.

5. "I can't get rid of anything that I might possibly need one day." How terrible would it be if you needed a glass jar and didn't have one? Do you have gigantic stores of things like rubber bands or ketchup packets? How many coffee mugs does one family use?

6. "I might get that gizmo fixed." Face it. If you've had something for more than six months, and it's still not repaired, it's clutter.

7. "I might learn how to use that gizmo." Again, face it. If you've had a gizmo on the shelf for a year, and you've never used it to make gelato or label a sugar jar, it's clutter.

8. "I might lose a ton of weight and then I'd fit into these clothes again." If you lose a bunch of weight, you'll want to buy a new pair of jeans, not a pair you bought seven years ago.

9. "I need to keep this as a memento of a happy time." I'm a huge believer in mementos; remembering happy times in the past gives you a big happiness boost in the present. But ask yourself: do I need to keep all these t-shirts to remind me of college, or can I keep a few? Do I need to keep an enormous desk to remind me of my grandfather, or can I use a photograph? Do I need fifty finger-painted pictures by my toddler, or is one enough to capture this time of life? Mementos work best when they're carefully chosen - and when they don't take up much room!

10. "I need to keep this, because the person who gave it to me might visit my house and be hurt when it's not on display." Is that person really likely to visit? Is that person really likely to remember the gift? Will the person really be upset by the lack of viewing of the gift?

11. "If I have any available space, I should fill it up with something." No! One of my Secrets of Adulthood is Somewhere, keep an empty shelf. I know where my empty shelf is, and I treasure it.

* Today I had coffee with the fabulous Pamela Redmond Satran, author of many books, including the recent New York Times bestseller How Not To Act Old and the absolutely hilarious blog of the same name. Enter at your own risk -- dangerously addictive, book and blog both.

* Today I gently encourage (or, you might think, pester) you to spread the word about the Happiness Project. You might:
-- Forward the link to someone you think would be interested
-- Link to a post on Twitter
-- Pre-order the book for a friend
-- Put a link to the blog in your Facebook status update
Thanks! I really appreciate any help. Word of mouth is the BEST.

Loral Langemeier: Would You Invest in a Zebra?

2009-11-12T18:02:25Z

In medicine, they say: "When you hear hoof beats, think horse, not zebra." According to the doctors in my Live Out Loud community, that translates to: "Don't go to the obscure and unlikely when you're dealing with the ordinary."

I believe there are two ways to invest: horses and zebras. Horses are obvious. Zebras are obscure. To my amazement, many investors choose to invest in zebras. Not me. I am in favor of horses.

Horses are simple, direct assets. Horses can be found in every asset class and sector, such as private equity, real estate and commodities. They include clear cut businesses, land and buildings, gold mines and oil wells -- the actual mines and wells, not the publicly traded stocks representing them. I'm also in favor of alternative investments like buying an actual bank or purchasing undervalued currencies, but again, only if these are horses, not zebras.

How do you identify these types of investments?

Horses are:

transparent and simple

not intertwined with other products

not lost in the haze of murky markets

things that have few layers between investor and asset

what they are and ain't what they ain't.

Zebras, on the other hoof, are exotic, extraordinary and often confusing. They may appear to be one thing, e.g. a fund that promises high-reward, low-risk value investing. But then turn out to be another, e.g. a fund that is not well-supported by a firm's best management, research or trades. Those unlikely zebras are like zero calorie fudge -- too good to be true.

I think anyone who invests in zebras is nuts. Yet, it's done all the time by the smartest and most experienced investors.

Take, for example, the zebra of collateralized debt obligations. To those who invested in CDOs they seemed to be excellent packages of diversification designed to manage risk. But, alas, no. In reality, they were mysterious mixes of mortgages more malicious than moderate. And the well-secured assets in the mix were no match for the insidious junk that spread to infect the whole deal.

The most interesting part of this, though, was that few people understood what exactly was in the CDOs. And this includes some of those people who sold them. (Yikes!) Yet, these were the hot ticket investment product of the last few years. And not only did these zebras of confusion and obscurity mess up investors, but they helped mess up the economy.

And this is just one example. Consider if you would ever buy into the following advertisement: "Accumulate great wealth by putting a lot of money into our newest derivative product assembled by the top Quant jocks on Wall Street using such sophisticated mathematical models that even they don't understand them." Absurd, right? But in the past decade many investors bought into exactly that.

People seem so eager to trust the experts that they are willing to put their hard-earned money into investment vehicles that make no sense to them. And you know what? I think people do this precisely because they make no sense. In some skewed alignment of logic and laziness, I believe people suffer through the tangled transitive traffic jam of:

complexity = sophistication = success, and thus, complexity = success.

But hey, guess what? If something is over your head, it's not necessarily a smart thing.

When investing, it's good to think like Jinbei Yamada, founder of Arrow Bicycles. The sign above his Tokyo shop reads: "simple is best." In the high tech world of gadgets and add-ons, he's been able to survive for over 35 years by keeping his simple machine simple. And I agree with him -- simple is the best way to invest.

