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Part 3: More on Buzzwords

Therapy Gems ©

More on Buzz Words Versus Meaningful Words

Buzzwords III: Why We Use Vague Buzzwords, Psychobabble, and Vague Jargon

The precipitating event for this article is the following comments in an article by Columnist Rex Huppke on how buzzwords are used in the business world.  Huppke wrote “Author explains buzzwords for office English speakers” in the Chicago Tribune, April 17, 2016.  Quoting James Sudakow, author of a book about buzzwords in the business world, Huppke wrote,

‘I think it becomes like this language and it allows people to look like they’re part of a special group that knows what this stuff means’ … [Sudakow] said. ‘I think that’s why its [sic] so prevalent in consulting.  They’re brought in to be experts on stuff and if they have their own language that makes them seem like they’re even greater experts.  It’s the opposite…. It’s like their credibility actually goes down because people wonder, “Why you can’t just use normal words?”’  (Section 2, p3) [italics added].

After reading those comments, I thought I should write about our motivation, as buzzword1Psychotherapists, to use buzzwords.

The Buzzword Motivation

I have observed eight motivations for using buzzwords.

Shorthand communications

Ease of making a statement

Identification with others who use them

Status or Appearance of being knowledgeable

Credibility, sounding expert

Distance from the object of the buzzword

Purposeful obfuscation, vagueness, or lack of clarity

Lack of understanding of appropriate professional language

Shorthand – The simplest, most benign reason is that we think we are communicating a large concept in a small package.  We may think we are using a robust term in order to convey a complex situation.  We imagine “can’t handle it” or “acting out” shrinks a lot of information about client behavior into a single term that communicates substantial meaning.  If we can access or picture the meaning, we think the word has communicated the meaning we have imagined.  If we see the client’s distress when she uses a buzzword, we think or assume we know what she means – with a lot of emotional disturbance packed into one or two words.

Of course, each person has his or her own connotative imagery for the buzzword. Therefore, what makes it a buzzword is that it no longer has a specific shared meaning.  The ‘large concept in a small package’ is actually ambiguous!  Often it is also pejorative.  The word usually has been co-opted to mean broad categories of meaning which lack the clarity required for professional communications.

Indeed, many of these words developed from meaningful professional jargon. They became ambiguous once they were used imprecisely by professionals.  Or they came into common parlance in which specificity is not only downplayed, it is often avoided!   For instance, when Hans Selye applied the word “stress” – formerly used mainly in engineering — to describe an internal physiological state in which certain organs are activated and bodily damage results, the meaning was clear and specific.  Now, the word is most often used to describe either external stressors or an emotional state of feeling pressure or feeling overwrought with too many challenges.   You can see it has lost most of its connection with the original professional jargon.  It no longer has one clear and specific meaning.

Let’s examine an analogous problem. Jet propulsion, for example, still means causing movement by forcing gasses to travel at high speed.  Imagine if we used it to have emotional meanings such as, “I feel a lot of inner propulsion, jet propulsion.”  “Too much propulsion is coming at me!”  Oh, yes, I can relate to that idea.   But after the term from physics becomes co-opted as an ambiguous term for a mental state, then we would soon have to find a new term for whatever it is that jet engines do.

Many of us worked in settings where buzzwords were commonly used and accepted. In those settings, a buzzword may have had a short-hand meaning understood by practitioners in that institution.  Sometimes, the culture of the workplace includes a meaning for a buzzword, that is, a meaning shared within the institution.  So, for many clinicians in many settings, using the word “issues” or “acting out” may appear to sound professional and comprehensible, a shorthand way of communicating  with other professionals in that setting.  I can imagine in a residential treatment center a statement such as “Because he has so many issues [i.e., emotional conflicts, painful or traumatic experiences with hostile feelings], he acts out [i.e., displays angry feelings and perhaps destructive behavior] when he is frustrated.”   Most of the staff in that setting know the behavior to which the statement refers. bw1

However, in an outpatient setting, those same terms could have a variety of meanings. When I hear “issues” or acting out,” I often find myself asking, “What do you mean by that?”  The shorthand has ultimately failed to communicate.

