Happy New Year From the Boss

I want to take a moment to wish my wonderful office staff at Dartmouth Medical a Happy New Year. Dallas Leonard, NP has been practicing at Dartmouth for over a year and I am so gratified to rely on her judgement and clinical acumen in the care of our patients. It is one of the joys of my life to be able to work with each of the staff members every day. I appreciate all of the staff for your insight, observations and opinions regarding the running of the practice and each of you brings a different perspective to your jobs. It is often revealing for me to sit at the nurses desk or to look out the reception window and imagine what it must be like to come to work each day. In this way, I am able to help solve the problems you may encounter, reaffirm and protect our valuable office culture and move the practice forward.

As always, our office will face new challenges and growth in this new year. I hope to be the best manager that I can be and to steward the practice wisely in the coming year.

Very Special Thanks:

The Saturday and support providers; Deb Bradford, NP, Leslie Stefanowicz, NP, Dr. Christiansen and Dr. Cummings have all done wonderful work this past year. Thank you! We welcome our new phlebotomist, Roberta from U Mass Lab. Thanks to the computer support team; Think Tech, our office consultants; Michelle Gerez, Kelly Walsh at Affusion Group, Corrigan Financial and Paradigm Consulting. Many thanks to Brian Chisholm, CPA from Kane and Kane who manages all of our finances, John Bentley, Esq. who looks after our legal questions. Thanks also to the area pharmacies who help our patients and to the medical specialists in our area who are so accomodating when we need them. Special thanks to the local ambulance companies, St. Anne's Pain Management Center and to the ER staff and physicians at St. Anne's, St. Lukes, and Charlton Memorial Hospitals. Our work every day with our patients requires a vast network of professionals and support staff in southern Massachusetts.

I wish all of you and your families a happy, healthy and safe New Year!

Healthier Longer Life.org

The New England Journal of Medicine published a review article this month on a new website called, Healthier Longer Life (http://healthierlongerlife.org/). The premise of the article is to bring public awareness to a comprehensive wellness and disease prevention information project which has been published by Drs. Carl Bartecchi and Robert Schrier. Their 224 page book can be downloaded free of charge from their website.

The book was distributed in bound form to 60,000 households in Colorado. One of the goals of the project was to try and engage the general population and to "have patients share in decision making about their health care which has been shown to improve patient adherence to prevention guidelines, increasing their satisfaction with the outcome of the clinical treatment or both."

The Journal article goes on to explain that the Internet has been a mixed blessing as "many patients are confused by the contradictory advice retrieved when they enter a search term on Google or Yahoo. Authoritative sources are critically important, and this book is an important addition to Web sites such as the one sponsored by the U.S Preventive Services Task Force."

I will be ordering a copy and reviewing it. At less than $5.00 per copy it might be just the thing to place in each examining room in my office instead of Field and Stream magazine.

Excerpt:
When discussing the risk of heart attacks, the authors note;
"For those who might wonder what a person with low risk factors would look like, here is an example. The ideal is a person between the ages of 35 and 74 who has:
1. Systolic blood pressure less than 120.
2. Diastolic blood pressure less than 80.
3. LDL cholesterol less than 100 mg/dl.
4. HDL cholesterol higher than 60 mg/dl.
5. Fasting glucose level less than 110 mg/dl.
6. Never smoked.
7. Reached the ideal weight.
8. Regularly exercises."

Thoughts for Fathers of Young Children

When you kiss your daughter good night and she looks up at you and asks you to tell her a story from your own childhood before she closes her eyes,
What do you remember?

When your little son looks up from his morning cereal and wants to know how fast you could run when you were his age,
What do you remember?

In the lifetime before house payments and bills, the nightly news and the morning alarm clock there was a time when the world was different. In the years before you 'grew up' it was easier to tell jokes, to laugh and to make friends. Being a kid was the best thing ever.

A squished bug was almost as good as a lightning bug.

The outcome of a baseball game was a matter of life or death.

You thought you would throw up when you sneaked a puff on your grandfather’s cigar.

Staying clean was the last thing on your mind.

Everything was funny. Everything.

Summer vacation really lasted a whole year.

Mosquito bites itched less.

Sissy bars weren’t for sissy’s.

Toads did give you warts…and you could prove it.

Gum wasn't just for chewing.

Nobody wore bike helmets or seat belts.

Heroes were everywhere and they always won.

Santa Clause really did leave footprints in the snow on the roof of your house on Christmas Eve and you did hear the jingling of sleigh bells deep in the snowy night one year.

So the next time your young son or daughter looks up and asks you to tell them a story about your childhood, remember how you felt when the world was larger, funnier, scarier and just plain better than it is now.

Make sure to tell them all about it.

Don’t leave anything out.

Being Mr. Edwards

One of the finest episodes in the history of television aired in December of 1974. That was the year that the Wilder family from 'Little House on the Prairie' recieved a visit on a stormy Christmas Eve from a gruff but lovable frontiersman named, Mr. Edwards. America was drawn to the story of this family struggling to survive as settlers moving west in search of land and opportunity.
As the story unfolds during that Christmas episode we learn that the Wilder family is facing every parent's bad dream; Christmas without the hope of providing toys for their children. The children sense their parents poverty and the family gets prepared to tell the children that Santa Clause must have missed them during the storm. Things will get better next year and besides, the kids will understand. They always do.
Meanwhile, in the howling wind and snow of the worst blizzard the West had ever experienced, a lonely figure trudges on foot from the nearest town through the forest. He is bundled up in a large coat and has a wide brimmed hat pulled low over his face to keep out the cold and ice whipping through the air. He comes to a freezing river and is almost foiled in his attempt to reach his destination but decides to take off his overcoat and clothes and wade through the icy water to reach the other side. Mr. Edwards stumbles into the Wilder cabin nearly unconcious, suffering from hypothermia and collapses in front of the fire.
The family rushes to revive him and he is saved by the heat of the fire and the glow of warmth from the Wilder children. Mr. Edwards explains that he met Santa Clause in town who asked him to deliver the Christmas gifts to the Wilder children this year because the storm was too severe. Ma and Pa Wilder have looks of joyful astonishment on their faces as they realize what a Christmas miracle this friendly, rough hewn neighbor has unselfishly performed for their children.
In that moment, on that night in 1974, Americans all over the country were reminded of what it was to be a true hero and to step up to engage a crisis, risking personal safety for the benefit of another. Soldiers, firemen, police officers, parents of sick children and millions of regular people are heroes every day to the poor, the desparate and the underpriviledged. This story was told to us in the simplest possible terms. Without any Hollywood glitz or glamor, with carefully scripted characters, a compelling score and a plain storyline, Mr. Edwards displayed the humanity and humility we all hope to achieve for others in our own lifetimes. On that winter's night in the little cabin on the prairie, a humble man without a family of his own earned his angel's wings by giving the gift of Christmas magic to children in need.

Jimmy Buffet's Christmas Gift

"If you are looking for perfect safety, you will do well to sit on a fence and watch the birds."

Wilbur Wright, 1901

Someday I'm going to get me an ultralight airplane. I really wanted at least a Citation jet like Lance Armstrong and Sheryl Crow rented to go on vacation to France once but that seems a little out of range at this stage in my life. Besides, I'm getting a little older and have to think about my future. This is why an ultralight plane would be perfect. It's cheap, almost anyone can fly one (so I hear) and even if you crash, you are usually on a grassy field going only about 23 miles an hour.

