Q: We started to work two-month rotating shifts during the first pandemic surge. My family has recently complained that I’m increasingly irritable, moody, and negative. My weight, blood pressure, and blood sugar levels are creeping up too, and I’m always tired. Could this be because of the shifts?

A: You’ll need a comprehensive clinical evalu­ation to assess what else might be going on. We recommend you talk to your doctor for a defin­itive answer. That said, shift work affects stress levels, sleep quality, and overall health because of disruption of biological rhythms and may indeed contribute to your situation.

Our brain, other organs, and even our cells have biological clocks that strongly influence—in a rhythmic pattern—the way our bodies function and how we behave. Internal clocks regulate our hormones, our immune system, our digestion, and much more. These clocks are encoded in our genetic material, and the rhythms they produce provide special windows of time that are best suited for the various types of activities that we engage in daily (such as mealtimes and bedtime), and even the optimal timing for medications and radiation therapy on cancer.

The predominant body rhythm cycles every 24 hours and 11 minutes, or almost a day; hence, circa (almost) dian (day). It produces predictable changes such as reduced blood pressure during night-time sleep and a rapid rise to daytime blood pressure levels starting around 6:00 a.m. It’s not coincidental that the risk of a stroke or heart attack is highest between 6:00 a.m. and noon!

Our brain’s performance also varies with the time of day, dipping, between 10:00 p.m. and 6:00 a.m. in otherwise normal people, below the levels of someone legally drunk. We are naturally more prone to accidents and errors during those hours. The cycle disrupted by sleep deprivation, rapid travel across time zones (jet lag), and shift work has consequences (see table). Consistent bedtimes, wake­up times, and mealtimes diminish bio­ rhythm disruption and facilitate realignment.

Your situation may not permit avoidance of shift work. We recognize that there are some jobs that are needed to sustain our modern, 24/7 way of life. You may, however, be able to reduce the severity of the impact of shift work on your health and well­being. The most powerful resynchronizers include consistent, routine mealtimes, bedtimes, exercise, and, most important, sunlight exposure.

Sleeping in the dark and avoiding post-shift light, alcohol, caffeine, sedatives, and screen ­monitor light within 90 minutes of bedtime all help to realign your body functions with your biorhythms. Keeping a consistent schedule, applied even on your days off, will help your body’s adjustment, but frequent shift changes are not optimal.

Individually tailored, carefully and prayerfully crafted, wholistic lifestyle intervention will help you (and your co-workers) reduce your physical, psychological, and even your spiritual risks.

Short-term DisruptionLong-term Shift Work
Decreased:Increased Risk:
CreativityNoncommunicable diseases
Empathy/compassionDiabetes, hypertension, heart disease
Information processingObesity
Decision-making abilityDementia, anxiety, depression, “fog”
Micro-sleepsImmune function
ImpulsivityPsychological resilience

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference.

Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q: My 28-year-old sister has breast cancer. Our mom died of ovarian cancer, and the doctor wants to test my sister’s genes. He mentioned that her high cholesterol needs to be controlled for best results with the cancer. I’m 33, and all four of us siblings have high cholesterol. What’s the link between cholesterol and cancer?

A: We’re sorry to hear about your sister’s diagnosis and encourage you and all your siblings—female and male—to get evaluated since your doctor suspects a hereditary cancer. Based on the history you provided, we also strongly recommend that you do some Internet-based research from trusted, accountable sources such as the Centers for Disease Control and Prevention,* and we remind you that prevention is more effective than any type of treatment available today. Early risk reduction and disease detection often produce greater survival, lower treatment complexity, and less cost.

Cholesterol biology is complicated. Our bodies naturally make as much cholesterol as is needed, but we can also get it when we eat foods of animal origin. For years correlations between high cholesterol in the blood and the likelihood of certain cancers have been reported. In some kinds of cancer—such as breast, prostate, testicular, and colorectal—lowering cholesterol levels seems to reduce the risk of getting and dying from these cancers. On the other hand, bladder and lung cancers do not appear to be associated with cho- lesterol levels, and the use of cholesterol-lowering drugs (statins) may increase the risk compared to the benefit. Specifically, increased dietary choles- terol is associated with an increased risk of breast cancer, and that’s probably what prompted the comment by your sister’s doctor. Some studies also estimate that for every 300 milligrams of cholesterol in the daily diet (about a two-egg omelet per day), the risk of pancreatic cancer increases by 24 percent, endometrial cancer by 18 percent, and throat cancer by about 25 percent.

