For more information: www.ists2012.com

Official Announcement

Inaugural World Extreme Medicine Conference & EXPO

“Taking Medicine to the Extremes”

April 15^th-18^th 2012, The Royal Society of Medicine, London

This spring, The Royal Society of Medicine will host the inaugural World Extreme Medicine Conference & EXPO from Sunday 15^th – Wednesday 18^th April, aimed at attracting a range of attendees from across the medical profession.

The last decade has seen the care of global casualties significantly improve.  Often, this has been driven forward by conflict and war, the rise in natural disasters and the capacity to respond quickly on an international scale.

As a result, there has been a growing interest and recognition of remote and expedition medicine and this has triggered the opportunity for an extreme medicine conference, the first of its kind in the world, accredited by the Wilderness Medical Society.

The four day event will host some of the very best speakers from around the world including Dr Gordon Giesbrecht,  Dr Kobi Peleg and Professor Mike Grocott, leading figures in remote extreme medicine fields including expedition and wilderness, pre-hospital, disaster and relief medicine.

The specialist conference has been developed specifically with medical professionals in mind and welcomes medical specialists (doctors, nurses and paramedics) and ‘aspiring’ extreme medicine university students from across the World.

“This conference is a fantastic opportunity for medics to gain insight and knowledge from leading professionals in extreme medicine. A mix of lectures, Q&A’s and exhibitions will focus on a variety of scenarios including expedition and wilderness medicines, disaster relief, endurance events and security and safety in hostile environments.”

- Dr Amy Hughes, Medical Director, Expedition and Wilderness Medicine

Each day of the conference will focus on a different aspect of extreme medicine. The first day will see keynotes and panel discussions on expedition and wilderness medicine including subjects such as frostbite, hypothermia, altitude medicine, terrestrial & marine envenomation.

The following three days will explore many subjects such as medicine in different environments, pre-hospital medicine for major events, code of conduct in disaster relief, natural disasters, endurance events and security and safety in hostile environments.

The conference is a unique opportunity to share the insight and knowledge of the leaders in the field, explore the opportunities that this area of medicine could offer and obtain valuable CME credits.

For full details of the topics and lecturers: www.extrememedicineexpo.com

Related BJSM publications

G Wortley and AA Islas. Editorials: The problem with ultra-endurance athletes. Br J Sports Med 2011;45:1085.

A I Sutherland, D S Morris, C G Owen, A J Bron, and R C Roach. Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on Mount Everest: a longitudinal cohort study. Br J Sports Med 2008;42:183-188.

M Pain and J H Kerr. Case report: Extreme risk taker who wants to continue taking part in high risk sports after serious injury. Br J Sports Med. 2004;38:337-339

Guest blog by Jon Drezner, Sports Cardiology Senior Associate Editor

Photo by Andrew E. Larsen, Flickr cc

A Summit on Electrocardiogram (ECG) Interpretation in Athletes is being held in Seattle on February 13-14, 2012.  The meeting is sponsored by the American Medical Society for Sports Medicine (AMSSM) in partnership with the Pediatric & Congenital Electrophysiology Society (PACES), European Society of Cardiology Sports Cardiology Subsection, the British Journal of Sports Medicine, and the FIFA Medical Assessment and Research Center (F-MARC).  Seattle will host experts on ECG interpretation in athletes from the U.S., Italy, Sweden, U.K., Belgium, Switzerland, Qatar and Brazil.

Summit participants aim to:

1. Define ECG interpretation standards in athletes and;
2. Develop a comprehensive, freely-available online training module for physicians to gain a common foundation in ECG interpretation in athletes.

This educational resource will help physicians distinguish normal ECG variants in athletes from ECG patterns that suggest an underlying cardiac disorder.

This state of the art E-learning program will be hosted by BMJ Learning and will be accessible to any physician in the world with the aim of improving the cardiovascular care of athletes.

