macarisms

Christians get depressed too

Last week I attended a half day seminar on mental illness. It was aimed especially at Christian workers, offering an introduction to the prevalence and complexity of depression in particular. It sparked my interest to refresh my understanding and delve a little deeper into this troubling matter. ‘Depression’ can be a polarising issue among people in general, and there are particular dividing lines among Christians. There are different schools of thought about what it looks like, how and why people become depressed, and what should be done to help people with depression. Christians get depressed too by David Murray is a short book (112 pages) that is well worth reading. It shows a good understanding of the complexity of this issue and argues for a decrease in dogmatism and an increase in humility.

Murray urges us to avoid simplistic extremes when considering the cause of depression. He demonstrates how Christian analysis has fallen into three camps: the cause is all physical; the cause is all psychological; or the cause is all spiritual. The problem with these positions is the word ‘all’. We are complex beings and it is unlikely that one factor alone can be found that explains the cause of depression. In the case of spiritual factors, Murray argues that spiritual problems are more likely to be the result rather than the cause of depression. This is not to rule out spiritual factors sometimes being the cause of depression. But we are urged not to jump to this conclusion any more than we would assume spiritual factors to have caused headaches, cancer or asthma. The second chapter of this book offers some helpful analysis of the approach and writings of Jay Adams and also the modern Biblical Counselling Movement.

This book seems especially aimed at helping the person who believes that having depression is incompatible with being a Christian. Murray shows how this is not the case, and provides biblical evidence for depression and faith in God coexisting in the one person. The book of Psalms illustrates this, with approximately one third of the Psalms demonstrating depressed thoughts and feelings.

Many factors can be involved in depression: life circumstances; unhelpful thought patterns; negative emotions and feelings; bodily symptoms; and changes to behaviour and activity. Acknowledging the complexity of causes and the variety of symptoms, alerts us to the benefits of a multifaceted approach to helping a depressed person. Murray suggests making helpful adjustments to our lifestyles in the areas of routine, relaxation, recreation, sleep, diet, and the like. He recommends addressing our thought processes and assessing our feelings. If making these adjustments doesn’t fix things, then he recommends seeking out trained medical help and possible medication. He also urges us to correct spiritual consequences and, where appropriate, spiritual causes of the depression.

The last chapter gives some good advice to non-professional caregivers. We are urged to learn more about the nature of depression, and there are some useful recommendations for further reading. Murray calls for sympathy for the person suffering depression. However , in my opinion, what he describes might be better described as empathy. We don’t all need to experience depression ourselves to be able to help those who do. Secrecy and stigma are among the problems to overcome in caring for a depressed person. There’s helpful list of things not to say to someone who is depressed. And there is an important section on helping someone who may become suicidal.

There are no easy answers and no quick fixes when it comes to depression. Ongoing support and understanding are required to be helpful and this book is a useful tool for becoming better equipped at both.

10-10-10

10-10-10 by Suzy Welsh is a very simple and very practical decision making tool. It revolves around asking three simple questions: When faced with a dilemma, stop and ask, “What will the consequences of my options be in 10 minutes, 10 months, and 10 years?”

This approach helps broaden the variables in complex decision making. It enables us to tap into our values and focus on our goals as we face the immediate crisis of making a decision. Some choices have long ranging consequences and other do not. 10-10-10 helps us weigh the different consequences of our decisions.

10-10-10’s applicability is wide ranging. “From college students to busy mothers to senior business executives, from artists to government administrators to entrepreneurs, 10-10-10 has shown its effectiveness in decisions large and small, routine and radical, changing lives for the better at home, in love, at work, and in friendship.”

While I appreciate the power of this decision making tool and recommend it to others, it doesn’t go far enough. And I mean more than extending it to 50-50-50, to enable decisions to be made with ‘whole of life’ implications considered.

As a Christian, I believe that we all make decisions with eternal consequences. Choices made today and tomorrow will have implications for more than this life alone. If I choose to shut God out of my life for the next 10 minutes, and the next 10 months, and the next 10 years, then I run the risk of distancing myself from God for all eternity. My choice is to trust God with the complexity of day to day, month to month, year to year decisions. I believe that God has secured my eternity through Jesus Christ and that every decision I make should reflect this reality.

The words of John Newton, in his famous song Amazing Grace, come to mind:

When we’ve been there 10,000 years
Bright shining as the sun
We’ve no less days to sing God’s praise
Than when we first begun

Let’s make our decisions by weighing up the consequences for 10 minutes time, 10 months time, 10 years time, and 10 thousand years into eternity. I’d love to cooperate with Suzy Welch in a Revised Edition called 10-10-10-10!

Comms are back

My computer just gave me a message…

Welcome back Macarisms!

Obviously a smart aleck Macbook Pro making the comment. But the truth is, I’ve written just three posts on this site since October 2014. So here comes a change.

My plan, God-willing, is to return to spending a bit more time reading, reflecting, and writing. Much of my bookwork in 2015 has been focused around planning, preparing, and preaching at Stromlo where I’m a pastor. Meanwhile, the pile of ‘unread good stuff’ gets higher and higher, and the space where I cram all the ‘I must write something about thats’ gets messier and messier.

My plan is also to repent of a personal pride—the pride of only allowing Macca’s stuff on macarisms.com. To be honest, I’ve found much value in the links, posts, and tweets of others. And much of the best stuff I’ve found gets passed on by a friend of a friend of a friend. So I plan to relax and pass on a few gems from time to time.

A picture seeing as it’s Seniors Week!

Ministry on holidays

I know I’m on holidays, and I didn’t plan it this way, but the beginning of 2015 has offered a number of opportunities for ministry. On Sunday 4th January I had the opportunity to preach on Hebrews 10:19-25 at South Coast Presbyterian Church and warn people of the dangers of making new year’s resolutions that focus on personal achievement. Typically on new year’s eve we decide how we’re going to work harder, but God is calling us instead to rely deeply and continuously on the completed work of Jesus. That night I was also interviewed on 2CH about Hope Beyond Cure.

During the following week I was interviewed by a leader of the Next Gen conference who drove down to the South Coast to ask me questions about suffering and hope in the gospel. I sat in front of my tent and answered questions for about an hour, so that he could edit the material into three 5 minute segments to use at the conference this week. Someone sent me a tweet saying they were at the conference and were encouraged by the interviews.

On Saturday we travelled to the Central Coast to celebrate my mother’s 80th birthday. It was a joyous occasion and good to see family again and meet my new niece, Annabelle. We stayed with Jim and Lesley Ramsay and as usual found them a great encouragement. On the return trip we dropped Marcus at the airport so that he could head to the Gold Coast to catch up with friends he made at the CMS MMM camp this year. He’s been preparing Bible studies to do with his friends during this time.

moretolife On the Sunday I spoke at the first of the Church@theBeach events for Austi Anglican. I had the opportunity to share something of my journey with cancer and to speak of my hope in the resurrection to come. Afterwards I met a woman who had just discovered she had metastatic cancer and had recognised her need to work out the big issues of life, death, God, and the life to come. I will be praying for her.

Next weekend we are looking forward to our son, Marcus, getting baptised here at Burrill. If you are down near Burrill at 3pm on Sunday you’d be very welcome to join us.

Our 31st anniversary present

We received a wonderful wedding anniversary present this morning—yesterday’s CT scan showed that I’m still NED! There is no evidence of cancer in my body. I don’t know why things have been going so well for me, especially when cancer destroys the lives of so many, but I’m very thankful to God. It is now over 18 months that I’ve been NED.

Do I have to continue with the chemo? Yes. Can I take a break? Yes. My oncologist was happy with the idea of me skipping two treatments over the summer. That could mean I get eight weeks in a row without the awful side effects of chemo. Awesome 🙂 We’ll need to make a decision about exactly what to do, but I’m looking forward to a bit of a break.

It’s fair to say that I have a bit of a spring in my step today. I am so appreciative to God for his loving kindness.

Marking a milestone

Today marks a significant milestone for me. Three years ago I was admitted to hospital with cancer and, within days, a year seemed like an eternity. Now three years, two operations, 50 cycles of chemotherapy, God’s kindness, and a lot of love from a lot of people, and I’m still here—thank God!

And thank you! For your prayers, your visits, your emails, your phone calls, your messages, your meals, your financial help, our walks, the words with friends, the motorbikes, the holidays, your feedback, your encouragement, your wisdom, your nursing, your doctoring, your acupuncture, your physio, the rugby, the camping, the fishing, the reading, the playing…

I thank God for my life! And I thank him for the solid hope of life to come!

