From childhood, we are told that patience is a virtue and that good things will come to those who wait. And, so, many of us work on cultivating patience.

This often starts by learning to wait for a turn with a coveted toy. As adults, it becomes trying to remain patient with long lines at the Department of Motor Vehicles, misbehaving kids or the slow pace of political change. This hard work can have mental health benefits. It is even correlated with per capita income and productivity.

But it is also about trying to become a good person.

It’s clear to me, as a scholar of religious ethics, that patience is a term many of us use, but we all could benefit from understanding its meaning a little better.

In religious traditions, patience is more than waiting, or even more than enduring a hardship. But what is that “more,” and how does being patient make us better people?

The writings of medieval Islamic thinker Abu Hamid al-Ghazali can give us insights or help us understand why we need to practice patience – and also when not to be patient.

Who was al-Ghazali?

Born in Iran in 1058, al-Ghazali was widely respected as a jurist, philosopher and theologian. He traveled to places as far as Baghdad and Jerusalem to defend Islam and argued there was no contradiction between reason and revelation. More specifically, he was well known for reconciling Aristotle’s philosophy, which he likely read in Arabic translation, with Islamic theology.

Al-Ghazali was a prolific writer, and one of his most important works – “Revival of the Religious Sciences,” or the “Iḥyāʾ ʿulūm al-dīn” – provides a practical guide for living an ethical Muslim life.

This work is composed of 40 volumes in total, divided into four parts of 10 books each. Part 1 deals with Islamic rituals; Part 2, local customs; Part 3, vices to be avoided; and Part 4, virtues one should strive for. Al-Ghazali’s discussion of patience comes in Volume 32 of Part 4, “On Patience and Thankfulness,” or the “Kitāb al-sabr waʾl-shukr.”

He describes patience as a fundamental human characteristic that is crucial to achieving value-driven goals, and he provides a caveat for when impatience is called for.

1. What is patience?

Humans, according to al-Ghazali, have competing impulses: the impulse of religion, or “bāʿith al-dīn,” and the impulse of desire, or “bāʿith al-hawā.”

Life is a struggle between these two impulses, which he describes with the metaphor of a battle: “Support for the religious impulse comes from the angels reinforcing the troops of God, while support for the impulse of desire comes from the devils reinforcing the enemies of God.”

The amount of patience we have is what decides who wins the battle. As al-Ghazali puts it, “If a man remains steadfast until the religious impulse conquers … then the troops of God are victorious and he joins the troops of the patient. But if he slackens and weakens until appetite overcomes him … he joins the followers of the devils.” In other words, for al-Ghazali, patience is the deciding factor of whether we are living up to our full human potential to live ethically.

2. Patience, values and goals

Patience is also necessary for being a good Muslim, in al-Ghazali’s view. But his understanding of how patience works rests on a theory of ethics and can be applied outside of his explicitly Islamic worldview.

It all starts with commitments to core values. For a Muslim like al-Ghazali, those values are informed by the Islamic tradition and community, or “umma,” and include things like justice and mercy. These specific values might be universally applicable. Or you might also have another set of values that are important to you. Perhaps a commitment to social justice, or being a good friend, or not lying.

“Nizamiyyah University Nishapur,” Digital imagining, Dall-E, 2024.

Living in a way that is consistent with these core values is what the moral life is all about. And patience, according to al-Ghazali, is how we consistently make sure our actions serve this purpose.

That means patience is not just enduring the pain of a toddler’s temper tantrum. It is enduring that pain with a goal in mind. The successful application of patience is measured not by how much pain we endure but by our progress toward a specific goal, such as raising a healthy and happy child who can eventually regulate their emotions.

In al-Ghazali’s understanding of patience, we all need it in order to remain committed to our core principles and ideas when things aren’t going our way.

3. When impatience is called for

One critique of the idea of patience is that it can lead to inaction or be used to silence justified complaints. For instance, scholar of Africana studies Julius Fleming argues in his book “Black Patience” for the importance of a “radical refusal to wait” under conditions of systemic racism. Certainly, there are forms of injustice and suffering in the world that we should not calmly endure.

Despite his commitment to the importance of patience to a moral life, al-Ghazali makes room for impatience as well. He writes, “One is forbidden to be patient with harm (that is) forbidden; for example, to have one’s hand cut off or to witness the cutting off of the hand of a son and to remain silent.”

These are examples of harms to oneself or to loved ones. But could the necessity for impatience be extended to social harms, such as systemic racism or poverty? And as Quranic studies scholars Ahmad Ismail and Ahmad Solahuddin have argued, true patience sometimes necessitates action.

As al-Ghazali writes, “Just because patience is half of faith, do not imagine that it is all commendable; what is intended are specific kinds of patience.”

To sum up, not all patience is good; only patience that is in service of righteous goals is key to the ethical life. The question of which goals are righteous is one we must all answer for ourselves.

Liz Bucar, Professor of Philosophy and Religion, Northeastern University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What struck me in their report is how unhappy the Middle East is. The only Middle Eastern country in the top twenty is Kuwait (for the first time in this cycle). Kuwait has oil wealth and is a compact country with lots of social interaction. The high score may reflect Kuwait’s lively labor movement. That sort of movement isn’t allowed in the other Gulf States. The United Arab Emirates came in at 22, and Saudi Arabia at 28.

These countries are all very wealthy and their people are very social and connected to clans and other group identities, including religious congregations.

But everyone else in the Middle East is way down the list.

As usual, Gallup found that the very happiest countries were Scandinavian lands shaped by social democratic policies. It turns out that a government safety net of the sort the Republican Party wants to get rid of actually is key to making people happy.

Finland, Denmark, Iceland, Sweden take the top four spots. Israel, which also has a Labor socialist founding framework, is fifth. The Netherlands, Norway, Switzerland and Luxembourg fill out the top nine.