I've got my retirement all planned out. When I'm about 78 years old I'll sell our Toyota Prius for about a million dollars, my wife and I will move to Arizona (where it's warm) and we will both get ultralight planes and raise sheep. Then we can wake up every morning and strap into our planes and buzz the sheep (you know...to give 'em some exercise). Then after a few hours of sheep buzzing we will land somewhere and have a picnic lunch on the high desert and meet up with all of our friends who have their own ultralight planes and play a pick up game of basketball. Then the whole lot of us will get into our planes and fly to a nearby lake and go swimming. After this we will find a place to camp out and start a really big bonfire and have loads of laughs just like all those people do in the Michelob commercials (except we will be 78 years old). There will be just me and my wife with about 200 of our close personal friends. Our kids will be busy with their kids and taking care of their multi million dollar mansions and flying their own ultralights. They keep wanting to borrow our sheep but we think they should get their own. Besides our sheep are tired out!

The next morning we will fly over the football stadium of the Arizona Cardinals in our ultralights and yell down to the team as they practice. Now that we live in Arizona, we don't expect them to win much but they need encouragement. Then some of our friends will have to go home and take their medication and have a nap but not me and my wife! We will be leaving our ultralights at the airport and hopping onto a private jet that belongs to our close personal friend, Jimmy Buffet and going off to a private island in the Caribbean for a huge tequila party with all the NFL cheerleaders and a few retired Academy Award Winners and Nobel Prize recipients. Then once the jet takes off, Jimmy will lean over across the aisle and ask me if I would do him a big favor and accept his Citation jet as a gift because he has three other planes. I would say, "Well..." then I would give my wife in the next seat a high five and accept his gift with the condition that we could come to his private island any time we wanted. Of course Jimmy would say "yes" and then invite me to play onstage with him at his next concert in Jamaica. My wife could be my roadie and back up singer and would wear a grass skirt with a fruity hat (so she would fit in with the locals).

By that time I'm 78 in our world, there will be peace on earth and there will be no poor people, prisons, pets being put to sleep or children in hospitals or pollution. And, best of all medical science will have come up with a pill that allows you to live forever at whatever age you choose.

I just love Christmas time.

I think I'll have my new Citation jet painted fire engine red.

When Wagons Collide

"Well I know what I've been told,

you gotta know just when to fold.

But I can’t do this all on my own.

No, I know, I’m no Superman"

Laslo Bane

We each have our own 'wagon' which is full of our own individual 'stuff''. The word 'wagon' reminds us that we tote around a sort of 'pile' that really consists of who we are and how we want to represent ourselves to the world at large. Just like a little kid walking down the street with his toys in his Radio Flyer, a wagon contains the items we would like to showcase and to have others admire about us. Children cart around dolls, toys, tools and other objects of interest that they intend to share and with which they have some sort of connection or relationship. Adults have a different sort of display but we also need a wagon to cart our display items around in and to help us to relate to other people and their wagon loads of their stuff.

What happens when two people meet up with each other is that each agrees to share, discuss, defend and even swap some of the 'stuff' in each others lives. If each person finds enough common ground and joy in the exchange, they may decide to make a commitment. Marriage is one such vehicle and sometimes marriage can be referred to as 'hitching' one person's wagon to another person's wagon.

"A study done by a pair of Canadian psychologists uncovered something fascinating about people at the racetrack. Just after placing a bet, they are much more confident of their horse's chances of winning than they are immediately before laying down that bet. The reason is that we have a nearly obsessive desire to be (and to appear) consistent with what we have already done. Once we have made a choice or taken a stand, we will encounter personal and interpersonal pressures to behave consistently with that commitment. Those pressures will cause us to respond in ways that justify our earlier decision."

'The Psychology of Influence', by Dr. Robert Cialdini

This analogy can easily explain some of the seemingly strange choices we make in life. Why would your daughter choose a drug addicted boyfriend with no prospects in life to marry and raise a family with? Why pay good money to own a car that you can't afford? Why choose a job that pays poorly and offers no opportunity for advancement? What is it about that particular girl's wagon that made my son want to hitch his wagon up to hers? According to this social psychologist, as human beings we are all hard wired to pursue consistency even in the face of a choice which seems to make no sense. Once we have made that commitment we have to fight against everything, (often including ourselves) to unhitch our emotional wagon and move on.

