It is refreshing listening to Bennet Omalu, MD. Omalu is the real hero of the story; he makes
me wear my MD hat with proudness. The
interview given by Eric Topol is very enlightening and helps to understand what
life is about. Topol was fired at the
Cleveland Clinic when he went on against Merck and the Cleveland Clinic for
using drugs that created more harm than the opposite:
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
administrative position as head of the Clinic's academic program was abolished.
What does it have to do with triathlon? Triathlon is not a contact sport but
competing in places without organization and contaminated as it would be the
case of Rio endangers competitors.
Organizers do not care about the problems the athletes will have. Triathletes do not speak clearly about this
danger because they already competed in Beijing, and they are afraid of
mentioning the dangers to authorities.
Fighting against our corrupted Federations is a parallel to what
happened to Bennet and Topol. We have written
an article regarding Topol:
21 déc. 2012
Triathlon and the legacy of Eric Topol
Bennet makes me rethink what we do as human beings: “Do
what you need to do if you are seeing things.”
He was misjudged because he is an African. He suffered the “white
privilege,” and was able to survive it.
Thanks man! Your actions help us
to stay human.
http://www.medscape.com/viewarticle/856308
The address is for Topol´s interview with Omalu in medscape. Below is Will Smith with Omalu
We have learned many things from Armstrong. “The only rational way of teaching is with the
example, even when we are not a good example,” quoting Albert Einstein. We learned about how pervasive
doping is in cycling and it was even worse; we learned how people lied even
when they can lose everything. Are they
stupid? Nope, lack of the right education to live according to the new circumstances
is the problem. It is Peter´s principle:
“The capacity to perform well disappears when we do not have the tools to deal
with the new scenario.” It is the case
of Debi Thomas.
Lance Armstrong: "I grew up ... like a
wild animal."
This week, Lance Armstrong said he made two really big mistakes in his life,
and one of them has proved to be much more costly than the other.
One was doping, the other mistreating people.
The disgraced global sports icon was speaking on
"Movember Radio" with CEO Adam Garone
in a podcast published on Tuesday.
Armstrong, 44, talked about how attacking people
during his cycling career proved to be a much more significant mistake than his
actual doping…
He replied: "Understand that you may face some decisions in this
sport, but, man, don't ever isolate, attack, ostracize, incite another human
being."
Armstrong, who was raised by a single
mother, added, "My mom and I had more of a brother-sister relationship ...
I never had that person that in my life — and I'm not making excuses — but
nobody ever tapped me on the shoulder and said,Dude.
"I sort of raised myself. But nobody
ever said,Dude, what I just saw. Never do that again.And so it is what it is. And I got to live
with that and spend the rest of my life trying to make it right."
Our posts are an effort to
teach our kids to think about what is coming for them in order to acquire the
tools to face a much more complex reality.
We have said: Dude, what I just saw. Never do that again. Sometimes parents are unable to say it for the
very same reason Armstrong mentions, and teachers do not speak clearly because
they are afraid of losing their jobs. We
have to say it knowing all possible consequences. Most of the time we are counterattacked by pointing
out our mistakes instead of looking at how to improve as a whole. This counterattacking is an ingredient of poverty and perhaps
the strongest that keep us poor. We are unable to reflect as Armstrong is doing. I am not sure that Armstrong will do what is needed because he has a habit/addiction that is very difficult to irradicate but reflecting is the first step.
There is a well written
article that looks into this matter from a psycho-social point of view:
Born to Be Conned
By MARIA KONNIKOVADEC. 5, 2015
New York Times
And the stories the grifter tells aren’t real-world narratives —
reality-as-is is dispiriting and boring. They are tales that seem true, but are
actually a manipulation of reality. The best confidence artist makes us feel
not as if we’re being taken for a ride but as if we are genuinely wonderful
human beings who are acting the way wonderful human beings act and getting what
we deserve. We like to feel that we are exceptional, and exceptional
individuals are not chumps…In a sense, all victims of cons are the same: people
swept up in a narrative that, to them, couldn’t be more compelling. Love comes
at the exact moment you crave it most, money when you most need it. It’s too
simplistic to dismiss those who fall for such wishful-seeming thinking as saps
— just as it’s overly neat to dismiss the types of people who would take advantage
of them as unfeeling psychopaths…Nobody thinks they are joining a cult, David
Sullivan explains. “They join a group that’s going to promote peace and freedom
throughout the world or that’s going to save animals, or they’re going to help
orphans or something. But nobody joins a cult.” We don’t knowingly embraces
false beliefs. We embrace something we think is as true as it gets. We don’t
set out to be conned. We set out to become, in some way, better than we were
before.
The
great Jacques Lacan would say: “L’amour, l’amour…c’est pour ça qu’on a
inventé l’ inconscient (Jacques Lacan,Le Seminaire, Livre XX; 11).” Armstrong is working hard trying to
understand why he blew his life up, perhaps for the sake of his children.
We have witnessed horrible things happening lately. Starting with the Russian Doping and the
bombing of Paris. Such things are
outside of any coherent paradigm, we need to be stupid and crazy to understand
such behavior. What we can understand is
the behavior of Debi Thomas (Olympic Medal skier and Orthopedic Surgeon), we
can understand the situation in the sense of knowing where it comes from. It is a tragedy! It is even worst for the people who supported
and pushed Debi to accomplish what she did. We have done the effort to support somebody
going to our limits, and we know the feeling.
Unfortunately, Debi does not see how low the fall was. We have written posts regarding this subject:
We wrote articles from the point of view of our
experiences, and what we see in Debi´s case is lack of education and lack of
support system to keep the uneducated functioning after the age of 40 if the
learning process does not take place.
She was subsequently forced to close her practice and live in a trailer
park with her fiance, Jamie Looney - who is battling an alcohol problem and
anger issues - and his two sons.
She also lost custody of her own 13-year-old son, Christopher Jules
'Luc' Bequette.
Thomas now lives with Looney and his sons in a trailer that she says
infested with bed bugs.
In a promotional video for tomorrow's interview, Vanzant asks Thomas
about her circumstances, and she responds that she's 'frustrated'.
'Frustrated?' Iyanla repeats.
'Not sad, not angry, not ashamed?'
'No,' Thomas responds.
'Not guilty that you've got
a man, two kids and a bedbug infestation in a trailer?' Iyanla continues.
We did an exercise with our kids to learn from Debi,
and we found traces at very early age. The
article was written when Debi was 21 years-old.
Lack of education was present then, and it was never addressed by a
loved one; it ended up destroying her when the support system failed:
THE
NIGHT WHEN IT ALL SLIPPED AWAY : A Year Ago, Debi Thomas Didn't Skate, or
Behave, Like a Champion
As the
first black skater to achieve international, or even national, prominence, she
was a champion, however reluctant, of minorities. Even though she said that she
wanted to be known as a skater, not as a black skater, she could not deny that
she felt responsibility as a role model.
She was a champion of the underprivileged,
which she did not mind so much because it allowed her mother to take some
credit. In figure skating, the underprivileged are all those whose parents earn
less than six figures each year. Thomas' mother, divorced when Debi was a small
child, earned considerably less than that as a computer programming analyst in
Sunnyvale, Calif. But she sacrificed whatever she had to assure that her daughter
could pursue her goals.
Then,
on the podium for the awards ceremony, she ignored the rules of sportsmanship,
failing to acknowledge Witt, the gold medalist, and Manley, the silver
medalist, even when they tried to congratulate her for winning the bronze
medal. Afterward, at a press conference, she did not take responsibility for
her failure to win, instead blaming her coach of 10 years.
It was a fall greater than any she had
ever taken on the ice, this fall from grace.
In the year since, Thomas, 21, has
developed a less than flattering reputation within the figure skating world.
People who have organized various shows in which she has performed, and those
who have publicized them, and even some of the other skaters, say that she is
demanding and temperamental, as if, they say, she expects to be treated as the
gold medalist that she never became.
In Mexico, the support system is very limited after
finishing High School. In the USA, one
is sheltered in College and even in a Residency by the system. Things changed after Residency, and a Surgeon
can hardly survived after 45 years of age without bouts of burning out. A Medical Doctor needs a net to survive after
a Residency to avoid burning out; one needs to be educated to create “nets.” The education at 18 years of age is very
limited, and far from teaching us how to create nets; all our athletes have
failed after that age. We work
countercurrent to teach how to create nets but most of the time we have failed
too.