The Gallup researchers believe that a few major considerations affect well-being or happiness. They note, “Social interactions of all kinds … add to happiness, in addition to their effects flowing through increases in social support and reductions in loneliness.” My brief experience of being in Australia suggests to me that they are indeed very social and likely not very lonely on the whole. Positive emotions also equate to well-being and are much more important in determining it than negative emotions. The positive emotions include joy, gratitude, serenity, hope, pride, amusement, inspiration, awe, and altruism, among others.

Benevolence, doing good to others, also adds to well-being. Interestingly, the Gallup researchers find that benevolence increased in COVID and its aftermath across the board.

They also factor in GDP per capita, that is, how poor or wealthy people are.

Gallup Video: “2024 World Happiness Report; Gallup CEO Jon Clifton”

Bahrain comes in at 62, which shows that oil wealth isn’t everything. It is deeply divided between a Sunni elite and a Shiite majority population, and that sectarian tension likely explains why it isn’t as happy as Kuwait. Kuwait is between a sixth and a third Shiite and also has a Sunni elite, but the Shiites are relatively well treated and the Emir depends on them to offset the power of Sunni fundamentalists. So it isn’t just sectarian difference that affects happiness but the way in which the rulers deal with it.

Libya, which is more or less a failed state after the people rose up to overthrow dictator Moammar Gaddafi, nevertheless comes in at 66. There is some oil wealth when the militias allow its export, and despite the east-west political divide, people are able to live full lives in cities like Benghazi and Tripoli. Maybe the overhang of getting rid of a hated dictator is still a source of happiness for them.

Algeria, a dictatorship and oil state, is 85. The petroleum wealth is not as great as in the Gulf by any means, and is monopolized by the country’s elite.

Iraq, an oil state, is 92. Like Bahrain, it suffers from ethnic and sectarian divides. It is something of a failed state after the American overthrow of its government.

Iran, another oil state, is 100. Its petroleum sales are interfered with by the US except with regard to China, so its income is much more limited than other Gulf oil states. The government is dictatorial and young people seem impatient with its attempt to regiment their lives, as witnessed in the recent anti-veiling protests.

The State of Palestine is 103, which is actually not bad given that they are deeply unhappy with being occupied by Israel. This ranking certainly plummeted after the current Israeli total war on Gaza began.

Morocco is 107. It is relatively poor, in fact poorer than some countries that rank themselves much lower on the happiness scale.

Tunisia is one of the wealthier countries in Africa and much better off than Morocco, but it comes in at 115. In the past few years all the democratic gains made during and after the Arab Spring have been reversed by horrid dictator Qais Saied. People seem to be pretty unhappy at now living in a seedy police state.

Jordan is both poor and undemocratic, and is ranked 125.

Egypt is desperately poor and its government since 2014 has been a military junta in business suits that brooks not the slightest dissent. It is 127. The hopes of the Arab Spring are now ashes.

Yemen is 133. One of the poorest countries in the world, it suffered from being attacked by Saudi Arabia and the United Arab Emirates from 2015 until 2021. So it is war torn and poverty-stricken.

Lebanon ranks almost at the bottom at 142. Its economy is better than Yemen’s but its government is hopelessly corrupt and its negligence caused the country’s major port to be blown up, plunging the country into economic crisis. It is wracked by sectarianism. If hope is a major positive emotion that leads to feelings of happiness, it is in short supply there.

Some countries are too much of a basket case to be included, like Syria, where I expect people are pretty miserable after the civil war. Likewise Sudan, which is now in civil strife and where hundreds of thousands may starve.

Poverty, dictatorship, disappointment in political setbacks, and sectarianism all seem to play a part in making the Middle East miserable. The role of the United States in supporting the dictatorships in Egypt and elsewhere, or in supporting wars, has been sinister and certainly has added significantly to the misery. For no group in the region is this more true than for the Palestinians.

( Tomdispatch.com) – Amid ongoing emergencies, including a would-be autocrat on his way to possibly regaining the American presidency and Israel’s war on Gaza (not to mention the flare-ups of global climate change), the U.S. has slipped quietly toward an assault on civil liberties as an answer to plummeting mental health. From coast to coast, state lawmakers of both parties are reaching for coercive treatment and involuntary commitment to address spiraling substance use and overdose crises — an approach that will only escalate despair and multiply otherwise preventable deaths while helping to choke the life out of America.

In December, we wrote about how loneliness has become a public-health crisis, according to the Surgeon General, and the ways in which it drives widespread substance use. We reach for substances to ease feelings of isolation and anguish — and when the two of us say “we,” we mean not just some hypothetical collective but the authors of this article. One of us, Sean, is a doctor living in long-term recovery from a substance-use disorder and the other, Mattea, is a writer who uses drugs.

And we’re anything but unique. Disconnection and loneliness aren’t just the maladies of a relatively few Americans, but the condition of the majority of us. Vast numbers of people are reaching for some tonic or other to manage difficult feelings, whether it’s weed, wine, work, television, or any mood- or mind-altering substance. These days, there’s scarcely a family in this country that’s been unscathed by problematic drug use.

Not surprisingly, under the circumstances, many elected officials feel increasing pressure to do something about this crisis — even as people who use drugs are widely considered to be social outcasts. In 2021, a survey of thousands of U.S.-based web users found that 7 in 10 Americans believed that most people view individuals who use drugs as non-community members. It matters little that the impulse to use such substances is driven by an urge to ease emotional pain or that the extremes of substance use are seen as a disease. As a society, we generally consider people who use drugs as rejects and look down on them. Curiously enough, however, such social stigma is not static. It waxes and wanes with the political currents of the moment.

“Stigma has risen its ugly head in almost every generation’s attempts to manage better these kinds of issues,” says Nancy Campbell, a historian at Rensselaer Polytechnic Institute and the author of OD: Naloxone and the Politics of Overdose. Campbell reports that she finds herself a target of what she calls “secondary stigma” in which others question why she even bothers to spend her time researching drug use.

Perhaps one reason to study such issues is to ensure that someone is paying attention when lawmakers of virtually every political stripe seek to answer a mental health crisis by forcing people into institutionalized treatment. Notably, such “treatment” can increase the odds of accidental death. Allow us to explain.

“Treatment” Can Be a Death Sentence

Across the country, the involuntary detainment and institutional commitment of people with mental illness — including those with a substance use disorder — is on the rise. Deploying the language of “helping” those in need, policymakers are reaching not for a band-aid but a club, with scant or even contradictory evidence that such an approach will benefit those who are in pain.

“The process can involve being strip-searched, restrained, secluded, having drugs forced on you, losing your credibility,” said UCLA professor of social welfare David Cohen in a 2020 statement about his research on involuntary commitment. He co-authored a study that found its use rose nationwide in the decade before the pandemic hit, even as there was a striking lack of transparency regarding when or how such coercion was used.

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Today, many states are expanding laws that authorize mandatory treatment for people experiencing mental-health crises, including addiction. According to the Action Lab at the Center for Health Policy and Law, 38 states currently authorize involuntary commitment for substance use. None of them require evidence-based treatment in all involuntary commitment settings and 16 of them allow facilities to engage in treatments of their choice without the individual’s consent. Nearly every state that ranked among the highest in overdose rates nationally has an involuntary commitment law in place.

In September, the California legislature passed a bill that grants police, mental healthcare providers, and crisis teams the power to detain people with “severe” substance use disorder. The Los Angeles County Board of Supervisors subsequently voted to postpone implementation of the law, with Board Chair Lindsey Hogarth noting the risk of civil rights violations as a reason for the delay. In October, Pennsylvania state legislators introduced a bill that would permit the involuntary commitment of people who have been revived following an overdose. While many mental health advocates acknowledge the good intentions of legislators, the potential for harm is incalculable.

New research shows that people who attended abstinence-based treatment programs were at least as likely, if not more likely, to die of a fatal overdose than people who had no treatment at all. By contrast, those who had access to medications like methadone or buprenorphine for opioid-use disorder were less likely to die. Those medications, however, are not considered “abstinence” and so are not uniformly provided in treatment settings. Though there is extensive evidence of the effectiveness of medications for opioid use disorder, abstinence still remains widely regarded as the morally upright and best path, even if it makes you more likely to die. The reason for the elevated risk of mortality following abstinence-based treatment is no mystery: abstinence reduces the body’s tolerance. If a person who has been abstinent resumes use, the ingestion of a typical dose is more likely to overwhelm his or her bodily system and so lead to death.

Disturbingly, both The Atlantic and the Wall Street Journal recently ran columns favoring mandatory treatment, with the Journal citing as evidence a 1960s study in which individuals fared well after 18 months of mandated residential treatment that included education and job training — a standard of care that’s virtually nonexistent today. The Atlantic referenced a study of 141 men mandated for treatment in the late 1990s whose outcomes were comparable to individuals who entered treatment voluntarily; the study’s own authors had, however, cautioned against generalizing the findings to other populations due to its limited scope — and since then, the potent opioid fentanyl has entered the drug supply and raised the risk of a fatal overdose following a period of abstinence.

Meanwhile, as policymakers turn to coerced treatment, consider this an irony of the first order: there are far too few treatment options for people who actually want help. “There is no place in this country where there is enough voluntary treatment. So why would you create involuntary commitment, involuntary treatment?” asks Campbell. The reason, she suggests, is the inclination of lawmakers not just to do something about an ongoing deadly crisis, but in no way to appear “soft on drugs.”

Just to put the strange world of drug treatment in context, imagine elected officials wanting to seem tough on constituents who have cancer or heart disease. The idea, of course, is ludicrous. But 7 in 10 Americans think society at large views addiction as “at least somewhat shameful” and people who use drugs as significantly responsible (that is, to blame) for their substance use. No surprise, then, that politicians would find it expedient to punish people who use drugs, even if such punishment only layers on still more shame, with research indicating that shame, in turn, exacerbates the pain and social isolation that drives people to use drugs in the first place. As Dr. Lewis Nelson, who directs programs in emergency medicine and toxicology at Rutgers New Jersey Medical School, pointed out to USA Today, the science of addiction and recovery is frequently overlooked because it’s inconsistent with ingrained social ideas about substance use.

“I Still Don’t Need Saving”

Punishing people for substance use worsens the pain and isolation that make drugs so appealing. So rather than punishment — and in our world today this will undoubtedly sound crazy — what if we treated people who use drugs as full and complete human beings like everyone else? Like, say, people with high blood pressure? What if we acknowledged that those who use drugs need the very same things that all people need, including love, support, and human connection, as well as stable employment and an affordable place to live?

Research on this, it turns out, suggests that human connection is particularly good medicine for the emotional pain that so often underlies substance use and addiction. Stronger social bonds — namely, having people to confide in and rely on — are associated with a positive recovery from a substance use disorder, while the absence of such social ties elevates the risk of further problematic drug use. Put another way, perhaps you won’t be surprised to learn that a powerful means of healing widespread mental distress is to connect with one another.

When people in distress have friends, attendant family, and healthcare providers who are genuinely there for them no matter what, their own self-perception improves. In other words, we help one another simply by being nonjudgmentally available.

