In WADA-type science, lab procedures take second fiddle.

Dick_pound
World Anti-Doping Agency chairman, Dick Pound, sounded more vigilante than professional when he commented on the arbitration panel’s decision in the Floyd Landis case:

"You can run but can’t hide."

Pound suggested that lab procedures did not matter if they ultimately found a positive test.  I would like to know what planet this guy lives on!  Lab procedures exist to ensure an accurate and reliable test.  The crux of all tests and measures is that a scientist/clinician can only feel confident in their results if they were performed in the EXACT same manner in which those tests were developed and measured.

Perhaps finding testosterone is a reliable and accurate test.  Perhaps finding testosterone through an altered procedure is not so reliable or not so accurate.  The truth is, we would not be able to know because no one tests the reliability and accuracy of mistakes in procedures.Floydlandis1

Landis’ argument here is that his test could have produced a false-positive due to these "less than perfect" procedures, or more sinisterly, that the lack of control of his sample could have opened the opportunity for tampering.  I would not presume to know the truth, but from an outside perspective I cannot trust an agency which conducts scientific tests without regard to the rules.

How can WADA not hold itself to the same high standard that it holds athletes to?

In other news, WADA announced an increased budget for next year, in part due to the publicity the Landis case has created for the organization:

"The rate at which WADA stakeholders fulfill their financial responsibilities accelerates every year…" said Dick Pound about the increase.

Perhaps it is these "stakeholders" which cause Pound to actually criticize the World Golf Foundation’s plan to begin drug testing on all the major golf tours.  The reason:  they decided not to use Pound’s set of tests and measures.  Finally, and in perhaps the best news of all, Dick Pound is set to depart.

ERIC

Genetics and Our Society

ILLUSTRATION: JENNIFER E. FAIRMAN, MA
This morning I would like to point you towards a really fun feature to check out at the Johns Hopkins Public Health Magazine.  As you might be able to tell by this image, the topic is about genetics:  "The Genetic Journey: Following DNA from Cell to Society." 

Its good to read some generally informative stuff that you were not planning to.  At the end of the article, some well known experts offer their opinions on where genetics, health, and our society will travel in the near future.

As usual, here is an excerpt from the feature: 

Given such dizzying intricacy and innumerable moving parts, veteran
researcher Sharon Krag says, "You can sit back and say, ‘My God, I’m
here, and most days I’m normal.’ That’s a miracle in itself."

Some of my friends might bed to differ on that last comment.

ERIC

Does "Peer-Reviewed" make it True?

I wrote a post a couple days ago about epidemiology in which I quoted a line from a news article about wrong hypotheses.  The concept of wrong hypotheses seems to have previously gotten a leg of its own in the blogosphere.  Most notably, Alex Tabarrok at Marginal Revolution wrote a thorough post entitled, "Why Most Published Research Findings are False" mirroring the title on an article written by John P. A. Ioannidis in PLOS Medicine.

The WSJ has even gotten in on the mix commenting on Dr. Ioannidis’s article.  This is a nice editorial full of resources if you wish to read more on this topic.

Speaking of the WSJ, I was excited to hear that Mr. Murdoch is considering eliminating the payed subscription requirement for the online journal much like the New York Times recently did as well.  Hooray for free info!!!

Here is the diagram used by Tabarrok to explain the false findings argument:

Truehypo_3_2

Health 2.0, Google tech updates, and Universal Health Care

Copyright Scott Shreeve, MD

I’m interested to see how the first annual Health 2.0 Conference in San Fransisco taking place this week will pan out.  Part of the conference objectives is to define exactly what Health 2.0 is!  This conference is the real deal, with a sell out attendance and reps from Google Health speaking (even after the big shakeup there 2 weeks ago).  Click here for an overview and background of the Health 2.0 concept. Or here.  Or the Health 2.0 Wiki page.

In other Health 2.0 news, the New York Times had used the term in a title of a report on Hillary Clinton’s new health care proposal:  "Unveiling Health Care 2.0, Again".

Finally, you may want to go check out Google and their new presentation product, a competitor to Powerpoint named, Presently.  Also, if you are someone who is afraid of experimental tech products, you may be happy to know that Google Reader has officially broken up with Google Labs.

A PT Blogger at ESPN!

I stumbled across this new blog at ESPN this morning and was very thrilled.  Stephania Bell, MS, PT, OCS, CSCS, has a new fantasy blog hosted at ESPN where she provides injury analysis for all of the worrisome fantasy sport managers around the globe.  This is a big time blog presence for a physical therapist.

Bell_stephania_m

This is some solid PR for PTs!  This very excellent post on Greg Oden is just one example of the nice analysis Stephania is providing on ESPN.  But, perhaps Stephania has even more marketing savy than she lets on.  You see, when she posted that post about microfracture surgery, Google Hot Trends tells us that "microfracture surgery" was in the top 25 of all Google search queries.  So, we have poignant information, very large broadcasting platform, and good writing all in one.  Go Stephania!

