This week, I want to pause to celebrate some of my friends who I find really inspiring. I don’t get a chance to see these folks much in person anymore as we’ve all moved on with our lives. They came into my life through various avenues – a childhood friend (C), high school (Sh), community work (K), and two I met through working at the bar (Sa and Y) – and yet thanks to technology and one of the few positive benefits of social media, I get to be a passive viewer as they live out their lives.
The concept of fitness is fraught with some terrible associations about what it means to be or look healthy. I don’t look to these friends because they embody some ideal of fitness, but for a more important reason. I admire them because they are consistent and dedicated, which is something I struggle with from time to time. Every day that I scroll through my feed, one or more of my friends are sharing the fitness part of their lives by showing up and putting in their time towards their goals.
“C”, for instance, is killer with her cardio and puts my runs to shame. “Sh” is in the gym almost every morning before I am conscious enough to roll out of bed. “K” has logged so many days of running on the trail, riding on her bike, and hours on the mat that she could stop all activity and I doubt I’d still catch up in my lifetime. “Y” is an absolute beast of a man and can deadlift two of me, but is one of the nicest guys I’ve had the privilege of working with. And “Sa,” who I’ve been fortunate to train with, is there, everyday, training his students in athletics and the martial arts.
These aren’t perfect people. Each of them has had their ups and downs, and has struggled in battle with their own personal demons. It’s not the “fitness” that makes me proud of their work, it’s because they inspire me to show up and not get discouraged.
To my friends – I see you. I see all of your hard work. I appreciate how honest you are. And I applaud that you all seem to do what you do for good, noble reasons. You aren’t vain and aren’t doing it for the attention. You are doing it for you, to live your best lives. To challenge yourself and to focus your energies.
In the ethics of conducting research with human participants, there is the concept of “informed consent.” At its foundation, informed consent is the process of communicating a sufficient amount of information about a research project to a prospective participant so that the prospect is able to decide whether they want to consent to being a participant in a study. There is a lot of nuance that can go into selecting what gets communicated because you have a lot of necessary information that needs be shared but you don’t want to share so much information that the participant is overwhelmed by the volume of information.
When I review research ethics applications, I am privy to a lot of information about the project. In the course of reviewing the project, I have to make judgement calls about what should be included in the informed consent letters that participants read. It would be counter-productive if the participant had to read all the documentation I am required to read when reviewing an application, so we use certain best practices and principles to decide what information gets communicated as a standard, and what is left in the application.
There is, of course, some challenges that we must confront in this process. As I said, when reviewing a research project, you have to balance the needs of the project with the needs of a participant. All research, by virtue of exploring the unknown, carries with it an element of risk. When you involve humans in a research project, you are asking them to shoulder some of the risk in the name of progress. Our job as researchers and reviewers is to anticpate risk and mitigate it where possible. We are stewards of the well-being of the participants, and we use our experience and expertise to protect the particpants.
This means that one challenge is communicating risk to participants and helping them understand the implications of the risks of the research. In many instances, the participants are well aware of risks posed to their normal, every-day lived experiences and how the research intersects with it. The patient living with a medical condition is aware of their pain or suffering, and can appreciate risks associated with medical interventions. A person living in poverty is acutely aware of what it means to live in poverty, and understands that discussing their experiences can be psychologically and emotionally difficult. Our jobs (as reviewers and researchers) is to ensure that the participant is made aware of the risk, mitigate it as much as we can without compromising the integrity of the research program, and to contextualize the risk so that the participant can make choices for themselves without coercion.
The concept of informed consent is hugely important, arguably the most important component of research projects involving humans as participants. It is an acknowledgement that people are ends in themselves, not a means to furthering knowledge or the researcher’s private or professional goals. Indeed, without a respect for the autonomy of the participant, research projects are likely to not be moved into action even when research funds are available.
All of this is a preamble to discuss the anger I felt when I read a recent CBC report on how anti-vaxxer advocates are using the concept of informed consent as a dog-whistle to their adherents, and are using informed consent as a way of both furthering their awareness and raising money with well-meaning politicians and the public.