Jordan Scott is a peer advocate for Recovery Link, which offers free digital peer support to people in Texas and Pennsylvania. She identifies as a person who uses drugs. “I felt like the message got reinforced that there was something wrong with me, that there was something broken with me,” she told us. “Anything that isn’t abstinence, or anything that doesn’t include total abstinence as a goal, is constantly positioned as less than.”

New research published in the journal Addiction draws a contrast between treatment focused exclusively on abstinence and a broader array of wellness strategies, including reducing drug use rather than eliminating it entirely. The study found that reduced use had clinical benefits and that health can distinctly improve even without total abstinence. Director of the National Institute on Drug Abuse Nora Volkow, for instance, supports a nuanced approach that includes many possible paths of recovery along with a shift away from the criminalization of drug-taking to a focus on overall health and wellbeing. And the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, has identified four dimensions critical to recovery: health, home, purpose, and community.

Most important of all, a person doesn’t necessarily need to be abstinent in order to make gains in all four areas. This makes good sense when you remember that addiction or other problematic substance use is a symptom of underlying pain. Rather than exclusively treating the symptom — the drug use — addressing the underlying loneliness, trauma, or other distress can be a very effective approach. “Family can be a valid pathway to wellness,” Scott pointed out, while adding that her own path went from 12-step meetings like Alcoholics Anonymous to active civic engagement.

For someone else, quality time with his or her kids or even exercising and eating well might be a linchpin for staying mentally healthy. In other words, healing from the pain that underlies substance use disorder can look a lot like healing from any other health challenge.

Yet policymakers continue to call for intensifying the use of coercive treatment. “I think we’re going to see more [involuntary commitment] before we see less of it,” said Campbell, who studies historical patterns in the social response to drug use. There’s nothing new, she noted, in the move to “help” people by institutionalizing them — even if such a move constitutes an erosion of basic civil rights.

“I think most of the time people are genuine in wanting to help,” said Scott, who has been a target of such “help.” The problem, she explained, is the idea that there is a group of people considered “normal” and therefore superior, who think they’re in a position to save other members of society.

“I didn’t need saving. I am a drug user now. I still don’t need saving,” Scott told us. These days she’s focused on being a part of her community through volunteerism while drawing on a support network of people who respect her path.

As for the two of us writing this article, Sean is spending time with his children, staying connected with friends, practicing meditation and yoga, and has for years facilitated a group of physicians in recovery. Mattea has started a new habit of going to the gym with her uncle to ease her loneliness, while also confiding in close friends for support. And all of that truly does make a difference.

Copyright 2024 Sean Fogler and Mattea Kramer

Via Tomdispatch.com

As I began this piece on trees in forests, woods and parks, a friend asked, why in January in New England?  Why didn’t I wait until the deciduous trees were a palette of new spring green crowning the stark brown trunks and branches of winter?  The next day, January 7, nature provided the answer: a 10” snowstorm.  Trees after a winter snowstorm – their upstretched dark deciduous branches shouldered with snow and their downreaching evergreen branches pillowed with snow – are a feast for the eyes.

  “A forest is a sacred place…The medicines available in the forest are the second most valuable gift that nature offers us; the oxygen available there is the first.”  These are the words of Irish born and educated in the ancient Celtic culture of spiritual and physical respect for trees, Diana Beresford Kroeger.  This brilliant botanist went on to receive advanced degrees, culminating in a doctorate in medical biochemistry.  She affirmed that simply walking in a pine forest is a balm for the body and soul, elevating our mood, thanks to their chemical gift of pinenes aerosols released by pine trees and absorbed by our bodies. 

The healing potential of nature even stretches to those hospitalized. Patients recovering from surgery heal more quickly and need fewer pain killers if they have a hospital room with a window that looks out onto nature.  Similarly, studies of students in classrooms with a view of nature have found that they both enjoyed learning and learned more than students without a view of nature.

Suzanne Simard worked for Canada’s minister of forests doing research on the most efficient ways to re-grow forests that had been clearcut by the logging industry.  Loving forests since a child growing up in rural British Columbia, she grasped immediately that clear-cutting whole areas of a forest and applying herbicide to kill any competitor plant or tree before replanting monoculture tree seedlings was a “war on the forest.” In testing her insight, she found that clearcutting and planting single species seedling trees made no difference to speeding up the growth of the desired tree plantation and in some cases, reduced tree survival in the monoculture wood lots. 

“Healing Forest,” Digital, Dream / Mystical, 2024.

In pursuing a doctorate and subsequent years of research, Simard documented that biodiverse forests are the healthiest of forests, with trees communicating with other trees of their own species and other species by an underground fungal network linking their roots with each other. Through this network, known as the wood wide web, trees provide chemical food and medicine to keep each other as healthy as possible.  Her work has shown that “the fungal networks between roots of diverse trees carry the same chemicals as neurotransmitters in our brain,” strongly suggesting, she says, that trees have intelligence.  She has learned from Aboriginal people that “they view trees as their people, just as they view the wolves and the bears and the salmon as their relations.”  We need that back, she asserts. 

Trees teach us lessons of community and cooperation through all the seasons, writes German forester Peter Wohlleben in The Hidden Life of Trees.  He deems forests as “superorganisms,” sharing food with their own species and even nourishing their competitors.  Together they create an ecosystem that enables them to live much longer as a community than a single living tree alone, a life lesson for us humans.  Moreover, “sick trees are supported by healthy ones nearby…until they recover; and even a dead trunk is indispensable for the cycle of lifesaving as a cradle for its young.”

Trees are essential for life on earth; the older they are, the more essential they are.  They remove carbon dioxide from the air, store carbon in their tissue and soil, give back oxygen into the atmosphere and slow global temperature increases. They offer cooling shade in hardscape urban neighborhoods, buffer cold winter winds, attract birds and wildlife, purify our air, prevent soil erosion during rainstorms and filter rainwater falling through their soil.  

