CodeBlueBlog

Serena Williams Wins Australian Open Despite Rib Dislocation!

Time Out --

I watch tennis for a lot of reasons. Recently, my rationale for this pastime has expanded as I am learning all about unusual and infrequently encountered medical problems that affect young superstar athletes in the peak of their athletic prime.

Like rib dysfunction.

If you are not a tennis spectator, then let me explain. During a match, a professional tennis player is allowed to call one injury time out, at which point a trainer trots out onto the court and addresses the "injury."

Here is the USTA rule on medical time outs (italics mine):

No extra time shall be given to allow a player to recover condition. However, a player suffering from a treatable medical condition may be allowed one medical time-out of three minutes for the treatment of that medical condition.

What is treatable and what is treatment? I'm sure they don't know, so why put that word in the rule?

And three minutes to treat? Are they kidding? What's the sense? The truth is, medical time outs almost always take longer than three minutes; for example, Serena Williams took a medical time out in the women's final at the Australian Open this weekend and actually took eight minutes, on and off court!

It is really remarkable how frequently these top superstar athletes are injured during important matches.  Of course, the injuries almost always come at a time when the injured player is losing (I guess that makes sense, right?).

Description of a New Medical Phenomenon

Even more remarkable is the way I have anecdotally observed that an injury time out represents a turning point in a match. I suppose, logically, that if the trainer is able to successfully "fix" or ameliorate the injury, then the superstar player returns to superstar status and is able to better compete.

Trouble is, I don't believe that. I have to laugh every time I see this little piece of gamesmanship in action. This weekend, in the Australian Open finals, I watched the "time out turnaround event" (TOTE) phenomenon occur twice.

Ribs? I Like Mine Barbecued

In the women's final, Serena Williams (a regular TOTE user) was playing against Lindsay Davenport, and losing badly during the first set. Unforced errors, two breaks of serve, and general malaise plagued Serena's game.

Suddenly, Serena began wincing and stretching on every point, reaching for her chest wall and scowling. Then she called an injury time out. The trainer attended to Serena's rib cage as Davenport cooled her heels, and her game.

When Serena came back out to play, the TOTE reared its magical head. Serena -- showing absolutely no further discomfiture -- steamrolled Davenport for the next two sets and walked away with the title. It was a classic TOTE phenomenon.

Serena would later say that she was suffering from "rib dysfunction" and that the trainer "popped it back in," thus the miraculous recovery. She said:

"I reached for a backhand and I think it tweaked my back out, one of my ribs out"

"I finally decided, ‘OK, why don’t you call for the trainer and see if she can put it back in place?’ She did, and everything worked out" 

Problem is that there is no such thing as rib dysfunction and ribs can neither pop out nor in. Evolutionarily, the ribs developed as a solid, unmoving apparatus designed to be a source of order, design, and stability, guarding the delicate Samba dance that goes on beneath their bony framework. If ribs were poppable, there would be dead tennis players littering the grand slam courts -- and no one would ever watch!

Sure, you can find the topic of rib dysfunction on the web, but predictably, it is an undocumented, unproven, unstudied diagnosis used by non medical personnel who make money by snowing patients with exaggerated physiological descriptions of human anatomy and teleological speculations designed to baffle uninformed consumers. Here's a good example.

By the way, FSU is looking to open a graduate school teaching rib dysfunction treatment along with dozens of other unproven therapies -- so maybe Serena is on to something?

Not a Sex Gene Related Phenomenon

TOTE is not exclusive to the women's circuit. Marat Safin showed that he CAN learn something as he slumped to the sideline at a critical point in the third set when he seemed to be orchestrating a typical big match Safin breakdown.

Tied at one set each, Safin and Lleyton Hewitt were at a critical juncture in the match. Playing brilliantly in the third set, saving break points and breaking Safin's serve for a 3-0 lead, Hewitt clearly had the match momentum moving his way. After the third game of the set, Safin slammed his racquet to the court and trudged to the sideline where he promptly...called a medical time out!

It was quite humorous to watch the trainer attend to Safin. The "treatment" consisted of rubbing Ben Gay into Safin's dorsal thighs over a drawn out, unctuous several minutes (more than three, seemed to me). It was even more humorous to hear Saffin explain that there may have been trouble with the blood circulating in his thighs...egad!

It is certain, to me, that the trainers understands exactly what is happening when these superstar athletes, in the prime of their athletic lives, calls these time outs. I'm sure that if the trainers were to poke around and quickly assure the players -- within the three minutes of time allowed -- that there was nothing serious amiss, said trainers would be quickly out of work and applying for adsmission at the FSU chiropractic college.

The TOTE worked again as Safin returned to the court and proceeded to mow down Lleyton Hewitt from then on -- to convincingly win the slam.

It seems a worthwhile sports science topic -- the TOTE. A study of the process might go a long way in understanding sports physiology and psychology, and may also help, eventually to refine the rule so that it isn't so commonly abused. If I were Davenport or Hewitt, I would be even more interested in elucidation of this phenomenon.

Are Canadian Health Care Consumers Morons?

  Updates From The Frozen North...

The vaunted and much admired Canadian health care system (you know, the one that provides low-cost pharmaceuticals -- subsidized by Americans -- to Americans) is much in the news lately.