The value of a life

I’ve written recently about our desire to see Crizotnib on the Pharmaceutical Benefits Scheme (PBS) in Australia as soon as possible. This decision must be made by the Pharmaceutical Benefits Advisory Committee (PBAC) who meet three times each year, in March, July, and November.

The PBAC is an independent expert body appointed by the Australian Government. Members include doctors, health professionals, health economists and consumer representatives. Its primary role is to recommend new medicines for listing on the PBS. No new medicine can be listed unless the committee makes a positive recommendation. When recommending a medicine for listing, the PBAC takes into account the medical conditions for which the medicine was registered for use in Australia, its clinical effectiveness, safety and cost-effectiveness (‘value for money’) compared with other treatments.

There are real difficulties knowing how to measure cost-effectiveness. The temptation is that a an expensive drug that helps a small number of patients, which is not guaranteed to be curative, will quickly be considered non-cost effective. However, when you factor in that the person or the government might be spending similar sums on other treatment; that the targeted therapy may have better medical outcomes; that it may introduce a much improved quality of life; that it may enable the patient to return to work and not experience the financial and personal costs of joblessness; and more… the equation is not simple.

And another important factor, and I do not know if this is considered by the PBAC or not—if a drug enables the person to live an extra six months, or six years, or whatever, with their family, friends, and community, isn’t this worth something. I know it is to me, and my wife, and my children, and my grandchild, and my friends, and my church, and a bunch of others.

I’ve recently met up with people from Rare Cancers Australia. They are doing a great work of helping to support people who cannot afford the treatments they need. This month they have launched a campaign called Sick or Treat. Please take a look and see if you might be able to help.

Please also watch this clip from the Today Show. Anita has the same cancer and mutation as me, and it is excellent that this is getting publicity. If you feel like lobbying the PBAC, please do. If you pray, please ask God that they will approve this drug and many others like it.

The morality of God in the Old Testament

How are we to understand the Israelites being commanded to wipe out all the Canaanites in Deuteronomy and Joshua? What do we make of the various Psalms that call down curses on the enemies of the writers and God? Perhaps, like me you are troubled by these things (and others) in the Bible. Atheists, such as Richard Dawkins, Daniel Dennett, Christopher Hitchens, and Sam Harris, point to these things as evidence for the moral corruption of God (who they believe is really a fiction). Christians come under attack for their beliefs in a God, whom some describe as a moral monster. Some would say how can Christians criticise the recent actions of the IS in Iraq or Syria, when the Old Testament provides evidence of God’s people doing similar things, and at the behest of God?

Let me say that this isn’t really the atheist’s problem—this is a problem that the Jews and the Christians need to deal with. For the atheist, the problem is not with God, for he/she/it doesn’t actually exist, but with the people who claim to believe in God. Their criticism is fundamentally toward religious people justifying their immoral behaviours in the name of an imaginary divine being. However, for the Christian who believes that God is real, that he has revealed himself to people, and that he is involved in human history—there are real issues to consider when it comes to trusting that God is morally pure. This is an issue that I’m keen to explore further.

In considering this matter, I’ve recently read a brief book by G.K. Beale, called The morality of God in the Old Testament. The book focuses on the commands of God to destroy every man, woman and child of the Canaanites (e.g.. Deuteronomy 20:10-18) and also on the imprecatory Psalms (e.g.. Psalms 7; 35; 55; 58; 68; 79; 109; 137) which call upon God to judge and destroy his enemies.

Beale explores various proposed solutions to deal with the difficulties raised by these passages. First, he describes how people argue that wartime ethics differ from peacetime ethics. While this may be true, it doesn’t account for the commands to kill non-combatants. Secondly, he explores the suggestion that the command to kill women and children is not meant to be taken literally, but is a metaphoric way of describing a total victory over the Canaanites. Beale demonstrates that while there may be something in both these suggestions, neither adequately explain the texts.

Instead Beale offers a fivefold approach to engaging with these issues. His approach gives important nuance and perspective to interacting with the difficult moral issues of the Old Testament.

God’s wiping out the wicked Canaanites as a demonstration of his justice;

God’s extermination of the Canaanites as a purifying of uncleanness of the Promised Land as an Edenic sanctuary;

God’s self-sufficiency and independence from creation;

suspension of ethical obligation by typology and intrusion of final judgment;

suspension of the law of neighbour love. (p33)

Beale argues that we need to recognise the uniqueness of the Canaan episode. It does not offer a paradigm for continued activity in the Old Testament, let alone the New Testament. Instead, it should be seen as a once-only, historic actioning of God’s redemption of Israel, as the nation enters into the land of promise. This salvation/judgment event is also to be understood as a type of what is to happen through Christ’s first and second coming.

There is more to his argument than this, but he demonstrates how it is important to allow Scripture to be understood in it’s full biblical context. The critiques of Dawkins and others show absolutely no understanding of the overall shape of the Bible or the saving purposes of God in the Old and New Testaments.

I still find the matters being described troubling, but no more so than the reality of death and the promise of eternal judgment for all who dismiss God. As a Christian I need to grapple with why God allows any suffering, evil or death, and especially with the moral rightness of God judging people for eternity. It’s sobering to remember how much my own moral failings corrupt my ability to recognise what is right and true and perfect. It’s totally presumptuous (and deluded) to think that I can stand morally superior to God, and judge him for his actions. This becomes clearest to me when I am reminded that God loved the world so much, that he sent his only Son, Jesus, to die in our place, so that all who trust in him will not perish but have everlasting life. Such is the moral character of God.

How can I be sure?

John Stevens’ little book, How can I be sure? And other questions about doubt, assurance and the Bible is definitely one that I will be recommending to others. It’s clear and simple, without being simplistic; it’s empathic and it uses the Bible well. The author understands that doubt is a complex beast, displayed in a variety of forms, and arising from many different causes. I personally found the book to be inspiring and reassuring. It resonated at times with my experiences of doubt, and some of the causes; and it took me to the places where I’ve found reassurance. While recognising that everyone’s circumstances are different, my prayer is that it will do the same for others. All in all, this compact book is one of the better books on doubt and assurance I’ve read.

If I’m going to engage with a book dealing with these topics, I want to know that the author has a firsthand personal understanding of the matter—and Stevens does. He writes about the impact that his father dying of lung cancer had on his faith. It rocked his world, not simply as an intellectual challenge to the goodness and sovereignty of God, but with personal pain and experience. He took some years to recover from the anguish of this time. Stevens has also explored these issues with many in his church over the past twenty years. This has helped him to grasp the different forms that doubt can take in people’s lives, and to apply his thinking to how the Bible helps each one. The book engages the reader by presenting a mix of personal stories of doubt. People have trouble believing due to their struggles with personal sin, unanswered prayers, the challenge of other religions, relationships with people who have different belief systems, God seemingly remote or out of touch with this modern world, feeling overwhelmed by all around who don’t hold the same beliefs, or questioning whether their ‘conversion experience’ was real. Recognising this complexity is so helpful, and many more scenarios could be added, because doubt is not a one-size-fits-all phenomenon. Doubt could mean a lack of certainty about the future, or a questioning of what we believe, or a lack of assurance, or unbelief. The first three types of doubt will likely be common experience for all Christians and if they are unchecked they can lead to the more dangerous position of unbelief. This book helps us to engage with our doubts as part of the normal experience of living as a Christian.