Buzzwords obscure deeper understandings.  Buzzwords gloss the surface so the clinician does not have to think more incisively and deeply.  Recently, an Intern used the word “issues” several times in a diagnostic report.  Careful reading of the text showed four meanings for “issues.”  In one place, “issues” meant all the person’s internal conflicts or emotional problems.  In another, “issues” meant foci of concern.  Another meant very serious emotional problems.  The last meant significant deviance from expectations.   I explained that using “issues” obscured the richer thoughts she may have about the client.

I asked her to work to avoid “issues.” That proves to be a challenge; such is the compelling pressure to use imprecise language.  I asked her to re-write those sentences to specify the meaning more exactingly, without using the word “issues.”  The first use of “issues” became “emotional symptoms most distressing to the client” (which she then specified).   That has a more specific meaning than “he spelled out his issues.” The second became “symptoms for which we set treatment goals.”  That has more precision than “he has serious issues.”  The third became “unusual mannerisms, such as frequently tapping bw2on his forehead.”  That also is more specific and more useful.  The fourth became “disagreed with therapist’s assessment of his symptoms as being consistent with PTSD, arguing that something that long ago could not be as crucial to his health as the therapist had asserted.”  The Intern had proven the point that buzzwords obscure more than they reveal.  She also proved that a richer meaning can be hidden behind a buzzword; a little clinical thought leads to deeper insight into the client’s functioning and dynamics.

Ease of making a statement  – Similar to a motivation to use shorthand language, the clinician may find it easy to use buzzwords.  They readily ‘roll off the tongue.’  We often use them in common conversation.  But in the clinical situation, the motivation could also be to allow the clinician to avoid having to stop to think more deeply or even to let the clinician gloss over a client emotion.

Buzzwords can also be used in a highly pejorative or dismissive way. It’s much easier to say “Attention-seeking” than to think out the true dynamics and explain them, such as, “Anxious attachment, leading to behaviors which elicit a response from mother so he knows he has value to her.” So this easy and often pejorative use of buzzwords is a bw3particularly important failure of clinical thinking.  Easy use of buzzwords is inevitably unhelpful to the client, who becomes somewhat distanced.  It causes the therapist to think on the surface rather than fully grasp the client’s emotions and dynamics.

Identification with other professionals – A natural tendency amongst trainees and newer therapists is the quest to know how professionals behave, how to become socialized to the work.  Identification with valued professionals is a process for acquiring those behaviors.  So if a supervisor uses buzzwords, the trainee is likely to do so.  If the supervisor does not ask for clarification of those terms, that omission tacitly reinforces the usage.  It also teaches the trainee to stay towards the surface of behavioral observations.  When I challenge the use of buzzwords, trainees and, sometimes, licensed professionals, tell me they have never before been asked to stop using those words.  I then ask them to look more deeply into the client’s behavior, a task which will lead to better understanding and more effective selection of interventions.

Status or Appearances – As Sudakow pointed out, we may feel a need to enhance our appearance of possessing a) professional status in the mind of the clients or our colleagues, b) a sense of importance in our own minds, or c) belonging in the in-group of the institution, being a member of the team.   If, however, the organization does not support buzzwords, using them reduces status!  If the organization supports them, the clinician can lead by avoiding them, speaking with more depth, and asking others to clarify meanings.

These use of some of the buzzwords may often be judgmental and pejorative! The team objectifies the client by the use of terms which place the person in a pejorative category.

We can counter that by re-framing the behavior upon which we are focusing as protective, adaptive, the best the client can do, motivated by positive purpose, or in other terms which shift the focus to what the client is doing effectively. Recently, for instance, a client whose former use of opiates was extremely heavy lapsed twice in one week.  Rather than use buzzwords such as ‘addict,” “resistance,” or “weak,” I described his behavior as a success in that he cut down his use by 75% in just a few weeks.  The focus of discussion shifted from his pathologies to how to assist his sobriety to get to 100% abstinence.  In fact, he progressed more rapidly than his history and challenges might have predicted.

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Credibility – Similar to a motivation of special status, the professional may try to sound more like an expert.   But, when using vague language, have we communicated an unmistakable message which the client can use effectively?  Expertise used for show just does not connect well. It leaves room for misunderstanding.   I once sat with a group of professionals observing a consultant through a one-way mirror.  He told the distressed woman in his office phrases such as “You’re projecting.” “That is passive aggressive behavior.”  “You are needy.”   The observers nodded.  Yes, her behavior could be adequately described by these terms.  But I didn’t think she understood any of it.  In terms used in Motivational Interviewing, the consultant’s labels produced more sustain talk which led to more of these interventions – which seemed more confrontive than interpretive.  That may have gratified the consultant and impressed the professionals, but I did not think the interchange helped the client.  She may have found the doctor to be a credible psychiatrist, but the language did not seem to help her.