When my daughters choose their boyfriends in the years to come I am going to try and help them realize that they, too are wired for consistency and that they have choices that do not require commitment. Then I'm going to pray.....

"Feel Good" Medicine

As a doctor, I have discussions every day with my patients who are interested in getting off of their prescribed medications and taking something holistic instead. I consider it my job to listen to my patient's frustrations and arguments and to try to accomodate their needs as much as possible without compromising my training, mandate and role as a licensed physician. Evidence based medicine is the cornerstone and the foundation of our science and art. Our professional articles and citations script for us the standard of care that we try to convey to our patients as we prescribe our medications to heal their illnesses. Chronic health conditions are often asymptomatic and convincing patients to embark on a daily therapy is challenging. After one heated exchange last week in which one of my patients tried to convince me of the validity of his holistic treatment over the therapy I was advocating to control his hypertension, I suddenly realized why we were not communicating. While this patient and I were repeating the same phrases and examples to each other, we both were expressing very different meanings for those same words.

My patient would repeatedly demand, "I feel good on my supplements so why should I take your medications?" It occurred to me that the phrase, 'I feel good' is a catch all or umbrella term which is synonymous with 'I feel well'. The patient was trying to communicate to me that their internal monitoring system was not detecting a health problem. The patient was, in fact saying, 'I feel well so I must be healthy so why are you prescribing me this medication?' This particular patient was well versed in the alternative medical literature and understood that since his supplements and vitamins left him feeling good, he must, therefore be free of danger from disease or medical disaster.

This is a fine point because doctors, especially family practitioners are trained to look for potential medical land mines that might loom up and strike a patient in the future.

"I feel good." is a construct which implies total wellness since the signals the body gives are looked upon as a good indicator of health and we all expect that our personal energy and sense of well being should act as a diagnostic screening tool or health barometer for each of us. To a medical practitioner it is, of course important to feel good but it is more important to be good.

Three of the deadliest health conditions we Americans face are all but impossible for our own internal diagnostics to detect; adult onset diabetes, high blood pressure and high cholesterol. Even many forms of cancer cannot be detected except by certain tests and are often discovered late. If a person comes to me for advice but are in the mindset that "feeling well" equals "being well" then the alternative health world of supplements and extracts makes perfect sense. If you are a trained health care practitioner then the patient in front of you whom you have been entrusted to safeguard is not truly well until that patients relative risk for long term disasterous health consequences have been checked and corrected even at the expense and risk of taking a prescribed medication. We, health care practitioners know we have done a good job for our patients when they die of old age and with the minimum of therapeutic interventions.

The next time one of my patients wants to know why they should take a risk and sacrifice their interpretation of wellness (feeling good) with my interpretation (lowering the relative risk of future catastrophic illness) I will simply tell that patient that while we both want the same things, as a physician, I am trained to help them attain goals for their health that go beyond just 'feeling good'. A good physician wants each patient to be able to go kayaking and mountain bike riding with their great grand children.....and feel well at the same time.

Meet Toby

Toby Storie-Pugh is co-founder of Flying Kites Kenya and Flying Kites Global. When he is not in Kenya with his long time friend and colleague, Leila de Brunye and their volunteer caregivers, he focuses his rescue efforts on the dying, abandoned and abused children in the slums of New Delhi, India. We recieved word that for the past month Toby has been living with the children who sleep on the railway platform in New Delhi. When the trains come in they dispense some of their left over food to the abandoned children. Toby is currently living in the train station comforting, feeding and protecting the children he has met there while using his cell phone to organize local volunteers and rescue efforts to support still more children.

When my wife and I think of young adults we would like our daughters to emulate we will often talk of Leila, Toby, Justine, Kaitlyn, James, Ryan and all of the dozens of volunteers of Flying Kites. These young people live and work with orphans and abandoned children often at great personal risk in India and Kenya.