In 2018 researchers at the University of California, Los Angeles, showed how cholesterol promotes tumor growth. In 2019 a scientific review concluded that both a high-fat, high-cholesterol diet and having elevated levels of blood cholesterol can affect cancer development because cholesterol handling is reprogrammed in cancer cells. In 2021 researchers at Duke University demonstrated the way breast cancer cells use cholesterol to fuel the mechanisms that make them impervious to the natural cell stress as they migrate (metastasize). Metastatic breast cancer is difficult to treat, so preventing the spread is preferable. Lowering cholesterol by lifestyle and, if necessary, with medications will interfere with breast cancer metas- tasis and be better for the affected person. Current cholesterol-lowering strategies include physical exercise, adequate sleep, stress reduction, and improved diets low in animal prod- ucts (saturated fat and cholesterol) and high in legumes, seeds, avocados, olives, and especially nuts such as pecans, walnuts, and almonds.

We encourage you and your siblings to find a health-care team that’s knowledgeable about lifestyle-based, wholistic risk reduction and follow their rational plan. Thank God for His evidence-based pathway to optimal health and wholeness even in our brokenness!

* https://www.cdc.gov/cancer/breast/young_women/bringyour- brave/hereditary_breast_cancer/index.htm

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q: Should I supplement for colds, flu, and COVID with zinc?

A: It depends! Your current situation makes the determination. Zinc is an essential nutrient. It must come from food, because the body can’t make or store it. Women need about 8 milligrams per day, and men about 11 milligrams per day. This is easy to get from a balanced diet, but in the United States it’s estimated that 12 to 40 percent of the population and 70 percent of the elderly are zinc-deficient.

Even in small amounts, zinc must be present for many cellular and bodily functions—such as taste, smell, wound healing, growth, digestion, vision, sexual development and reproduction, DNA synthesis, and DNA repair—to work properly. Zinc is essential for optimal immune function and cancer surveillance. The individuals most susceptible to zinc deficiency are elderly individuals, lactating or pregnant women, and persons with bowel, kidney, or liver disorders.

Vegetarians may be at risk if their diets are high in raw, unsprouted seeds or heavily grain-based (maize, wheat, wild rice, brown rice, amaranth, and oats, and the “brans” of these) and legume based (peanuts, almonds, sesame), since compounds (phytates) found in these foods may decrease zinc absorption from the intestines.

The most recent analyses of zinc used for pre- vention and treatment of infections show mixed results. Zinc may be helpful in reducing the severity and duration of colds and flu. In one study pub- lished in February 2021, zinc supplementation had no measurable effect on COVID infection; while another study a few months later showed that zinc status may be predictive of COVID severity (lower levels correlated with greater COVID severity).

It’s known that zinc is necessary for many aspects of the immune responses to bacterial and viral infections, and numerous studies demon- strate antiviral activity of zinc in the laboratory.

So it seems plausible that making sure you have adequate intake to meet your body’s demand would be beneficial.

Of great significance is the association between zinc deficiency and chronic disease such as dia- betes and cardiovascular diseases. Low-dose, long-duration fortification of the diet with zinc has been shown to improve specific risk factors for certain noncommunicable diseases (NCDs), decrease insulin resistance, and improve good cholesterol and triglyceride levels. This approach to fortification mimics natural zinc intake from food and was superior to high-dose or short-du- ration zinc supplementation; it also has the poten- tial to decrease the comorbidities that are associated with the greatest risk of severe and fatal COVID infections.

God gave us a health-optimizing lifestyle that helps protect us from a wide variety of physical and mental diseases. Healthful practices such as adequate sleep, exercise, and hydration; healthy eating; wholesome relationships; stress manage- ment; and trust in God are fundamental to all health enhancements.

Unequivocally, we state that you should avoid zinc deficiency, which increases the risk of acute and chronic infections and a host of other problems. Zinc is inexpensive; low-dose, easily absorbable preparations have few side effects and should help avoid deficiency. But it can interact with certain medications, medical conditions, other supple- ments, and foods, so a conversation with your health-care provider is essential. Also, do not exceed 40 milligrams intake per day as a supplement.

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:I see doctors and pastors on the Internet who challenge the need for quarantine and social distancing. They say that quarantine was historically only for people who were sick, so if we don’t have COVID-19, we shouldn’t be “locked down.” Are quarantine and social isolation really necessary for our health?

A:Navigating the Internet is challenging. Separating fact from opinion is daunting. We live in a prophetic “age of confusion.” In response to your question, we present biblical and historical perspectives of quarantine.

Most authorities cite the Bible as the most ancient documentation of restricted social interaction to limit the spread of disease. Leviticus contains divine instructions for evaluating and physically (socially) distancing individuals thought to be harboring potentially serious contagious diseases. Such people were barred from associating with others for seven days, and if their situation remained unresolved over that time, a second seven-day separation was enforced.

Coincidentally, in those days 14-day physical distancing was not a novel, human concept but rather a biblical prescription. Should an individual be diagnosed or confirmed to be acutely infected, they would be disallowed free access to society and required to broadcast aloud that they were “unclean” whenever in a public space (see Lev. 13:1-46). Furthermore, ceremonially unclean individuals could not congregate or be involved in communal worship activity.

Despite claims to the contrary, the most reliable evidence is that COVID-19 is a serious contagious disease. For a while, how it was spread was largely unknown, testing for infection was inadequate or unavailable, and the infectiousness and number of asymptomatic carriers was merely speculative; everyone became a potential case! So, to interrupt the spread, it was prudent to apply social distancing and various forms of preventive hygiene, as the Bible also describes and prescribes (see Lev. 15).

In today’s language, persons in biblical times who were suspected of disease were “quarantined,” and confirmed cases were placed in “medical isolation.” Both involved physical (social) distancing and meticulous hygiene. Moreover, quarantined or medically isolated individuals were disallowed from the Hebrew equivalent of going to church.

The Bible describes the concept and practice of quarantine, but doesn’t give it a name. The word “quarantine” (from quarantina, or“40 days”) was coined in Venice in 1448. Before that time, ships were held offshore for 30 days (trentena) to curtail the spread of the bubonic plague (Black Death). The “trentena” was not completely effective since the plague’s time course from infection to death averaged 37 days; thus, we have “quarantina.” As people learned more and “knew better,” they “did better.” Today, we can ignore history or learn from and prudently build on it. For example, we now can be physically distanced but still socially connected—a win-win.

God cares for us; we care for others; we don’t put them at unnecessary risk. While protecting others, we protect ourselves. It’s inconvenient and costly, very costly, sacrificially costly. Yet Christ’s followers are motivated by love and compassion for all, especially the most vulnerable (see Matt. 25:31-46). After all, aren’t we our brother’s and sister’s keeper?

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:We recently moved close to my husband’s elderly aunt, whom he hadn’t seen since he was a teenager. Her house was filled with moldy newspapers and just “stuff.” There was literally no place to sit. This couldn’t be healthy, could it?

A: You describe a well-developed case of hoarding—and, no, it’s not healthy, on several levels.

Hoarding is a subtype of obsessive-compulsive disorder, in which affected individuals stockpile and have emotional attachments to items—regardless of the objects’ real value—that others view as worthless. Hoarders have a compulsive need to constantly acquire “stuff” and have difficulty in getting rid of possessions. The thought and process of discarding brings significant stress and distress, often because of fear of losing something valuable, important, or useful. This appears to be the driving force of the disorder. Hoarding is estimated to affect between 2 and 5 percent of the U.S. population, is more common in Western countries, and, unfortunately, is a growing problem.

As in the case you described, accumulated possessions grow to the point of blocking off living spaces (bathroom, kitchen, utility and clothes closets) and appliances (stove, refrigerator), thus affecting the ease of doing everyday household tasks, such as cleaning and cooking. As a result, sanitation and hygiene become challenging, and personal safety becomes compromised.