Buzzwords obfuscate deeper meanings. They lead us to the surface rather than the depths. They lead us to objectify the client – which is incompatible with core therapeutic conditions.

So, just as we want the client to be clear and to express feelings and thoughts with some clarity, and just as we push the client to probe feelings and thoughts, so we should expect the therapist to think and speak with clarity and accuracy.

Distancing – Buzzwords can be used to maintain emotional distance from another person.  Such words as “over-reactive,” “needy,” or “attention-seeking” set the therapist at a seeming distance – a judgmental distance — from the distress or emotional whirl of the client’s life.  We frequently see this kind of response when the client has a Borderline Personality Disorder, bipolar symptoms, attachment difficulties, substance abuse, or hostile behavior.   By labeling them, respectively, as needy, moody, cold, weak, or full of anger, in effect we are being judgmental and dismissive of the client’s personhood.  The person becomes the disorder rather than a person who is affected by the disorder. The paradox is that the therapist’s emotional distance, which may lead to more punitive or directive interventions, may also be a stimulus for the very emotional reactions the therapist is labeling!  

Purposeful obfuscationOften, we are intentionally vague.  Perhaps we are writing a bw5report and we conclude the client will be upset by a statement in the report.  Perhaps we create a document that is going to a reader who is unfamiliar with mental health jargon.  Perhaps we want to present the client in a favorable light.  We have many reasons for writing or speaking in vague terms.  But, just as we would not let the client use the defense of vagueness in order to suppress painful feelings and thoughts, we should not let professionals use vagueness in order to obfuscate.

In a recent report to a pediatrician of a seven year-old boy, the psychologist did just that. He used obscure language, such as, “On scale three, the client scored two standard deviations from the mean for global behavioral scores.”  The pediatrician sent the letter back with a note that she could not understand it!  The motive for the original letter was to disguise the worst findings from the client’s mother, who received a copy of the note.  But then she appeared at the clinic asking for an explanation of the letter.   The re-written letter clarified each point in plain language.  “On a scale measuring behavioral problems, such as disturbing others, occasional hitting of other children, and breaking or throwing objects in anger, J’s score suggested he is in the top two percent, meaning only 2-3 children in 100 show disruptive or aggressive behavior to that degree.”

Lack of understanding of appropriate professional language.  A mental health bw6professional has a Bachelors degree with a major or minor in psychology, social work, or an overlapping field, then a Masters degree in a mental health discipline, an internship, and a post-Masters supervised training experience.  The latest standard for a Masters is around 60 graduate hours of course work.  A Psychologist has completed several more courses than that and original research.  During all that intensive training, the professional learns an enormous number of psychological terms, theories, research findings, methods, and principles.  To learn how to apply all those terms to the labeling of client behavior takes years.  I try to model how a professional ought to be able to explain all behavioral phenomena and patterns.  In these papers on buzzwords, a consistent theme has been the proper use of professional terminology.  One reason for the use of vague terms is that trainees may not have been held to the standard of proper labeling of all their observations.  Further, they have learned so much of the jargon in the abstract and may not have enough training in applying terminology to real situations.  Let’s make sure we communicate that learning to explain the client’s actions and one’s own interventions in appropriate professional language is a goal.  We understand this skill is always a work in bw7progress.

In summary, most often the use of buzzwords derives from the needs of the clinician, not the benefit of the client. The clinician may presume the words communicate what the clinician intended.  But that is not often the case.  Clinicians may have learned to use buzzwords in a training situation, but the time has come to stop using them.

I will confess that it is a challenge. In a typical day, my trainees will hear me start the word that sounds like “iss…” or the word “handle” may emerge.  Fortunately, I am able to catch myself and to find a clearer way to explain.  We hear these words so often that we have to work to avoid them so we can speak more clearly.  Doing so will pay off in more effective clinical work.

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© Don D Rosenberg, Version 1.0 2017

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Clinical News You Can Use

Adult ADHD: Medication Plus Cognitive Behavioral Therapy, Latest Research

An article by Sanjay Gupta*, “Talk Therapy Alone for ADHD Doesn’t Cut It,” reviews a recent multi-site study of treatment for Adult Attention Deficit Hyperactivity Disorder [ADHD]. In sum, “talk” therapy does have a significant benefit, but it doesn’t benefit ADHD symptoms quite as much as medication or the combination of medication plus therapy.

Treating ADHD means BOTH

adhd11) improving symptoms of concentration, focus, and memory with medications AND

2) developing skills for organization, social behavior, following-through, remembering responsibilities, and anticipating consequences.

The research addressed mainly the symptom domain.

We have known since the 1980s that “psychosocial” therapy, such as individual psychotherapy, group therapy, or social skills training, does not significantly reduce the symptoms of most children with ADHD unless medication is also used. The most common medications for children with ADHD are formulations of one of four drugs,

1) methylphenidate (e.g., Concerta, Daytrona, Focalin, Metadate, Methylin, Ritalin),

2) dextroamphetamine (Adderall, Desoxyn, Vyvanse),

3) atomoxetine (Strattera), or

4) guanfacine (Intuniv, Tenex).

A child may do well on the first drug chosen. But often, one drug may have unwanted side-effects or weak benefits for that child. So then a different one of these drugs needs to be selected. Sometimes, the child benefits more from taking the drug twice per day. Depending upon other behavioral symptoms besides those of ADHD, some children receive a second medication, such as Clonidine (catapres), riperidone, or an anti-depressant.

Adult ADHD Outcomes

The recent German study published by Alexandra Philipsen, et al, in JAMA Psychiatry shows the same is true for adults with ADHD, adding medication produces more benefit than therapy alone. The researchers adhd2analyzed data from 419 patients who had been randomly assigned to one of these four conditions: methylphenidate, individual therapy, structured cognitive behavioral group therapy, or placebo. Simply stated, the methylphenidate group experienced larger reductions in symptoms than patients in the two therapy conditions. The main measure was the ADHD Index of the Conners Adult ADHD Rating Scale.

The implications of these findings are of special importance for mental health professionals and ADHD patients.

  1. A reduction of 20-25% in symptoms can be achieved by a combination of therapy and medication.
  2. Medication should be added to the treatment regime in order to boost the improvement.
  3. Realistic expectations are important. The state-of-the-art approaches lead only to modest gains in ADHD symptoms.

The study only measured the overall ADHD Index on the Conners. (CAARS) Note that in addition to measuring how closely the patient’s symptoms match DSM-IV symptoms for ADHD, the Conners also measures various adhd3other symptom domains as well.   We present these in order to clarify that a person with ADHD has both SYMPTOMS, as measured in the study, and IMPAIRMENTS, that is, areas of functioning which are limited by ADHD symptoms.

1) Inattention-Memory Problems – Since Working Memory deficits are thought to be central to ADHD, many patients have problems with concentration, short-term memory, forgetfulness, absent-mindedness, disorganization, and planning.

2) Hyperactivity/Restlessness – Many, but by no means all, patients feel or appear restless and have trouble sitting still.

3) Impulsivity/Emotional Lability – Many experience rapid shifts in mood (not to be confused with Bipolar Disorder), irritability, making snap choices without stopping to think about consequences.

4) Problems with Self-Concept – Lifelong difficulties with relationships, academic performance, and choices lead to a loss of self-esteem, a poor sense of competence.

The study did not determine if the treatments led to improvements in the adhd4range of domains and impairments. Nor did the study look at long-term skill improvements specifically. However, since Conners scores did not go down much in the study overall, we see that, without medication, patients lagged in the acquisition of new skills.

 

In recent years, an industry has arisen using coaching as an intervention with adults with ADHD. Motivated individuals can benefit from coaching or working with a psychotherapist to improve follow-through, completing important tasks, social interaction and relationships, and self-concept. The Philipsen study suggests that medication may enhance the ability to learn these crucial skills.

Lastly, ADHD is a lifelong condition. A person with ADHD learns

*to manage the symptoms

*to overcome the impairments,

*to acquire skills for effective performance in school, work, partnering, family life, and in the community

The study should not be read to mean that medication alone if the answer. Therapy or coaching is essential to helping many ADHD patients to manage the social, occupational, and educational effects of their primary ADHD symptoms.

