We are looking at a huge
problem in Medicine: The number of patients needed to treat in order to have
the expected response:
Number Needed to Treat: A
Double-Edged Sword
This concept can best be
understood using the number needed to treat (NNT).1 If
a novel drug has an NNT of ten—a fairly robust effect by most standards—we are
implying that we would need to treat ten patients to prevent one from
experiencing the outcome of interest. In other words, 90% of individuals who
received this highly efficacious drug would actually derive no benefit. Are we
meeting our ethical obligation to this 90%? Do physicians owe our patients an
explanation of this phenomenon when we prescribe a medication? Should we say
that “this medication probably won’t make a difference in your life, but there
is a chance that it may. I suggest you take it.”?
During decades we ignored
the above concept due to excess of optimism from colleagues. Money is getting shorter and patients do not
want to be subjected to side effects without knowing their chances of getting
better. This is not different from “talent
identification” in triathlon. So far we
know that at the Mexican National Center for Sports (CNAR) the cost per athlete
is too elevated and we have not triathletes capable of winning a World Cup;
they hardly obtained a podium at Continental Cups. They take athletes into their program based
on their ability to swim and run short distances. It is obvious that swimming and running is
needed to win in triathlon, but there are more important variables to take into
consideration if we want to develop viable triathletes.
In the case of the Mexican
National Center, they have the numbers to start looking at this problem
differently, none of the triathletes is viable.
The problem is that people at the Center are so ignorant that they do
not know what is needed to have viable triathletes. Looking and studying Mario Mola or Javier
Gomez could give us information about what is lacking in our athletes, but we run into another
problem. In order to see the
differences, we have to know what we are looking for and to be knowledgeable about the subjects;
the value of perseverance, passion, and simple professionalism (something that
lacks in the Center) need to be studied and pursue by mentors/coaches.
As a team, we have the
translational model that allows to target the athletes that could benefit with
triathlon training to the point of being at least the National Champions. Jack Daniels puts it simple and explains the reason why the Center fails producing viable athletes:
