Health, Truth, And The Bell Curve

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<p>Bastyr University Commencement 2017, Benaroya Hall, Seattle</p>

Bastyr University Commencement 2017, Benaroya Hall, Seattle

I was privileged this past week to deliver commencement addresses for Bastyr University on their campuses in San Diego, and Seattle, to a combined audience of several thousand, celebrating the graduation of hundreds of students receiving various bachelors, masters, and doctoral degrees in the health professions. Here, more or less, is what I said.


I am honored and delighted to be here today to join in this celebration, and partake vicariously in your triumph. As I will reiterate at the end of my remarks, today is a triumph, truly, and I congratulate you heartily for it. I am privileged to celebrate it with you.

We preside today together over the consummation of one set of proverbially big “ifs:”- IF I make it through; if I pass my exams; if I make it to graduation . You have, you did, and you are- and along with your faculty and parents, friends and family- I am delighted to be here to offer my congratulations.

We preside today together over the conception of innumerable contingent “ifs” as well. After all, this is a commencement, not a termination; it is the beginning of things. The many implicit “ifs” – if I go on to more study or not; if I move here, or there; if I take this job, or that job – echo into the uncertainty of the future.

As we ponder those reverberations emanating from today’s milestone, we might productively consider the words of the ostensible expert on that very topic, Rudyard Kipling, whose most famous poem is entitled, simply- “IF:”

If you can keep your head when all about you

Are losing theirs and blaming it on you,

If you can trust yourself when all men doubt you

But make allowance for their doubting too,

If you can wait and not be tired by waiting,

Or being lied about, don't deal in lies,

Or being hated, don't give way to hating,

And yet don't look too good, nor talk too wise:

If you can dream--and not make dreams your master,

If you can think--and not make thoughts your aim;

If you can meet with Triumph and Disaster

And treat those two impostors just the same;

If you can bear to hear the truth you've spoken

Twisted by knaves to make a trap for fools,

Or watch the things you gave your life to, broken,

And stoop and build 'em up with worn-out tools:

If you can make one heap of all your winnings

And risk it on one turn of pitch-and-toss,

And lose, and start again at your beginnings

And never breathe a word about your loss;

If you can force your heart and nerve and sinew

To serve your turn long after they are gone,

And so hold on when there is nothing in you

Except the Will which says to them: "Hold on!"

If you can talk with crowds and keep your virtue,

Or walk with kings--nor lose the common touch,

If neither foes nor loving friends can hurt you;

If all men count with you, but none too much,

If you can fill the unforgiving minute

With sixty seconds' worth of distance run,

Yours is the Earth and everything that's in it,

And--which is more--you'll be a Man, my son!

--Rudyard Kipling

Kipling’s famous poem, and wisdom, have stood the tests of time; but we may concede that time has tested them sorely just the same. For one thing, there is the blatant sexism acceptable in his day, but objectionable in ours. We can have none of this man/boy, father/son exclusivity- even on the cusp of Father’s Day! Were we to write the poem today, we might end with something like:

Yours is the earth, all that’s tame and that’s wild-

And what’s more, you will merit that treasure, my child.

I have another objection to the poem, specifically on our behalf as crusaders for health. Why does health matter? We may tend to forget that health is not a virtue. Health, per se, is not the prize either; health is a currency uniquely applicable to the purchase of the prize. Health matters because…healthy people have better lives; healthy people have more fun.

What we feel matters: pain and sadness, or today- joy and pride. Disaster, when it happens, as it inevitably does to us all, is undeniably real. Triumph is as well.

Accordingly, I have presumed to write a rebuttal to Kipling’s ‘If.’ Mine, naturally, is entitled- “If, and but:”

Triumph and disaster are both

real; for life and death are set

apart by little more than our

capacity to feel. and Kipling, grown

more old than wise, unlearning to

despise or love; mistold the goal, concealed

the prize. For triumph and disaster are

both real; all that I

feel is nervously alive upon the slippery

verge of death. triumph

fills, inspires me; disaster

drains me dry; and neither, more,

nor less reliably

than breath.


To reiterate: today’s triumph is real, and deserves to be celebrated. How it makes us feel matters.

But my job here today is not just to celebrate and congratulate you, pleasant though that might be for us both. My job- the job of a commencement speaker- is to provoke and harangue, goad and attempt to inspire. I have only faint hope of achieving all that, but in accepting this invitation, I pledged my best effort.

In service to that mission, then, it is other lines of the poem that seem most to warrant our consideration today. Namely:

If you can bear to hear the truth you’ve spoken

Twisted by knaves to make a trap for fools…

There’s a lot there to ponder in a post-truth world of alternative facts. There is a lot to that in a world where every opinion mistakes itself for expertise; every voice can access the megaphone of cyberspace; and every assertion can amplify itself in echo chambers populated by those attending carefully only to the opinions they already own, drowning out all else.

