The Eightfold Path as Tending Causes and Conditions

The Eightfold Path as Tending Causes and Conditions

Steve Lovinger | mindfulnessmeditationgroup.com | October 2026

The Eightfold Path is usually taught one factor at a time: Appropriate View, Intention, Communication, Action, Livelihood, Effort, Mindfulness, and Concentration. Each has its own emphasis, and taking them up separately has its uses. But they are not eight separate practices. They are eight ways of participating wisely in the ongoing unfolding of causes and conditions.

The more I study the early discourses—and, more to the point, the more I try to practice them—the more I notice a single thread running through the Pali Canon. The Buddha consistently turns our attention away from fixed things and toward unfolding processes.

Thoughts arise and pass away. Feelings arise and pass away. Habits are cultivated. Intentions shape actions, and actions shape future experience. Suffering arises from conditions; freedom arises from conditions. The emphasis falls less on what things are than on what they are doing—arising, changing, conditioning, fading, becoming. The Buddha’s world is one of verbs rather than nouns.

The early texts give this a name: paṭicca-samuppāda, dependent arising. The Buddha expressed this insight in many ways, but perhaps nowhere more simply than in one of his most fundamental formulas of dependent arising—when this is, that comes to be; with the arising of this, that arises; when this is not, that does not come to be; with the ceasing of this, that ceases. Taken as cosmology it can stiffen into doctrine. Taken as description, it is simply how experience works: nothing stands on its own, and everything leans on the conditions that give rise to it.

Rather than asking, What is this?, the Buddha repeatedly invites us to investigate, What conditions give rise to this? What conditions sustain it? What conditions allow it to cease? Dependent arising describes how experience unfolds through changing causes and conditions. The Eightfold Path is the practical response to that insight. If dependent arising explains how experience works, the Eightfold Path shows us how to participate wisely in that process.

We tend to approach our own lives differently. We try to control outcomes. We want different thoughts, different feelings, different people, different circumstances, different results. But outcomes cannot be willed into being. They emerge from conditions.

The Eightfold Path offers another way. Rather than trying to control results, we learn to understand and tend the causes and conditions from which results naturally emerge.

A gardener cannot force a tomato plant to grow. Pulling on the stem accomplishes nothing. But the gardener can prepare the soil, water, weed, and see that the plant gets enough sun. Growth happens because the conditions support it. Meditation and the Eightfold Path work the same way. Wisdom cannot be forced, peace cannot be demanded, compassion cannot be manufactured by willpower alone. But we can cultivate the conditions in which these qualities naturally develop.

Over time, this has become the lens through which I understand the whole of the path. It is only a model, of course—in the Buddha’s image, a raft built for crossing and not for carrying once we reach the far shore. A model is worth only as much as it helps us see experience more clearly and suffer less. Like any model, it is, and it isn’t: workable enough to lean on, empty of any nature of its own. Held lightly, it serves. Grasped as the way things ultimately are, it becomes one more thing to cling to.

Why “appropriate,” not “right”

A word about the translation. The Pali term at the head of each factor is sammā, usually rendered “right”—Right View, Right Intention, and so on. But “right” carries a weight in English that sammā does not. It suggests a fixed standard, a rule that holds regardless of circumstance, a right answer set against a wrong one. Sammā points elsewhere: toward what is complete, fitting, well-aligned—appropriate to the situation actually at hand.

That difference matters, and it is of a piece with everything above. If experience arises from conditions, then what is skillful cannot be settled in advance. The same words that comfort one person wound another; the same action that helps within one web of conditions causes harm within a different one. There is no view, no speech, no effort that is right in the abstract, apart from the conditions it meets. What the path asks is not obedience to a rule but responsiveness to a situation.

The ethics of the Eightfold Path are fundamentally responsive rather than rule-based. They are grounded in wisdom and compassion, but their expression depends upon the conditions present. I describe this as a form of situational ethics—not moral relativism, where anything goes, but an ethics rooted in dependent arising. The criterion remains constant: does this response cultivate conditions that tend toward well-being or toward suffering? The early texts frame this in terms of kusala and akusala—the skillful and the unskillful—rather than simply right and wrong. To act appropriately is to understand the conditions clearly and respond in ways that are likely to reduce suffering and foster human flourishing. “Right” tends to freeze the path into a code. “Appropriate” keeps it responsive to the living reality of each moment.

Each factor, both cause and effect

Seen this way, each factor works in two directions at once. Each shapes the conditions that follow it, and each arises from conditions already in place. Every factor is both cause and effect, both tending and tended.

Appropriate View helps us see experience as an unfolding process arising from causes and conditions, rather than as a collection of fixed things. And view itself is conditioned—by what we have been reading and listening to, the assumptions we inherited, whether we slept, whoever last shaped our mood—all of it present before we interpret anything.

Appropriate Intention reminds us that every intention becomes part of the conditions shaping what follows. Goodwill sets up different conditions than resentment; curiosity, different conditions than fear. And intentions arise from conditions of their own: our state on waking, hunger, an unresolved argument still humming, the tone of the last message we read.

Appropriate Communication recognizes that every conversation, every email, every act of listening or speaking becomes part of the conditions shaping trust, understanding, and future exchanges. It also unfolds within conditions—who is in the room, the medium (a text strips tone; a call restores it), whether either person is rushed, the history between them, the noise in the background.

Appropriate Action means acting in ways that cultivate conditions for well-being rather than suffering. Each action develops within its own web of conditions: the environment (a cluttered desk or a clear one), who is present, the time of day, what is within arm’s reach, our energy, and whether the easier path happens to be the wholesome one.

Appropriate Livelihood asks us to earn a living in ways that contribute to healthy conditions for ourselves and others. Our work is shaped by its own conditions—colleagues, the incentives built into how we are paid, the physical setting, what the job asks of us daily, who benefits and who is harmed.

Appropriate Effort is the ongoing work of encouraging wholesome conditions and letting unwholesome ones weaken. The effort we can muster is itself conditioned—by fatigue or freshness, established habit, the people around us and whether they pull toward wholesome states or away from them, the cues in the environment that trigger old patterns.

Appropriate Mindfulness lets us notice causes and conditions as they unfold, before automatic habit takes over. Our capacity to notice is supported or undermined by conditions: our pace (rushing collapses the gap where noticing happens), the sensory load, how much is competing for attention, the tension already held in the body.

Appropriate Concentration steadies the mind, creating the conditions in which deeper insight can arise. It too depends on conditions—noise or quiet, interruption, posture, the reliability of a settled place and time, a calm or agitated body, whether the phone is within reach.

None of these factors stands alone. Each supports the others, and each conditions the others: view steadies effort, effort deepens concentration, concentration clarifies view. They are not eight tools but one practice seen from eight angles.

Seen this way, dependent arising is not simply one teaching among many. It is the principle that gives coherence to the entire Eightfold Path. Dependent arising describes how experience unfolds; the Eightfold Path is the practical expression of that insight. Each factor both arises from conditions and helps shape the conditions that follow. Together they form a practical guide for participating wisely in dependent arising—that is, in the continual unfolding of experience through causes and conditions.

We cannot control everything that happens to us. Many conditions are inherited; many lie well beyond our influence. Yet every moment offers a chance to help shape the conditions from which the next moment will emerge. That, to me, is the heart of the Eightfold Path: learning to participate wisely in the continual unfolding of causes and conditions.

The Dharma of Pleasure

Early Buddhism as Refined Hedonism Based in part on Bernat Font, “Early Buddhist Hedonism” (2026), with additional material on Epicurus

A Different Way to Read the Buddhist Path

Buddhism is often presented as a tradition preoccupied with suffering: life is dukkha, pleasure is unreliable, desire is dangerous, and practice means learning not to want very much. That picture contains something real, but it can also distort the early texts. Bernat Font proposes a more provocative reading: the early Buddhist path does not oppose pleasure. It reorganizes pleasure. It trains us to become less impressed by pleasures that agitate, entangle, or harm, and more capable of enjoying states that are ethical, settled, clear, and free from disturbance.

Font calls the Buddha of the early discourses a “refined hedonist.” He is not saying the Buddha recommends indulgence. It is almost the reverse. Sensory pleasure is criticized because it is a poor bargain: the pursuit can generate craving, conflict, anxiety, dependency, and harm, while the pleasure itself is limited and unstable. Practice therefore works with the ordinary organism’s tendency to move toward what feels good and away from what feels bad, but educates that tendency. The question becomes not, “How do I stop liking pleasure?” but “What kinds of pleasure are actually worth learning to enjoy?”