We wrote about triathlon and running economy, but
there is a swimming economy. “Swimming
with the body” instead of swimming with your arms and legs; same thing for
running, we should maximize the use of gravity when running instead of running
with the legs. It is more economical;
and above all, it is economical when going fast. We need to be economical when going fast in
today’s world. It is the SWAT karma: “It
is not only well-done and precise but fast.”
Science is not a democracy, so there are ways to do
things that have more advantages than others.
There is a way of doing things well and efficiently. Furthermore,
technique can improve all the time as it is shown in the video below. The video claimed that there is an individual
technique for each individual. We should
know that swimming technique is just one and we can adapt it to individuals
depending on their circumstances and the individual’s capacity to learn. ¿Is a
Paralympic swimmer? Every individual can improve his/her technique, but it can
take years to see the difference. We can
see the following swimmer with the swimmer’s head lifted; he can improve by
looking at the bottom of the pool but it would change the entire stroke and
perhaps it is not worth it considering time, effort, and where he is
competitively at the present time. It is
very important to know Physics in order to start swimming, considering the body
position, drag (including kicking and pulling) or support, under Physics’ premises. Remember from previous post on running
economy, we have to know the variables playing a role swimming; we should not
accept that things could not be improved.
At the end, swimming can be interpreted with basic Newtonian Physics in
order to have full advantage of the vectors that works on the stroke and
resistance of the water.
After what it was said, let’s look at videos.
1) The number of strokes does not change with speed.
2) The speed of doing the stroke is the only thing that changes.
3) Open water swimming needs more concentration to perform as well as in the swimming pool.
4) In the Olympics finals, the number of strokes for the first eight swimmers. The number of strokes is the same less than 35 strokes per 50 meters for males when going more than 200 meters.
We discussed how research has been done and the confounding
variables that exist in the three previous posts. Let´s look at how
the Japanese try to do research on running in the following video. We can come up with valid data useful for our
triathletes:
1)Touching
the ground less than 0.16 of a second.
2)The
weight of the subject when touching the ground is less than 50% of the total
when touching the ground, meaning that the weight is dependent on the time
touching the ground. The Japanese runner
stays on the ground longer (0.22), so his weight is higher than 80% of the
total.
3)The
time on the ground limits the elasticity and the energy stored in the muscles
and tendons is wasted.
4)The
weight is a big factor in our performance.
It is easier to increase cadence in our practice than to trim a
triathlete when talking about running economy.
Practicing technique will direct the needed structure.
We have written on what it is confounding
variables; nonetheless we came up short.
An article written in www.medscape.org
helps to understand this subject better.
We just copied the introduction for you. Unfortunately, the running research is full of confounding variables due to the complexity of running.
How Do You Know Which
Health Care Effectiveness Research You Can Trust? A Guide to Study Design for
the Perplexed CME
Stephen B. Soumerai, ScD; Douglas Starr, MS; Sumit
Majumdar, MD, MPH, FRCPC
Editor’s Note: The purpose of this Editor’s Choice article is translational in
nature. It is intended to illustrate some of the most common examples of
potential study bias to help policy makers, journalists, trainees, and the
public understand the strengths and weaknesses of various types of healthcare
research and the kinds of study designs that are most trustworthy. It is
neither a comprehensive guide nor a standard research methods article. The
authors intend to add to these examples of bias in research designs in future
brief and easy-to-understand articles designed to show both the scientific
community and the broader population why caution is needed in understanding and
accepting the results of research that may have profound and long-lasting
effects on health policy and clinical practice.
Evidence is mounting that publication in a
peer-reviewed medical journal does not guarantee a study’s validity.[1]Many studies of healthcare
effectiveness do not show the cause-and-effect relationships that they claim.
They have faulty research designs. Mistaken conclusions later reported in the
news media can lead to wrong-headed policies and confusion among policy makers,
scientists, and the public. Unfortunately, little guidance exists to help
distinguish good study designs from bad ones, the central goal of this article.
There have been major reversals of study findings
in recent years. Consider the risks and benefits of postmenopausal hormone
replacement therapy (HRT). In the 1950s, epidemiological studies suggested
higher doses of HRT might cause harm, particularly cancer of the uterus.[2] In subsequent
decades, new studies emphasized the many possible benefits of HRT, particularly
its protective effects on heart disease — the leading killer of North American
women. The uncritical publicity surrounding these studies was so persuasive
that by the 1990s, about half the postmenopausal women in the United States
were taking HRT, and physicians were chastised for under-prescribing it. Yet in
2003, the largest randomized controlled trial (RCT) of HRT among postmenopausal
women found small increases in breast cancer and increased risks of heart
attacks and strokes, largely offsetting any benefits such as fracture
reduction.[3]
The reason these studies contradicted each other
had less to do with the effects of HRT than the difference in studydesigns,
particularly whether they included comparable control groups and data on
preintervention trends. In the HRT case, health-conscious women who chose to
take HRT for health benefits differed from those who did not — for reasons of
choice, affordability, or pre-existing good health.[4] Thus, although most
observational studies showed a “benefit” associated with taking HRT, findings
were undermined because the study groups were not comparable. These fundamental
nuances were not reported in the news media.
Another pattern in the evolution of science is that
early studies of new treatments tend to show the most dramatic, positive health
effects, and these effects diminish or disappear as more rigorous and larger
studies are conducted.[5]As these positive effects
decrease, harmful side effects emerge. Yet the exaggerated early studies, which
by design tend to inflate benefits and underestimate harms, have the most
influence.
Rigorous design is also essential for studying
health policies, which essentially are huge real-world experiments.[1]Such policies, which may
affect tens of millions of people, include insurance plans with very high
patient deductible costs or Medicare’s new economic penalties levied against
hospitals for “preventable” adverse events.[6] We know little about
the risks, costs, or benefits of such policies, particularly for the poor and
the sick. Indeed, the most credible literature syntheses conducted under the
auspices of the international Cochrane Collaboration commonly exclude from
evidence 50% to 75% of published studies because they do not meet basic
research design standards required to yield trustworthy conclusions (eg, lack
of evidence for policies that pay physicians to improve quality of medical
care).[7,8]
This article focuses on a fundamental question:
which types of healthcare studies are most trustworthy? That is, which study
designs are most immune to the many biases and alternative explanations that
may produce unreliable results?[9] The key question is
whether the health “effects” of interventions — such as drugs, technologies, or
health and safety programs — are different from what would have happened anyway
(ie, what happened to a control group). Our analysis is based on more than 75
years of proven research design principles in the social sciences that have
been largely ignored in the health sciences.[9] These simple
principles show what is likely to reduce biases and systematic errors. We will
describe weak and strong research designs that attempt to control for these
biases. Those examples, illustrated with simple graphics, will emphasize 3
overarching principles:
No study is perfect. Even the most rigorous research design can
be compromised by inaccurate measures and analysis, unrepresentative
populations, or even bad luck (“chance”). But we will show that most
problems of bias are caused by weak designs yielding exaggerated effects.
“You can’t fix by analysis what you
bungled by design”.[10] Research design
is too often neglected, and strenuous statistical machinations are then
needed to “adjust for” irreconcilable differences between study and
control groups. We will show that such differences are often more
responsible for any differences (effects) than is the health service or
policy of interest.
Publishing innovative but severely
biased studies can do more harm than good.
Sometimes researchers may publish overly definitive conclusions using
unreliable study designs, reasoning that it is better to have unreliable
data than no data at all and that the natural progression of science will
eventually sort things out. We do not agree. We will show how single,
flawed studies, combined with widespread news media attention and advocacy
by special interests, can lead to ineffective or unsafe policies.[1]
The case examples in this article describe how some
of the most common biases and study designs affect research on important health
policies and interventions, such as comparative effectiveness of various
medical treatments, cost-containment policies, and health information
technology.
The examples include visual illustrations of common
biases that compromise a study’s results, weak and strong design alternatives,
and the lasting effects of dramatic but flawed early studies. Generally,
systematic literature reviews provide more conservative and trustworthy
evidence than any single study, and conclusions of such reviews of the broad
evidence will also be used to supplement the results of a strongly designed
study. Finally, we illustrate the impacts of the studies on the news media,
medicine, and policy.
After the previous post, we looked into the
economy of running from the point of view of a researcher and not of a
coach. Researchers continue to struggle with the ECONOMY OF
RUNNING. Variables are many and they are not considered as variables most
of the time. We have problems to have models to study economy of running
because we are unable to see athletes; we just study theories instead of
looking at athletes or plain and simple technique models. Researchers
translate technique in a simpler way, when technique encompasses multiple
variables itself and it is impossible to break it down as it has been done by
researchers. It is like a word in a language that cannot be translated
because of its multiple meanings. Albert Einstein said it and
started looking at the phenomenon instead of playing with the theories:
Everything should be made
as simple as possible, but not simpler.
If, then, it is true that the axiomatic basis of theoretical physics
cannot be extracted from experience but must be freely invented, can we ever
hope to find the right way? I answer without hesitation that there is, in my
opinion, a right way, and that we are capable of finding it. I hold it true
that pure thought can grasp reality, as the ancients dreamed. (AlbertEinstein, 1954)
It should be explained in a simple way but not simpler,
as Albert Einstein said. We looked into
the cost of running, actually while running. There are good attempts to study running while running
which consider technique, and especially foot ground contact:
Elite North African runners have performed
outstandingly on the track at international athletic events. Despite the high
level of runners participating in this study, a possible limitation was that
they were 3-4 minutes slower than athletes of an Olympic standard. A question
arises whether the physiological and biomechanical responses of the pace in
North African runners implies that their outstanding performance on the track
at international athletic events appears not to be linked to running
efficiency. The differences in metabolic demand at increased velocity were
found to be associated with differing biomechanical running patterns.
The ground contact is faster in faster runners; the
winners. The authors need to study
champions for a comparison. The authors
found foot ground contact as the only difference for the best running economy
and this is very simple to understand.
We assume that the energy store in our muscles and tendons is the most
important variable to keep running.
Our success in
linking metabolic cost to whole-body mechanics suggests that this approach has
potential to further advance the understanding of the relationship between the
mechanical activity of the musculoskeletal system and the energetic cost of
movement in general. Finally, we conclude that metabolic rates during running
are determined by the time course of muscular activation and the volume of
muscle recruited to apply support forces against the ground.
Technique implies that the center of gravity is in
front of the subject, foot ground contact as short as possible, utilization of
energy to move us forward instead of using the energy to lift the body weight.
I leave you with a good presentation and a question:
¿Could you find the confounding variables?
Technique and physical structure are complementary and belong to
different languages. Practice technique
and the physical structure will come with time; many years later.
We received reports on VO2 at rest from our
athletes. The testing was done 16 hours
after the last regular practice. The
values were high, 404 ml/ min in one case, and 6.49 ml/kg/min in another
case. The first thing that came to my
mind was to call Volkswagen for an explanation on the machine now that we know
about the fraud with the software used to measure gases. Of course, I did not call, but I still think
that it could be related to the machine used to measure the VO2 at rest (red
flag). The athletes were training
regularly, they were growing up accordingly because they were adolescents. Their laboratory data was within normal
limits, and they did not have illnesses or problems living at home. Our second question after the machines
measuring the gases, it was whether this is a case of EPOC (post-exercise
oxygen consumption). We reviewed the
literature on EPOC.
The literature deals mainly with the effect and
control of EPOC peripherally instead of centrally:
The direction of this
research narrative on post-exercise recovery differs to the increasing emphasis
on the complex interaction between bothcentral and peripheral
factors regulating exercise intensityduringexercise performance.
Given the role of the central nervous system (CNS) in motor-unit recruitment
during exercise, it too may have an integral role in post-exercise recovery.
Indeed, this hypothesis is indirectly supported by an apparent disconnect in
time-course changes in physiological and biochemical markers resultant from
exercise and the ensuing recovery of exercise performance.
Is recovery driven by central or peripheral
factors? A role for the brain in recovery following intermittent-sprint
exercise
Table 4.10:
Resting values for respiratory variables (Mean ± SD) summarized by gender and
combined/total; male (n = 10), female (n = 4), total (n = 14).