Participants include:

AMMSM:

Jonathan Drezner, MD  (Chair)

Jeff Anderson, MD

Chad Asplund, MD

John DiFiori, MD

Kim Harmon, MD

Stephen Paul, MD

ESC Sports Cardiology Section:

Mats Borjesson, MD

Domenico Corrado, MD, PhD

Hein Heidbuchel, MD

Antonio Pelliccia, MD

Sanjay Sharma, MD

PACES

Michael Ackerman, MD, PhD

Bryan Cannon, MD

Peter Fischbach, MD

Jack Salerno, MD

Other U.S. Cardiologists

Euan Ashley, MD

Aaron Baggish, MD

Vic Froelicher, MD

Joseph Marek, MD

David Owens, MD

Jordan Prutkin, MD

Victoria Vetter, MD

F-MARC (FIFA Medical Assessment and Research Centre)

Christian Schmied, MD

Qatar (Aspetar)

Mathew Wilson, PhD

Brazil

Ricardo Stein, MD, ScD

Related Publications:

• Drezner, J, Harmon, K, and Borjesson, M. 2011. Incidence of sudden cardiac death in athletes: where did the science go? BJSM, 45: 947-948.

• J A Drezner JA, Rogers KJ, and Horneff JG. 2010. Automated external defibrillator use at NCAA Division II and III universities. BJSM, Published online first: 16 November 2010.

• September 2009 BJSM – deals specifically with cardiac issues and the athlete

Podcast:

• Preventing sudden cardiac death with Jon Drezner

Blogs:

• Authoritative resource for sudden cardiac death – finally! Guest blog by Jon Drezner
• New Guidelines to Improve ECG/EKG Interpretation in Athletes – Guest Blog by Dr Babette Pluim
• Sports Cardiology by Dr Jon Drezner
• Debating Strategies to Reduce Sudden Cardiac Death in Athletes: Dr. Drezner Responds to Sports Cardiology Editorial

More information, and call for abstracts coming soon!

Contact: alex.scott@ubc.ca

The link to the ECOSEP home page is here

And the February 2012 issue of BJSM (next issue) is guest edited by ECOSEP’s Nikos Malliaropolous, Carl Askling and Nicola Maffulli – it focuses on Hamstring injuries!

Just a quick alert that Richard Budgett, the Chief Medical Office for the London Olympics, shares his very special insights.

He was an Olympic Gold medal winner in Los Angeles before serving the UK and now the world!

Click here for the podcast

And remember, the IOC, through its Medical Commission, supports the 4 of the 16 issues of British Journal of Sports Medicine (BJSM) annually. See recent editorial about Youth Olympic Games here. The BJSM is the leading clinical source of sports and exercise medicine.

Guest blog by Adam Weir

The 7^th Annual Scientific Congress of The Netherlands Association of Sports Medicine recently took place on December 1^st – 2^nd,, 2011. This congress was held for the first time at the Efteling, the largest attraction park in Holland. The atmosphere was great; the fairy tale surroundings gave the congress a new twist.

You can hear more about the congress and sports medicine in the Netherlands listening to this podcast with Hans Tol and myself.  You can also read more about it in the Editorial, by Tol and Visser in the October issue of BJSM.

The opening keynote lecture was from Prof Meeusen, from the Free University in Brussel, who spoke about the facts and fiction surrounding overtraining. He demonstrated the large number of misconceptions surrounding this topic, and gave us a lot to think about. More blood tests are not always the solution.

The closing keynote of the first day was presented by Prof Sundgot-Borgen from Norway, who spoke about eating disorders in young athletes. She gave a great overview of the topic and highlighted the projects they are working on in Norway. She gave useful advice about how to make it acceptable to speak about eating disorders and changing the culture surrounding sports. As many as 45% of athletes in some aesthetic sports have disordered eating and she warned against measuring fat percentage in those under 18 years of age.

My colleague Maarten Moen and I dressed up to chair our session on prevention issues in adults. There is now broad consensus as to the benefits of exercise; however, identifying and removing obstacles remains a big challenge. Some exciting local initiatives were discussed.

In the evening there was a social programme with dinner, music and dancing and then a night in the famous Efteling hotel. Dr van den Hoogenband, the Dutch chief medical officer for London 2012, presented the key note lecture in the morning of the second day on the future of elite sports medicine in the Netherlands. The current vision is to reduce the number of top sports medical centres to four regional locations to centralise care. This stirred up an animated debate, and I am sure we will hear more about this.