So if you are reading this book because you are struggling with a problem of doubt at the moment, be encouraged! The fact that you doubt does not mean that you can’t be a Christian. “Doubt” is not the same as “unbelief”. However, you can’t afford to ignore your doubt, treating it complacently or just hoping that it will go away. You must deal with it so that it does not develop into unbelief, and use it as an opportunity to develop a more confident, resilient and mature faith. (p18-19)

Stevens answers the important question “How can I be sure that I’m really a Christian?” by pointing not to us, but to God’s love for us in Jesus. There are dangers in becoming too introspective about this issue. We can end up placing confidence, or lack of, in ourselves rather than the gospel. If we base our assurance on a response we previously made at church, or at a Simply Christianity course, or on a university camp, or an outreach event, this can lead to a misplaced and false assurance. We are not made right with God because of our response, but because of God’s gracious work in Jesus’ death and resurrection on our behalf. For me, who had made decision after decision to become a Christian (again) in my teens, it was realising the truth of Romans 5:8-9 — that Jesus had paid for my sins past, present and future — that led to my assurance before God. While this book generally leads us away from introspection, it does call us to examine the evidence for our lives being changed. The Bible pushes us to look for evidence that our faith is real and we should expect to see our lives changed by the Spirit of God at work within us. On three occasions, Stevens recommends that we keep a spiritual journal to chronicle the evidence of God working in us and changing us. I must admit that I worry a little about this strategy. It’s not that I’m opposed to journalling, it’s more that documenting our experiences will always provide fickle evidence at best. I’d recommend that if we’re going to journal, we spend even more time documenting the promises of God that we discover in the Bible. God’s promises remain trustworthy, whereas my experiences lead me here and there. If I want clear evidence that God loves me, then I need to look at the cross, not what happened in my life last week or last year. As Martyn Lloyd-Jones describes in his book Spiritual Depression, after looking at Psalm 42-43, we need to spend more time speaking to ourselves (about God), than listening to ourselves (about why God is absent or doesn’t care). The chapter on overcoming doubt is practical and helpful. Stevens recommends the following strategy:

Admit that you are struggling with doubt and seek help.
Come to Jesus for help with your doubt.
Seek the help of mature believers with your doubt.
Identify the root causes of your doubt
1. Doubt rooted in our bodies: Physical causes of doubt.
2. Doubt rooted in our minds: Intellectual causes of doubt.
3. Doubt rooted in our hearts: Experiential and emotional causes of doubt.
4. Doubt rooted in our spirits: Spiritual causes of doubt.
Addressing the causes of doubt.

In the end, the Christian faith stands or falls on whether Jesus really was the Divine Son of God who took on human flesh, was crucified and rose again after three days. If this really happened, then we can be sure that God exists. We can know what God is like because Jesus fully reveals him to us. We can be sure that the Bible, both Old and New Testament, is true because Jesus tells us so. We can be confident that God is love, and that he will accomplish his good purposes for his people. We can trust that our sufferings are part of his good plan for us, even though we may not understand how, because we can see that Jesus entered into glorious new life after suffering on the cross. We can trust that Jesus will return to bring true justice and remake our broken world. If we can be confident about Jesus, then this is the basis from which we can address all our doubts. (p71-72)

This book will point you to Jesus as the basis of your assurance and the antidote to your doubts. Any book that does this is worth a read, I reckon.

Be the best bad presenter ever

I’m a regular preacher (again) and I’ve preached my fair share of dud sermons. Mind you, I’ve also listened to plenty of dud talks from others. What gets me most is when there’s a disconnect between the message and the medium, or the message and the messenger. It’s difficult to listen to an important message that completely lacks passion. It’s frustrating to have to fight to understand where the talk is going, when there doesn’t seem to be any logic or coherence to the message. It’s deadening to listen to the speaker drone on and on without changing pitch or tone or volume or speed.

Be the best bad presenter ever: break the rules, make mistakes, and win them over by Karen Hough caught my attention. It sounded like a book that might have something useful to say to preachers and presenters alike… and it does. Hough critiques 14 rules that are commonly given to public speakers and shows how they can actually get in the way of good communication. She speaks of the respected rules for speaking and why you should break them—mercilessly. This book is built on the conviction that you are part of the message. People want to connect with you, not a proxy of you. If they know you care deeply about your message then they will forgive your clumsiness and mistakes. Passion overrides technique.

I will list the rules Hough says to break, and follow each with the alternative:

Your purpose is to give a good presentation
“Good” is to a presentation like “fine” is to a compliment. Your purpose is to make something happen!
What purpose does your presentation serve? Having a searingly clear purpose will filter out all the silt from your presentation. Think of the purpose as the destination—the outcome of your presentation. What do you want to have happen? What change will come from you taking the time to talk to these people? (p15)
Give informational presentations
That’s about as exciting as watching grass grow. Take action!
Remove inform from your list of acceptable actions. Replace it with words such as motivate, convince, teach, inspire, anger, entertain, invigorate.
Practice in front of a mirror
Mirrors are just a one person show. Practice often, out loud, and on your feet.
Why would you want to submit your audience, and that critical speech, to your first unpleasant dry run?” (p32-33)
Picture the audience in the underwear
Stupid visuals distance you. Connect with your audience. Who really wants to visualise Bob from accounting in his underwear?
You’re not there to impress your audience with how remarkable you are; you’re there to communicate with them. Become more “audience involved” and less “me involved”. Self-consciousness results from too much attention to yourself, which puts others—your audience—in the background and you in the front. (p42)
Open with your introduction and close with questions
Like a dreaded college lecturer. Bookends will hook your audience and send them out singing.
People form opinions of others within the first seven to thirty seconds, so a hook must grab people’s attention right away. Give people a reason to listen. Use the power of repetition to teach your main points. Finish with what you want your audience to take away. The risk of finishing with questions is they can take the audience anywhere and completely away from your talk. If you take questions have a closer afterwards.
You either have confidence or you don’t
That’s bogus. You can teach your body confidence. And your body is your most powerful tool.
Hough comments on research that shows how by changing our bodies we control chemicals that affect our confidence. Body language and tone of voice are both critical features of good communication. (By the way, this is why email is such a poor communication tool for influencing others. It has neither body language or tone of voice.)
What you say is most important
It’s how you say it that matters.
I don’t agree with this contrast. It’s a ‘both/and’ rather than an ‘either/or’. Truth matters, but so does how we communicate truth. Hough talks about the tools of articulation, volume, pitch, timbre, speed, connection to breath, and silence.
Scan the back wall to simulate eye contact
Scanning is fake.
Far better to plant a friend in the audience and make regular contact with them—especially if they agree to smile at you regularly!
Stand behind the podium
Podiums are really, really awful.
Body language is important. People want to see you, not a piece of furniture, so step aside and feel free to move around.
Explain each topic
Tell stories! Stories are the most powerful way to share information.
Why does this remind me of my good friend Chappo! He was the master story teller, and as he did he explained his topics better than most. People like to hear about people rather than concepts. When it comes to preaching, stories are an excellent way of showing how it all works.
Have all your bullets on PowerPoint slides
Bullets are so called because they kill good presentations. PowerPoint numbs the brain. You are the presentation.
Personally, I loved this chapter! I’m over PowerPoint. PowerPoint is a scourge—on our ability to communicate effectively and keep an audience awake. Worse yet, it has become a substitute for us. (p97) PowerPoint is a lot like email: it’s a perfectly good tool that should make our lives easier, but it’s become a time-sucking, efficiency-mauling monster. (p98)
If we are going to use PowerPoint, Hough recommends three simple suggestions:
10/24 Only ten words per slide, and never smaller than 24pt font
Don’t read your slides. Your audience is quite capable. Use them to illustrate.
Prefer pictures to words. They will stick in people’s minds.
If something goes wrong, act like nothing happened
Everyone knows what happened, and ignoring it is weird. Acknowledge it, deal with it, and move on.
Ignore your nerves, and they will go away
Only zombies never get nervous. Nerves are good—breathe and embrace them.
The truth is, nerves are a great bad thing! They are the body’s way of telling you that you care, that this is important. (p115) A helpful strategy for coming our nerves was developed by Dr Andrew Weir: breathe in through your nose for 4 seconds; hold that breath for 7 seconds; release the breath through your month with a whooshing noise for 8 seconds. This technique is used to help your body calm down.
Control you emotions at all times
Passion and emotion are okay.
Emotional intelligence is a key concept in managing yourself as a presenter. (p121) Don’t fake it, and don’t be controlled by it, but expressing your true self appropriately to the context is important.

If you’ve been presenting or preaching for a while, and you have a feeling that you’re not really connecting as you should; if people complain you’re a bit hard to understand; if you don’t seem to be motivating change in people; if you think your talks could do with a tune up; then I recommend taking a look at this book.

Please put Crizotnib on the PBS. Please!

This an edited version of a letter my wife, Fiona, sent to support an application to the Therapeutic Goods Association (TGA) to ask them to please put Crizotnib (Xalkori) on the Pharmaceutical Benefits Scheme (PBS). This drug has proven results and yet is virtually unaffordable to all, at $7400 per month.