Hedonism Does Not Have to Mean Indulgence

In ordinary English, “hedonism” often means sensual excess. Philosophically, it is a broader claim: pleasure has a central role in what makes a life good. That leaves open the crucial question of what pleasure is, which pleasures are worth choosing, and what their consequences are. Both early Buddhism, on Font’s reading, and Epicurus answer those questions in ways that are disciplined rather than indulgent.

Font emphasizes that early Buddhism does not abolish the basic hedonic structure of experience. Sukha — ease, happiness, pleasure or well-being — remains something toward which practice moves. Ethical conduct can be enjoyed. The absence of remorse can be enjoyed. The fading of the five hindrances can be enjoyed. Quiet can be enjoyed. Even a neutral state may become subtly pleasant when it is recognized as free of the disturbance that was present before. Across many early Buddhist maps of practice, pleasure becomes progressively less dependent on stimulation and progressively closer to ease and equanimity.

Cultivating the Taste for What’s Skilful

Font’s more provocative claim is that early Buddhism does not fight our drive toward pleasure and away from pain – it uses that drive. The goal of ending suffering is itself hedonic. The strategy is to redirect the drive: train the mind to find skilful states genuinely enjoyable, so that ethical conduct and meditative practice become self-reinforcing rather than merely effortful. If virtue only feels like restraint, we are unlikely to sustain it. If virtue starts to feel good, we will.

You can see the same hedonic curve running through several formulations of the path that are often treated as separate. The seven awakening factors, the four immeasurables, the development of satipatthana, and the jhanas all move through a similar arc: rising pleasure and clarity followed by a settling into equanimity. Font’s suggestion is that these may be less like separate technologies than different descriptions of one underlying process.

The ACID Doctrine, Held Loosely

One useful reframe is Font’s discussion of the ACID doctrine – ‘Anything Conditioned and Impermanent is Dukkha.’ It need not be taken as a metaphysical claim about reality, as though impermanence is suffering, full stop. It can instead be held as a practical strategy: a perception deliberately cultivated because it loosens clinging. You adopt the lens because of what it does, not because it is the last word on the nature of things. This fits comfortably with an anti-metaphysical reading of the discourses: teachings as tools, models, and practices, rather than final cosmological descriptions.

Epicurus: Pleasure as Freedom from Disturbance

Epicurus (341–270 BCE), who lived only a few generations after the period in which the early Buddhist tradition was developing, is one of the clearest Western examples of this refined form of hedonism. He explicitly called pleasure the beginning and end of the happy life, but he rejected the idea that pleasure means constant stimulation, luxury, or sensual excess. In his Letter to Menoeceus, he says that not every pleasure should be chosen and not every pain should be avoided. A pleasure that produces greater trouble may be a bad choice; a difficulty that produces greater wellbeing may be a good one.

Epicurean philosophy distinguished kinetic pleasure — the active pleasure involved in satisfying a desire — from katastematic pleasure, the more stable ease present when the disturbance of desire has subsided. Epicurus’s ideal was not perpetual excitement but ataraxia — freedom from mental disturbance — together with aponia, freedom from bodily pain. Once hunger has been satisfied, for example, the important pleasure is not endless eating but the ease of no longer being hungry. This is why simple food can be enough. When the disturbance of need has ended, adding more stimulation may add very little.

This turns Epicureanism into a practice of subtraction as much as acquisition. What must be removed? Needless fear, status anxiety, unlimited desire, dependency on luxury, false beliefs about death and the gods, and the conviction that happiness always requires something more. The good life becomes surprisingly modest: bodily sufficiency, mental tranquility, prudent judgment, freedom from unnecessary fear, and dependable friendship.

Epicurus on Desire

Epicurus divided desires into categories. Some are natural and necessary: food, shelter, bodily security, and the conditions of a stable life. Some are natural but not necessary: richer food or extra comfort. Others are empty or groundless: desires for unlimited wealth, fame, power, or social status. The distinction matters because unlimited desires have no natural stopping point. If enough money means “more than I have now,” satisfaction is always deferred. A natural and necessary desire, by contrast, can actually be completed.

This is close to a Buddhist diagnosis of craving in one important respect: the problem is not that pleasant experience exists, but that the mind constructs a cycle of craving that cannot settle. The pleasure of completion is repeatedly displaced by the next acquisition, the next recognition, the next reassurance. Epicurus asks us to notice when desire serves life and when life has begun serving desire.