Interestingly, the situation is often not perceived by the affected individual as a “problem.” Clutter inhibits free passage, thereby increasing falls and injuries. It poses a fire hazard and impedes access by emergency personnel. Clutter invites and shelters pests, mold, and structural damage, increasing the risk of respiratory, allergic, and infectious conditions.

Genetics, brain functioning, and stressful life events are all being scientifically evaluated as contributors to this derangement. Although elderly people exhibit more extreme examples, most can trace telltale behaviors as far back as childhood or adolescence. Despite being more prevalent than anxiety, hoarding hasn’t received much attention. The main treatment, cognitive behavioral therapy, is highly successful but requires time, often six to 12 months. The goal is to help hoarders think through and “see” the situation; stop the acquisition; acquire new, effective, organizational skills; and begin the act of discarding the accumulated items. Hoarders often know that they can’t find things and realize they prize things that are of dubious potential usefulness, are spending unnecessarily, and are placing themselves at risk; but they have an inner script that overrides corrective action.

In a way, many of us have some tendency toward accumulating “stuff,” even knowing that our value isn’t based on our possessions and that discarding what isn’t useful may not necessarily be wasteful. But even our spiritual understanding may not fix this psychological problem, which is best attended to professionally and with Christlike compassion.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:I have pain in my calves when I walk a short distance or up a few stairs. My practitioner says it’s artery clogging, which needs medications or surgery. Are there any natural treatments?

A:It seems as though your practitioner is talking about peripheral artery disease, or peripheral vascular disease (PVD), which is often treatable and sometimes reversible. It affects more than 8 million people in the United States, especially those over the age 60 and those who smoke, have diabetes, have high blood pressure, and are sedentary. Establishing a firm diagnosis will likely include some combination of laboratory tests, functional tests, and imaging.

If PVD is confirmed, you should know that your risk of stroke and heart attack will also be high, since it develops through the same process. Depending upon the severity of your condition, you may be able to use lifestyle approaches to relieve symptoms and reverse or slow the progress of the hardening of the inner lining of your arteries and the development of “scarring” of the arterial walls (plaque). But while lifestyle improvement is absolutely essential, it may be insufficient.

When the lining cells function properly, they produce nitric oxide (NO). NO is very potent in widening the capacity of arteries and improving circulation. Systemic inflammation, psychological stress, weight gain, high bad cholesterol, high blood pressure, diabetes, and smoking all promote malfunction of this normal process. Consequently, stress management, weight loss, smoking cessation, and active physical exercise may all contribute to your improvement or even help you avoid surgery. Please follow the recommendation for your treating physician. But get a second opinion, as treatment may necessitate surgical or balloon interventions to reestablish healthy circulation and avoid unnecessary loss of a limb.

Once diagnosed, stop smoking or using any tobacco product that you may now be using. If you have diabetes, high blood pressure, high cholesterol, or high triglycerides, get it (or them) under control by becoming actively involved in your own care. Take special care of your feet, which are at risk of gangrene. If you have diabetes, get your HbA1C, an indicator of blood sugar control, to the recommended level, since levels greater than 8.0 are associated with blood vessel complications in the eyes, heart, brain, and kidneys, as well as the legs.

Get active. A progressively more intense, daily walking schedule may reduce calf pains and increase the distance you can walk without pain. Consult your doctor about your heart disease risk, and get a recommendation for a safe starting point. If you smoke, stop! If you’re overweight, try to get lean and maintain a healthy weight. Check your blood pressure regularly and, if high, get it to safe levels. Eat more healthfully, and choose foods that help normalize nitric oxide levels and response in cells lining the arteries. Foods high in flavonoids, such as cocoa, walnuts, berries, and grapes, have been shown to help to some degree.

Prayerfully consider your situation and all options, and by God’s grace, do your best.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:My dentist is recommending expensive treatments for my bad breath, teeth, and gums. She said my gum disease is interfering with my blood pressure and blood sugar. Is she just scaring me to get business?

A:It’s impossible to judge the integrity of your dentist based on your question. The substance of her argument, however, is sound, and we hope this was also emphasized by your medical doctor, if you have one. Here are the facts (and they may be scarier than what was already said!).