I understand you are collecting letters of support for Crizotinib being accepted on PBS. I’m not sure if TGA read submissions from individuals, but here goes…

This is not a scientific submission, but more a letter from one family suffering through a family member having ALK+ lung cancer. Whilst the TGA doesn’t court letters of submission from patients, this is an attempt to explain how TGA decisions affect individual families.

My perfectly well husband presented with a pleural effusion in Dec 11, being diagnosed with ALK+ lung cancer. He missed getting on the Crizotinib trial, because by the time we got the result, he had already received his first cycle of carboplatinum, alimta, and avastin, thus making him ineligible for the trial.
I chose this combination over what was being offered by the PBS (and our oncologist) at the time—Carbo/Docetaxel—because international research seemed to suggest it was more effective and had less severe side effects for general lung cancers.

My understanding when I spoke to the TGA a couple of years ago, was that the testing for ALK had to be passed by MSAC, with Crizotinib going before PBAC at the same time, before the TGA could consider putting Crizotinib on the PBS. My understanding is that both MSAC and PBAC have again deferred decisions as of Nov 2013. At that point they were struggling to understand who to allow ALK testing for.

As a carer for her non-smoking 49 year old Aussie husband it was pretty obvious to me, especially when he came back EGFR negative, that we should ask for and pay for the ALK test.

Looking through the ‘ALK+ roll call’ discussions on http://www.inspire.com it’s still obvious to me who should get tested for ALK. They are all younger non-smokers, who present late with stage 4 metastatic symptoms, because the original is on the periphery, not in the bronchi like standard smoking cancers. There are also histological features which are more suggestive of ALK—signet ring or acinar histology.

Our pathologist noted these on David’s histology, alerting the thoracic surgeon that this was unusual for standard lung cancer, and that maybe there was something else going on.

Surely it’s not too hard to offer ALK testing as a priority to patients in this category.

I’ve also heard that there’s new testing becoming available, which will be much cheaper, quicker, and give more of an idea as to whom to send for the more expensive testing. Hopefully, this will be commonplace soon.

In 2014, about 11550 Australians are expected to be diagnosed with lung cancer. Approximately 15-20%, or roughly 2000 people, will be non-smokers with a genetic mutation. Of these approximately 3-4 %, or 35 people, will be ALK+.

The Inspire roll call only found about 10, but obviously not everyone reads or visits http://www.inspire.com, and nor is everyone connected via a clinical trial.

We do not know of any other ALK+ patients in Canberra, but then oncologists don’t share patient information. There hasn’t been anyone else with this mutation coming to the lung cancer support group at Canberra Hospital.

But then again, how many are being tested, or not tested because of financial reasons?

I’ve just referred a younger, unusual, possible lung cancer patient to Canberra Hospital in this last week, and I’ll be willing to find money for him through my workplace or the Eden-Monaro Cancer Support Group, if need be, because he couldn’t necessarily afford the money for testing.

As stated earlier, my understanding was that PBS approval for Crizotnib was again deferred in Nov 2013. This seemed more due to semantics than actual proof that Crizotinib did or didn’t work, or the cost-benefits of approval.

Even for intelligent people in the medical profession, it is difficult to read and understand the documents deferring approval. To read that PFS has shown ‘statistical improvement’ is hugely exciting. But to read ‘that OS hasn’t been demonstrated’—how does one prove that, except by time and death?

As a carer it’s also hard to read the statistics of overall survival and progression free survival without taking it personally. These statistics are talking about the future of my husband. He can’t read them without being overwhelmed, even though he’s been outside the statistics thus far.

It shouldn’t be up to the patients and carers to have to trawl through these statistics to prove to the government that life is worth living, that some good quality of life is better than life cut short for lack of funding for medication that works, even if just for a limited time.

My husband has responded miraculously to an Alimta/Avastin combo for over 40 cycles, being NED for nearly a year and a half now. These treatments have cost us very large sums of money. Avastin isn’t on the standard guidelines treatment plan and the study on the benefits of adding Avastin to Alimta has not yet been released. Given that this combination has worked for my husband, he continues to endure the physical impact and financial costs until there is definitive proof that it doesn’t help.

But, we still need Crizotinib to be placed on the PBS list. Please consider the following…

1. The demand of 3 weekly cycles is hard. It’s hard for my husband to psyche himself to go to the hospital every 3 weeks to pump poison into his veins, knowing that its going to make him sick for the next week, often spending 3 or 4 days in bed. Not that the following 2 weeks till the next cycle are easy, with fatigue, headache, GIT upset, mouth/tongue ulceration, pain, acne, skin rash, itch, and more.

From early on he’s had to add in Cymbalta for peripheral neuropathy, increasing amounts of antihypertensive, pain relief, antinauseants, dexamethasone, folic acid, Vitamin B12 injections, etc.

Do they consider the cost effectiveness of paying for medications to deal with the side effects of ‘standard chemo treatment’? There is also the cost of the private chemo ward every 3 weeks.
Because Alimta or Avastin weren’t on PBS when he started, all treatment had to be done through a private hospital.

How much simpler it would be—physically, mentally, emotionally, financially—if my husband had been able to simply take a Crizotnib tablet twice a day.

2. Unfortunately chemo brain is a real phenomenon too (as is carer’s brain). His memory isn’t as good as it was, and nor is mine. The 3 weekly cycles take a toll on all our family, including the kids.

3. Furthermore, no one can tell us how long one can continue on maintenance therapy. When my husband was diagnosed, it was still being debated as to whether patients shoud go on maintenance therapy, whether it added anything. Fortunately that debate has been won and put to rest.

There are some in the USA, in the Inspire network, who’ve been on maintenance for longer than my husband (I think about 5-6 years is the longest). But how long can one continue to use non-targetted therapy, continually killing ordinary, healthy cells every 3 weeks, without doing some permanent harm, perhaps even causing further cancer. There is no answer to that question yet.

4. He’s worked part time since mid 2012, returning to full time work this year. He’s continued to pay taxes since his diagnosis, using sick leave and long service leave until returning to work, paying his taxes at the same rate as prediagnosis.

I’ve had to work more, to pay for the chemo, so now I pay even more tax. We have never applied for Centrelink help, or been able to because of our income. I understand that even the Centrelink payments are being tightened up, it has to be proven that you’ll die within 2 years, when all you really want to do is prove them wrong and keep living. Having not asked the government for help with living, are we also to be denied the cost of medication by the same government as we continue both to live and pay for medication, and pay taxes?

Has the cost benefit analysis been done on how I and my 4 children would have coped with me as a widow and them fatherless?

I’ve been willing to pay the cost of initial chemo and maintenance chemo, as opposed to what the PBS would have given us for free, because I think the cost benefit analysis of having a husband who’s alive has been worth it. But not everyone is as fortunate financially or with such generous friends or workplaces, who’ve supported us through the financial impact.

5. We’ve always been told he could go to Crizotinib once the Alimta/Avastin failed. It’s always been his next step. But it’s extraordinarily expensive, at $7400 month, now it’s off the special access scheme. Suddenly our next step is unsure.

6. Access to trials isn’t a certainty, as we’ve already experienced.
Nor is it without cost, as ALK+ Australian patients have moved cities to be able to access the trials in the few major centres that are offering them. Had we gained access to the initial phase 3 Crizotinib trial, we would have had to travel to either Melbourne or Sydney.

7. Highly regarded world class experts in the field of ALK+ Adenocarcinoma, including an Australian, recommend first line Crizotinib. The latest “Up to Date”, does so: http://www.uptodate.com/contents/anaplastic-lymphoma-kinase-alk-fusion-oncogene-positive-non-small-cell-lung-cancer
How can doctors follow recommended international guidelines, if the Australian PBS is still years behind?

It’s quite distressing to me to have to be writing this submission in support of Crizotinib, when I wrote a very similar submission (a begging letter really) almost two years ago. Nothing has changed in Australia, in those years. Except more friends, colleagues, patients have died of lung cancer.

Lung cancer continues to be one of Australia’s biggest killer. Crizotinib has been approved as first or second line therapy in so many countries throughout the world. It is normal in other countries, but for some reason we continue to drag the chain on best-practice care.

In the USA the FDA has now approved the second generation targetted therapies for ALK+ patients, both as initial and as second line treatments. We haven’t even got the first generation treatment approved as yet.

