I think it’s safe to say that the U.S. Preventive Services Task Force has opened an interesting can of worms recently at a rather inopportune moment. They have published what is, to my understanding, an evidence-based report on screening for breast cancer, including the use of mammograms. Emotional topic, without a doubt.
There have been some rather extreme responses as can often be expected when the discussion is driven by emotion. This discussion is taking place at a time when the current health care reform climate is volatile at best. People have already started proclaiming that “this is rationing of care – and exactly what health care reform is going to do”, “this will prevent women from getting the care they need”, and “hell yes, as a doctor I am still going to perform them regardless of what the study says”.
Let’s make sure that we understand the conclusions of the report. All suggestions are given a grade that reflects the level or degree of recommendation. Recommendations are just that – recommendations, not demands or rules.
The part that seems to have everyone outraged is this:
The current versions of health care reform being proposed and debated are really starting to make me wonder. We started off with “making the system better”, “outcomes”, “efficacy”, and “coverage for all”. Now we’re talking about something that is becoming increasingly far-removed from that. And it’s getting worse.
We’re now being told – in the latest iteration of legislation - that there will only be coverage for part of the population (current estimate: 93%). We’re being told that tort reform has to be a significant factor in health care reform – yet in states in which it has occurred, there have been no savings to the patient. We’re being told that the patient will be forced to buy health insurance – in a system that has not inherently changed. It’s like taking your beat-up 1972 Ford Pinto into the shop for a quick coat of spray paint, thinking that might get you a few extra years of driving – but never looking at the oil leak or the old tires. Or the product recall.
The debate now is about protecting the status quo – and has become misguided to say the least, and unethical to say the most. But fortunately, it should now become readily apparent that there is but one solution to health care reform debate.
It’s name? Legislative reform.
I am starting to think that our currently held beliefs on running and, specifically, running a marathon, are creating a new type of health risk.
The November 23 issue of the Austin American-Statesman has an article by Fit City writer Pamela LeBlanc entitled “Are slow runners ruining marathons?”. In it she refers to a recent article in the NY Times on the same topic. Here is the original NY Times quote:
“From 1980 to 2008, the number of marathon finishers in the United States increased to 425,000 from 143,000 … In 1980, the median finishing time for male runners in United States marathons was 3 hours 32 minutes 17 seconds, a pace of about eight minutes per mile. In 2008, the median finishing time was 4:16, a pace of 9:46. For women, that time in 1980 was 4:03:39. Last year, it was 4:43:32”.
She states that “making an effort to lead a healthy lifestyle is important, and having a goal like a marathon — whether you run it all or walk part of it — can help”. She then states that “proper training is crucial to prevent injury”.
And therein lies the quantum leap. I would totally agree with LeBlanc as she makes note of two critical issues – fostering active lifestyles, and doing so safely by preventing running injuries. But is it possible that the increased levels of participation – and the slower overall pace of the runners – combined with a high rate of running injuries, could actually be creating a greater health risk?
Principles define training. Principles can lead you to personal best performances, injury prevention, and health – if they are simply applied correctly.
Historically, running has a social and coaching culture that would have you believe that very diverse methods are required to train for different events. For example, most would assume that training for the 800 meters on the track would be in complete opposition to training for a 100 mile trail run. One is 200 times longer than the other. Currently-held beliefs would tell us that these events utilize different “energy systems”, that one event is anaerobic while the other is aerobic, that one event is for those with lots of fast twitch muscle fibers while the other is only for those with a predominance of slow twitch fibers, that perhaps a specific periodization or structure of training is required, or even more commonly, that perhaps a certain number of miles of training are necessary.
These traditional methods make some assumptions that, sadly, have not stood the test of time or science.
Much of the traditional thinking assumes that the cardiovascular system is the primary limiter of performance – and thus the primary aspect to address in training. But as we’ve built a body of knowledge in the sports sciences, this has been found to not be the case. The central nervous system and neuromuscular system are the primary limiters of performance, and thus issues such as power output should define the training plan. The greater the power output (at any given distance), the faster you go.
What does this mean from a practical application?
I have coached runners of all skill levels and paces, and through a wide variety of event distances. And the one common element that links events like the 800 meters and a 100 mile run is that the training principles are the same. Yes, the same.
Sure, this may have been in jest. But, consider for a moment what it says if it wasn’t in jest.
Tom and Ray Magliozzi write a column (and have written a book) called "Car Talk" which is syndicated nationally. They answer reader questions related to automotive issues and news, and also have a podcast. In a recent column, there was an interesting letter from a physician, the full text of which can be found here.
“You mentioned in a recent column that ethylene glycol (antifreeze) is toxic to animals. Is it also toxic to humans? I'm a doctor, and I prescribe a medicine for my patients that cleans out their colon called Go-Lytely (which makes a person do anything but go lightly). The main ingredient in Go-Lytely is polyethylene glycol, which sounds an awful lot like ethylene glycol, or antifreeze. So, when I prescribe Go-Lytely to prepare my patients for a colonoscopy, am I really prescribing antifreeze? If so, could I just tell my patients to down a gallon of Prestone and save themselves a trip to the pharmacy? – Dan
Let’s just say that I really, really hope, that this wasn’t an actual reader question.
The rules of sport are put into place for a reason. They are usually implemented for safety, or to decrease the liability of the event director and sanctioning body. They may be instituted to create a level playing field for all competitors. Rules are generally not made to be broken. And yes, rules ARE made to be enforced.
Perhaps this post should be entitled “An Open Letter to USA Triathlon” … or the World Triathlon Corporation, or to all of the triathletes out there that are doing events sanctioned by these bodies. Suffice it to say that in the races that I have either participated in or have viewed as a spectator, there have been plenty of instances of people “breaking the rules”. It’s not just the pros. And it’s not getting better with more and more participants in the sport – if anything, I think it’s getting worse.
The basic premise of triathlon is simple – complete the course under your own power, and without any external assistance. It’s the thrill of the competition, and the challenge that we face within ourselves. Sadly, this can get lost in the mix.
Yes, I know it may be hard to believe, but the World Health Organization’s report on health care systems rates the United States as number 37 – yes 37 – in the world. But those in the status quo want you to think otherwise, stating that we have “the best medical care in the world”. So who do you believe? And what really ARE the issues at stake?
Before we even get into the issue at hand, let’s take a light-hearted look at the issue by musician/actor/filmmaker Paul Hipp:
Humor can certainly bring light to the insanity of the situation. So now that we’ve taken a collective sigh of relief (and hopefully had a chuckle in the process), let’s now look at a couple of elemental issues in the health care reform debate.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.