risk

Armstrong and Hesch: A tale of two athletes

Last week, shockwaves went through the sporting media as Nike officially cut ties with Lance Armstrong and Armstrong stood down as chairman of his Livestrong charity in the light of a massive swathe of damning evidence released by USADA, the USA’s anti-doping agency. Lost in the waves were the ripples of another doping story: little-known US runner Christian Hesch admitted to two years of EPO (erythropoietin; hormone controlling red blood cell production) use. Little needs to be said about the achievements of Armstrong, the most celebrated cyclist in modern sporting history. A ‘road warrior’, Hesch is a member of a sub-elite class of athletes who earn their living travelling from road race (running) to road race picking up small winnings, sometimes with a little travel/equipment support from racing teams. With a 3:58 mile best, he has never and will never make the Olympics; he is unknown outside of the USA’s running community where he made himself visible with flamboyant racing outfits and finish-line stunts.

In 2010, Hesch was hit by a car, picking up minor injuries and putting him ‘out of business’ for 5 months. With no workman’s comp, he turned to EPO to speed his return to racing fitness. While Armstrong was retiring from competitive cycling, Hesch was making trips down to Tijuana, Mexico, and smuggling EPO vials back into the USA, stuffed into his pockets. Armstrong was part of what USADA has referred to as “the most sophisticated, professionalised and successful doping programme that the sport has ever seen”; Hesch was architect of his own doping programme, injecting himself 54 times over the course of two years. He was rarely tested; eventually team-mates from Nike Team Run LA found evidence of drug use in his possession and presented him with an own-up-or-we’ll-tell ultimatum. They contacted USADA on September 6th and Hesch promptly confessed. While breaking the news himself on popular running forum http://www.letsrun.com, he posted “I want to make it clear that I don’t blame anyone for any & all feelings against me, it’s my bed that I’ve made and I will sleep in it… hopefully, someday I can earn your respect back.”

When it comes to the very top level endurance sport athletes, where the bar is set in terms of legal vs. illegal enhancements appears largely irrelevant. The current legal list currently includes altitude tents for the ‘natural’ EPO effect, high doses of caffeine, medication to correct previously undiagnosed asthmatic and thyroid conditions and a lot more. The USADA evidence suggests that in many cases where illegal doping is happening in combination with these legal supplements, it is being very closely monitored by medical teams. The argument for saying “make everything legal and be damned with it” is clear.

Is the same true for athletes coming through, and athletes on the cusp of the professional ranks? Is a scenario where, to compete with the pros or even be noticed it is a requirement to be on EPO and HGH, in the best interests of athletes; especially young athletes? Become a top athlete and you have a medical team to monitor you; until then, the choice may end up being between Tijuana, a syringe and a bathroom stall, or being an also-ran. Consider also the implications for athletes in developing nations like Kenya (where reports of more widespread doping are starting to appear); drugs with significant risks attached like EPO can be fairly cheap and easy to procure, medical supervision can be less so.

Given that we cannot protect all athletes with medical monitoring, is it better to protect them with a culture in which use of these drugs is wrong,  and with the knowledge that even the mightiest and best-protected of cheaters can fall?

Why strongly encouraging or legally enforcing bike helmets is not necesserily a good idea

In Australia and New Zealand wearing bike helmets is compulsory. In the United States, bike helmets are strongly promoted. The message in these countries is clear – not wearing a bike helmet is stupid because it can significantly damage your health. The stigma attached to cycling without a helmet may even be comparable to that attached to smoking cigarettes.

If you crash but were wearing a helmet (properly!), you will be less likely to suffer a head injury. Bike helmets may thus prevent disability and even death in this way. I don’t want to question that. (Though it has been questioned -it has been said that bike helmets give both cyclists and drivers a false feeling of protection resulting in more risk-taking behaviour on both sides; given that most helmets are not worn properly, this could overall be more dangerous than not wearing helmets.)

But, is the fact that bike helmets may reduce head injuries a sufficiently weighty reason to strongly encourage or legally enforce wearing bike helmets?

Perhaps I’m biased. I’m from Belgium – a cycling-friendly country where hardly anyone wears helmets. Why? It’s uncool, it messes up your hair, it’s safe enough to bike here (just reciting reasons people give), it’s impractical, it’s uncomfortable, it’s annoying to have to carry your helmet around when you get to your destination, it spoils the ‘freedom-feeling’ on a bike, etc. No doubt, there are costs to wearing a helmet.