It is so frustrating that Australia is lagging so far behind. Bureaucracy seems to be holding us back unnecessarily. The irony is that Australians have been been benefitting from Crizotinib, at least since the phase 3 trial initiated in 2011.
Pfizer have been generously supplying both patients on the trials, and allowing patients to access the medication via the special access scheme until 30/6/14, when such access ceased.

Since that date, there have been at least two patients who’ve signed up to the Inspire Australian roll call for ALK+ patients who are struggling to how they can possibly afford $7, 400 per month. We should not be a country that only provides quality health care to the wealthy.

It’s enough being confronted with advanced lung cancer at a young age, let alone being faced with an unaffordable financial bill.

How many more people are either not being tested or not being treated because of financially prohibitive costs?

We can’t blame the drug company for trying to recoup some of their costs, when the Australian government has benefitted from their provision of the drug via trials and a special access scheme for two and a half years.

With the new trials investigating LDK378 initiation in both Crizotinib resistant and naïve patients in Australia, isn’t it time that Crizotinib is given government recognition for it’s important place in the treatment pathways?

Chemotherapy isn’t a one size fits all. As proven, Alimta/Avastin chemo has been a God-given, proven-thus-far combination for my husband. But it hasn’t worked for others.

Crizotinib has worked amazingly for some, but some have had resistance develop fairly quickly. The second generation targeted drugs will no doubt have similar success and failure stories. But that doesn’t mean people should be denied access to them if they can’t afford to obtain them privately.

What is obvious was that the older, cheaper drugs like Docetaxel were failures in PFS, OS, quality of life and every parameter you can think to measure them by, but they’re still held up as the ‘gold standard’ of treatment, by which to compare newer medications which aren’t designed to act it the same way, so shouldn’t be compared. This is ludicrous.

I hope this helps the application for Crizotnib to be place on the PBS.

Yours sincerely

Dr Fiona McDonald (MB BS)

Decluttering the inbox

I’ve spent much of the past couple of days in bed due to my three weekly chemo malaise and I feel like I’ve achieved something worthwhile—I’ve decluttered my inbox. More than simply getting hundreds of emails down to a small handful, I’ve systematically unsubscribed to dozens of regular newsletters, blogs, advertisements, and junk that fill my box every day. I have no idea how I ended up collecting many of these emails. Some were an impulse click. Some were a good idea at the time, but are no longer relevant. One or two I’ve changed the frequency from daily to weekly or monthly. People keep telling us that too much information—which often corresponds to too many emails—can’t be be doing us any good. I’m looking forward to a simpler eLife!

My cancer, my future, my request…

I love what this man and these people are doing. He has my cancer, my mutation, and my needs for affordable treatments. Many need this drug more than me, and have no possible means to afford it. We need the Pharmaceutical Benefits Scheme to support people who would benefit so much by this drug Xalkori (Crizotnib) targeted therapy. Currently it costs around $90,000 per year. Please click on the image above to watch, and then share this hope-filled video with others.

A long legacy of caravanning

Yesterday I received this reflection from my father, who turns eighty next birthday, on his experience of life in caravans. I thought some of you might be interested in his reflections…

From time to time in recent years I have written of our movement through the stages of life—the marked changes that occur from time to time in our health, or work, or the circumstances that shape the course of our life.

This week there has occurred another change; this one effectively marking the end of an era in my life. In fact, the era of which I write is almost as long as my life. I write, of course, of my caravan experiences which have been brought to a close by the sale of our caravan of the last ten years.

I do not remember the beginning of my life with caravans but a photograph of my brother, Graeme, and me indicates that those first experiences began before I was four years old. The first caravan was a home-made foldaway unit built onto a trailer by my father. Towed behind our 1928 Chrysler Royal motor car, it was the pre-cursor of today’s Camper Trailer. Its facilities were the most basic and our caravan park was but a clearing in the bush or a space among the dunes beside the sea. I know not how we fitted into the caravan or how we would have fared in the inclement weather which surely came our way from time to time. My memories of this early period are sparse, but they mark the beginning of a life time of holidays in which we took our home with us behind the car.

In the late 1940s, “after the war”, my father purchased the first of several caravans which would become the base of family holidays over many years. Each one of plywood construction, each slightly larger and having a little more comfort and convenience than the previous one, they enabled us to travel further afield. The cars changed, too. The Chrysler was replaced by a 1934 Plymouth Fluid Drive, which I later purchased as my first car and re-named ‘Esmerelda’. Then in 1953 came Dad’s first new car, the Ford Customline. Our holidays took us to many parts of Victoria—along the coast east and west of Melbourne, to inland cities and towns and along the Murray River. Interstate and around Australia caravanning was still in the future for most people. For us, Victoria had much to offer and we returned often to the beaches and surf and the forest country along The Great Ocean Road.

The second phase of the caravan experience is easy to identify. It began on 25 February 1961 when Ruth and I set off on our honeymoon, driving the Customline and towing the streamlined ‘Don’ caravan. It began dramatically when a shattered windscreen on our second day prevented us reaching our intended destination. The only parking available was at the local football ground, and the only facilities were the open-to-the-skies change rooms and their cold showers. Although this was not Ruth’s introduction to the caravan, as she had accompanied our family on several occasions, it surely was a cool introduction to marriage.

That journey took us along the unsealed Princes Highway through Gippsland and the NSW south coast to Sydney and Palm Beach where we spent an idyllic week near the Barrenjoey Lighthouse with views to both Pittwater and the Pacific Ocean. Our return was via Canberra where we spent several days exploring the still young National Capital, little knowing that fourteen years later it would become the home for our family during a very significant period of our lives. Coincidentally, exploring the centre of Canberra known as Civic, we happened on a Canberra Day event—the commissioning of the new Ethos Fountain in Civic Square.

For several years, family holidays followed a familiar pattern. Travelling from Tasmania (King Island or Longford) to the mainland, we would borrow car and caravan and head for such places as Echuca or Mildura, Philip Island or Western Victoria. Thus another generation of McDonalds was being introduced to the caravan experience.

Eventually, it was time for phase three. In 1970, whilst at Longford, we purchased from a Launceston caravan hire business, which had fallen on hard times, our own caravan, a heavy 16 feet long, 8 feet wide Millard with high flat roof. With caravan in tow behind our HR Holden station-wagon, canvas annexe and stretcher beds for the children, many accessories stowed away, and three children in the back seat, we visited much of Tasmania and enjoyed many summer holidays near the sand dunes and beaches of St Helens. They were happy days.

There was one near disaster with that caravan. On 5 January 1975, we left our Launceston home for the last time, to travel to Devonport where the ferry, Empress of Australia, would take us to Melbourne for some holiday time before travelling on to Canberra and the Reid Methodist Church. A tyre on the heavily-laden caravan blew out just a short distance from Launceston and without a replacement tyre we could not continue. It was Sunday afternoon and shops and garages in Tasmania were not open for business. Eventually we found the owner of a small garage who was able to open his workshop and fit a replacement tyre for us. Resuming our journey, the caravan was wandering a bit behind the car. A policeman stopped us, commented on the erratic driving, warned us to take care and allowed us to continue. We arrived at Devonport just in time to be the last vehicle to join the ferry, but too late to enjoy the picnic with the many friends who had travelled to Devonport to farewell us. One of those friends noticed that the replacement tyre did not match its partner.

Sadly, a real disaster occurred that night, just a few hours into our Bass Strait crossing. News travelled through the ferry that the bulk ore ship Lake Illawarra, had collided with the Tasman Bridge, linking western and eastern shores of the Derwent River at Hobart, sinking immediately and causing a major portion of the bridge to fall. Many lives were lost and the life of the City of Hobart and its citizens was affected for long time. That date is deeply etched in our memory.

Now mainland residents, our family holidays and occasional travels took us further afield. The summer family holiday was always at the coast—Pambula Beach, Bateau Bay, and Nambucca Heads. After ten years, it was time to replace the Millard which, though very spacious, had felt somewhat like a brick wall being towed behind the car. We replaced it with a lower-profile Viscount pop-top. Later again, the Viscount gave way to a Golf pop-top. With these lighter vans we not only continued our summer holiday bookings, but travelled throughout NSW, learning much of the history and geography, and building a photographic record that now fills many albums. These caravans were frequently our home as occasionally we crossed borders into Queensland or South Australia, or travelled by various routes to Melbourne to visit family and friends.