In fairness, I can see the chain of reasoning at play that tries to connect informed consent with concerns about vaccines. For instance, in the article there is a photo of supporters of a vaccine choice group with a banner that reads “If there is a risk there must be a choice.” This sentiment is entirely consistent with the principles of informed consent. The problem with this application is that the risk is not being communicated and understood properly within context, and instead fear, misinformation, and conspiracies that lead to paternalistic paranoia are short-cutting the conversation. Further, the incentive structures that are borne out of the economics of our medical system are doing little to address these fears. Because so little money is flowing from the government to the medical system, doctors are forced to maximize the number of patients they see in a day just to ensure enough money is coming into the practice to pay for space, equipment, staff, insurance, and supplies. Rather than seeking quality face-to-face time with a patient, doctors have to make a choice to limit patient time to just focus on a chief complaint and address questions as efficiently as they can.
I don’t think it’s all the doctor’s fault either. I think we as patients, or more specifically we as a society, have a terrible grasp of medical and scientific literacy. I don’t have a strong opinion about what the root cause of this is, but some combination of underfunded schooling, rapid technological innovation, growing income disparities, entertainment pacification, a lack of mental health support, increasingly complex life systems, and precarious economic living in the average household are all influencing the poor grasp people have about what makes the world around us work. Rather than being the case that we are hyper-specialized in our worldviews, I think it’s the case that “life” is too complex for the average person to invest time into understanding. Let’s be clear, it is not the case that the average person isn’t smart enough to grasp it (even if sometimes my frustration with people leads me to this conclusion). Instead, I think that people are pulled in so many directions that they don’t have the time or economic freedom to deal with things that don’t immediately pay off for them. People are so fixated on just making it day-to-day and trying not to fall behind that it becomes a luxury to have the leisure time to devote to these kinds of activities.
What this results in, then, is the perfect storm of ignorance and fear that congeals into a tribal call to rebel against the paternalism of a system that is ironically also too cash-strapped to allow the flexibility to educate people on the nature of risk. People don’t have the time and ability to educate themselves, and doctors don’t have the time to share their experiences and knowledge with their patients.
Within this gap, opportunistic charlatans and sophists thrive to capitalize on people’s fears to push their own agendas. This is why bad actors like the disgraced former doctor Andrew Wakefield and movement leader Del Bigtree are able to charge fees to profit from speaking at anti-vaccination events. I’m not saying a person who spreads a message should do it for free. What I am saying is that they are able to turn a personal profit by preying on people’s fears while doing little to investigate the thing they claim to worry about.
We must find a way to communicate two simultaneous truths:
There is an inherent risk in everything; bad stuff happens to good people, and you can do everything right and still lose. Nevertheless, the risks involved when it comes to vaccines are worth shouldering because of the net good that comes from it and the risks themselves are vanishingly small.
In the 22 years since Wakefield published his study and the 16 years since its retraction, there has not been any peer-reviewed credible evidence that supports many of the claims given by the anti-vaxx movement. The movement is predicated on fears people have of the probability of something bad happening to them or their loved ones. The motivation behind the fear is legitimate, but the object of the fear is a bogeyman that hides behind whatever shadows it can find as more and more light is cast on this area.
The anti-vaxx ideology knows it cannot address head-on the mounting scientific evidence that discredits its premise, and so it instead focuses on a different avenue of attack.
This bears repeating: the anti-vaxx ideology cannot debate or refute the scientific evidence about vaccination. We know vaccines work. We know how they work; we know why they work. We understand the probabilities of the risk; we know the type and magnitudes of the risks. These things are known to us. Anti-vaxx belief is a deliberate falsehood when it denies any of what we know.
Because of this, the anti-vaxx ideology is shifting to speak to those deep fears we have of the unknown, and instead of dealing with the facts of medicine, it is sinking its claws into the deep desire we have for freedom and autonomy. It shortcuts our rational experience and appeals to the fears evolution has given us to grapples with the unknown – the knee-jerk rejection of things we don’t understand.
Informed consent as a concept is the latest victim of anti-vaxx’s contagion. It’s seeping in and corrupting it from the inside, turning the very principle of self-directed autonomy against a person’s self-interest. It doesn’t cast doubt by calling the science into question. Instead, it casts doubt precisely because the average person doesn’t understand the science, and so that unknown becomes scary to us and we reject or avoid what brings us fear.
Anti-vaxx ideology is a memetic virus. In our society’s wealth, luxury, and tech-enabled friction-free lives, we have allowed this dangerous idea to gain strength. By ignoring it and ridiculing it until now, we have come to a point where it threatens to disrupt social homeostasis. Unless we do something to change the conditions we find ourselves in – unless we are willing to do the hard work – I fear that this ideology is going to replicate at a rate that we can’t stop. It will reach a critical mass, infect enough people, and threaten to undo all the hard work achieved in the past. We have already seen the evidence of this as once-eradicated diseases are popping up in our communities. The immunity and innoculations have weakened. Let’s hope those walls don’t break.
As the year is winding down, I (like many others) am beginning the process of looking over the year that was and weighing in on how things went. While I ideally would have set goals for myself for 2019, truthfully I am terrible on the follow-through and I ended up setting something more akin to an “intention.” For instance, over the last two years, I had set as a New Year’s resolution to 1.) stop being late for things, 2.) keep exercising, and 3.) start making better eye contact when talking to people.
In reality, I’m still late for everything (but at least I track it), I stopped exercising a while ago (I’m disheartened no one called me out about it on social media), and I still feel my eye contact at work is spotty at best.
Last year though, instead of creating a quarterly goal for myself, I set a grand focus or theme for the year. I had tried setting quarterly themes for myself a few years ago, but I found that I wasn’t making progress during the quarter through poor goal management on my part, so I simplified and decided to work on one thing for the year.
At the start of 2019, I decided I would place greater emphasis on my health. I kept it fairly broad in its application, but I did brainstorm a number of concrete areas I could work on, such as weight loss, lowering my blood pressure, regularly attending the gym, better nutrition.
I think the fact that I kept things open-ended was a main reason why I feel like I didn’t accomplish this focus as well as I had wanted to. Had I set specific goals with realistic action items, I might have made better progress.
That’s not to say I haven’t “lived healthier.” For instance, I have:
experimented with intermittent fasting all throughout the year which did help to keep my overall weight regulated.
finally got a family doctor after having been dropped from my doctor when she closed her practice a decade ago.
went in for my first physical in a long time and had blood work done to check-in on how my body is doing.
been weighing myself and measuring blood pressure more frequently, though still haphazardly.
experimented with app-based meditation; I found the experience interesting and meriting further exploration, but I haven’t carved out the time to dedicate to it.
while on my honeymoon I hiked up Mt. Vesuvio and did a roundtrip on the Path of the God hike (nearly 20km and 200 flights of stairs registered on my Fitbit for the day).
began tracking things like my down/depressed days, headaches, and time with family and friends in addition to my sleep tracker.
visited my optometrist for a check-up.
two regular visits to the dentist.
cut down on the amount of junk food I take in my lunches at work to essentially zero.
While these aren’t quantified victories, there are worthwhile achievements to celebrate. As I look to the new year, one lesson I can draw is that limiting my one thing for the year is a good way to focus my attention, but if I want to make any tangible progress (e.g. weight loss on the scale), I would still need to set proper SMART goals and create an action plan that requires me to carve out time intentionally.
I’ve been thinking about endurance recently, specifically in two areas of my life. First, I’ve been experimenting with intermittent fasting since January of this year and I’ll be sharing some reflections on it soon. By fasting each day, it requires a certain amount of endurance to push through on cognitively and physically demanding tasks while your body deals with the exertion in a fasted state.
Second, as the winter weather hits us, I have to endure colder temperatures while working at the bar. I’ve managed to push myself over the last two years and use a sufficient number of clothing layers to eschew wearing a coat while on the door position. I have the coat on hand, but I like the challenge of working without it and standing outdoors for long stretches of time exposed to the elements.
It might seem silly or pointless to put myself in these positions when I don’t have to – I make enough money so that I never need to worry about food scarcity or not owning enough proper clothing to protect myself. On some level, it’s stupid machismo to willfully deprive myself in this way. Yet, I like the challenge and the sense of satisfaction that I can achieve some level of control or mastery over myself and my situation.