Visit these extraordinary volunteers on their website at:
http://www.flyingkitesglobal.org

Work, Legacy and Cairo Stand

Artists, musicians, performers, authors, film makers and craftspeople are all known to create some thing which is loosely referred to as 'a body of work'. These artists create work which can be viewed or listened to over and over and will last through generations. The rich and colorful expressions we see and hear could not have existed without these people. The world is clearly a much more vibrant and interesting place with the art, music and beautiful crafts they have created for all of us to enjoy. Here you see a promotional photo of a creative band called, Cairo Stand. Their music is the result of their energy, skill and ambition. The band's musical recordings are their legacy; their 'body of work'.

Doctors, teachers, lawyers, priests, social workers and others who work in the human service professions also contribute to the human experience just as the artists do. In their own way, they too create a 'body of work' but just not in quite the same way. Doctors, for example are presumed to create a landscape of healthy people wherever they go so their 'body of work' can be found everywhere. Teachers, too generate a tremendous legacy in how they teach and guide children and adults through the educational process. Parents who raise their children with care and respect have certainly created a 'body of work' that will be their legacy.

To paraphrase a famous sociologist, meaningful work is work that is 'complex, interesting and offers a clear correlation between effort and reward. Meaningful work is more than just showing up at a job until you get fired or you die'. Finding our true life's work may actually take much of our lifetime.

Those of us who do not paint, sing, have recording contracts or belong to the Screen Actors Guild can still produce our own 'body of work'. We can all create a memorable and lasting legacy among our family, co workers and friends by committing to good physical and emotional health, making good choices in our friendships and relationships and choosing meaningful work.

Cairo Stand has been producing rock music in New England and Los Angeles since 1982 and have produced three albums. The band's discography contains no less than 44 songs, tours and interviews.

http://CairoStand.com

The Rule of Reciprocity

"There is an obligation to give, an obligation to recieve, and an obligation to repay." Quote from the French anthropologist, Marcel Mauss.

The Rule of Reciprocity is well described in the book, 'Influence, the Psychology of Persuasion' by Dr. Robert Cialdini. In his book, Dr. Cialdini describes, "the reality of internal discomfort and the possibility of external shame" which is brought about when a favor or kindness is extended by one person or group toward another and this act then, creates a feeling of obligation in the recieving person or group. This feeling of obligation offers sales people a great opportunity to sow the seeds of guilt within a potential client or customer causing them to sometimes buy an item or service that they might have otherwise passed by. Dr. Cialdini describes the fund raising techniques of the Hare Krishna cult members as being a textbook example of an application of the rule of reciprocity. A cult member insists on giving a passer by a flower as a "gift" and then asks for a small "donation". The unwilling flower recipient feels such guilt at accepting the flower that they take out their wallet and give to help themselves to feel better about the "gift".

My wife and daughters lived in the Caribbean in 2003 for seven months on a tiny island while my wife was completing her Ph.D fieldwork in anthropology. She told me how reciprocity is so ingrained in the culture of the islanders that it seems to actually contribute to poverty and limit an individuals ability to improve his or her economic situation. I learned that if one of the island inhabitants were to experience an economic windfall and were to come into some money or to recieve a gift, their neighbors and friends would come by and demand their share of this money. The recipient of the money, gift or property would be made to feel so guilty that they would end up giving their gift away and remain just as poor as they were before. Meanwhile, the prize that had been divided up had been reduced to such small amounts of capital and spread so far among the local population that no one person could ever recieve any real benefit. The community benefitted a little for the short term but the individual lost all to the rule of reciprocity and never had anything to show for it. Everyone remained poor on the island. The selfish and the independent islanders who ignored the cries for reciprocity and used the money they made to develop businesses and industry ultimately helped their neighbors in a more meaningful way.