In 2004, it was farewell to the Golf and welcome to our first ‘new’ caravan, a Jayco Heritage pop-top. The government’s pension bonus and an extraordinarily generous trade-in on the Golf enabled us to up-grade just one more time. (The story of that purchase is itself remarkable and may become the subject of some later writing.) No longer was there need of space for family members, though the beachside holiday tradition continued at Shoal Bay on Port Stephens; and visitors were always welcomed. There were dreams of travelling further afield, including particularly the Flinders Ranges and other parts of South Australia, but some health issues for both Ruth and me, and other circumstances caused the postponement, and eventually, the setting aside of those dreams.

In recent years, the caravan travelled less, but in fact was used more. It was the occasional extra bedroom if the number of visitors stretched beyond the resources of our small home at Valley Heights. It was a private space where Norman would meet and talk with colleagues or people who sought his counsel. It was the prayer room for many years where Ruth met regularly and prayed with several women in our community.

The realization that we would not use the caravan again for holiday or travelling was hard to accept and our initial attempts to sell were unsuccessful; so the caravan came with us to our new home. The night and day after our arrival here, the area experienced a ‘one in one hundred year’ storm with much local damage. The caravan suffered serious water damage, via a broken seal in the roof. Repair work has taken many months, covered by insurance, and now the caravan has passed to a new owner.

For the writer, the caravan experience era has spanned a lifetime; for Ruth it has been a part of our life together. For me, it is an experience I have embraced with joy and enthusiasm; for Ruth, probably less so as the caravan still carries with it many of the familiar duties of domestic life. It just puts them in a more confined space. But the caravans have enabled us and our families to enjoy holidays that would not otherwise have been possible, to tour and visit parts of our country we would not otherwise have seen and to enjoy a freedom that is different from that of many holiday environments.

Perhaps for Ruth and me it is the end of an era. Family holidays have found different expressions in the next generation. Heather and her family enjoy the Canadian cottage by the lake. Stephen and his family enjoy erecting their tents in remote places. The caravan experience lives on as David and Fiona and their family have continued to enjoy the sand and surf of the coast, as well as exploring the vast outback of Australia on their several safaris. Their Ultimate Xplor Camper is more directly a descendent of the home-built fold-away caravan with which I was introduced to the caravan experience. Perhaps the era of the McDonald caravan experience has not ended, after all.

Serious hope for Adam

A review of Hope Beyond Cure by Adam Scott, first posted by Dave Miers…

“It’s actually very serious.”

That was the last thing I wanted to hear from the doctors treating me.

An MRI had apparently revealed a large arterial tear in my neck and the consensus was that I’d probably had a stroke. It all started feeling very serious. I was 28 years old, laying in a hospital bed, surrounded by pensioners who were apparently healthier than I was – go figure!

It was the first time in my life that someone spoke candidly and clinically with me about the reality of dying and it was terrifying. I’d always expected dying to be a future, far-off, unfortunate but inevitable reality, but someone with more authority on the subject was telling me that perhaps my presumptions were wrong.

That’s probably why I’ve appreciated reading Hope Beyond Cure by David McDonald as much as I have. It’s a book written by a pastor who was humble enough to admit that facing death can be terrifying and perhaps our presumptions are wrong.

The opening chapters recount the events leading up to his cancer diagnosis and the emotional turmoil that followed. He talks openly about how the insidious nature of his illness filled him with fear, doubt and hopelessness. It’s a gutting and incredibly humble way to start a book about hope: in the context of a terminal illness.

Given how raw and real the book begins, you’re left with the impression that the kind of hope it’s going to dish up is going to have to be robust enough to withstand a daunting prognosis and remain relevant in the face of death. That’s not an easy task given that hope has become synonymous with wishful thinking in our culture.

For example, Ben Folds sings a song called Picture Window that talks about hope that’s cruel and inappropriate in the context of a terminal illness. He sings:

“you know what hope is,
hope is a bastard,
hope is a liar, a cheat and tease,
hope comes near you, kick it’s backside,
got no place in days like these”

Hope Beyond Cure engages with the kind of false hope that Ben Folds sings about and exposes a few of our favourite places to find it. Whether it’s in medicine, positive thinking or relationships, David gently points out that they all leave us exposed and each can be the very thing that Ben Folds describes: a liar, a cheat and a tease. They’re false hopes because none of them can promise to endure in the face of death.

Off the back of that David argues that we need something solid to anchor hope in. Because death is a serious business, we need a equally serious hope – not wishful thinking or clutching at straws. We need a serious hope that aims even higher than a cure for the illnesses that will ultimately take us, a hope that will flavour life and endure in the face of death. That’s the kind of hope that David ends up introducing when he talks about Jesus.

Hope in Jesus isn’t cruelly inappropriate wishful thinking. It’s all the things false hope isn’t: true, trustworthy and reliable. It doesn’t become inappropriate or irrelevant when we’re facing death, and because of that, hope in Jesus is worth having.

Towards the end of the book David writes this:

“I have no idea how many days, weeks or months I have before me – few of us do. Our times are in God’s hands and he alone knows when they will come to an end. But we don’t need to fear that day. In the resurrection of Jesus, God has taken away the sting of death. As Paul reminds us:

“When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true:
“Death has been swallowed up in victory.
Where, O death, is your victory?
Where, O death, is your sting?”

In the years that followed my injury, I’ve had countless scans. Apparently, there’s no longer any evidence of that terrifying time. I’m really glad about that, but the truth is one day something else is going to break and the wheels will fall off. That’s why I’m so thankful that real, authentic, robust hope is what I have – it’s what we need to endure in the face of death and to flavour life in the here and now.

Hope Beyond Cure says that hope is found in Jesus and I couldn’t agree more.

Stabletalk

I’ve been asked by the Brumbies CEO to contribute a regular piece to their in-house newsletter. This is my first contribution:

In my first contribution, I’d like to share a few lessons I’ve picked up from a book by Patrick Lencioni called The Five Dysfunctions of Team. This is one of the best books I’ve read on teamwork and I think it has much to offer our organisation, both on the team and admin sides.

The five dysfunctions can be summarised as follows:

Dysfunction #1: Absence of Trust

This occurs when team members are reluctant to be vulnerable with one another and are unwilling to admit their mistakes, weaknesses or needs for help. Without a certain comfort level among team members, a foundation of trust is impossible.

Dysfunction #2: Fear of Conflict

Teams that are lacking trust are unable to engage in unfiltered, passionate debate about key issues, causing situations where team conflict can easily turn into veiled discussions and back channel comments. In a work setting where team members do not openly air their opinions, inferior decisions are the result.

Dysfunction #3: Lack of Commitment

Without conflict, it is difficult for team members to commit to decisions, creating an environment where ambiguity prevails. Lack of direction and commitment can make employees disgruntled.

Dysfunction #4: Avoidance of Accountability

When teams don’t commit to a clear plan of action, even the most focused and driven individuals hesitate to call their peers on actions and behaviors that may seem counterproductive to the overall good of the team. 4

Dysfunction #5: Inattention to Results

Team members naturally tend to put their own needs (ego, career development, recognition, etc.) ahead of the collective goals of the team when individuals aren’t held accountable. If a team has lost sight of the need for achievement, the business ultimately suffers.

I raise these insights not because I think the Brumbies suffer badly from these dysfunctions, but so we can be vigilant in not allowing them to sabotage our efforts and prevent good results. It’s worth asking ourselves once or twice a season whether any of these dysfunctions are raising their ugly heads. We pride ourselves on being family at the Brumbies, but even families can develop bad patterns of relating to one another. Every season our family changes. Even one new member makes a difference to the whole. This coming season we will have new coaches, management, admin staff, and players. So let’s work to develop trust among each another, so that we’re not afraid of constructive conflict, we build commitment, we increase accountability, and we achieve great results.

Is God anti-gay?

Christians have bad press when it comes to homosexuality. This hasn’t been helped by the bigotry and hatred of the Westboro Baptists in the United States and their appalling website godhatesfagsdotcom. The assumption by many is that all Christians are homophobic and therefore God must be anti-gay. The reality is the opposite—John 3:16 famously declares…

For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.

By extension, this also means…

For God so loved gay people that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.

Sam Allberry’s little book, Is God anti-gay? And other questions about homosexuality, the Bible and same-sex attraction is an excellent guide to this issue. It’s not shaped by politics, sensationalism, or right-wing ideologies. It’s not seeking to ride the trends of culture or church opinion. This book is an attempt to seek the mind of God honestly and sensitively from the Bible.