Difficult Difficile

What happens, in the hospital, if you overuse antibiotics, don't wash your hands, have poorly funded infection control staff and lightly trained personnel? You get rampant Clostridium difficile infection running through your patient population.

For those of you who are new to microbiology, the Clostridium family of bacteria is one of the nastiest bunch of bugs in the whole infection universe. Members of the Clostridium family cause botulism and tetanus. C. difficile causes severe, hard-to-treat diarrhea which can be fatal for hospitalized patients, especially those with immune system problems.

This week the Canadian government fessed up (partly) about the C. difficile infections ravaging their hospitalized patients. In fact, in one province alone, in a three month period last year, the government is now acknowledging that there were 1,400 cases, and an unfigured amount of deaths that they admit were probably at least 100 -- but likely much higher.

Notice how they only report one province and a three month period. Let's see...multiply that by twelve months of the year and ALL Canadian provinces and you get ...  AN EPIDEMIC.

But Canada's health minister Phillippe Couillard isn't worried (thank God!) and actually says:

I would go myself to any of these hospitals with members of my family without any fear

He's a liar. He wouldn't expose himself or his family to one of those dirty hospitals, you can bet on that. He would ship his family off to Buffalo General or beyond. I certainly hope that there is a special place in the afterlife for health ministers who downplay ghastly epidemics for the sake of their political positions

But lying is effective, let's admit it. In this Yahoo news story about the horrible C. difficile epidemic, the opening line of the article is:

Quebec's hospitals are safe even though the province has reported that 1,406 people were infected by the potentially fatal C. difficile bacterium over three months late last year

Did the writer of this article choke on those words as he wrote them? How can a hospital be safe if when you go there you might get a NEW disease to add to the one you ALREADY have and the NEW disease can kill you? Safe? Do they think the Canadians are morons and would BELIEVE that?   

Maybe.

Night of The Living Moron

You won't hear an uproar in Canada. That's because when people are not responsible for their health care they become health care morons. You see, if someone else pays the bills then one doesn't comparison shop, and one doesn't compare results. One doesn't get educated. You stay stupid. That way, when the Couillards of the world tell you that getting deadly bacterial infections in the hospital is not a problem -- you just accept it. Thank you sir, may I have another?

I think, Phillippe, that you should be afraid. Be very afraid. Then again, I'm sure that politically important people in Canada actually get the best health care available -- that's how nationalized systems work. The important people get sterile bed pans, hoi polloi get ... C. difficile.

Terri Schiavo To Be Executed Because She is Not A Murderer

The Supreme Court has refused to review the case of Terri Schiavo. In essence, the justices are refusing to intercede in a case where a profoundly mentally challenged individual's death will be actuated by the state.

However, the same Court had no problem hearing and ruling on the case of a profoundly mentally challenged murderer, Daryl Atkins, whose death was to be actuated by the state. The Court decided that severely mentally deprived individuals could not receive the death penalty precisely because of their incapacitated mental state. THIS constitues cruel and unusual punishment, the justices ruled in June, 2002.

You see, apparently, the lives of severely mentally deprived individuals are only considered worth saving if they have murdered someone.

Poor Terri. Why couldn't she have at least killed one person? Then we could keep her alive. Then the Supreme Court justices might care about HER case and the cruel and unusual punishemnt to be meted out NOT by lethal injection or even electrocution...but by starvation and dehydration!

CSI: MEDBLOGS...AN ETHIOPIAN WOMAN DIES IN THE FORREST AND NO ONE HEARS

A Man, A Plan, A Plot: What Price Running Glory?

Kenya's world 5,000 meters champion Eliud Kipchoge is running around telling the world that he and other Kenyans have "plotted" out a "Master Plan" to defeat Ethiopia's multiple world cross country champion Kenenisa Bekele.

Said Kipchoge:

"We have a master plan to beat him. We have enough personnel and ammunition to execute the master plan and France will be his Waterloo"

The allusions to war and execution are not unintentional analogical trivialities. In case you didn't know, success at running means riches beyond dreams for the Kenyans and Ethiopians.  Although we, in the West, maintain simple illusions about these African runners based on our fanciful notions of their origins; reality is indeed different. These are world class athletes, involved in cut-throat competition...for money and fame. They spend half the year travelling the globe, have powerful agents and they are known to indulge in the trappings of success...like most everyone else:

At a cross-country meet in Eldoret this past November, four former Kenyan stars arrived in separate Mercedes-Benz sedans, all with curtained windows, each driven by a chauffeur. Two-time Boston Marathon champion Moses Tanui has built himself a mansion so large that acquaintances wonder if he sleeps in a different bedroom each night of the month.

What's it worth to African women? Well, Kenyan Catherine Ndereba set the marathon world record in Chicago in October of 2001, and on that single day she earned $75,000 for the victory, $100,000 for breaking the world record and a 2001 Volkswagen Jetta worth $26,125. She also received an appearance fee for simply participating, an undisclosed sum that is certainly six figures.

The average annual income in Kenya is $360.

The Death of Alem Techale

  The stakes could not have been higher this year, especially for the 18 year-old Ethiopian female middle distance runner, Alem Techale. Techale won young, scoring a surprising victory 18 months ago in the world youth 1500m title. Since then, Alem got a Dutch agent, a world famous boyfriend/fiancee (the aforementioned Ethiopian star Kenenisa Bekele) and the burden of early success , which a string of injuries had so far prevented her from repeating.

It is important to remember that we are not talking about innocent country natives jogging  barefoot through the forests of Africa, propelled by the glorious instincts of running. These are serious women with a serious purpose: Take advantage of their athletic talents to become successful.

Women runners from Africa have the same problems as women in other sports (and life) everywhere as this account of female Kenyan runners attests to:

Many Kenyan girls aren't prepared to stand up to overbearing agents, fend off sexual advances from male athletes and coaches, or protect their winnings from relatives who feel entitled to a share.

It's impossible to know how many promising careers have been derailed by such problems; the situation isn't discussed openly. It is clear, however, that many of Kenya's talented girls never advance beyond the junior level.

Given these revisions of common perception we need to again think over the situation of Alem's death:

On January 4th 2005, Techale was alone with fiancee Bekele -- on a training run in the hilly forrests outside Addis Ababa -- when she reportedly collapsed and died. She was quickly buried the next day without an autopsy. There was no significant investigation of her death and there have been no explanations for its occurrence, as I have written about in multiple previous posts.

The Headline Fallacy

Without a murmur, the world accepts the presumption that Alem Techale simply died a sudden death from a cardiac cause, despite the complete improbability of that event, as I have detailed previously.

This is a phenomenon of selective attention. When young athletes die it makes headline news, and a "cardiac" cause is almost always associated with the death. This notoriety taints recall and causes a statistical indifference which buffers the normal impulses of inquiry against the rarity of the occurrence. This is why no one even BLINKED when many media outlets reported that Techale had a 'heart attack", an idea which -- in the context of an 18 year old super athlete -- is patently absurd.

However, we must all remember, importantly, that all notions and studies of sudden cardiac death in athletes are formed after careful analysis of the data, including the post mortem exam. Therefore, without the data, as in this case, it would be criminal to assume sudden cardiac death.

Selective attention is alloyed into pig iron with antiquated preconceptions of these African athletes being beyond scandal or immune from the same temptations other athletes face. The perception of the Ethiopian runners as some manner of bumpkins, or free bucolic spirits running barefoot thorough the mountains and just 'doin what comes naturally creates preconceptions that deter serious evaluation of just what has happened here.

The fact is that there is no way this young woman should drop dead while running. And there is no way this mechanism of death should be accepted by the public without an autopsy and an investigation.

Bekele, In the Forest, With The Ice Pick

If we were asked to consider the alternative explanations for Alem Techale's death they would be listed as:

Death as a consequence of using performance enhancing drugs

Death as a consequence of other medications

Murder or accidental death by undetected trauma

In the United States, every detective worth his badge will tell you that if a girlfriend goes away alone with her boyfriend and he brings her back dead, the first ten people on the suspect list are the boyfriend. Yet Bekele goes unquestioned and his sketchy and sometimes contradictory recounting of the event (did he carry her to his car or go get his car...and what car are we talking about?) goes unchallenged.

What was Alem's relationship with Bekele? Were there items of contention between them? Were they still planning to get married? What exactly were their plans?  Was there any pressure on Alem to win?

Do we not want these questions answered?

Tonya Harding Couldn't Say It Better

  And what about competitors? We easily imagine Techale dying from an impossibly rare cardiac event, so can it be beyond our imagination to posit a competitor's sabotage? As quoted in the beginning of this article, the Kenyan runner, Eliud Kipchoge is intent enough on the stakes to publically declare his bellicose plans to overcome Kenenisa Bekele; and he followed that statement with this rather cold acknowledgement of the tragic demise of Bekele's betrothed:

"Even if I don't win the 12 kms title, we are working on a grand plan to tame Bekele. I am sorry for him and I condole with him after losing his fiancee only this week. But Kenyan athletes have decided that it is time the title returned home," he said.

Is it cold hearted? Or a message to the Ethiopians?

Alem Techale had a Dutch sports agent, Jos Hermans (see my post here), who also happens to be the agent for Kenenisa Bekele, as well as many other African runners. Hermens attended the funeral of Techale and consoled Bekele while at the same time offering contradictory stories to the press concerning Techale's death.

Couldn't Hermens shed some light on these issues?

Shouldn't he be more closely questioned?

Thicker Than Water?

Elite athletes have been toying with blood doping, and now it's biotech replacement, erythropoietin (EPO), for years. EPO was highly implicated in a rash of cycling deaths in young, otherwise healthy athletes and it is the performance-enhancing drug Lance Armstrong stands accused of abusing.

Erythropoietin is a drug that causes an increase in the density of red blood cells. Long distance athletes have been experimenting with EPO for years and multiple deaths in young athletes -- certainly many more deaths than by cardiac malformation -- have implicated EPO use to enhance performance as a causitive agent.

It is not unthinkable that Alem, who had tremendous success at an early age, and had so much at stake, would be spurred to experiment with EPO. She had been injured chronically over the past year, and with her career, fame, and pending marriage to a top runner all in the balance -- who knows whether or not she might use the drug?

Achilles and the Arrow

And what of Alem's injury? She was reported to be suffering from thigh and calf problems as well as chronic achilles tendon injury for which she sought treatment from a Dr. Hans-Wilhelm Mueller-Wohlfahrt. Dr. Wohlfahrt is renown for his association with several world-class athletes as well as his weird homeopathic remedies for musculoskeletal injuries.

Dr. Wolfgang touts an oral enzyme preparation containing many digestive enzymes as a kind of antiinflammatory agent.  Press reports also identify Wohlfahrt as administering bizarre injections containing extracts from turkeys and cows.

Did Wolgang give Alem any medications -- homeopathic or otherwise? Did she take them? Did she understand how to take them and how much of the preparations were necessary?

No Rest In Peace

There are many reasons why the death of Alem Techale should not be let to rest in this way. If we don't know how she died, we cannot learn from her death.

Other runners may die unnecessarily from causes that may be further elucidated here. Techale's own relatives could harbor defects that are amenable to repair should they be found to be genetic and inheritable.

Without an adequate investigation, and no data revealed, speculation becomes a valid form of inquiry. I would think that if for no other reason, Kenenisa Bekele and the rest of the Ethiopian runners would want the whole truth known.

Otherwise, speculation will now and forever be centered around Bekele, Wohlfarht, Hermens, and EPO. And the past can haunt, forever, as many public figures have discovered before, and will discover again.

Don't let Alem Techale's death go unexplained.

CSI: Medblogs.....Sports Agent Changes the Official Story of Alem Techale's Death

Spinning Alem Techale's Death

I've been waiting for someone involved in the death of Alem Techale  to catch on that THE BLOGOSPHERE IS WRITING about the implausible story of Alem's demise...

If you are unfamiliar with this story, see my posts here and here and here.

I've been waiting for the guilty shuffling of feet, the stuttering retreats, and garbled contradictions that begin, inevitably, before the illogical medical backtracking begins.

There is a faint shuffle coming from Nijmegen, Holland. Can you hear it?

Nijmegen is the home of Global Sports Communication -- a sports agency --owned by Jos Hermens. GSC represents Kenenisa Bekele and until two weeks ago represented Bekele's fiance, Alem Techale.

Bekele, by the way, is already a huge long-distance running superstar and many people think he has the stuff to become the greatest of all time. Bekele tells people he believes he will run faster in the future (is he prescient?)...

Gebrselassie, with two Olympic gold medals, four world championship wins and 17 world records, is widely considered the greatest distance runner ever, but the murmurings in the athletics community suggest Bekele may become even greater.

Bekele adds fuel to such talk when he says he can still take another two seconds off his 10,000m record.

This may come into play later...but for now, back to the spin...

Version #1: Death in The Chevy

Here is the first iteration of the story of Techale's death:

Tuesday, 1/4/05:

Alem Techale goes on a "routine training run," with Bekele, in "a forest in a hilly area on the outskirts of Addis Ababa."

Techale collapsed.

Bekele carried Techale to his car, but she died before they could get to a hospital.

Wednesday, 1/5/05:

Techale is buried without an autopsy.

It doesn't take anyone too long, after looking at this story, to ask why Alem Techale was buried the next day without a medical examination and autopsy. The first flimsy excuse was that this is not the way things are in Ethiopia -- autopsies are not well-accepted.

But Alem is attached to one of the biggest stars in track and field. And HIS agent was HER agent: Jos Hermens. Wasn't Jos sophisticated enough or smart enough to call up on the phone and say "Whoa--let's find out what the hell happened -- IT MIGHT BE IMPORTANT?

Maybe not.

The Agent Speaks

But Jos is talking, now, from Nijmegen:

" It is difficult to say if it was heart failure or somethingto do with the brain. The Ethiopian doctors who performed the autopsy could find nothing."

HOLD EVERYTHING!

Did he say AUTOPSY? But she didn't have an autopsy...right? I mean she was buried the next day and every source I have -- besides this quote -- says that she did NOT have an autopsy.

But why would Jos say this?

By the way, Jos Hermens FLEW to Ethiopia for the funeral. He was THERE when Alem Techale was buried, so I don't think he's confused. I don't think he's suffereing from jet lag either. So why did he say that?

And he didn't just SAY THAT as an isolated statement (that we or some reporter might be misconstruing)...no...he also tied it in with two diagnoses: heart failure and "something" to do with the brain.

I have news for you. This is no accidental slip of the tongue. And it does not make sense as the truth.

If the doctors HAD dome an autopsy we certainly would know that there was nothing wrong with the brain  (Hermens is trying to implicate a ruptured aneurysm) and we would also know if the heart were structurally normal, thus eliminhating several of the most common reasons for sudden death in athletes.

Was This Guy A Kerry Campaigner?

Jos isn't done, yet. He's also about to revise Bekele's story more as in:

At first we thought Alem had died on the way to hospital, but she actually died in the woods while Kenenisa was running to get his car. She passed away before he could get back to her. He took her to hospital but there was nothing he could do. To have your fiancée die in that way is a terrible thing.

Oh, I see. And does this make a difference? I mean the first story was that he picked her up and put her in his car and she died before they got to the hospital. Now Jos wants us to know that he left her -- collapsed in the dirt -- in the hilly forest and then ran to GET his car?

She "passed away" before he could get back to her.

I see.

Ethiopian Autos?

Can I ask the marathoning community something?