In his book, Dr. Cialdini instructs his readers how to say "no" to a sales pitch or to a guilt laden request. He asks the readers to look past the obvious guilt and blame and to see the request for what it really is. "Perhaps we can avoid a confrontation with the rule by refusing to allow the requester to commission its force against us in the first place. Accept the desirable first offers of others but accept those offers only for what they fundamentally are, not for what they are represented to be. We should look to participate fairly in the 'honored network of obligation'. As long as we percieve and define the rule of reciprocation being enacted as a compliance tactic instead of a favor, we no longer are obligated".

Incidentally, the Salvation Army volunteer outside the supermarket is not invoking the rule of reciprocity. That person ringing the bell in the snow is asking for a donation for a poor family so get out your wallet and be generous this Christmas.

Flying Kites in the Holiday Season

This Christmas season, there is one website we should all visit and two online documentary films we should all see to make each of us thankful for the gifts we have. My wife and I have two close friends who live and work on the very edge of safety and sanity. Toby Storie-Pugh and Leila deBrunye have started a unique non profit organization to help orphans who live in extreme poverty and are faced with life threatening danger. They have named their revolutionary approach to the orphan crisis; Flying Kites Global.

Leila deBrunye is the Executive Director of Flying Kites Kenya and Flying Kites Global. She sent us an email last night from her small orphanage in rural Kenya which I have reproduced below. One of her young new arrivals had been diagnosed with HIV that he contracted from his mother at birth. Below is a transcript copy of her conversation with this 12 year old boy who was left an orphan when his mother died of AIDS.

Joseph finally lifted his head, "I have it?" he asked. And I said, "Yes and thank God we are able to look at your blood so we can get you really good medicine to make sure you stay just as strong as you are now. You wouldn't believe it if I told you how many people have HIV in their blood, - friends in America, family members, people on TV, sports people, doctors." Joseph was incredulous, "Doctors?" , he asked. He asked why we came for him and we talked about how he came to Flying Kites. I told him the story of how I had worked at By Grace for a while, and that I wanted to set up my own home with Benson- then I explained that I had always promised the kids at By Grace that when I could, I would come back and help them too, but this year we only had room for one child, so I said to Salome, "I can't chose between all my little friends, I don't want to separate them and I don't want others to feel badly that I didn't chose them." So I asked Salome to send me a child that I had never met before. And when she asked me if I had any hopes, if I wanted a boy or a girl, I just said, "Give me the smartest child in the centre, so I can send them to a real school." That made Joseph smile from ear to ear, as if he hadn't just learned that he was sick. "So that's how she sent me you." (We found out earlier today that Joseph came in 9th out 120 in the national school exam, despite having not been in class for over a year and without any review. I am so proud of him!). We hugged and he said that he was glad that God hadn't forgotten him.

Toby Storie-Pugh is co-founder of Flying Kites. When he is not in Kenya with Leila and their volunteer caregivers, he focuses his rescue efforts on the dying, abandoned and abused children in the slums of New Delhi, India. We recieved word that for the past month Toby has been living with the children who sleep on the railway platform in New Delhi. When the trains come in they dispense some of their left over food to the abandoned children. Toby is currently living in the train station comforting, feeding and protecting the children he has met there while using his cell phone to organize local volunteers and rescue efforts to support still more children.

Toby is less than thirty and Leila is in her mid twenties. On fund raising tours in Europe and the US, they sleep in the homes of their friends and speak in churches and colleges to raise money to support their non profit organization. During these trips, they attract and organize volunteers from all over the world to work in their orphanage to help care for the children. They believe in a hands on, grass roots approach to their work and Flying Kites with it's sponsors and consultants has developed plans and infrastructure that will ultimately change the way governments view their millions of orphaned children.