Without trees, we could not survive, whereas they have and could live without us.  Older than we so-called homo sapiens (“wise men”) by a thousand times, they are wiser than many humans: they do not wage war with each other nor destroy their own habitat.  They know not genocide nor ecocide.  They are our ancestral model for cooperative, non-violent and sustainable communities.

I write this to honor and thank the multitude of forest protectors across our country and for those working to restore nature to their towns and cities.

Auburn, Al. (Special to Informed Comment) – Peter Attia, M.D. received his medical degree from Stanford University School of Medicine and trained at John Hopkins Hospital in General Surgery and worked at the NIH as a surgical oncology fellow at the National Cancer Institute focusing on immune-based therapies for melanoma. Bill Gifford, a veteran journalist, authored the N.Y. Times bestseller Spring Chicken: Stay Young Forever (or Die Trying). Each of us will one day die. There are two aspects to longevity: first, your chronological lifespan and two, your “healthspan” or how well you live. Most people die as result or effect of the “Four Horsemen,” or chronic diseases, viz., heart disease, cancer, neurogenerative disease (or type 2 diabetes) and related metabolic dysfunction.

Peter Attia (P.) argues that there are three periods or eras in medical history. Medicine 1.0 lasted two thousand years after the death of Hippocrates and dealt with observation and guesswork. Medicine 2.0 has seen its finest hour with fighting COVID-19 yet has made meager progress against what P. names the four Horsemen (heart disease, cancer, metabolic dysfunction, and metabolic syndrome including diabetes and neurodegenerative diseases like Alzheimer’s). Medicine 3.0 suggests that we have an early screening for various diseases. For example, we need to deal with cancer on three fronts: early prevention, more defective and targeted treatments, and accurate and comprehensive detection. The problem is this: we know very little about how cancer begins and why it spreads. In sum, cancer is not one, simple disease, but a condition with “mind-boggling complexity.”  Yet, despite hundreds of billions of dollars spent on research on cancer, death rates have barely moved. We are intervening at the wrong point in time, i.e., well after the disease has progressed. Most diseases have been in our body for several years before they have been detected.  

The main question in this book is this: how can we reduce our risk for disease and death, plus upgrading the quality of our lives as we age? In evaluating new patients, P. asks these basic questions: do we take in too many or two few calories? Are we adequately muscled or under muscled? Are we metabolically healthy or not? If we want to live a long life, we need a tactical plan. P. suggests these five dimensions: exercise, nutrition or diet, sleep, techniques to improve our emotional health, and various supplements, drugs, and hormones or molecules we take in from outside our body. Limitations of space allow me to speak to only three of these dimensions, viz., exercise, nutrition and sleep.

Exercise has the greatest power to determine how one will live out the rest of one’s life. Why so? Exercise retards the onset of chronic diseases, reverses physical decline, gives one more energy, and reverses cognitive decline. Doctors measure cardio-respiratory fitness in terms of VO2 max which is the maximum rate at which one uses oxygen. The good news is this: VO2 max can be increased by training. It’s especially important to strengthen one’s muscles. As a diabetic, I lift weights at the gym four times a week. I also walk vigorously seven days a week and avoid sugar and avoid eating pasta, rice, and heavy carbs. I take no medicine to control my diabetes. The last time I checked my HbA1C score was 5.9. At age 82, I can do twenty-five pushups and can walk with a forty-pound dumbbell in each hand for five minutes. Exercise acts like a drug in that it tells one’s body to produce its own endogenous drug like chemicals. Having strong muscles delays death because it preserves “healthspan” (or the quality of one’s life), as opposed to one’s life span.

Peter Attia with Bill Gifford, OUTLIVE: THE SCIENCE & ART OF LONGEVITY, (New York: Harmony Books, 2023). Click here.

Nutrition has several easy rules. One must eat essential fats, obtain the vitamins and minerals one needs, avoid fructose heavy foods (that likely cause blood- glucose spikes), eat fish, cut down on calories, and avoid pathogens like E. coli and toxins like lead or mercury. No dose of alcohol is healthy; hence I drink one or two bottles of Budweiser Zero Alcohol daily. One should also eat 50 grams of fiber each day. Foods high in protein like eggs have no effect on blood sugar. There’s no one diet for everyone. It depends on one’s health and one’s individual needs. Excess calories contribute to heart disease, cancer, metabolic disorders like diabetes, and Alzheimer’s disease.

Sleep is undoubtedly the best medicine for one’s brain. Our brain works well when we are unconscious as we process memories, thoughts and emotions, hence dreams. Sleep influences one’s memory, cognitive function, and emotional equilibrium. Sleep also staves off Alzheimer’s disease. P. suggests we sleep between seven and a half to eight- and one-half hours a night. One night of bad sleep has a negative effect on our physical and cognitive performance and wreaks havoc on our metabolism. Sleep deprivation increases insulin resistance by up to a third. Higher stress levels make us sleep poorly and cause glucose to be released from the liver. Less than six hours of sleep is associated with a 20 percent higher risk of a heart attack. Chronic bad sleep causes dementia and Alzheimer’s disease. P. notes that alcohol impairs sleep quality more than any other factor. Trazadone works well to help one sleep. The exact dose depends on the individual. Fifty milligrams or even less improves one’s sleep quality without grogginess the next day.

In sum, I give high marks to this study by P. He gives us forty pages of references and a helpful index. In sum, this book took my breath away. Highly recommended!

By never mentioning the potentially deadly side effects of Medicare Advantage plans, insurers’ pitchmen—like ‘Broadway Joe’ Namath, Danny Glover and others—mislead everyone about what Medicare Advantage enrollees are really getting into . Leaving out important (Medicare Advantage) details we better know about before we sign on the dotted line is a recipe for disaster.

WHAT IS MEDICARE ADVANTAGE ?

Medicare Advantage is a program offering private health insurance industry plans as options to replace public traditional Medicare. Medicare Advantage plans differ from traditional Medicare in that they are paid with capitation (per member), they are required to limit enrollees’ out-of-pocket spending, and can offer extra benefits (e.g. gym memberships, $900 worth of groceries, dental benefits). They almost always offer prescription drug coverage and use a defined and often restricted network of providers that can require enrollees to pay more for out-of-network care. Utilization management techniques are used, such as prior authorization, and they can also fund special programs such as rewards for beneficiaries to encourage healthy behaviors. The hope is that these differences will lead to improved care at lower cost compared to Traditional Medicare.

In reality, “Medicare Dis-Advantage” is a better, more accurate name for the programs however, as insurance companies push Congress to corporatize all of Medicare, yet keep the name for the purposes of marketing, deception, and confusion.

HOW MEDICARE ADVANTAGE PLANS DIFFER FROM TRADITIONAL MEDICARE:

* They are owned and operated by for-profit, private insurance corporations;
* Unlike traditional Medicare, Medicare Advantage plans often refuse to pay for treatments and medications physicians prescribe;
* Unlike traditional Medicare, many physicians, other healthcare professionals, and hospitals will be off-limits to patients because Medicare Advantage companies create their own proprietary and often skimpy, managed care type “networks” of healthcare providers;
* If patients go out of network, they could be on the hook for thousands of dollars out of their own pocket; and
* They likely will have to pay extra—often a lot extra—for some of those extra benefits.

OVERCHARGING BY MEDICARE ADVANTAGE PLANS:

A). To put the sheer magnitude of overcharging in MA in perspective, a CBO analysis of a 2019 bill proposing to add dental, hearing, and vision benefits to Medicare and Medicaid estimated that in the most expensive year of its implementation, these benefits would cost a combined $84 billion.

B). Even by minimum estimates, private insurers receive more than enough surplus money to provide critically needed benefits to all Medicare and Medicaid beneficiaries.

C). Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American health care, siphoning money from vulnerable patients while delaying and denying necessary and often life-saving treatment.

D). While there is obvious reason to fix these issues in MA and to expand Traditional Medicare for the sake of all beneficiaries, the deep structural problems with our health care system will only be fixed when we achieve “improved Medicare for All.”

ARE YOU CONSIDERING ENROLLMENT IN A MEDICARE ADVANTAGE PLAN?
! C A V E A T E M P T O R – B U Y E R. B E W A R E !

1). DON’T DO IT ! Stay with (or return) to traditional Medicare and buy a supplemental Medigap policy, because unfortunately, traditional Medicare has some big holes in it.

2). The trouble with Medicare Advantage plans is they look good while you’re healthy. But when you get sick, odds are high they will deny you.

3). Beware of another important factor: The door will have been slammed behind you if you have been in Medicare Advantage for more than six months and then decide you want to return /re-enroll in traditional Medicare.

4). With the exception of four states in this country, if you’re in Medicare Advantage for more than six months and decide you want to go back, and then buy a supplemental coverage, the insurance companies that sell you supplemental coverage can turn you down for supplemental coverage..

5) If they don’t like the look of your pre-existing conditions, they can also charge you a lot more money.

6). You need to make this decision in the next six months enrollment timeframe if you are still fairly new to MA.

7) The basic recommendation to everyone is: don’t even think about enrolling in Medicare Advantage in the first place!

DON’T ALLOW PRIVATE HEALTH INSURANCE INDUSTRY TO DISMANTLE TRADITIONAL MEDICARE: REJECT MA !

DISMANTLING MEDICARE WITH MEDICARE ADVANTAGE: Over 50% of Medicare beneficiaries have signed up and now have for-profit corporations in charge of their care through Medicare Advantage (MA). Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving patients with no option but to give their money to private insurers.

DENYING TREATMENT: Investigations into claim denials in MA found that insurers were inappropriately denying treatments and tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.

DECEIVING PATIENTS AND TAXPAYERS: Reports from journalists, researchers, and government agencies have shown that health insurance companies like United Health and Cigna overcharge Medicare by giving patients exaggerated,upcoded or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking citizens’ tax dollars for conditions they aren’t even treating.

Image by Arvi Pandey from Pixabay

BOTTOM LINE: Medicare Advantage is not the same Medicare program that Americans have come to know and love. The private insurance industry has spend millions on advertising in order to hide the ugly truth: Their MA plans raid taxpayer funds and routinely fail to deliver the care that patients expect and deserve.

TERMINATE MEDICARE ADVANTAGE: Physicians for a National Health Program (PNHP), concludes that the Center for Medicare Services (CMS) should terminate the Medicare Advantage program. It would be far more cost-effective for CMS to improve traditional Medicare by capping out-of-pocket costs and adding improved benefits within the Medicare fee-for-service system than to try to indirectly offer these improvements through private plans that require much higher overhead and introduce profiteers and perverse incentives into Medicare, enabling corporate fraud and abuse, raising cost to the Medicare Trust Fund, and worsening disparities in care. These problems are not correctable within the competitive private insurance business model, and the Medicare Advantage program should be terminated.

BIG INSURANCE MOTIVATED BY PROFIT:

Highly respected healthcare reform advocate, Wendall Potter, reports on the alarming scope of profiteering by Medicare Advantage plans:

1). Big Insurance revenues and profits have increased by 300% and 287% respectively since 2012 due to explosive growth in the insurance companies’ pharmacy benefit management (PBM) businesses and the Medicare replacement plans called Medicare Advantage.

2). The for-profits now control more than 70% of the Medicare Advantage market. In 2022, Big Insurance revenues reached $1.25 trillion and profits soared to $69.3 billion. That’s a 300% increase in revenue and a 287% increase in profits from 2012, when revenue was $412.9 billion and profits were $24 billion.

3). Big insurers’ revenues have grown dramatically over the past decade, the result of consolidation in the PBM business and taxpayer-supported Medicare and Medicaid programs.

4). What has changed dramatically over the decade is that the big insurers are now getting far more of their revenues from the pharmaceutical supply chain, Medicare, Medicaid, and from taxpayers as they have moved aggressively into government programs. This is especially true of Humana, Centene, and Molina, which now get, respectively, 85%, 88%, and 94% of their health-plan revenues from government programs.

5). The two biggest drivers are their fast-growing pharmacy benefit managers (PBMs), the relatively new and little-known middleman between patients and pharmaceutical drug manufacturers, and the privately owned and operated Medicare replacement plans marketed as Medicare Advantage.

6). Huge strides in privatizing both Medicare and Medicaid have been made. More than 90% of health-plan revenues at three of the health industry companies come from government programs as they continue to privatize both Medicare and Medicaid, through Medicare Advantage in particular. Enrollment in government-funded programs increased by 261% in 10 years.

TURNING PUBLIC MONEY INTO A BONANZA OF PRIVATE RICHES:

for the”BigInsurance/BigPharma/Congressional Complex”

Political support for private health insurance industry and Medicare Advantage exists because our government permits private health insurance companies to exact large profit from its citizens as Wall Street banks and investors who back Big Insurance turn public money into a bonanza of private riches. High health insurance costs are the result of a political decision to essentially allow Big Insurance to do what they want and charge whatever they want. It’s no wonder so many beholden members of Congress want to protect the interests of their donors, Big Insurance and Big Pharma, industries that spent $371 million on lobbying in 2017.

The website/blog The Lever reported that The Better Medicare Alliance, an advocacy group for Medicare Advantage plans, spent $570,000 lobbying Congress in the first quarter of this year, nearly double the $330,000 spent in the prior quarter. All told, the four major publicly traded health insurance companies that operate Medicare Advantage plans, as well as the insurance lobby America’s Health Insurance Plans, spent nearly $19 million on federal lobbying in the first quarter of 2023, a 66% increase from the prior quarter, according to a Lever analysis of data from OpenSecrets.

The USA is a country where health insurance for medical and mental healthcare is a function of socioeconomic status. Everyone knows that this inhumane system should have been corrected long ago. We must immediately end our moral crime of having one of the greatest health system in the world, but only for those who can afford it. We must support the common principles that healthcare is a human right, must be free from corporate profit, and must be achieved through national legislation.

Let’s never forget that universal Medicare for All is a solid investment in, not a cost for, all citizens of our country by simply promoting a social service for universal access to affordable healthcare insurance for all. Aren’t we a society that cares enough to see that everyone receive the healthcare they need? That’s the basic purpose of Medicare for All. The history of our most successful national health insurance program, Medicare, provides one of the best arguments for expanding the program to cover everyone. It’s time to end inadequate and dangerous health insurance programs like Medicare Advantage. Insist on real health insurance reform essential for individuals and families.

Contact your legislators asking them to oppose and end Medicare Advantage plans immediately. Most importantly, ask them to strongly support new legislation now filed in Congress, “The Medicare for All Act of 2023” House Bill (H.R. 3421) and Senate Bill (S. 1655) that would establish this badly needed reform.

Review of Tylor Brand, Famine Worlds: Life at the Edge of Suffering in Lebanon’s Great War (Stanford: Stanford University Press, 2023).

Munich (Special to Informed Comment) – Suez, Gallipoli, Kut al-Amara, and Jerusalem saw some of the major battles of the First World War in the Middle East. The countries that are nowadays Egypt, Turkey, Iraq, and Israel/Palestine were the scene of considerable fighting between the Ottomans and the British during the conflict that would bring about the collapse of the Ottoman Empire. On the contrary, the territories that currently belong to the modern state of Lebanon saw no fighting during the war. The global conflagration, however, also brought death to Lebanon, if only more slowly and indirectly.

It was hunger, and the vulnerability to disease that came with it, that decimated Lebanon. We learn about this in the book Famine Worlds: Life at the Edge of Suffering in Lebanon’s Great War. The author, Tylor Brand, is an Assistant Professor in Near and Middle Eastern Studies at Trinity College Dublin. In Famine Worlds, he brilliantly studies how the population of Lebanon experienced a famine that brought massive death, changed society, and left an often unspoken but indelible mark on the country’s historical consciousness.

Brand writes that historically, there have been two main narratives to explain the causes of the famine in Lebanon. One ascribes responsibility to the Ottoman administration and blames it for having intentionally starved Lebanon. The other points at the blockade of Lebanese ports by the Entente powers, which abruptly stopped grain imports, of vital importance for a region that was not food self-sufficient. Neither of these explanations fully convinces Brand, who presents a more nuanced view. The Ottoman administration was certainly responsible for the shortage of labor in the agricultural sector that followed the conscription of peasants to fight in the war, as well as for the army’s mismanagement of grain reserves in Syria. Even so, there was no deliberate Ottoman policy that led to Lebanon’s suffering.

Meanwhile, the Entente blockade severely restricted Lebanon’s options to secure its food supply. Moreover, the blockade was accompanied by the halt of remittances from Lebanese migrants in Europe to their home country, with the ensuing decline in the purchasing power of many Lebanese. But the Ottoman Empire entered the war with considerable grain reserves and the famine in Lebanon cannot simply be explained by a lack of food. Equally important was the food speculation of Lebanese businessmen who, after trade routes were closed by the blockade, decided to make a profit in the local grain markets. And, although the famine was largely man-made, a plague of locusts that decimated local crops made matters worse.