*Click here to read the Sanja Gupta article.

Click here to read the abstract of the Philipsen article. 

The entire article reference is:

Philipsen A, et al (2015). “Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult ADHD. JAMA Psychiatry, 2146.

If you have more interest in the Conners Adult ADHD Rating Scale (CAARS), here are two sites which give examples of scoring for the CAARS and a breakdown of the symptom domains measured by the Scale, which include the major areas of difficulty in adult ADHD. The scale itself is only available to trained mental health professionals.

CAARS: Long Version (CAARS-S:L)

CAARS: Short Version (CAARS-S:S)

If you want to dig deeper into the professional literature on Cognitive Behavioral Therapy for ADHD, a good place to start is this review:

Knouse, L.A., & Safren, S. (2010). Current Status of Cognitive Behavioral Therapy for Adult Attention-Deficit Hyperactivity Disorder. Psychiatric Clinics of North America, 33 #3, 497-50

This link to the Knouse and Safren article on PubMed brings the reader to a number of other articles on this subject:

Current Status of Cognitive Behavioral Therapy for Adult Attention-Deficit Hyperactivity Disorder

 

Introducing Our Administrative Assistants

Rachel Niyonsaba, In-Home Administrative Assistant

Rachel Niyonsaba is our new Administrative Assistant for In-Home Services,
helping Carol Trout, Director of In-Home Services, to manage a program
which has nearly 60 staff in 24 counties.  We welcome Rachel to the
Shorehaven team.  She has been diligently working on learning all the
policies and procedures and getting up to speed on our in-home services.

 

Rachel Nionsaba's office sign

 

 

 

 

 

 

Alyssa Korsch is our Executive Assistant for Lynn Godec, Executive
Director, and Don Rosenberg, President.  With cheerfulness and eagerness,
Alyssa does all those important tasks that keep us going, such as trackingAlyssa Korsch
clinician productivity, coordinating repair and maintenance, setting up
the projector for meetings, managing Relias learning materials and
creating courses, coordinating psychological testing referrals, and
whatever else may come up. Recently, she spent most of the night at the
office working with a painting crew and repairmen getting the offices
fresh and lovely, and then putting up all of our new signs.

Introducing Shorehaven’s Referral Department

Most people who call Shorehaven for help will feel therapy has helped
them.  Whether the problem is with a child’s behavior, a couple problem,
anxiety, depression, substance abuse, or any number of other behavioral or
emotional problems, psychotherapy helps.

When you call Shorehaven to make your first appointment, your call will go
to our Referral Department.  Let’s introduce our Referral Coordinators:

Ryan Van Remmen
Leader In-Home Referral Coordinator

Laura Henning
In-Home Referral Coordinator

Antoinette Morrow
Outpatient Referral Coordinator

Cheronne Burks
Outpatient Referral Coordinator

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Antoinette (“Toni”) and Cheronne (“Ronnie”) set up appointments for clients who need psychotherapy, substance abuse treatment, or psychiatry.

Your Referral Coordinator will ask for all the information necessary to
start your treatment.  We will ask about your problem and your insurance.
We will check on your insurance coverage. Usually, we can make an
outpatient appointment for you while we have you on the phone.

Most clients who need help from a psychiatrist and who will be taking
medications also benefit from psychotherapy.  In order to make sure
psychiatry clients receive a thorough assessment, we will have one of our
mental health therapists do an initial assessment and recommend the best
services to help with your problems.

We hope to hear from you.  Call 414-540-2170 or write
referrals@shorehavenbhi.com.

Therapy Gem: Professionals’ Biases and Misconceptions With Substance Abuse Patients

Table of Contents: Biases and Misconceptions

Introduction and Fundamental Premises

The fundamental biases and their correlated misconceptions

I.      Substance users are not like me.

II.     Drug use always means addiction.

III.    Heavy drinking always means addiction.

IV.   All their problems are caused by their substance use.

V.    Treatment doesn’t work.

VI.   Drug users and heavy drinkers always need detox or intensive care.

VII.  Twelve-step programs are the way to go.

VIII. Any mental health professional should be able to treat such symptoms

Introduction and Fundamental Premises

subst abuse1I received a request to address staff at an HMO about substance abuse.  I was given this question: “What information about substance use and abuse will be most useful for nurse case managers?”