The mouth is a special window through which your bodywide (systemic) health or disease state can be observed. Oral disease is associated with and, indeed, may cause systemic diseases. Periodontal (gum) disease, like well-known chronic medical conditions, takes quite a while to develop. It may first be noticeable as bad breath and gingivitis (inflammation of the gums), in which the gums bleed easily with brushing and become swollen and red. As it worsens, it becomes periodontitis, in which the gums separate from the teeth, the underlying bone becomes thin, and the teeth may loosen or fall out.

This, however, is just the tip of the iceberg, since it seems that the inflammation that accompanies gum disease affects the susceptible tissues of the entire body.

Bad breath has a variety of causes that originate not just in the mouth; one pathway is through the production of sulfur-containing chemicals that make the delicate gum tissues porous to bacteria and their toxins, which, in turn, enter the body’s circulatory system. Masking bad breath with mints and mouthwash does not deal with the causative bacteria, so definitive treatment should be sought.

Gum disease is associated with atherosclerotic vascular disease and heart attack, lung disease, diabetes, pregnancy-related complications, osteoporosis, rheumatoid arthritis, kidney disease, high blood pressure, liver and pancreatic cancers, even Alzheimer’s disease. Preventing and treating gum disease is part of the chronic disease risk-factor reduction strategy and adjunctive therapy for these conditions.

Just for the record, you are not alone—in one large, multinational anaysis 73 percent of people with diabetes didn’t know that their oral health affects and is affected by their diabetes. You might consider asking your doctor and dentist to collaborate with your care, since good evidence suggests that treating either the diabetes or the gum disease positively impacts the other.

Facts at a Glance:

Gum disease affects:

The good news is that gum diseases are preventable and manageable. But as with tooth decay, they are infectious. Effective, daily self-care, including meticulous oral hygiene, the judicious use of antibacterial rinses, and appropriate professional care, are essential components of a total health regimen.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Adventist Review editor Bill Knott asks Dr. Peter Landless, General Conference Adventist Health Ministries director, about the “Statement on the Biblical View of Unborn Life and Its Implications for Abortion,” recently adopted by the denomination’s Executive Committee.

Bill Knott: The recent Statement voted by the Executive Committee emerged from a specific history. Any time the world Church decides to change or amend one of its published statements, we assume it does so for reasons it believes are compelling. What were the reasons that motivated church leadership to want a new Statement about unborn life and abortion beyond the Guidelines the Church voted in 1992?

Landless: The 1992 Guidelines actually served the church well, though we recognize there are some who don’t accept that. When we look at the data since 1992, the number of terminations of pregnancy overall decreased significantly. Some Adventist hospitals had a checkered history with abortion (practicing elective abortion), particularly in the ‘70s and ‘80s. There were issues, there were problems, with the numbers of abortions being performed at certain locations. Accountability in some entities was lacking. This is unacceptable.

Voting this Statement is an historic moment and one that we should welcome. Abortion is a sensitive and delicate topic that must be discussed—and is being discussed. The regrettable practices of the last century have left doubts and questions in the minds of many, and rightly so. When we look at the numbers  and the practices from some entities before 1992, they are facts of which we can’t be proud. We’ve also now moved from a time of selective disclosure to full disclosure, aided by trust and respect.

Knott: What would you describe as the significant differences between the 1992 Guidelines and the newly voted Statement?

Landless: The 1992 Guidelines were drafted by a large committee—The Christian View of Human Life Committee, made up of theologians, ethicists, and health professionals—and it addressed mainly the guidelines regarding termination of pregnancy. The current Statement is a biblical statement on the sanctity of life of the unborn, and was drawn up by the Biblical Research Institute Ethics Committee in consultation with dedicated Adventist health professionals from around the world. It’s difficult to clearly and responsibly draw the distinctions between the two documents, since the 1992 Guidelines also referenced biblical principles.  Guidelines useful to the church are of necessity informed by a biblically grounded Statement, which has now been voted.

I deeply appreciate the fact that the new Statement is fully biblical—well-rounded, thoughtful; establishing a deep respect both for the Word of God and for the women and men who have to make decisions based on their understanding of the Word.

22 3
Live Births/Terminations of Pregnancy. These statistics may be compared to information provided by the United States Centers for Disease Control (CDC). Out of every 1,000 live births in 2015, there were 188 terminations of pregnancies.