Respiratory Variable
Gender Male Female Total
Resting tidal volume [L] .55±.14 .38±.11 .50±.15
Resting breathing frequency
[br/min] 21.64±4.40
20.78±2.94 21.39±3.94
Resting minute ventilation [L]
8.57±1.61 5.88±1.64 7.80±2.00
Resting volume of oxygen consumption
[L/min] .29±.07
.18±.07 .26±.08
Resting volume of carbon dioxide
produced [L/min] .25±.06
.15±.05 .22±.07
Resting respiratory exchange ratio
.86±.08 .84±.04 .86±.066
Rate of oxygen consumption (relative to body
weight) at rest [ml/kg/min]
5.30±1.10 3.84±1.41 4.89±1.33
The Kenyans’ values are more in accordance with our
athletes. Our athletes are younger but
the values are higher compared to the Kenyan’s values. Is the V02 of any value to measure training
level? Theoretically it could be a
marker but needs to be standardized, what we see in well trained athletes is
what counts and our findings are in that direction. Is our empirical research enough to say that
VO2 resting level is a good marker for quality of training? It is enough for us that deal with
performance.
Our findings are not related to EPOC but to a good
quality training. We are hoping to come
up with an answer from Volkswagen to see how good it is VO2 as a marker for
quality of training. But we can say that
taking into consideration our five athletes tested it is a good marker:
19-year-old male VO2: 404 6.21
ml/kg/min
18-year-old male VO2: 283 4.16
ml/kg/min
17-year-old male VO2:
387 5.73 ml/kg/min
15-year-old female VO2:
282 5.22 ml/kg/min
11-year-old female VO2: 237 6.49 ml/kg/min
Our athletes have learned the same technique, so the
VO2 is taken when they practice the same and use the same muscles. Performance in triathlon is according to
their resting VO2 shown above. The
11-year-old is unique for her age; she can train with the 14-year-old girls and
leads the swimming lane.
After the previous post, we looked into the economy of
running from the point of view of a researcher and not of a coach. Researchers continue to struggle with the
ECONOMY OF RUNNING. Variables are many
and they are not considered as variables most of the time. We have problems to have models to study
economy of running because we are unable to see athletes; we just study
theories instead of looking at athletes or plain and simple technique
models. Researchers translate technique in
a simpler way, when technique encompasses multiple variables itself and it is
impossible to break it down as it has been done by researchers. It is like a word in a language that cannot be
translated because of its multiple meanings.
Albert Einstein said it and
started looking at the phenomenon instead of playing with the theories:
Everything should be made as simple
as possible, but not simpler.
If, then, it is true that the axiomatic basis of theoretical physics
cannot be extracted from experience but must be freely invented, can we ever
hope to find the right way? I answer without hesitation that there is, in my
opinion, a right way, and that we are capable of finding it. I hold it true
that pure thought can grasp reality, as the ancients dreamed. (AlbertEinstein, 1954)
Many confoundable variables are present when doing
this kind of research and we end up with a laughable conclusion:
A spurious relationship is a perceived relationship between an independent variable and a
dependent variable that has been estimated incorrectly because the estimate
fails to account for a confounding factor. The incorrect estimation suffers from omitted-variable
bias.
As a human endeavor, scientists become politically
involved and we end up seeing the confounding errors as real variables.
Factors affecting the energy cost of level running at
submaximal speed
Jean‑René Lacour · Muriel Bourdin
Eur J Appl Physiol DOI
10.1007/s00421-015-3115-y
The superiority of black African runners is presumably
related to their leg architecture and better elastic energy storage and reuse…
The contrast between the large differences (about 20
%) in Cr between individuals and the small changes (7 % at the most) found in
response to training must be underlined; they plead in favor of a major role of
inherent factors. This
interpretation is, however, challenged by the large improvement in Cr reported
by the single long-term study of an outstanding female championship runner…
Among the factors accounting for differences in Cr
between individuals, calcaneal tuberosity length seems to be of major
importance, accounting for a very high percentage of running cost variance;
this, however, was only recently described (Scholz et al. 2008)
Let’s think as a smart coach looking at champions and
the competition we are dealing with.
Einstein would say: “I hold it true that pure thought can
grasp reality, as the ancients dreamed. (AlbertEinstein, 1954).”
Is the technique able to better
elastic energy storage and reuse… using the Newtonian concept of a “bouncing ball, with the
least vertical movement and maximum horizontal displacement,” as the article
written this year says? We do not need
to be from Africa, we need a technique according to our advantage. Please see our articles regarding running
technique in this blog.