Consider these 5 TIPS FOR INVESTING IN THE OBVIOUS VS. THE OBSCURE:
1. Sensible. Make sure the investment actually makes sense. If there's a logical gap, (a water park in the desert? Wow!), don't let it go.
2. See-through. Don't hope for transparency, require it. And this means access to operations, as well as financials.
3. Stand alone. Assets that rely on too many other moving parts in order to be successful can create complications.
4. Stable A good climate and foundation are key. Investors must understand all of the environmental and internal issues that can affect returns.
5. Simple. ('Nuff said)

A responsible and diligent investor does not complicate. Building wealth can be simple when you invest in horses. You can learn more here.

I'd like to hear your thoughts. Call in to the Loral Langemeier Show at 877-777-7713, Monday through Friday, 7 a.m. Pacific, 8 a.m. Mountain, 9:00 a.m. Central, 10:00 a.m. Eastern. Or listen to the podcasts.

Mike Robbins: Worrying Never Works

2009-11-12T17:56:00Z

I was talking to a friend of mine last week and she said, “If worrying worked, I’d weigh 115 pounds and be a millionaire by now.” I laughed out loud – appreciating her humor and insight.

Worrying, which is something I’ve spent and wasted a lot of time and energy on throughout my life, never seems to work, does it? Worry is actually detrimental to our health, well-being, and our ability to manifest both the things and feelings we truly want in life. When we worry, we’re simply preparing to be upset in the future – assuming that something “bad” will happen.

I’ve recently become even more aware of my own obsession with worry and have realized for me, as is true for many of us, it has simply become a habituated and unconscious behavior. At some level, I find myself justifying my own worrying – thinking that it proves I really care, helps keep me focused, or allows me to stay on top of things in a responsible way. While this all makes sense, on a deeper level I’ve realized that worrying is just my erroneous attempt to control the uncontrollable – life.

Given that we all know, at least to some degree, that worrying doesn’t really work and actually makes things worse – why do we do it?

First of all, we’ve been trained to worry – by our parents, teachers, friends, family members, co-workers, the media, our culture, and more. From the time we were kids and to this day, we’re taught (directly and indirectly) that we’re supposed to worry about lots of things – crime, illness, money, our children, being taken advantage of, pollution, and so much more. While some may argue that there are many things we should be concerned and aware about, “worrying” about any of these things doesn’t make them better or help us address them in a specific way.

Second of all, we’re not usually encouraged or even all that good at acknowledging, addressing, and expressing our real emotions. Worry is often a suppressed form of fear, anger, shame, or other emotions we find difficult to deal with. Because worrying is much more socially acceptable than expressing our authentic fear (or anger, guilt, helplessness, shame, sadness, etc.), we tend to actively worry about things all the time. Our inability to express our real emotions, which is usually the source, is what keeps worry in place.

Finally, we worry that if we stop worrying, something really bad will happen. As ironic and odd as it may seem, we continue to worry somehow thinking we are protecting ourselves. In actuality when we worry we're just setting ourselves up for more stress and fear.

Here are a few things you can do to let go of worry and live with a deeper sense of peace and freedom:

1) Notice what you worry about – Like most aspects of life and growth, the first step is authentic awareness. When we become conscious about our own habits, thoughts, and patterns as it relates to worrying, we can start to make some healthy choices and changes. As you notice your own tendency to worry, have compassion with yourself and see if you're willing to let it go.

2) Identify and express your real emotions – The root cause of all worry is an emotion or set of emotions. If we can identify how we really feel (scared, angry, sad, ashamed, helpless, etc.) and we’re willing to express our emotions with passion and authenticity, we will move through the emotion and release its energy, thus transforming it and letting go of our worry.

3) Take conscious and courageous action – Worry often renders us inactive; stuck in a state of negative thinking or fear based reactions. Taking conscious and courageous actions in the face of our fear and worry can be one of the most empowering things for us to do. This is not about frantic, random, erroneous activity (just for the sake of doing something), this is about us taking deliberate action as a way of moving through our fear in a direct and confident way.

There’s nothing wrong with us for worrying – it is part of being human, especially in our world today. We don’t need to judge ourselves for it, but it is important for us to acknowledge our worry when it shows up, as it can be quite detrimental to our success, well-being, and fulfillment in life. When we remember that worrying never works and we’re willing to dive deeper into what is really going on within us, we can transform our worry and use it as a catalyst for positive change.

Mike Robbins is a sought-after motivational keynote speaker, coach, and the bestselling author of Focus on the Good Stuff (Wiley) and Be Yourself, Everyone Else is Already Taken (Wiley). More info - www.Mike-Robbins.com

Sara Avant Stover: Unplug and Recharge: How Yoga Can Open Your Heart (VIDEO)

2009-11-12T17:24:07Z

Sometimes the circumstances in our lives--relationships, overwhelming emotions, or even the way that we habitually sit and stand--can shut down our hearts.

Here's a short yoga sequence to help you transform your armor into openness.

Enjoy!

To watch more videos from Sara, please visit http://www.thewayofthehappywoman.com/videos