Where exactly do you keep your cars while you are marathoning?

Especially in the hilly outskirts of Addis Ababa? I mean are they always close by? Do they FOLLOW you? Are they CLOSE ENOUGH so that you can run and retrieve them in case someone is DYING?

And what kind of car does Mr. Bekele keep so close to his marathon course in the hilly forests of Ethiopia? A Bradley?

This is spin, CBB readers.

I don't know why Mr. Hermens is spinning junk, but I could make a lot of guesses...can't you?

STAY TUNED.............

CSI: MEDBLOGS...THE WORLD LOOKS THE OTHER WAY AS ALEM TECHALE IS BURIED AND FORGOTTEN

Call the Police?

Let's do some role playing. Pretend you are in Anywhere, U.S.A. The following circumstances need your attention:

A twenty two year old man and his 18 year-old fiance go out for a walk / run / car ride / boating jaunt.

Where they go, there are no other people.

When they return, the 18 year old girl is dead, in the front seat of the young man's car. His story is that the young woman just dropped to the ground and died. There are no witnesses. There is no history of disease or illness in the woman.

Multiple Choice?

You are (pick one):

                  1. The police chief

                  2. The medical examiner

                  3. The girls parents

                  4. The boyfriend

               5. Someone who gave the girl a drug that might have killed her

Given each of the above roles, choose what you would most want to see  happen next:

1. Police investigation and autopsy to determine the cause of death

2. A quick funeral and burial with NO further investigation, NO autopsy, and NO questions asked.

Scott Peterson Wishes He lived in Ethiopia

Welcome to the case of Alem Techale.

We are ignoring the circumstances of this young woman's death. Why? Because she was running when she died and everyone simply accepts the idea that she must have suffered sudden cardiac death -- even though the likelihood of this event in an eighteen year old female marathoner is vanishingly small.

And MOST importantly, sudden cardiac death is a diagnosis of exclusion.

That means that when everything else has been eliminated as a possible cause AND the autopsy shows no heart abnormality AND we have no further clues -- then and only then can we label the death a sudden cardiac death.

The case of Alem Techale fulfills NONE of these criteria.

It is much more likely that Alem Techale was struck by lightning. Or murdered. Or died because she was taking or using drugs or medication.

And if she DID die from sudden cardiac death then it is important to know if she had any cardiac malformations that her family needs to be aware of --because if it's a genetic condition they might die also!

Alem Techale needs to be exhumed, her final weeks of life need to be retraced, and everyone associated with her medical care and training need to be questioned thoroughly.

What's the matter with everyone? Why isn't the running community HOWLING about this?

CSI MEDBLOGS: YOUNG FEMALE MARATHONERS DON'T DROP DEAD...THE MYSTERY OF ALEM TECHALE'S DEATH

Part II of CSI MEDBLOGS:

DEAD RUN...HOW DID MARATHONER ALEM TECHALE DIE?

Part One is HERE.

All Ye Know On Earth and All Ye Need to Know

The world press is telling us that the elite 18 year-old female Ethiopian marathoner Alem Techale collapsed and died while training with her fiancee Kenenisa Bekele. 

What the world press is not telling us -- or maybe what they do not themselves know -- is that 18 year old female marathoners don't drop dead while running. Not ever. So why now? So why Techale?

The Odds? They Don't Exist

For every 1,000,000 female college-age athletes, only one will die suddenly while exercising, every year. One in a million.

To put this into perspective, there are thirteen WNBA teams with approximately ten women on each team. These thirteen teams would have to play for about seven thousand seven hundred years (or until the year 9705) before we might expect to see one player die from sudden cardiac death during exercise.

But the odds are even longer if we consider Alem Teleche's particular niche in the sports world: Female marathon runner, age 18. In the largest, most comprehensive study ever done on sudden death in marathoners*, 18 years of modern marathons were reviewed, and there were four exercise-related sudden deaths. Three of these deaths were MEN and three of the deaths were due to coronary artery disease (= "hardening" of the arteries) which is not relevant in an 18 year female. 

Although by such precedent, the odds of Alem Teleche dying from sudden cardiac death while running are ZERO, if forced to calculate the odds from the above data, her risk during any given marathon would be about 1/150,000, which means, if she ran a marathon every day (and never aged), it would be over 4 centuries before you would expect such a rare event to occur.

In my line of work, and in a policeman's line of work, a bizarre, nearly impossible explanation for unexpected death can mean only one thing: There's more to the story.

A Broken Heart?

I know what many of you are asking:  was Alem predisposed to sudden cardiac death by a congenital ( = present since birth) cardiac abnormality? The literature indicates that over 50% of exercise-related sudden deaths in athletes are associaterd with such abnormalities (mainly hypertrophic cardiomyopathy and coronary artery variants). And yes, we could then talk endlessly about the value of screening these athletes and testing them... but the presence or not of congenital abnormalities in Alem Techale is irrelevant.

Because?

18 year old female marathoners don't die from any cause. Not that we know of. Not in all the world literature. So how did Alem Techale die? And why did NO ONE demand an autopsy? And why did they bury her IMMEDIATELY? And why isn't anyone anywhere asking...

HOW DID THIS GIRL DIE?

Stay Tuned

*Another study of the entire world literature (that's all the marathons anyone has ever reported on) there were 36 cases of heart attack or sudden death in marathoners, but the mean age affected was 43.8 and 75% of these runners had "hardening" of the arteries --again, a disease Alem Teleche could not have.

CSI MEDBLOGS: DEAD RUN: HOW DID MARATHONER ALEM TECHALE DIE?

Because I do not Hope to Turn Again

18 year old Alem Techale was destined for marathon stardom. An elite Ethiopian long distance runner, the young woman had already won the world youth title in the 1500m. Training with the top group of Ethiopian marathoners, Alem was preparing for what everyone believed would be a spectacular career. Last week she went for a training run with her fiancee, 22 year old Kenenisa Bekele, the Olympic gold medal and world record holder in the 5,000m and 10,000m.

During that run through the hilly forests outside Addis Ababa, Alem Techale collapsed. According to syndicated reports, Bekele rushed to Techale and scooped her up in a desperate attempt to get her help. It is said that she died in his car.

Within days Alem Techale had been eulogized and buried -- without an autopsy. Some media sources say Alem had a "heart attack." Most simply expressed the grief and sorrow all are stricken with over the loss of such a young, promising life.

Guesswork Not Allowed: How Do Young Athletes Die?

An 18 year old super athlete dies suddenly and unexpectedly, then has a quick funeral and burial. No autopsy is performed ... and the press is asking no questions. Shouldn't we investigare this ? Shouldn't we explain this staggerring loss? Doesn't everyone want to know, as best as possible, what happened, so that perhaps we can prevent it next time? 

Is there more to this case, though, than just rounding up the usual suspects? Cardiac dysryhthmia...heart attack...is it just that or is there more?

There may be more. I can tell you this much: There is something wrong with this picture.

In the coming days

CSI MEDBLOGS

explores the death of Alem Techale

  &

HERE'S WHAT I AM THINKING:

• It is extremely unlikely that an 18 year old super athlete would just fall over dead -- Why did Alem collapse? How did she die?

• Alem was treated by a well-known German physician who is famous for using alternative therapies -- Is this important to the diagnosis? Was she on medications or using any treatments?

• Sudden death in young athletes was almost epidemic in the cycling community not long ago. It is strongly believed that this phenomenon is due to the use of EPO (erythropoeitin) -- the high-tech equivalent of blood doping --  Could Alem have been using EPO?

• East Africans have totally dominated long distance running for years in a way that seems statistically impossible -- Are they genetically suited to be marathoners or is there another explanation?

• Are Ethiopian and Kenyan marathoners folksy distance runners, honing their skills in the mountains of Africa -- Or are they actually just another subgroup of "globetrotting superstars" replete with PR and sports agents -- and all the dangers that come with that lifestyle

• Are our kids in danger as they participate in athletics; What preliminary tests should they have or not have -- What do you need to know? What are the warning signs? What are the danger signs? When should you act?

     CSI Medblogs...Stay Tuned

It isn't Pork in That Poke at FSU...It's a Pod

Infected Pork   Does anyone know how the plan for a state-sponsored chiropractic school got so far along without anyone knowing? How did we get to the point where, as FSUblius says today: ...for anyone who cares about FSU this is just the latest scene in a very sad chapter in FSU's history.  If FSU had a serious academic administration, the issue never would have been put in the hands of the faculty in the first place (isn't it a job of the university president to insulate the faculty from political criticism?), but this administration is so intertwined with state and local politics that it will not take on one or two key personalities in the state legislature. At first I just figured it as PORK. But it isn't. Not really. It isn't going to bring a lot of jobs or revenue to Tallahassee. It's going to COST money. So, if this is pork, it's got a tapeworm...no, pork is wrong. There is something greater, and more insidious going on here. Operation Overlord It's not pork, or a legislative favor...it's far different. It's a LANDING. On a beach. At a time of great vulnerability. It's a move by a well-positioned lobby group.... part of a long-range plan to institutionalize the illegitimate and unfounded practice of unnaturally bending people’s backs in an attempt to make them well. Those who have rammed this school down the taxpayers' throats are no fools...they KNOW Chiropractic medicine will NEVER find its legitimacy in double-blinded placebo guided trials published in respectable peer reviewed journals. That way is a medical and scientific impossibility. Yet thousands upon thousands of people make billions of dollars from this enterprise. It is too risky to continue into a future where documentation of efficacy may be demanded. So, if legitimacy is not to be had through the established empirical method, how then to keep the money train on the tracks? The propagators of this charade have already sued and leveraged their way into mainstream reimbursement streams. But that's not enough. They have to legitimize this charade via governmental fiat, and so become a de facto part of the government's future reimbursement strategies of Medicare, Medicaid and any national health care program that might come by way of a Clinton or a Kennedy. FSU is a beachhead. And it will be to FSU's shame. Because once established and given the Imprimatur of that University, the invaders can never be turned back. There will be more colleges built with more public funds ... and then the next phase of the battle plan will become evident.   Chiropractors will come "out of the closet" with their REALLY crazy stuff: Their manipulations of infant's cervical spines for allergies; their manipulations to treat headaches, and nausea, and diverticulitis...The whole homeopathic/alternative medicine monster that we have been toying with for twenty years will finally reach over and decapitate legitimate health care ...and who will eventually suffer? Invasion of the Body Snatchers Who will suffer when the government and HMO's smilingly opt for less expensive alternative remedies foisted on a public that remains ever ignorant about it's own health care choices? It's not pork the chiropractors are bringing to Tallahassee. They're bringing pods. Strange seedpods. The kind Dr. Miles Binnell found in the great 1956 classic film: Invasion of the Body Snatchers: Jack Belicec: Stop trying to rationalize everything, will ya? Let's face it, we have a mystery on our hands! Dr. Dan 'Danny' Kauffman: Sure you have. A real one! Whose body was it and where is it now? A completely normal mystery. Whatever it is, it's well within the bounds of human experience and I don't think you ought to make any more of it. Dr. Miles J. Binnell: Look, I wouldn't if I hadn't looked in Becky's cellar! How do you explain away the body I saw there? Dr. Dan 'Danny' Kauffman: I don't think you saw one there. Dr. Miles J. Binnell: You don't think I saw one here either? Dr. Dan 'Danny' Kauffman: I know you did because three others saw it too. Dr. Miles J. Binnell: But I dreamed up the second one? Dr. Dan 'Danny' Kauffman: Doctors can have hallucinations too. Dr. Miles J. Binnell: They're here already! You're next! You're next, You're next...