Allberry writes with sympathy for the matters at hand. He discloses to his readers that his own sexual orientation is homosexual. However, he does not presume to speak for everyone for whom homosexuality is an issue. As a Christian, and minister of a church, this has caused him to grapple seriously both with Scripture and it’s application in his life. He prefers not to describe himself as ‘gay’ but rather as ‘someone who experiences same-sex attraction’. He writes:

But describing myself like this is a way for me to recognise that the kind of sexual attractions I experience are not fundamental to my identity. They are part of what I feel but they are not who I am in a fundamental sense. I am far more than my sexuality. (p8-9)

Allberry explains that the way to understand homosexuality is to view it against the backdrop of God’s good purposes for gender and sexuality. We need to understand what it means to be made in God’s image, to understand one-flesh union in marriage, and to explore God’s reasons for the gift of sex. We must also recognise that in our fallen world there will be many temptations to live alternatively to God’s ways. Some of these pressures come from the outside, others come from within us. We will all face trials and temptations of different kinds—this doesn’t mean we blame our DNA or upbringing or culture, but that we seek God’s help to trust and follow him.

While acknowledging that God’s design for sex as outlined in the Bible is heterosexual, within a loving and faithful marriage relationship, this doesn’t mean that God is anti-gay. It is, however, a significant call to trust God when our preferences and passions don’t align with his. Allbery reminds Christians who are attracted to persons of the same sex, that they should take the opportunity to talk to God about it—about our confusion or distress, our temptations, or our failings and sins. He reminds us that particular feelings do not disqualify or define us as Christians. All Christians struggle with a multitude of feelings and temptations. What matters is how we respond to these things. We are also reminded that Christians need to be willing to support one another in these matters.

Sadly, many churches do not engage well with matters of sexuality, and especially with homosexuality. Many people with same sex attraction have felt deep rejection at the hands of Christians. There is much for our churches to change in how we engage with people whom God clearly loves.

Allbery offers helpful advice to Christians in engaging with people who are homosexual in orientation. He prefers to start at the centre and work outwards, rather than start at the edge and work in. The matter of sexuality is not of first importance. Jesus’ death and resurrection take centre stage. This is where God is most fully revealed. It shows his heart towards all people.

This is what I most want people to know—for people to be bowled over by the God of the cross and resurrection. And, once gripped by this, to help them think through what trusting in this God will involve—what will need to be given over to him, including our messed up sexuality.

But I want the conversation to take place in the context of the gospel, rather than start with their sexuality and try to get from there to the gospel … So when a gay couple start coming to my church, my priority for them is the same as for anyone else: to hear the gospel and to experience the welcome of a Christian community. (p63-64)

I found this book to be very helpful in understanding issues of same-sex attraction from the perspective of the Bible. It is written with warmth, insight and compassion. It upholds the dignity of all people, and it demonstrates the depths of God’s love for all, regardless of sexual orientation or anything else. I commend it especially to Christian people wanting to understand the mind and heart of God in todays cultural climate.

How will the world end?

The beauty of a couple of interstate bus trips and a return flight to Brisbane over the past couple of weeks, is that I’ve been able to find time to do some more reading. And the brief books from the Questions Christians Ask series have been ideal travel reading—far better than most stuff you pick up at the airport bookstores!

How will the world end? And other questions about the last things and the second coming of Christ by Jeramie Rinne takes us into some hotly debated topics among Christians. We are very good at dividing over millennial positions, the meaning of world events, identification of the anti-Christ, when the end will happen, and more. Careful reading of the Bible is paramount to understand God’s intentions in these matters.

The book starts by affirming that the end of the world will arrive according to God’s design and purpose. It won’t be the result of arbitrary forces of the universe, nor the inescapable consequence of human failure to care for our planet.

The problem facing the human race is not that it’s on a collision course with an asteroid. Our problem is far worse: we are on a collision course with a holy God who is coming to judge a sinful world. (p13)

God has promised to address our sin and rebellion and to bring us to account. In fact, we could not describe God as ‘good’ if he was to ignore sin and tolerate evil forever. His judgment reveals that he cares about this world that he has made and the people within it. Though we don’t know when, God promises that he has set a day when he will judge this world through his Son. This is the day when Jesus will return.

Rinne discusses what will happen before this day when Jesus returns to judge the world. He does so with special reference to Matthew 24. We are warned that there will be false messiahs; many who oppose Jesus; wars and disasters; persecution of Jesus’ followers; wickedness and evil; growth in the gospel. These things are not the end—but they are signs that the end is on the way. The overwhelming testimony of the New Testament is that we are in the Last Days now. Not because we live in 2014 when there is evidence of these things all around us—this has been true of every age since Jesus first spoken these words. Jesus came to inaugurate the last days and he will bring them to an end when he returns.

A chapter of this book is devoted to helping Christians understand and navigate the various millennial perspectives that arise from Revelation 20. This provides a clear and helpful introduction to people’s thoughts on this matter. He concludes the chapter saying:

It’s probably all too much to hope that this chapter would clear up all the questions. But I hope that it did at least three things:

I trust this chapter lifted you above the trees to see the forest.

I pray this section increased your humility and patience toward others with different views.

I hope this chapter increased your appetite to learn more about God’s word.

As your mind works to make sense of the details, may your heart swell with excitement that our Lord is returning! (p65)

How will the world end? draws heavily on the book of Revelation to make it’s case. However, I am always a little cautious about going to Revelation as the primary place to build my theological understanding. My rule of thumb tends to be ‘check my theology of Revelation with what I can verify clearly from the rest of Scripture’. Having said this, I do believe that Rinne handles Revelation faithfully and clearly.

From Revelation 20 we’re reminded that when Jesus returns to judge there will be ‘the books’ and the ‘book’. The ‘books’ will contain a record of our thoughts, words, and deeds. These will provide the incontrovertible evidence that God’s judgment is fully-informed, just and true. There is no hope for anyone in these books. It is the ‘book’ that offers hope. This is the Lamb’s book of life—what matters is whether our names are recorded in this book. The book of life reveals all who have trusted not in our deeds, but only in the sacrificial death of Jesus in our place. Is your name in this book?

For those not listed in the Lamb’s book of life the future is very grim. Images of hell and judgment speak of an everlasting judgment on all who reject God’s offer of rescue through Jesus. It is impossible for us to appreciate the magnitude, or indeed the rightness, of God’s judgment because we don’t have any sense of the gravity of our crime. (p76).

The closing chapter explores how we should live as we wait for Jesus’ return. He starts with the basics—because Jesus is returning to judge, we need to turn from our sins and put our trust in Jesus now. As we trust in Jesus, he doesn’t merely save us from our sins, but his grace transforms us and teaches us to live godly, Christ-like lives while we wait (Titus 2:11-14). We are urged to pray (1 Peter 4:7) and encourage one another to pray. We’re to remember our calling to take the good news of Jesus to all nations. As this world is passing we should not be too attached to stuff (1 Corinthians 7:29-31). We should remember that whatever trials and suffering we will face in this life, they are not worth comparing to the glory that will be revealed in us (Romans 8:18).

It is far too easy for us to live our lives stuck in the moment, to assume this life is all we’ve got, to lose sight of the end that is coming. This book is an important corrective.

Who on earth is the Holy Spirit?

Who on earth is the Holy Spirit? by Tim Chester and Christopher de la Hoyde is written to reassure believers about the experience of the Spirit in their lives. It’s also written to help believers become more aware of the work of the Spirit. The writers want to raise people’s expectations…

When you pray, we want you to expect the Spirit to work miracles. When you talk about Jesus, we want you to expect the Spirit to create faith in people’s hearts. When you read God’s word, we want you to expect the Spirit to create intimacy with the Father. When you’re tempted, we want you to expect the Spirit to give you alternative desires.

In your daily life, we want you to expect the Spirit to show you how you can serve others in love. We want you to be able to appeal to the experience of the Spirit as Paul does in Galatians 3 v 2-5. (p8-9)

These are wonderful aims for the book, and filled me with great anticipation as I set about reading another book in the Questions Christians Ask series. The book begins by demonstrating the fundamental role of the Spirit in giving us spiritual life. Without the Spirit’s work we are unable to recognise the beauty of Jesus and the power of his work, or to turn to him and trust him. The Spirit gives us new birth or ‘regeneration’. The life-giving work of the Spirit reveals that salvation is God’s work from beginning to end. It is entirely a work of grace—even our faith is a gift from God. Put simply, if we don’t have the Spirit then we cannot be Christian.

