21 déc. 2012

Triathlon and the legacy of Eric Topol



Eric J. Topol, M.D. is an American cardiologist, geneticist, and researcher. Much of Topol's career was spent at the Cleveland Clinic, where he served as chairman of cardiovascular medicine and founded the Cleveland Clinic Lerner College of Medicine. Topol was one of the first researchers to question the cardiovascular safety of rofecoxib (Vioxx),[1] culminating in the drug's ultimate withdrawal from the market. Topol's advocacy on the subject led to what the New York Times described as an "unusually public dispute" with the Cleveland Clinic's leadership over ties between the academic institution and the pharmaceutical industry, ultimately leading to Topol's departure from the Clinic after his academic position was abolished.[2][3]
Topol is more than a simple mortal. Topol has many secrets, as many as WIKILEAKS.  Those secrets are from a well-educated environment and related to Medicine.  His knowledge is equally related to VATILEAKS.

After leaving the Cleveland Clinic, which by the way it was considered the best clinic for Cardiology in the world when he was working in, continued to work on the “deconstruction” of Medicine.  He called his work differently by the title of his book:

Topol is not a psychiatrist/philosopher, so he uses a different term for what he does, but it is a “deconstructive” process what he follows.  He is given a different twist to Medicine.  It is pertinent to mention what Albert Einstein said regarding time and space in Physics, which relates to Topol´s thinking:”…This is applicable to our concepts of time and space where physicists brought these concepts down from the Olympus of a priori concepts, so they could be useful to our thinking (53).” El significado de la relatividad. Barcelona, 1993.  Topol works a posteriori, which it is called working from experience.  He has the experience of the world in himself.  He will never destroy Medicine (who can?), he is just making it better.
Paul de Man was a member of the Yale School and a prominent practitioner of deconstruction as he understood it. His definition of deconstruction is that,"It's possible, within text, to frame a question or undo assertions made in the text, by means of elements which are in the text, which frequently would be precisely structures that play off the rhetorical against grammatical elements."[35] http://en.wikipedia.org/wiki/Deconstruction

What is the relationship between Topol and triathlon?  Research in triathlon should exist, and Topol mentions how to pursue.  “If we have such a good relationship, should we wait for the clinical trials (could be ten years) to use the medication that we know it works?”
 

In triathlon we are not close to something compared to Evidence-Based-Medicine and we have an obsolete way of doing research.  And what it is the worst, we are trying to apply "what we do as research" to triathlon.  Our subjects studied are limited and we are unable to represent a coherent group regarding the multiple variables in preformance.  We are unable to represent the reality of triathlon or the variables involved when practicing triathlon, but we want to generalize findings.  In Medicine, we could serve jail time for what we do without evidence.  Evidence is considered valid when the clinical trials are done and we have positive results regarding the outcome.  One needs thousands of people for a clinical trial in the real world.  It means money, time, researchers, etc. unavailable to triathlon; but we can limit harmful practices in triathlon but we do not do it for ignorance, politics or corruption.
Clinical trials are sets of tests in medical research and drug development that generate safety and efficacy data (or more specifically, information about adverse drug reactions and adverse effects of other treatments) for health interventions (e.g., drugs, diagnostics, devices, therapy protocols). They're conducted only after satisfactory information has been gathered on the quality of the nonclinical safety, and health authority/ethics committee approval is granted in the country where approval of the drug or device is sought. http://en.wikipedia.org/wiki/Clinical_trial

We do not have clinical trials in triathlon and we do not have evidence-based triathlon training, and unfortunately we are afraid of putting rules forward for what we do.  Topol wants to change the clinical trials that last up to 20 years by using the data from the web to finish the last two steps of the clinical trials. In practical terms, if there is a good match between what we observe and we experimented with few subject during the step of experimentation, one could use the drugs matched or the intervention before finishing corroborating that the drug is safe in the general population.  This last step of corroborating could last 10 years to accomplish (Topol thinks that the web can make it faster and at the same time of finishing experimenting) 
Because the clinical trial is designed to test hypotheses and rigorously monitor and assess what happens, clinical trials can be seen as the application of the scientific method, and specifically the experimental step, to understanding human or animal biology.
The most commonly performed clinical trials evaluate new drugs, medical devices (like a new catheter), biologics, psychological therapies, or other interventions. Clinical trials may be required before the national regulatory authority[3] approves marketing of the drug or device, or a new dose of the drug, for use on patients

When I say that we are afraid of looking at these problems of CLINICAL TRIALS in triathlon, I speak that organizations are afraid of limiting the experimentation of the National Federations.  In Mexico, the athletes need to have swimming and running times to represent Mexico in international competitions without having any kind of experimentation to have an evidence-based-triathlon selection. Even worse, their limited experimentation points out the damage done to human beings when adopting this kind of protocols by the Federations and the lack of results when adopting such measures (except their pocket).  Topol saw the same when using Vioxx and the drug was withdrawn from the market after a bitter legal battle.  Please see different articles related to this subject of human rights in the blog.

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