Knott: But is there more that needs to be said beyond the voted Statement?

Landless: Even the most well-thought-out Statement will still need principles of care that help both families and Adventist medical practitioners understand how to faithfully implement the principles articulated in the Statement. These are particularly important in those rare and extremely difficult situations where very difficult decisions need to be made. The life of a mother might be at stake. Or, as has proven true in the very few terminations that now take place in Adventist hospitals, when life outside the womb would be impossible. In these tragic settings, where there seem to be no good options, it’s important to have some understanding about how to proceed with these unfolding tragedies. In those extreme circumstances, we have to form plans that will help us make wise decisions, and practice humane, Christ-like medicine.

Knott: So these protocols and processes don’t so much mandate outcomes as advise outcomes?

Landless: That’s correct.

Knott: Let me push the question: Faithful medical staff, using these protocols, would then be able to present parents of an unborn child unable to experience life outside the womb with options drawn from the biblical principles of the Statement?

Landless: That’s just how we want it to work. And it has to be done sensitively, carefully--a graceful and gracious approach to people who are in those rare and very difficult circumstances. This isn’t at all the same as offering what has become known in the public mind as “choice.” We should note that the 1992 Guidelines did help make a significant difference, for they drew a distinct line between these tragic, rare circumstances and all issues of elective abortion, abortion on demand, abortion for contraception, convenience, or gender selection. All of those were totally excluded by the 1992 Guidelines.

Knott: You said a moment ago that very few terminations of pregnancy now take place at Adventist hospitals. Is that widely understood by most members?

Landless: I think what has surprised many people is the fact that the numbers of pregnancies terminated at Adventist hospitals, especially in North America, is small—and the rationale for each one is carefully documented. [See chart above]. In the single largest Adventist health-care system in the world, AdventHealth, which handles nearly 40,000 live births each year among its 50 hospitals, there was a total of 23 pregnancies terminated in the latest year on record—in every case, a situation where life outside the womb could not have been sustained. The numbers are thankfully dramatically smaller than almost anyone realized, and also represent a small fraction of the national abortion rate in the United States. Like each of our North American health-care systems, the leaders of this system have been very, very determined to continue best practice and careful interventions related to termination of pregnancy into the future. And I know not only from their words but from their practice, that it’s their desire that termination of pregnancy be as close to zero as is absolutely possible.22 1 4

Knott: During the recent Annual Council, one delegate pointed out that it’s virtually impossible to compose a Statement that’s entirely comprehensive for such a difficult and painful human moment. Two situations that continue to cause a lot of discussion, even though the Statement is voted, are the questions of what to do in cases of rape and incest. Were these addressed in this new document?

Landless: They weren’t included among those rare and extreme conditions referenced. What was very interesting in the general floor discussion at Annual Council was that there were deep concerns expressed about the omission of these two situations by delegates, especially from outside of North America—some from regions in which rape is a tactic of war, and where incest may be thought to occur more frequently.  It’s going to require great care and prayer to craft protocols that actually assist our medical institutions and our church members when dealing with these realities.

Knott: If I’ve understood you correctly, the Adventist Health Ministries Department, as advised by the General Conference Bioethics Committee, will be recommending protocols based on the new Statement to Adventist medical institutions and hospitals around the world.

Landless: Principles of care will emerge in these protocols and processes that will help caregivers, hospital systems, and ethics committees advise individuals of what they might appropriately consider in such moments. All of us—those who wanted a fuller and more biblical Statement, and those who were comfortable with the 1992 Guidelines—will be monitoring the implementation of these protocols. The intention is that no protocol or process opens the door to elective abortion or abortion on demand, to both of which this department and the wider Seventh-day Adventist Church are totally opposed.

As a physician who spent 11 years in family practice, attending many pregnancies and delivering hundreds of babies, I find it hard to imagine that anyone wouldn’t strive to preserve and support life. It’s crucial to make every effort to ensure that the life, the pregnancy, is maintained and respected for the miracle and inestimable value it is.

Knott: Talk to me for a moment about persons—the families—that are actually at the center of these heartbreaking situations. What do they have a right to expect as a result of the counsel your department will be providing?

Landless: As vital as it is for the church to approach these dilemmas from a thoroughly biblical perspective, we can’t forget that it is people—mothers, fathers, families, and family systems—that must be our focus in such moments. There needs to be a well-informed, compassionate system that asks the right questions in these awful moments.

Knott: What are those questions?

Landless: “How is the mother—how are the parents—going to be supported and sustained through—and beyond—this crisis? How is the family going to be supported?” “How will we hold ourselves accountable to the principles emerging from God’s Word?” We’ve got to ask—and answer—these questions with sensitivity. So chaplains need to be involved. Psychologists need to be involved. Ethics committees need to be involved.

Knott: These issues aren’t half a world away. Within the last two years, a General Conference family received the devastating news early in a pregnancy that the child forming in the womb was anencephalic, developing without a brain. The physicians brought this terribly difficult information to the mother and father, along with the grandparents. And the family wrestled with their pain; they sought pastoral support and counsel. They consulted hospital chaplains. They worked through every detail to try to find the right answer. No one was mandating anything or telling them what they must do. The physicians were painfully clear that there was no opportunity for life outside the womb. And the family ultimately reached a decision that, as terrible as it was for them, they believed was the best route to peace for them and for all the people who supported them.

Landless: Stories like that break my heart—and I know them well. I’ve walked with families who faced these awful moments. It’s probably true that almost every family system in our worldwide church has been in one of these dilemmas in the last seve
ral generations.

22 2 5Knott: Several participants in the process of drafting the new Statement noted that no more than 5 percent of Seventh-day Adventists around the world are likely to engage with an Adventist hospital or an Adventist practitioner in the course of a year. The vast majority of these stories will unfold in congregations and families. Will there also be protocols and processes to guide congregations and pastors and church boards about how to respond appropriately in these worst human moments?

Landless: This is an extremely important point you’re raising, and one I’ve also made on committees as well. This isn’t just a health-care issue: we are multidimensional beings. We are body, mind, and spirit, with social, emotional, and spiritual capacities. It’s a chaplaincy issue as well. It’s a pastoral issue. It’s a young adult issue. It’s a family issue—a massive family issue. Pastors, elders, and members have to recognize their role as caregivers as well as counsel-givers in these situations.

Knott: That sounds like a whole-church response.

Landless: This is a ministry that belongs to all of us: we can’t leave it only to the physicians and the bioethics committees. Families need support right where they live—from those who worship with them and serve with them and share the journey with them. The challenges don’t end when an unsustainable pregnancy is terminated. Parents wrestle with the sense of loss, with feelings of inadequacy for not being able to fulfill what is deemed a natural function, but one in which they may be judged to have failed.

And those who have made unwise choices to end an otherwise viable pregnancy especially need the church’s love and care. We dare not extend our care only to those who make choices we approve of. I’m particularly proud of the Statement for calling on all members to “create an atmosphere of true love” for those who make these painful decisions. The body of Christ needs to act like a body does—as a unit for healing and restoration and recovery—so that every member is embraced by the love of God, immersed in His grace, and loved by their fellow pilgrims.

The ministries and departments of the Church we love and serve are a blended ministry, not ministries at war. The health work is the right arm of the message with all the complexities, challenges, and opportunities that come with this special ministry. As we prayerfully consider and implement the voted document, I’m praying that we’ll be respectful and considerate at all times, showing by our love for one another that we are His disciples. That for me is an illustration of Church at its best.

Q:I am a cigarette smoker transitioning to vaping. My father, a cigar smoker, says that cigars give all the pleasure of smoking without the risk. Are cigars safer than cigarettes?

A:The short answer is: no. Cigars are rolls of tobacco wrapped in tobacco leaf or tobacco-infused paper; cigarettes are chemically treated tobacco wrapped in paper. Premium cigars use aged, fermented, additive-free tobacco. Cigars burn slowly, and, according to some researchers, the nonporousness of the wrapping may produce smoke that is more dangerous than cigarette smoke. “Little cigars” look like cigarettes in size, shape, and packaging, and may even have a filter attached, but they are taxed at a lower rate, making them less expensive.