Grand Rounds Mad Today

Medical Grand Rounds is a weekly sampling of posts from the medical blogosphere and its friends.

Today, go to the Chronicles of a Medical Madhouse where the Madman has somehow been able to put together an astute compendium despite his maddening schedule.

A Call To Arms --

  ...   _ _ _    ...

  I've picked up a blogosphere SOS.

Yesterday I posted a piece about the planned chiropractic college at FSU. Little did I know that there is a widespread rumore throughout the science and medical Internet regarding this academic TRAVESTY unfolding in Florida.

Essentially, a chiropractic legislator has rammed a project to build a state sponsored chiropractic college through the Florida legislature . The academicians and physicians at FSU -- where this alien is supposed to land -- are up in arms.

Several important sites around the net are taking up the cause and I urge you all to visit  Chirobase, especially this article; The 2% Company; and, Rhosgobel: Radagast's Home has a synopsis.

FSUblius is a site almost totally dedicated to this topic. Pharyngula is at it, so is University Diaries and Confessions of a Quackbuster .

Chiropractery is one of those things society lets people do to one another because it is too much trouble to fend off anecdotes, lawyers, and venal congressmen... but everyone who is serious about science and medicine KNOWS it is just old fashioned BS ... a leftover of the snake oil days.

But we need to make a stand sometimes, and this is one of those times. We cannot let them INSTITUTIONALIZE this practice by allowing a state sponsored school of chiropractery to be built!

State Senator Jimmy King, who has been running the flying wedge through our legislative process with the chiropractic football had this to say:

``I don't think we should turn our back on people who want to become part of a profession that pays $90,000 a year.'' 

Well, Jim, strippers make more than that...should we open a school for ecdysiasts? How about hired killers and assassins -- they make a good wage. God knows we don't want to turn our backs on MONEY in Florida...it might DAMAGE our reputation!

Now Mr. King and certain legislative thugees are threatening bad things if the FSU professors are successful in blocking his little pet. Oh Boss Tweed be gone! Here's what FSUblius said:

Senator King denies that he is vindictive but has indicated (through the press) to faculty that the "Legislature will be angry" and that they should "evaluate with their department heads what kind of cuts there will have to be."  Here is classic quote:

"Would I be disappointed? Yes," King said. "Am I going to be vindictive? No."

He added: "I'm a Scorpio. I'm much more subtle than that."

I would ask all science and medical bloggers to join in a general, Internet-wide protest against the state-supported QUACKERY as is being proposed in FLORIDA -- the same state that recently lured the Scripp's Institute on the basis that Florida was  fecund  ground for the growth of legitimate scientific enterprises...

There is no reputable body of peer-reviewed literature to support cracking backs as a valid medical treatment. How then can we allow this to continue? And how then can we allow the state to use our tax dollars to build colleges to teach students to use this unvalidated undocumented unscientific treatment?? How??

This is a call to arms.

Torter Costs: Don't Forget, Snapping Turtles Hide Under Rocks

How They Get Us: A Continuing Series

A study released today shows that if you remove breasts because of breast cancer and replace them with inert implants, the implants do not raise a woman's long-term risk of dying from breast cancer or other causes

Please join in with a big, collective "DUH?!"

Why do we waste our time and resources on these studies? According to the Reuter's dispatch:

This is mainly due to the general concern that first arose in the 1980s that breast implants filled with silicone gel might raise a woman's risk of certain serious illnesses, including cancer and immune system-related diseases such as lupus and rheumatoid arthritis

  Okay, now I understand. Now that the torters have destroyed the companies that made silicone implants based on anecdotal stories and backed by NO research or proof, we need to waste MORE money by showing that implants are safe -- despite the fact that they were never shown to be harmful.

See how torters waste our money, time and resources? There are ways we haven't even counted yet.

Remember The Seminole! FSU Docs Take a Stand Against Kook Medicine

Go 'Noles

You may be used to seeing the Florida State Seminoles raking over opponents on the football field, but now you can watch their professors taking a stand against the metastasis of quackery threatening their institution.