While recently listening to Oprah’s book The Path Made Clear, I came across a really interesting way of framing this tendency I have. The specific section runs from 4:53-5:52 of the clip below, where Oprah is chatting with Alanis Morissette about the yearning to seek out a time in the future where all your present problems are solved and you are finally happy. They discuss that this forward-orientated hope for the future never manifests itself as peace; that money and fame doesn’t bring you happiness or contentment. Instead, you are always chasing that future where you are free from whatever pain you feel in the present.
“One of the big lessons I’ve learned over the last little while has been that if I can be comfortable with pain, which is different than suffering, if I can be comfortable with pain, as just an indication, and it’s potentially a daily thing (in my case it often is) then there won’t be my living in the future all the time; that one day if and when I will be happy.
“And even if I’m not comfortable doing that, I’m very uncomfortable in pain – I hate it – we run from it with all kinds of addictive, fun things (temporarily fun things). But at least knowing it’s a portal, and that on the other side is this great sense of peace that goes beyond this ego development.”
~Alanis Morissette (lightly edited for readability)
This sentiment spoke to me. I have an affinity towards stoicism and the idea that one should re-frame their relationship with the external. To me, I like knowing that I can endure, even when I don’t have to. It becomes practice for those moments when I need to dig in deep to perform, because life isn’t always easy. Through this practice, I can also appreciate my comforts all the more. And, it also doesn’t need to run in opposition of my goal to remove discomfort from my life so long as I remember that I’m not entitled to a life of comfort and ease and instead have to intentionally earn it.
I acknowledge that I’m fortunate not to live with serious pain or suffering. I have a comfortable life and I wouldn’t exchange it for machismo points. I don’t think the point of life is to suffer, but instead my goal is to learn to suffer well when life brings me pain.
In January of 2008, I was walking through my university campus’s student centre and passed by a table for the UW Campus Response Team, whom were recruiting volunteers for the new semester. I doubled back, chatted with the team members, and signed-up to participate in their interview process. I had taken first aid courses periodically during my cub scout and army cadet days, plus I had ran some basic first aid courses while abroad, so it felt like a good fit.
In retrospect, my “experience” was quite paltry, but I had shown the team managers that I had enough of the “right stuff” that they invited me to join the team and participate in the weekend training course they put on for new recruits. It’s an intense crash course in first aid skills that were well beyond my experiences and the training spanned several hours Friday night and all days Saturday and Sunday, before you perform your final scenario test to qualify as a secondary responder.
The material covered was largely derived from emergency first responder courses, along with some material covered for pre-hospital trauma professions (e.g. fire fighters and paramedics). The training was designed to create heuristics in the responder’s mind to quickly flow through critical details while gathering as much information as possible and start treatment momentum. The last thing you want is for a responder to have to intentionally think through what steps they should follow, because it shunts cognitive capacity away from situational awareness and into operational procedures.
In an effort to automate one’s thinking, you end up doing a lot of mock scenarios and skill drills. As a responder, you end up creating a script in your mind to follow. The script is based on a common set of things to attend to, which you follow according to handy mnemonics and other memory aids.
Despite the mnemonics functioning to provide mental triggers for actions, you still need to learn the process to go along with the mnemonics, and from the start of training weekend, you only have precious few hours after training concludes for the day to encode the information out of your working memory and into longer term storage.
I needed a way to quickly drill myself and aid in recall. The system I settled on was to get some window writable markers and write out my mnemonic devices on the bathroom mirror. Every time I used or walked passed the washroom, I would attempt to fill in as many of the mnemonics as I could remember, and note where I made mistakes. Through constant repetition, I was able to turn:
Mechanism of injury?
Count the casualties
Signs and Symptoms
Past medical history
Last meal/beverage intake
It was a quick and dirty way to give myself quick feedback on these concepts that I could readily apply to my first aid treatment during training and eventually on shift. Any time I lost momentum or felt nervous about the judges evaluating me, I would mentally go back to my bathroom mirror and fill in the blanks. I haven’t been on the first aid team in almost a decade but these concepts easily come back to me, even during my crazy nights at the bar. It’s a testament to the stickiness of the ideas and the effectiveness of the drills.