In the United States, cigars are marketed as symbols of sophistication, luxury, and successful lifestyle; and cigar smoking is often linked to high-end consumer drugs such as expensive alcohol and specialty coffees. Cigars are traditionally offered by individuals who are celebrating a special occasion, such as the birth of a child, and to individuals who have achieved a milestone socially or professionally. Both cigars and cigarettes are often considered stress-relievers. Cigars may even have aromatic flavors, but we should not be fooled: tobacco kills, and cigars are tobacco.

A very robust analysis of 22 studies showed that ongoing, exclusive cigar smoking with no history of previous cigarette or pipe smoking was associated with increased death from any cause; cancers of the mouth, throat, esophagus, lung, and pancreas; and increased risk of potentially fatal heart and blood vessel diseases. The number of cigars smoked per day and the degree of inhalation of the cigar smoke strongly correlated with oral, esophageal, laryngeal, and lung cancers. Even those who did not inhale had highly elevated associated risk of dying from oral, esophageal, and laryngeal cancers.

Tobacco in all forms contains the highly addictive stimulant drug nicotine. The average smoker absorbs about two miligrams of nicotine per cigarette smoked. The typical cigar contains about seven times the amount of tobacco compared to the average cigarette. But while most cigar smokers don’t inhale, prior cigarette smoking makes a person more likely to inhale.

Although you did not ask about your vaping, we want you to know that the chemicals in the e-liquid have been linked to death.

Your best course of action, then, is not to switch to vaping, which is dangerous and addictive, but rather to eliminate these dangerous chemicals from your life and be free. Adopt a new pattern of naturally stimulating life-giving or lifesaving activities rather than the artificial, chemically induced life-taking ones: vaping and smoking. Start training for a triathlon; engage in short-term missions; join a band or singing group and listen to melodic instrumental music; engage in outdoor sports; get first-responder training; volunteer for your local fire department, etc.

These kinds of activities stimulate the same pleasure centers in the brain as nicotine but without harm. Prayerfully consider these along with an effective smoking-cessation program, and you’ll be better off than doing even what your dad suggests.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:This may not be politically correct, but I see pet dogs invading our public spaces on airplanes, trains, and buses, and just wonder if pets are really all that healthy for humans.

A:It is said that “a dog is man’s best friend”; and, as you pointed out, more and more animals are seen providing support, even therapy. “Pet therapy” refers to the use of animal intervention for human health. It ranges from animal-assisted activities (such as comfort, companionship, and cheer to institutionalized patients) to animal-assisted therapy to help people cope better with, and recover from medical conditions. A new term, emotional support animals (ESA), refers to animals that are trained to provide special comfort and ease to persons with anxiety (especially for flying and crowds) and depression. Anyone who has ever been greeted enthusiastically by a dog when arriving home after a hard day has experienced the power of pet therapy firsthand.

Despite the aforementioned, a great concern with the use of animals in hospitals and public indoor spaces is safety and sanitation. Well-thought-through and strictly enforced rules concerning cleanliness, vaccinations, training, and field testing must be in place. Unfortunately, some people fraudulently pass off their pets as service animals, and this creates a significant potential hazard since real service animals undergo careful selection for temperament and stringent training that allows them to perform their functions with calm efficiency and appropriate gentleness without becoming distracted or uncontrollable.

Regular pets are usually not trained in this way, but should be healthy and of appropriate size and temperament, especially around small children and those who are elderly.

Home pets have been shown to:

Some pet dogs have been able to detect health conditions of their owners and warn them of impending problems, such as migraine, epileptic and nonepileptic seizures, high and low blood sugar levels, and even some cancers. This adds new meaning to the expression “pet scans.” Playing with your pet, hugging your spouse, watching sunsets, or appreciating the beauty in nature raise serotonin and dopamine, the body’s “feel-good” hormones, healthily without drugs. Oxytocin, our “trust and bonding” hormone, is boosted in both dogs and humans when dog owners look into the eyes of their dogs. Even robot pets provide health benefits to lonely people.

Yes, it is God who made us and the animals to work and play together, and that is His desire for us in the new earth. But despite all that’s been said above, it is God Himself, not the dog, who is man’s and woman’s best friend!

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.