In the past, Florida Universities were poorly regarded nationally, perhaps not without good reason. However, the last twenty years have seen the emergence of  powerful, burgeoning, and important academic forces in Tallahassee, Miami, and Gainesville.

So the physicians, professors and teachers at FSU -- reluctant to give back hard-won academic prestige  -- have rightfully taken a stand against the pork barrel establishment of -- of all things -- a state-sponsored Chiropractic school at FSU!  OMG!

From the Palm Beach Post via blog.bioethics.net:

A petition opposing the school has been signed by about 500 FSU faculty members. At least nine assistant professors have said they will resign if the legislatively prompted, and funded, chiropractic school is allowed to open.

How could such a thing come about? Political PORK. Backscratching, in the most foul backroom political way.

The Back Cracker Suite

  The theory that cracking the back could affect health was a teleological assumption by a nineteenth century self educated nonscientist who, lore has it, cured a deaf janitor by cracking his back. This autochthonous chiropractor ( who was using MAGNETS to treat patients before landing on their backs!)  "reckoned" that since the spine is important, and nerves come out of the spine, then "adjusting" vertebral bodies could affect health.  What are the chances one can come up with a valid medical discipline on the basis of a series of uneducated assumptions? ZERO.

The sound one hears when a joint is "cracked" represents the release of nitrogen, forced by distraction, from the vacuum of a joint space. There is NO proof whatsoever that any chiropractor has ever actually changed the alignment of anyone's spine; moreover, there is no proof whatsoever that even if one COULD "adjust" vertebral alignment, this would result in some salutary benefit.

It CAN hurt you, however, and there are many cases of vertebral artery damage and cerebellar infarction (a stroke) due to neck manipulation.

Why do people report that back cracking makes them feel better? First and foremost, most cases of acute backache are self-limited. Most people get better within one month, and 90% of people get better within three months. Whether the back is cracked or not, the ache goes away. So back crackers get credit for normal healing tendencies.

Second, THE PLACEBO EFFECT is powerful, statistically significant, and seems to be especially potent when surrounded by the pomp and circumstance that many back crackers put into their cracking rituals.

Just The Back Facts Jack!

So why the hell has the Florida legislature agreed to spend $9 million to start this project, with an estimated $35 million more to finish the building and then untold millions to run the school in years to come? It hurts to look at how this bill came about...because it reinforces the stereotypical view of Florida as a state run by backwater Huey Long-type politicians.

As Jann Bellamy, Talahassee lawyer wrote:

If there is a pressing need for more chiropractors (phone book listings suggest otherwise), that fact is not reported in the legislative analysis.

The driving force to get the school built is Senate Majority Leader Dennis Jones, R-Seminole, whose occupation is...Um...chiropractor.

Backing Senator Jones is Senate President Jim King, R-Jacksonville, and Speaker of the House Johnnie Byrd, R-Plant City, each of whom gets a research program named in honor of his parents in the same bill (CS/SB 2002). The legislation to do this badness ran quickly through committees and was brought to a vote within the first week of last year's legislative session.  It passed with only one vote against it.

One is tempted to call this legislation pork, or logrolling, but it is more. It's like some kind of personal favor for Dennis Jones specifically designed for his own aggrandizement. Ugh! Tammany Hall politics is about as close a concept as I can find to describe this sort of political foreplay.

Chiropractic Nation

The University administrators at FSU are supporting the plan to establish the chiropractic school. It will be the first such state-sponsored back-cracking institute in the country. This is not the sort of publicity we need in Florida -- a State that worked so hard to lure the Scripps Institute to it's shores. This decreases Florida's legitimacy. It denigrates the scientists and professors who have made this state our home and it propagates -- no institutionalizes-- quackery...is THAT what we want Florida science to be known for?

It's time we stood up to alternative voodoo medical treatments in this country. With health care dollars in severe shortage the last thing we need to do is stamp the Imprimatur of FSU and the State of Florida on a pseudoscience invented on a hunch and unvalidated by scientific evidence.

It's a disgrace.

Dr. Raymond Bellamy, an assistant professor at FSU  has scheduled a public forum on the issue on Jan. 13 in Tallahassee — the night before an FSU Board of Trustees is to meet about the issue. We need to throw our support behind him.

Jeb Bush -- get this tripe out of our system! What are you thinking!??

The War on Obesity: Report From an Embedded Journalist

Obesity Wars: Update from The Alternate Universe

The Long Haul

When the war on obesity  was first declared, most of us thought it would be a quick lightning-like strike, we'd obliterate the enemy and come home. But now it looks like we're in for a long, expensive fight. I guess we should have learned from the wars on poverty and drugs. These wars take time. Forever kind of time.

After all, the enemy is smart, strong, and pernicious. It makes money by poisoning our kids with fattening foods through advertising and clever recipes, designed to manipulate genetic tendencies and human foibles.

Goodbye Columbus

As we learned this past weekend in the The New York Times Sunday Magazine (subscription), according to the "thrifty-gene hypothesis" (no, it is not the locus for that inexplicable desire of some women to shop at Target), "situations" are "created" by our "chromosome combinations"  which can explain obesity in certain groups of Mexican-Americans:

the theory that some combinations of chromosomes create a situation in which cells are more inclined to store calories effi