So why should cyclists be required or strongly encouraged to wear helmets? Surely there are many other activities where the risk of head injuries is high? For example, playing in a children’s playground is equally, if not more, dangerous in that respect (other examples are hiking, walking or running at swimming pools, and simply getting into your bath). Is there something special about head injuries that result from bike crashes? Surely we wouldn’t argue for strongly encouraging or making ‘playground helmets’ compulsory (or ‘bath helmets’ – imagine that!). It would be terribly impractical, and uncomfortable for children. It would somehow restrain them in their freedom – it would just make playing on a playground less fun. But the best reason for why we don’t make playground helmets compulsory is that there are alternative ways for reducing the risk of head injuries at playgrounds that have fewer disadvantages. One measure that has increasingly been implemented in various countries is to provide playgrounds with a softer ground. This too helps to prevent head injuries, but without any of the disadvantages playground helmets would have.

So why don’t we do the same for bikes? Obviously, there is an alternative to wearing bike helmets too. We can change the environment and make cities safer for bikes such that fewer crashes will happen. It’s not that biking is intrinsically very dangerous. My daily bike ride to work,  at a moderate pace on safe bike paths away from the road is probably not more dangerous than walking on the footpath. (Of course, I’m not implying that it would be unwise to wear a helmet when racing or when going off the road on rocky ground.)

Perhaps one could say that, in bike-friendly cities, cyclists shouldn’t be enforced or strongly encouraged to wear helmets. It’s relatively safe to bike there – like it’s relatively safe to play on a playground with a soft ground. The overall health benefits of biking (better health for the cyclist and less air pollution) outweigh the risk of head injuries. But, one may say, people should surely be legally enforced or strongly encouraged to wear helmets in cities that are currently very bike-unfriendly (like Oxford).

However, I think this is too quick. It may take away incentives to make cities more bike-friendly. It sends the message that it is cyclists that need to adapt, not drivers. We should, however, keep in mind that there is an alternative to enforcing or strongly encouraging bike helmets: it’s making cities bike-friendlier. This may be costly, but it should be seen as a public health and environmental measure. We should  not forget that discouraging people from cycling (by requiring them to wear a helmet) also has significant costs.

 

 

 

 

What is the chance of an MP being wrong?

When MPs took a maths exam it showed that the members of parliament are pretty bad at elementary probability. When asked “if you spin a coin twice, what is the probability of getting two heads?” 47% of conservatives and 77% of the Labour MPs gave the wrong answer. About 75% of the MPs felt confident when dealing with numbers, although they generally though politicians did not use official statistics and figures correctly when talking policy.

How should a rational person react to this news?

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A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

By Brian D. Earp 

* Note: this article has been re-posted at various other sites, sometimes with minor edits. This is the original and should be referred to in case of any discrepancies.

 

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

1. Experimental doubts 

A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled trials (RCTs) conducted in Africa between 2005 and 2007.

These studies have generated a lot of media attention. In part this is because they claim to show that circumcision reduces HIV transmission by about 60%, a figure that (interpreted out of context) is ripe for misunderstanding, as we’ll see. Nevertheless, as one editorial [2] concluded: “The proven efficacy of MC [male circumcision] and its high cost-effectiveness in the face of a persistent heterosexual HIV epidemic argues overwhelmingly for its immediate and rapid adoption.”

Well, hold your horses. The “randomized controlled trials” upon which these recommendations are based are not without their flaws. Their data have been harnessed to support public health recommendations on a massive scale whose implementation, it has been argued, may have the opposite of the claimed effect, with fatal consequences. As Gregory Boyle and George Hill explain in their extensive analysis of the RCTs:

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World funds: implement free mitigations

The future is uncertain and far. That means, not only do we not know what will happen, but we don’t reason about it as if it were real: stories about the far future are morality tales, warnings or aspirations, not plausible theories about something that is going to actually happen.

Some of the best reasoning about the future assumes a specific model, and then goes on to explore the ramifications and consequences of that assumption. Assuming that property rights will be strictly respected in the future can lead to worrying consequences if artificial intelligence (AI) or uploads (AIs modelled on real human brains) are possible. These scenarios lead to stupidly huge economic growth combined with simultaneous obsolescence of humans as workers – unbelievable wealth for (some of) the investing class and penury for the rest.

This may sound implausible, but the interesting thing about it is that there are free mitigation strategies that could be implemented right now. Continue reading

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