Thinking about that question, I knew the answer lay in one attitude that had troubled me more than any other.  Namely, too many colleagues in the mental health field believed that knowledge of substance use disorders (SUD) was outside their competence and, what’s more, they did not want to become knowledgeable about SUDs and their treatment.

Rather than learn the basics about treating substance use disorders – treatment which does work and which has applicability well beyond the treatment of SUDs — I heard many mental health professionals avoid knowledge of addictions and refer even mild cases to substance abuse professionals.  So the answer to the question “What information will be most useful?” is simply, “Before you can help change patients with substance use disorders, you first change yourself, your own attitudes, biases, and misunderstandings about substance use disorders.”

subst abuse2Over several weeks, I developed lists of such biases.  I also polled some of my colleagues who work in our Dual Disorders Department.  The result is a fairly comprehensive list of biases and misconceptions, each of which is juxtaposed with corrected information.

While I was organizing these biases by category, the list factored into what turned out to be eight domains.  A few crucial premises emerged from these ideas.  These premises summarize the main purpose and point of this presentation.

A.         The persistence of biases and misconceptions often leads to inappropriate, out-dated treatment recommendations and other potentially incorrect clinical decisions.  Accurate information AND attitudes lead to higher quality recommendations, treatments, and clinical decisions.

B.        Resolving our biases, we can connect with the substance using patient rather than distance from the patient or judge that person.  We can believe in and express hope – the foundation of motivation to change – rather than convey disapproval, judgment, or pessimism related to the patient’s lifestyle and distress.  Many of our biases derive from cultural beliefs and attitudes; therapists quite successfully overcome cultural beliefs about mental disorders, so they should easily overcome biases and misconceptions about SUDs and persons with addictions.

C.        If we judge addicts as weak and hopeless, will we do our best to help?  If we see them as people with strengths and abilities as well as with problems, we are more likely to see the best in them and do our best to help.

subst abuse3D.        Furthermore, a common fallacy is that we can cajole, guilt, criticize, admonish, confront, punish, or push a substance abuse patient into changing his or her outlook, attitudes, needs, burdens, pains, or behavior.  What we truly can change is our own outlook and attitudes. Rightly aligning ourselves, we can then better express empathy and help the other to see a hopeful vision of the changes he or she may be able to make.

Continue reading

New signs at our Brown Deer office!

This month we put up new office signs at our Brown Deer office. Lynn Godec and Alyssa Korsch helped design these unique and elegant office signs. Thank you for your very successful efforts. They look great. We also had a crew in to make repairs and paint hallways and touch up offices. Thanks to Alyssa for coordinating the project and for working third shift to oversee the work which was completed outside of normal business hours without disturbing any of our clients or staff.

Get Your Rear in Gear

This Saturday, for the third year, our Executive Director, Lynn Godec, her
family, and Eli and Don Rosenberg will walk in the Get Your Rear in Gear
fundraising walk for colon cancer.  Shorehaven, is the major localcolon-cancer-ribbon
sponsor. The mission of GYRIG, a national organization, is to promote
prevention and early detection. Lynn Godec is on the Board for this event
and runs our team. She was also selected to be on billboards around town
promoting the event. You may learn about her in the video at:

http://www.getyourrearingear.com/events/list/2013/milwaukee-wi-2013/

She wrote about it at:

http://events.getyourrearingear.com/site/TR/Milwaukee/General?px=1040060&pg=personal&fr_id=1700

If you choose, contributions to Lynn’s team can be made at

https://secure3.convio.net/gyrig/site/Donation2?idb=1064578988&df_id=2745&FR_ID=1700&2745.donation=form1&PROXY_ID=1040060&PROXY_TYPE=20

Lynn is also connected to a new foundation which raises money to fund
clinical trials at the new state-of-the-art cancer clinical trials
facility at the Medical College of Wisconsin. We attended a moving and
exciting fund-raiser for that cause just a couple of months ago. Exciting
research is being done. But early detection is still the essence of
confronting this disease.

Speaking of early detection, have you been doing your colonoscopies
starting at age 50 or, if indicated, before 50?