The APTA has even gotten in the mix on this one and includes a link to the ESPN blog on their consumer page.  I do consider this a solid upgrade over conversations about backpacks.  As a fantasy football player, I appreciate the input and advice a therapist can bring to interpreting injuries.  For example, I understood that Eli Manning and his AC joint sprain would probably play, but why another player with a meniscus injury might not.  That type of information is gold to fantasy players and I can think of few others more qualified to offer it that a PT.
 

Examining Epidemiologic Research…

Spider_web

…or why you shouldn’t believe much of the health information coming to you from your local newscast.

The New York Times magazine has presented a wonderful article written by Gary Taubes, which describes the strengths, weaknesses and intricacies of epidemiological research studies.  It is lengthy, but contains more than its fair share of great quotes and good information.  It nicely concludes with some basic suggestions for how you or I, as individuals, should interpret what we hear from these type of investigations.

This is a great read for providing some good insight into complicated research in some nice, plain language.  The prescriber effect, healthy person effect, and the inability of observational cohort studies to conclude causality between variables are just a few of the topics discussed.  My favorite quote of the article: 

"There are, after all, an infinite number of wrong hypotheses for every
right one, and so the odds are always against any particular hypothesis
being true, no matter how obvious or vitally important it might seem."

Update:  The WSJ has checked in with another Hormone Replacement Therapy update at their blog this morning.  The title aptly mentions the words "clue" and "mystery."

ERIC

Welcome the new NPA Think Tank!

Welcome!

Thanks for joining me here at the new domain for NPA Think Tank.  I do apologize if your feed e-mails have been a little weird lately, the transfer process wasn’t as smooth as I would have hoped.  Anyway, here we are.  I had a lot of help from Jessica King designing my site, so if you like the page and want one of your own, a link to Jessica can be found in the right sidebar.  I should also point out, that Jessica is also quite the musician and can help you out if you’d like to hear some nice music from someone who can work wonders on an acoustic guitar!

Some Updates:

Since this post isn’t really about anything, I’ll continue in the same direction and provide some updates about me.  Most of my readers are probably well aware of my new job by now, but to update, I’m now on the faculty at Medical College of Georgia teaching in the Physical Therapy department of course.  I’ve been there for about a month so far and I’m really loving it!  I hope to be able to explore some new twists in the field of evidence and technology as I go, so stay tuned.  As far as upcoming content goes, I plan is to use my teaching content as a generator for posts thoughts.  For example, if I’m teaching about Power Training, I might try to write a post on the same subject.  That way, the MCG students at least will be able to find something else to think about and the rest of you can keep up with where my brain is. 

I’ve run on for long enough!  Make sure to re-subscribe to the new feed for this site if you did not subscribe to the Feedburner feed.  Not sure if you need to resubscribe?  Do it anyway…if you get two feeds, just delete the old one.

Thanks for Reading!
ERIC

Gotta love those ice packs!

Unless you’ve been living under a rock, pretty much everyone must be aware that Kevin Everett suffered a severe spinal cord injury this weekend in the Bills game.  At first, the prognosis was expectedly grim after an estimated impact force of 2/3 of a ton to Everett’s spine.  Now it seems a more positive outcome may be expected.

In listening to some of the interviews, a physician from the Miami Project made a statement that Everett benefited from the earliest application of moderate hypothermia after a spinal cord injury…ever.  That is rather profound.  From what I can gather as a very outside observer, doctors began lowering Everett’s body temperature in the ambulance and further reduced it once at the hospital by means of an IV catheter.

It is widely understood that cooling tissues reduces the damage cause by inflammation.  It is practiced in neurosurgery, with neonates, after sprained ankles, and now with spinal cord injuries.

This image demonstrates the reduction in neural tissue possible with hypothermia treatment.  The top two tissue samples were controls, and the bottom sample was cooled to 32 degrees C.  The highlighted parts of the image shows areas of tissue death.  Pretty amazing!

And, in a big example of "what comes around, goes around," it was reported that the Buffalo Bills owner is a large donor to the Miami Project.

One final note, the Miami Project doctor I cited earlier did upset me with the quote, "…will walk out of the hospital."  This is far from a foregone conclusion and seemed a bit overzealous and self-promoting to say that on ESPN.  Either way, I’m writing about him.

A sadly growning market


The US Census announced today (pg 26-28 of pdf) the latest numbers on income, poverty and health insurance for 2006.  For the 6th year in a row, the number of uninsured Americans rose.  For 2006, the number was 15.8% of all Americans or 47 million were uninsured.

While this is a somber fact, I would like to look at it another way:  a growing market.  Whoever figures out how to provide inexpensive health care to this population has a steadily growing market on their hands.  It could be good business.  Again, I refer you to retail health clinics.