If anyone does not have the Spirit of Christ, he does not belong to Christ. (Romans 8:9)

God was at work through his Spirit in the work of creation, bringing order out of disorder. The work of the Spirit continues to sustain and renew the creation. The Spirit is God’s seal upon his people, rather like God’s name tag, stating clearly that we belong to him. And the Spirit gives us a foretaste of life in the new creation. He’s the first instalment of the new creation, given to us as a guarantee that it really is coming. This is more than an a divine engagement ring, given as a pledge of the marriage to come—it’s more like a lover’s kiss, given as a foretaste of what is to be experienced.

Chester and de la Hoyde show us from the Scriptures how the Spirit is at work in us, making Christ present in and among believers. He dwells in the church and individual believers, and works in us to transform us into Christ’s likeness. We are reminded of the wonderful promise that if we live by the Spirit, we won’t gratify the desires of our sinful natures. (Galatians 5:16).

I appreciated the chapter entitled The Spirit of love where we are reminded that throughout all eternity God has been a Trinity of persons-in-relationship, an eternal family, a community of love. (p40) God has existed forever in a relationship of love between Father, Son and Spirit. Thus God can be known simply as being ‘love’. He always has been—it’s part of his essential being. The extraordinary thing is that we can be drawn into this family of love by the Spirit. God adopts us into his family and he wants us to know that we belong to him and are loved by him. (Galatians 4:4-7)

However, I also found some of the author’s comments about our relationship to the Spirit ambiguous and potentially unhelpful…

But it’s possible to grow less aware or sensitive to the Spirit’s prompting in our hearts. It’s possible to find ourselves acting more like God’s employees than his children. That’s what’s happened to the Galatians. They’ve lost their joy (4 v 15) Why? Because they’ve been duped into thinking they can earn their relationship with God. They’re going back to the law (4 v 8-11). They’ve become deaf to the Spirit. (p51)

I agree that the Galatians are being drawn back to reliance on the law, thinking they can earn their way to God. This is not the way of the Spirit. They began with the Spirit in reliance on Christ alone, and they are called to continue in the same fashion. I understand that this is, in fact, becoming deaf to the Spirit. However, describing this as growing less aware or sensitive to the Spirit’s promptings opens the way to confusion and misunderstanding. I don’t believe that the Galatians’ problem was one of failing to tune into ‘promptings’, but that of being drawn away from the true gospel of grace to a self-righteous gospel of works of the law.

The language of ‘being sensitive to the promptings of the Spirit’ (eg. p64) is used by the authors on a number of occasions in this book and I’m not persuaded it’s helpful. Don’t get me wrong—I believe whole-heartedly that the Spirit can prompt people, and that he has prompted me on many occasions. Yet, the authors seem to me to go beyond the promises of Scripture on this matter. They seem to be greater advocates of the freedom of God than the explicit promises of God. We need to be careful about ‘tuning into promptings’ and be encouraged to weigh up carefully the ideas of others, our inner hunches, the desires of our hearts, the circumstantial evidence, the feelings that these things must be from God. We also need to be careful not dismiss what is of God. Thus, we will do well to follow the advice of Paul to the Thessalonians:

Do not quench the Spirit. Do not treat prophecies with contempt but test them all; hold on to what is good, reject every kind of evil. (1 Thessalonians 5:19-22)

I had a couple of other minor complaints about this book, such as the author’s unwillingness to state clearly that the baptism in the Spirit in 1 Corinthians 12:13 refers to the conversion experience of being united with Christ, rather than a second experience of the Spirit after becoming Christian. I am persuaded that to understand Paul to be speaking of an experience subsequent to conversion, is to undo his argument in this passage altogether. The authors may agree with me, but they leave it ambiguous. Perhaps, they do not want to make an issue of this point thereby making their book more accessible to a broader readership.

Despite my reservations, this book has much to commend it. It’s anchored in Scripture and it warmly invites the reader to embrace the work of God’s Spirit in our lives. We have nothing to fear in doing this. Rather, we enter more deeply into the blessings of God for his beloved children.

What happens when I die?

What happens when I die? And other questions about heaven, hell and the life to come by Marcus Nodder is another little book in the Questions Christians Ask series by the Good Book Company. Firstly, let me commend Nodder for being willing to share his life with the reader. This is not an academic book, written in ignorance of the pain of death. It’s a book that integrates the promises of God with the experience of death. He begins by reflecting on the death of his dad, and I immediately warmed to the author as one who would empathise with people’s experiences. I am convinced that this should be a vital component of any book that deals with sensitive and painful matters of life and suffering.

Nodder identifies the reality that death is not part of popular conversation and in the developed world we’ve become very adept at avoiding the issue altogether. Yet death intrudes on each of us, and the reality of death confronts us with some uncomfortable truths. I could identify with these words:

If you’ve been diagnosed with a terminal illness, you will need no convincing of this, but for the rest of us Sigmund Freud was onto something when he once wrote: “No-one really believes in his own death”. (p6)

This book takes us to Jesus who knows what lies beyond the grave and, not only that, provides the solution to the problem of death. Jesus broke the power that death holds over people, so that in turning to him and trusting him, we can look forward to life with God beyond death.

The basis for our hope for life beyond death lies in the evidence for the resurrection of Jesus from the dead. The empty tomb; the appearances to various people at various times; the eye-witness testimonies; the circumstantial (even embarrassing ) evidence for the resurrection recorded in the New Testament; the transformation of his followers, many of whom would give their lives rather than change their testimonies; all points to good reasons for trusting God on this matter.

If anyone at any time after the resurrection of Christ had been able to produce Jesus’ body —his corpse—Christianity would have sunk without a trace and that would have been the end of it. But there was no corpse because the body had been raised to life. The empty tomb is a powerful piece of evidence. You can go to the Red Square in Moscow and see Lenin’s embalmed body on public display. Followers of Bruce Lee go to visit his grace in Seattle’s Lake View Cemetery, where the remains of his super-fit body are interred. Followers of Mohammed go on a pilgrimage to the Mosque of the Prophet in Medina, where the the prophet is buried. But followers of Jesus Christ going to the Garden Tomb in Jerusalem find just an empty grace. (p39-40)

Many important practical and pastoral concerns are addressed in this book’s 94 pages. The author addresses such matters as What will happen to my body?; What will it be like to die?; How do we cope with bereavement?; and What will life be like in eternity? There are also brief answers to questions relating to prayers for the dead, ghosts, cremation versus burial, soul sleep, rewards in heaven, recognising loved ones, what is a soul or spirit, and even whether our pets will join us in the new creation! There is much to consider in this book, and each matter is addressed with appropriate sensitivity.

Nodder writes also of his grandmother dying of cancer. She was in her seventies and ready to go home to be with her Lord. However, she was bothered by well-meaning Christians who couldn’t accept the place of death. The reality is that one day we will all die. It may be tragic and sudden, or it may be slow and peaceful. There will be a day when our organs will cease to function, when there is no more healing to be found in this life. This is God’s will for each of us—for since the fall we are no longer equipped to live forever in this life, and God has something far greater in store for all who trust him. Sadly, there are some Christians doing much damage by their unwillingness to accept this.

Some people by their obsession with healing seem to me to rob Christian souls of their privilege and opportunity to glorify God in the way they die. Instead of a triumphant acceptance of death, as simply one more step in the purposes of God for them, we find instead an hysterical search for healing as if it were quite impossible that it should be God’s will for a Christian to die. Instead of courageous testimony, we find an attitude to death that resembles in many ways the conspiracy of silence and the double-think that we find in the world. It ought not to be so. (p59)

I notice ads on the TV for life insurance, funeral insurance, and leaving a will, a lot more often since I’ve been diagnosed with a terminal cancer. They’ve probably all ways been on TV and I haven’t noticed. Perhaps I just watch more TV now! The ads are correct in highlighting the need to make decisions about these matters while we can; but they almost suggest that once these choices are made, we can go back to just getting on with life. It’s not sufficient to consider our death—we need to make plans and preparations beyond death, and this means we need to go to the Bible.

The philosopher, Cicero, said that “to study philosophy is nothing but to prepare ourselves to die.” God says the only way to prepare ourselves is to put our trust in Jesus as our Rescuer and Ruler before we meet him as our Judge. (p61)

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