Brand is deeply skeptical about the possibility of establishing with some certainty how many people succumbed to the famine in Lebanon during the First World War. He points out that “the available statistics are little more than pointed guesses or ways to denote severity” and notes that, although death tolls are important, “suffering in famine does not necessarily correlate with death.”[1] It is this suffering, and the Lebanese population’s resistance to it, that is the focus of Famine Worlds. The book is not a political history of the Ottoman authorities’ response to the food crisis. Sometimes, the reader might actually feel that the political and historical contextualization of the famine is too vague. Instead, Brand’s attention is focused on how the Lebanese society experienced this period of widespread hunger and disease.

This is no simple task. The newspapers of the period are of little use due to the strong censorship imposed by the Ottoman authorities during the war. Brand’s research importantly relies on memoirs, letters, and reports written during the war period or shortly afterwards. Many of these were authored by Americans employed in education or missionary institution in Lebanon. While British and French citizens had to abandon the country when the First World War began, American nationals could stay as the United States never declared war against the Ottoman Empire.

Tylor Brand, Famine Worlds: Life at the Edge of Suffering in Lebanon’s Great War. Click here.

The Americans were relatively privileged as they had sufficient resources to avoid hunger, even if they could not always escape the diseases that proliferated during the period. In this sense, the contemporary accounts of Americans living in Lebanon need to be understood as the writings of first-hand witnesses to hunger, not of people whose bodies and minds deteriorated as food became increasingly scarce. It is difficult to know how the poor, and the former members of the middle class who were impoverished by the exorbitant prices of food, would have told their own stories. Even so, when we consider all the limitations, Brand succeeds in presenting a portrait of how the famine shaped the lives of ordinary people.

Famine Worlds describes a society in which ownership of land and animals, as well as the social capital of family, community, and patronage networks, could be the difference between life and death. It was also a society where the ubiquity of death and suffering progressively anesthetized people’s consciences. Jirjis al-Maqdisi, who published in 1919 a historical account of the effects of the war on Lebanon, describes this change in detail. Al-Maqdisi writes: “In 1915, the sight of a starving man falling would cause people to surround him and give him some water, some food, and some dirhams. By 1916 we would walk in the streets with men, women and children lying in the mud on both sides, whimpering for mercy or for a crust of bread. (…) Most frequently, on passing, people turned their face and blocked their ears so they could not see or hear.”[2]

With the spread of a typhus epidemic, the poor and their emaciated bodies were not only an uncomfortable sight to the relatively privileged. They were also seen as “potential carriers of deadly disease.”[3] Despite their vulnerability, Brand cautions against imagining the poor as devoid of agency. They had very limited options, but they exploited them to the fullest. They changed their diets and migrated in search of work or aid. As Brand notes, “not all survived, but no one lay down to die without a fight.”[4]

This rebellion against a looming death often implied a subversion of the traditional moral codes that governed social life until that moment. As Middle East historian Najwa al-Qattan succinctly puts it in an article discussing the famine, “the question of food during the war was about morality as well as mortality.”[5] Thievery and robbery saw a dramatic increase, and the same happened with prostitution. Very often, the desperation brought by hunger and disease on most of the population was not reason enough for the privileged to suspend their usual moral judgments. The American Red Cross and the American missionaries in Lebanon saved many lives but, as Brand documents, used moralistic criteria when deciding who deserved help.

Beggars, people with physical disabilities, or those who suffered from syphilis (a sexually transmitted disease likely to prey upon prostitutes), were to be denied aid after the American Relief Committee adopted a new set of guidelines in late 1917. Faced with an increase in aid demands and declining resources, the American humanitarian organizations adopted a policy that “instead of seeking to preserve the helpless, (…) deliberately excluded those whose physical or perceived moral characteristics rendered them unworthy.”[6]

Writing in 2014, on the occasion of the 100^th anniversary of the beginning of the First World War, Najwa al-Qattan noted that “the famine does not occupy a prominent place in nationalist and other public narratives of the war, where it competes with more heroic public markers of the period, such as the Arab Revolt.”[7] In Famine Worlds, writing a decade after al-Qattan, Brand explains that the centennial of the Great War significantly contributed to more people learning about the famine in Lebanon during the conflict. Back in 2014, al-Qattan lamented that victims of the famine were not “publicly mourned or memorialized.”[8] This appears to be slowly changing. In 2018, for instance, a sculpture to remember the victims of the famine was unveiled in Beirut.

The expert on conflict and humanitarian crises Alex de Waal notes that most famines are caused by war and political repression, with the current situation of widespread hunger in Yemen being no exception. De Waal adds that the main driver of hunger in Yemen is not a lack of food but the fact that “a large section of the population simply doesn’t have money to buy it from the local markets.” Swarms of red desert locusts have also negatively affected domestic agricultural production. The famine that ravaged Lebanon during the First World War has strong echoes in our current times.

[1] Tylor Brand, Famine Worlds: Life at the Edge of Suffering in Lebanon’s Great War (Stanford: Stanford University Press, 2023), p. 41.

[2] Quoted in ibid., p. 98.

[3] Ibid., p. 145.

[4] Ibid., p. 82.

[5] Najwa Al-Qattan, “When Mothers Ate Their Children: Wartime Memory and the Language of Food in Syria and Lebanon,” International Journal of Middle East Studies 46, no. 4 (2014): 721.

[6] Brand, Famine Worlds: Life at the Edge of Suffering in Lebanon’s Great War, pp. 164-5.

[7] Najwa Al-Qattan, “When Mothers Ate Their Children”: 722

[8] Ibid.