On their website, you can view compelling film footage documenting their relief work in India and in Kenya. Toby and Leila do not have apartments of their own and they do not own cars or have regular jobs, health insurance or retirement plans. Both are college educated and have supportive families and friends but choose to live and work abroad with their orphaned children, to be close to them every day. Individuals, groups and corporate sponsors interested in conributing toward their extrordinary efforts with the most neglected and abused children in the world may contact them through their website:

http://www.flyingkitesglobal.org/

Flying Kites Kenya Mission Statement:
Flying Kites is a non-profit organization that helps vulnerable children in developing countries. We are currently building a home for orphaned, homeless and abused children in Kenya. The children we take in have often endured tragic or traumatic experiences and often have no close relatives to provide the care they need.
As an organization providing for children from such desperate circumstances, we must define ourselves by the high quality of care we deliver. We do this by providing first class care and first-class education, by hiring the best staff in the country; by being innovative in everything we do, by questioning long-held assumptions and by always, always, always searching for the better solution.

This holiday season, be sure to visit this website and learn about an incredible non profit organization of inspired volunteers....

Then find a way you can help.

http://www.flyingkitesglobal.org

The Age of Leverage

"Manners should never be taught. If a child of seven wants to eat with his fingers, he should be free to do so. No child should ever be asked to behave in a certain way, so that Aunt Mary will approve. Sacrifice all the relations and neighbors in the world rather than stunt a child for life by making him behave insincerely. Manners come of themselves. No child should be forced to say "Thank you". Quote from 'Summerhill-A Radical Approach to Child Rearing' by A.S. Neill

I am fascinated by the concept of 'leverage'. Entrepreneurs and investors speak of it as a way of describing the traction and forward progression of one idea or project into another, more meaningful idea or project.

Websters dictionary describes leverage as follows:

le·ver·age: def.
1 : the action of a lever or the mechanical advantage gained by it

2 : power, effectiveness (i.e.,trying to gain more political leverage)

3 : the use of credit to enhance one's speculative capacity

When communicating with one of my patients, it is important that I try to appeal to reason and to engage that person so as to promote my ideas for their treatment or to explain the answer to their questions. I am not only not making my bid for leverage but also attempting a conversion in the mind of the patient to affect a certain end. To use a football metaphor, the football team will never create leverage for their team to advance to the Playoffs if they cannot convert enough first downs on the field to score touchdowns and win games. It does not matter how great the team or an individual player is if they cannot convert and then leverage these conversions into success. Doctors should always attempt even the smallest conversions and keep on moving forward until they have helped the patient to leverage their own health and wellness.

This is a picture of my Dad who has just used a fishing pole to leverage a really big fish from the ocean. He is hanging on with his hand so that the waves do not tip the boat to leverage him out of the boat and into the water. In this example, the fish is not going to be going to the Playoffs. My Dad has managed to convert his fishing efforts into twelve tasty fish dinners so he has, in effect won the tournament and will advance to...the kitchen. Now you understand the concepts of leverage and conversion. Or at least you will if you have ever gone fishing...

In the quote in the beginning of this blog entry, A.S. Neill has expressed his opinions about the harm which can come to children forced to learn and practice basic manners. In Neill's opinion, imposing the guidelines of acceptable social behavior actually stifles the child's normal capacity to create his or her own ability to apply leverage. Children who are forced to conform are less capable of learning the skills needed to express themselves to others as adults. Fearlessness, self actualization and intuition are skills that cannot be taught but must be developed through life experience. Parents who generate real life situations for their children in which the child is able to face their fears and experience courage and in which a child will be allowed to interact with an authority figure and communicate their own wants and needs will be doing their children a great service. This is a philosophy of practical parenting called 'concerted cultivation'. Prodding a child into rote recital of a series of culturally acceptable responses and actions is not an effective way of helping them to develop intuition, courage and fearlessness. Prompting and scripting also does not teach a child to look an authority figure in the eye and tell that person what they think. In order to develop the skills to get what we want from life we need to be self assured, self reliant and not intimidated by authority.

Introduction to the Summerhill School:

This remarkable school in Leiston, England runs under a true children's government where the "bosses" are the children themselves. Summerhill opened in 1921 and is described as "the world's greatest experiment in bestowing unstinted love and approvel on children. Children are taught that freedom is not the same as license and that healthy human development makes it necessary that a child eventually cut the primary ties which connect him with his father and mother and learn to face the world as an individual."