Cardiac Screening
October 31, 2014
Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”
“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”
“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”
“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”
“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”
“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”
The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”
Limitations of Rules
November 15, 2013
Those who make rules ought to have knowledge of the limitations of rules, lest they overreach and over-regulate.
Dov Seidman writes in how: Why HOW We Do Anything Means Everything: “Rules fail because you cannot write a rule to contain every possible behavior in the vast spectrum of human conduct. There will always be gray areas, and therefore, given the right circumstances, opportunities, or outside pressures, some people might be motivated to circumvent them. When they do, our typical response is just to make more rules. Rules, then, become part of the problem.”
The NCAA is under constant criticism for its voluminous rule book which seems to pry into myriad of daily activities of athletes, coaches, boosters and others with so many rules it’s impossible for people to know them all. So university athletic departments must hire compliance officers to guide people – effectively absolving the people in the trenches from knowing the rules and committing to their adherence; and the NCAA office must hire investigations to sort through all the allegations of wrongdoing.
While much trimmer than the NCAA Manual, the MHSAA Handbook is much larger today than its original versions. Still, every year in December when the MHSAA staff conducts a series of meetings that kicks off a six-month process of reviewing theHandbook, there is a concerted effort to “make the rules better without making the rule book larger.”
We know that unless the rules address a specific problem and are written with clarity and enforced with certainty, rules do more harm than they do good. “This,” according to Seidman, “creates a downward spiral of rulemaking which causes lasting detriment to the trust we need to sustain society. With each successive failure of rules, our faith in the very ability of rules to govern human conduct decreases. Rules, the principal arm of the way we govern ourselves, lose their power, destroying our trust in both those who make them and the institutions they govern.”