Epicurus on Prudence, Virtue, and Friendship

Epicurus made prudence central because pleasure has to be understood across time. Immediate gratification is an unreliable guide if tomorrow’s cost is ignored. A good choice therefore asks about the whole sequence: anticipation, pursuit, attainment, aftermath. This closely resembles Font’s practical suggestion to observe pleasure as a process rather than merely noticing the pleasant moment at its peak.

For Epicurus, virtue and pleasure are not rival goals. A life of prudence, justice, and honorable conduct is inseparable from a pleasant life because deception, exploitation, and reckless appetite generate fear and disturbance. Friendship is especially important. Epicurean community was not incidental to happiness; trusted friends provided security, conversation, affection, and a setting in which simple pleasures could be fully enjoyed. The famous “Garden” was therefore both a philosophical school and a community of practice.

Where They Converge

The strongest overlap is not simply that both traditions value pleasure; it is that both discriminate among pleasures. Early Buddhism treats craving and clinging as sources of agitation and trains enjoyment toward skilful states. Epicurus distinguishes natural, limited desires from empty desires for wealth, fame, power, or endless acquisition. In both traditions, ethics is not an enemy of pleasure. Skilful conduct, prudence, and justice make a more settled form of wellbeing possible because they reduce remorse, fear, conflict, and dependency.

Both also shift attention from acquisition toward quiet wellbeing. Buddhist renunciation reduces dependence on stimulation and possession, while Epicurus points toward ataraxia and aponia – tranquility and freedom from bodily distress. Both ask us to examine the whole sequence of a pleasure: wanting, pursuit, attainment, aftermath. The common question is not how much stimulation can be accumulated, but what forms of enjoyment leave the mind less disturbed and less dependent on getting the world to cooperate.

But They Are Not the Same Philosophy

The comparison is useful precisely because the traditions are not identical. Epicurus gives pleasure an explicit philosophical status as the goal of a happy life. Early Buddhist texts contain a much larger vocabulary of liberation, awakening, non-clinging, ethical training, and insight, and Font’s claim that pleasure is the “highest good” is an interpretation of how those elements function together, not a standard formula used by the texts themselves.

Their intellectual settings also differ. Epicurus developed a materialist physics and argued that death is not something we experience and therefore should not be feared. Early Buddhist discourse usually approaches the problem through impermanence, conditionality, craving, and release rather than Epicurean atomism. Epicurus also makes friendship unusually explicit as one of the great securities of a happy life. While early Buddhism also places importance on wholesome friendship, it places greater institutional weight on sangha, ethical discipline, meditation, and liberation.

Still, the family resemblance is striking: neither tradition recommends maximizing stimulation. Both are interested in reducing the machinery that makes wellbeing conditional on getting the world to cooperate with our wants.

Dukkhacentrism

Font also makes a historical observation worth sitting with: the intense focus on suffering that characterizes much Western Buddhism may be less a feature of the original teaching than an artifact of who received it. He contrasts a Thai temple, centered on a serenely smiling Buddha, with a Christian church, centered on a figure in agony. When people from a largely Protestant background encountered a tradition organized around dukkha and its ending, the resulting modern synthesis may have doubled down on suffering and grown suspicious of joy.

We already evolved to pay close attention to pain – ordinary negativity bias. Cultural conditioning can add another layer on top of it. Font calls this ‘dukkhacentrism.’ The question worth asking is what practice looks like if we do not assume suffering deserves the microphone by default. A path concerned with dukkha need not become a practice organized around feeling bad; it can also be a training in recognizing, cultivating, and trusting forms of wellbeing that do not depend on grasping.

Pleasure, Prediction, and Craving

There is a useful distinction between enjoyment and pursuit. Much of what we call pleasure may occur before the pleasurable event as anticipation, and much of our dissatisfaction may come from the gap between the predicted reward and the event that actually arrives. The mind can therefore become attached less to pleasure itself than to the cycle of wanting, imagining, acquiring, briefly settling, and wanting again.

Seen this way, both Epicurean and Buddhist practice ask us to become better students of the full hedonic process. What does wanting feel like in the body? Is the pursuit itself pleasant or tense? How long does satisfaction last? What new want is generated? What is the emotional cost of maintaining the thing acquired? And, just as importantly, what forms of wellbeing are already present when nothing is being added?