We presume that Kipling is speaking to us, and thus that THE truth is OUR truth. But if everyone is the person to whom Kipling is speaking- if each of us owns the truth- then who is the knave, who twists the truth? Who is the fool taken in by such willful distortion? Recall the precautionary lyrics, courtesy of The Main Ingredient: everybody plays the fool, some time

Sometimes our view of the truth can be too narrow. Those of us who embrace and espouse holism see just that liability in staunch conventionalists who refute any truths that reside outside the bounds of their comfortable conventions.

Sometimes, though, our view of truth can be too broad. Not all that glitters is gold; not every therapeutic modality with intrinsic appeal and vocal proponents- actually works. In the pursuit of truth, we must keep open minds- but not ever so open our brains flop out!

We can all too readily believe what isn’t true, and play the fool. In our fervor, we can pass along that misguided conviction, playing the knave- and making fools of others.

When you know the truth reliably; defend it. When you don’t know the truth, admit it. When you hear the truth, embrace it. When most uncertain, listen and reflect at greatest length. Respect how readily we all mistake our native preferences for truth.

Kipling says if you meet all criteria, the earth is yours. But I say: if you are worthy, you know the world cannot be yours, because it belongs to everyone. And to no one. It was here before us, and will be here after us. It belongs as much to butterflies and bears, penguins and pine trees, lizards and lemurs.

We cannot own the earth, and should aspire to no such thing. We should not seek to own the truth, either- we should strive to share it.

Sometimes, our view of truth is too proprietary. Many of us try on our own to be that source of truth that rises above the shouts of the knaves, and reorients the gullible fools. But in this age of incessant din and endless echoes of every opinion- no one voice can reliably deliver the signal of truth; no one voice can overmaster the din. Only in our unity is there sufficient strength to try.

We should not seek to own fundamental truths about well-being, or anything else for that matter. We should share them. And if sharing them requires us to build new bridges to unexpected places, then we should all be just such engineers.

The True Health Initiative is my effort at bridge building- a global coalition, devoted to defending and disseminating the fundamental truths about a sustainable, health-promoting lifestyle. Alternatives to those truths are forever tempting the public because they are provocative, and magical, and sexy. Sadly, they are untrue.

When you do find the truth, don’t seek to own it. The truth is only ever distorted in echo chambers. The truth withers and dies in bunkers. The truth is made for bridges, not bunkers. The truth blossoms in the disinfecting rays of daylight. The truth is best shared.

That, in turn, brings me to the one truth of my own I presume to share today, reflecting on my own efforts to do good in the world. We all want to be special, and rightly so. You are distinguishing yourselves today, so my comment may seem a bit incongruous- but the truth does not promise to be congruous or convenient; only true. Here it is: I believe the best measure of our worth is not how much better we can be than average, but how much we do to make the average better.

What difference does it make if you know that health care should be a right, but society treats it as a privilege? What difference does it make if you know that access to care should be universal, but it remains exclusive? What difference does it make if you know that holistic models of care can be kinder and gentler and highly effective, but the system is unreformed? What difference does it make if you know that climate change is real, and we are complicit in it, but our culture remains committed to doing far too little far too late about it? What difference does it make if you know that multicolored marshmallows are no part of a six-year-old’s complete breakfast, but Madison Avenue doesn’t give a damn?

Gertrude Stein famously said: a difference, to be a difference, must make a difference. To make a difference, we must make the mean different. We must raise the average- of awareness, knowledge, and understanding; of empowerment and opportunity; of concern, compassion, and civility.

Society does not do the bidding of outliers; it heeds the tolling at the center of the bell curve. Society, and culture, regress to the mean. They are governed by the popular imperatives, not the most erudite.

So don’t seek exclusive islands in the tail of the bell curve; you can be different there, but you cannot make a difference there:

No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend's or of thine own were: any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.

-John Donne

Like John Donne’s church bell, the bell curve tolls for us all. We will rise or fall together.

That’s my truth for today. The true measure of our worth is not how much better we can be than average, but how much we can do to make the average better. It’s your time, and it’s your turn to make the mean of us all- better.

Graduates of 2017- push your youthful strength up against the reluctant weight of the mean- but do it tomorrow. Put your shoulder to the unyielding line drawn through the middle of the bell curve and lift, tomorrow. Welcome to the revolution, tomorrow; it will be waiting for you.

Today, the simple truth is- you’ve made it. That is a triumph. Perhaps a small triumph in the grand sweep of things; but all triumphs are small in the grand sweep of things. It is a triumph, truly, and worthy of celebration. It matters.

I am honored to celebrate it with you, and proud to be here to say: Class of 2017- congratulations!


Director, Yale University Prevention Research Center; Griffin Hospital

Immediate Past-President, American College of Lifestyle Medicine

Senior Medical Advisor,