I’ve noticed something about myself: as time goes on, it’s getting easier for me to make “good” choices. I’m not sure if everyone shares this and it’s a common thing as we get older, but I’m finding it easier to do things that I struggled with when I was younger. Through some combination of experience, changes in my living conditions, and physiology, my ability to adopt certain habits and mindsets has improved. Here are a few examples I’ve noted.
First, sometime around turning 30, I found it easier to start going to the gym and exercise. Maybe it was the tail-end of the quarter-life crisis, but going to the gym (and paying for it!) seemed like a more important thing and it was easier to embrace. The trick is to make the habit stick.
Also around the time I turned 30, I found it important to stop pirating media content. Instead, I sought out legitimate sources for content, such as the library, paying the $1 for song and app purchases, paying for Spotify, renting movies on my gaming system, etc. I’m not perfect – I still pirate foreign shows from fan sites that subtitle the content and I make liberal use of an adblocker, but overall I have shifted away from feeling entitled to content to valuing paying for it.
Recently, I found it super easy to start flossing. This might also be an existential issue, where my teeth aren’t going to get any better, so it’s important for me to take care of my gums.
Even turning down junk food is getting easier. I appreciate that my body is changing, and it no longer has the resiliency to allow me to eat whatever I want. In my 20’s, I could eat anything I wanted at any time and I never felt sick because of it. Now, I find that those same poor choices lead me to feeling off or ill in the hours that follow. The food was never good for me, but in my 20’s I didn’t experience the short-term negative feedback that told me it was bad to consume junk (instead, it was just hurting me long-term through slowly accumulating body fat and other bad stuff).
This is not to say that I’m now perfectly virtuous. I can’t get the gym habit to stick quite yet, I binge on Nibs and Netflix when the opportunity presents itself, I enjoy my craft beers, and I never go to bed on time. I’ve been experimenting with systems to help stem my poor self-control (such as intermittent fasting or connecting my router to a timer) in order to give my rational brain a leg up on my monkey brain. It’s a slow, steady, incremental slog towards progress, but I keep at it.
I suppose a common thread that runs through all of this is that the short-term downsides that come with bad decisions are finally manifesting themselves, which provides near-immediate feedback. Rather than putting off the negative outcomes to some indeterminate point in the future, my body and attitude are giving me early signals that bad choices have consequences – consequences that can be mitigated if you address it now (exercise, good nutrition, and flossing are all forms of preventative maintenance, which Jim and I talked about on our podcast a few years ago).
This reminds of an exchange between Socrates and Cephalus from Book 1 of Plato’s Republic, when Cephalus is talking about what it’s like to be old and free from the passions of youth. Being in my 30’s is a far cry from “being old,” but I think we can derive wisdom from the speech:
“I will tell you, Socrates, (Cephauls) said, what my own feeling is. Men of my age flock together; we are birds of a feather, as the old proverb says; and at our meetings the tale of my acquaintance commonly is –I cannot eat, I cannot drink; the pleasures of youth and love are fled away: there was a good time once, but now that is gone, and life is no longer life. Some complain of the slights which are put upon them by relations, and they will tell you sadly of how many evils their old age is the cause. But to me, Socrates, these complainers seem to blame that which is not really in fault. For if old age were the cause, I too being old, and every other old man, would have felt as they do. But this is not my own experience, nor that of others whom I have known. How well I remember the aged poet Sophocles, when in answer to the question, How does love suit with age, Sophocles, –are you still the man you were? Peace, he replied; most gladly have I escaped the thing of which you speak; I feel as if I had escaped from a mad and furious master. His words have often occurred to my mind since, and they seem as good to me now as at the time when he uttered them. For certainly old age has a great sense of calm and freedom; when the passions relax their hold, then, as Sophocles says, we are freed from the grasp not of one mad master only, but of many. The truth is, Socrates, that these regrets, and also the complaints about relations, are to be attributed to the same cause, which is not old age, but men’s characters and tempers; for he who is of a calm and happy nature will hardly feel the pressure of age, but to him who is of an opposite disposition youth and age are equally a burden.”