A Practice: Learning to Enjoy What Is Already Quiet

During meditation, notice moments when some disturbance has simply stopped: a thought sequence ends, irritation fades, the body settles, a sound disappears, an urge is no longer demanding attention. Instead of immediately moving on, notice the absence. What is the texture of experience when nothing needs to be fixed for this moment? There may be no dramatic pleasure. The point is to become sensitive to subtler forms of ease. A regular meditation practice can enhance this sensitivity, including the capacity to notice the subtle pleasure that can come simply from the absence of disturbance.

The same experiment can be used outside meditation. After hunger is satisfied, notice the state of no longer needing food. After finishing a task, notice the ending of pressure before opening the next task. During conversation with a trusted friend, notice whether well-being comes from stimulation or from the absence of defensiveness and demand. The training is not to manufacture a special state but to recognize forms of pleasure that are easy to overlook because they are quiet.

Questions for Discussion

  • When you hear the word “pleasure,” what do you normally imagine — stimulation, satisfaction, relief, ease, connection, or something else?
  • Can the absence of a disturbance genuinely be experienced as pleasure, or is it merely neutral?
  • Which desires in your own life have a natural stopping point, and which tend to recreate themselves after being satisfied?
  • Does judging a pleasure by its entire sequence — anticipation, pursuit, attainment, aftermath — change whether it looks worth pursuing?
  • Where in your own practice or life do you notice the difference between kinetic pleasure (chasing, obtaining) and katastematic pleasure (the ease that follows when a disturbance simply isn’t there)?
  • Is there a skilful state — generosity, kindness, stillness — that you’ve trained yourself to genuinely enjoy, rather than merely approve of?

Sources and Further Reading

  • Bernat Font, Early Buddhist Hedonism: The Role of Spiritual Pleasure in the Pali Discourses (Bloomsbury, 2026), and his September 3, 2026 Substack summary.
  • Epicurus, Letter to Menoeceus — on natural and necessary desires, weighing pleasures and pains, simple living, and pleasure as freedom from pain and disturbance.
  • Background: Epicurean ethics on pleasure, ataraxia, aponia, prudence, desire, and friendship.
  • Steve Lovinger | mindfulnessmeditationgroup.com | September 2026

The Eightfold Path from a Secular Perspective

The Eightfold Path as Tending Causes and Conditions

Steve Lovinger | mindfulnessmeditationgroup.com | July 12, 2026

Over the past several months, we have explored each factor of the Eightfold Path one at a time: Appropriate View, Intention, Communication, Action, Livelihood, Effort, Mindfulness, and Concentration.

Each factor has its own emphasis. But they are not eight separate practices. They are eight ways of participating wisely in the ongoing unfolding of causes and conditions.

The more I study the early discourses and, more importantly, the more I try to practice them, the more I see a common thread running throughout the Pali Canon.

The Buddha consistently directs our attention away from fixed things and toward unfolding processes.

Thoughts arise and pass away. Feelings arise and pass away. Habits are cultivated. Intentions shape actions. Actions influence future experience. Suffering arises from conditions. Freedom arises from conditions.

The emphasis is less on what things are and more on what they are doing—arising, changing, conditioning, fading, becoming. The Buddha’s perspective is almost always one of verbs rather than nouns.

We often approach life differently. We try to control outcomes. We want different thoughts, different emotions, different people, different circumstances, and different results. But outcomes cannot simply be willed into existence. They emerge from conditions.

The Eightfold Path offers another way.

Instead of trying to control results, we learn to understand and tend the causes and conditions from which results naturally emerge.

A gardener cannot force a tomato plant to grow. Pulling on the stem accomplishes nothing. But the gardener can prepare the soil, provide water, remove weeds, and make sure the plant receives enough sunlight. Growth occurs because the conditions support it. Meditation and the Eightfold Path work the same way.

Wisdom cannot be forced. Peace cannot be demanded. Compassion cannot be manufactured through willpower alone. But we can cultivate the conditions in which these qualities naturally develop.

This understanding has gradually become the organizing principle through which I understand the entire Eightfold Path. It is also just a model—in the Buddha’s words, a raft, built for crossing and not for carrying once we reach the far shore. It is valuable only to the extent that it helps us understand experience more clearly and reduce suffering.

Like any model, it is, and it isn’t: workable enough to rely on, empty of any nature of its own. Held lightly, it serves; grasped as the way things ultimately are, it becomes one more thing to cling to.

The Eightfold Path Through the Lens of Causes and Conditions

Notice that each factor works in two directions at once. Each shapes the conditions that follow it, and each arises from conditions already in place—both cause and effect, both tending and tended.

Appropriate View helps us see experience as an unfolding process arising from causes and conditions rather than as a collection of fixed things. The conditions affecting view include what we have been reading and listening to, the assumptions we inherited, whether we slept well, and whoever last shaped our mood—all present before we interpret anything.

Appropriate Intention reminds us that every intention becomes part of the conditions shaping what follows. Goodwill creates different conditions than resentment. Curiosity creates different conditions than fear. And intentions themselves emerge from conditions: our emotional state on waking, hunger, an unresolved argument still humming, the tone of the last message we read.

Appropriate Communication recognizes that every conversation, every email, every moment of listening or speaking becomes part of the conditions shaping relationships, trust, understanding, and future interactions. Communication also unfolds within conditions—who is in the room, the medium (a text strips tone; a call restores it), whether either person is rushed, the history between the two people, the background noise.

Appropriate Action means acting in ways that cultivate conditions supporting well-being instead of suffering. Every action develops within its own web of conditions: the environment (a cluttered desk or a clear one), who is present, the time of day, what is within arm’s reach, our energy level, and whether the easier path happens to be the wholesome one.

Appropriate Livelihood asks us to earn our living in ways that contribute to healthy conditions for ourselves and for others. Our work is shaped by conditions such as our colleagues, the incentives built into how we are paid, the physical setting, what the job asks of us daily, and who benefits and who is harmed.

Appropriate Effort is the ongoing process of encouraging wholesome conditions while allowing unwholesome conditions to weaken. The effort we extend is influenced by conditions such as fatigue or freshness, established habits, the people around us, and whether they pull toward or away from wholesome states, and the cues in the environment that trigger old patterns.

Appropriate Mindfulness allows us to notice causes and conditions as they unfold, before automatic habits take over. Our capacity to notice is supported by conditions such as our pace (rushing collapses the gap where noticing happens), the sensory load, how much is competing for attention, and the tension already present in the body.

Appropriate Concentration steadies the mind, creating the conditions in which deeper insight can naturally arise. Concentration is supported by conditions such as noise or quiet, interruptions, posture, the reliability of place and time, a settled or agitated body, and whether the phone is within reach.

None of these factors stands alone. Each supports the others, and each conditions the others; for example, view steadies effort, effort deepens concentration, and concentration clarifies view. They are not eight tools but one practice seen from eight angles.

We cannot control everything that happens in our lives. Many conditions are inherited, and many lie beyond our influence. Yet every moment offers an opportunity to help shape the conditions from which the next moment will emerge.

To me, that is the heart of the Eightfold Path: learning to participate wisely in the continual unfolding of causes and conditions.

Reflection questions

  1. When you think about your own practice, do you usually focus more on changing results or on tending the conditions that give rise to those results?
  2. Can you think of a recent situation where changing one small condition produced a surprisingly different outcome?
  3. Which factor of the Eightfold Path has been most important in changing the conditions of your own life? Why?
  4. How does viewing experience as an unfolding process differ from seeing people—or yourself—as fixed?
  5. If every action both arises from conditions and becomes a condition for what follows, how does that change the way you think about responsibility and karma?
  6. Are there conditions in your daily life that consistently support mindfulness? Which conditions consistently undermine it?
  7. If suffering arises from conditions rather than from fixed selves, how does that change the way we respond to ourselves or to other people?
  8. The Buddha often emphasized tending causes rather than controlling outcomes. Is there an area of your life where that shift in perspective might be helpful?
  9. Which of the conditions mentioned in the handout—sleep, environment, relationships, habits, media, physical setting—has the greatest influence on your own mind?
  10. If we can’t directly produce wisdom, compassion, or peace, but can only cultivate the conditions from which they arise, how does that change the way we approach Buddhist practice?
  11. Looking back over the entire Eightfold Path, has your understanding of practice changed in any significant way? If so, what has changed