After two more parallel sessions the congress closed until next year. Let us hope that this new location is the start of a new era – and that we will all live longer, and more happily ever after!

*************************************

Adam Weir is a sports medicine physician who works at the Hague Medical Centre (MCH) department of sports medicine and the sports medicine advice centre (SMA) in Haarlem. He is interested in research in sports medicine and has a PhD on the field of athletic groin injuries. Current projects that he is involved in are RCT’s on stem cells in Achilles tendinopathy, PRP for acute hamstrings ruptures, physical training for type 2 diabetics with complications, ESWT for patella tendinopathy and risk factors for groin injury.

On Monday the Guardian published It’s not obesity that’s killing us – it’s the lack of exercise. Inspired by research presented at UKSEM (see also Blair Physical inactivity: the biggest public health problem of the 21st century, and BJSM Warmup 2011; 45), the Guardian exhorted us to focus less on obesity and more on physical activity. With 191 comments, 1000 Facebook likes, and 71 tweets (in 48 hours) it doesn’t take a social media expert to figure that this topic is hot.

A critical question is whether exercise is THE primary tool for weight loss (rather than just as part of a healthy lifestyle).

Does exercise promote weight loss?

King, Horner et. al’s have a great article – Exercise, appetite and weight management…in BJSM Online first.

Professor Timothy Noakes (and @GaryTaubes) add these insights to the discussion in this guest blog:

Photo courtesy of Gavin Clarke, Flickr cc

What astonishes me is the continuing failure of so many people, my medical colleagues included, to realize that the solution to personal obesity is so simple. The cause for most people is exactly as Gary Taubes described it – a diet too low in fat and protein and too high in carbohydrate especially sugar. If you are over forty, overweight, personally motivated, and not eating a high fat/high protein/low carbohydrate diet, then you are missing out – your life is passing you by.

The second key is also as Taubes describes it – obesity begets inactivity whereas leanness promotes activity. Trying to get lean by exercising whilst continuing to eat the “healthy” high carbohydrate diet will be unhelpful for most with an elevated BMI (and who are are therefore by definition, carbohydrate intolerant/resistant). You need first to lose the weight by changing to a high fat/high protein/low carbohydrate diet. As the weight falls of (as it does very dramatically at rates that most will not believe), the desire to exercise becomes increasingly overwhelming. In time the desire to exercise becomes addictive.

Trying to encourage overweight people to exercise without first changing their habitual eating patterns (not diet, please note) will never produce the same outcome as will one in which the initial focus is on changing to a high fat/high protein/low carbohydrate diet.

As Gary Taubes describes, this has been known since 1861 but was written out of the medical and popular literature after 1970 when Dr Ancel Keys essentially single handedly developed the global fear of fatty foods that mislead the world and led directly to the epidemic of obesity and diabetes that began to engulf especially people in the developed world especially after about 1977.

Until we rid ourselves of the ridiculous idea that carbohydrate foods are somehow “healthy” (for all) and fatty foods are unhealthy, and as long as we allow our eating patterns to be dictated by industries that aim remorselessly to increase global consumption of sugar and refined carbohydrates, then we cannot solve the global problem of obesity and diabetes.

But at an individual level we can take control by realizing that obesity is a genetic/nutritional disorder caused by excessive carbohydrate consumption in those who are carbohydrate-resistant (and who are therefore unable to metabolize carbohydrates especially fructose, appropriately but who will store the excess calories in fat, rather than expend them in physical endeavor).

Dr. Timothy Noakes is a Sports Physician, Exercise Physiologist and Discovery Health Professor of Exercise and Sports Science at the University of Cape Town and Sports Science Institute of South Africa.

UKsem was the first conference to have a ‘Moneyball’ panel session; attendees voted with their feet that this should happen again. What’s ‘Moneyball’? The unabridged term refers to Michael Lewis’ book of that name. It’s about a baseball team who performed much better than they should have by recruiting cheap players who didn’t have the ‘look’ of top draft picks but whose statistics were impeachable. The implication is that an astute statistician may help to recruit this type of player whereas a ‘sport expert’ might be fooled by intangibles – the style, the charisma, pedigree – but in the end things that don’t predict success as well as the carefully analyzed data. The concept was in the news in Australia just today.

In the sports medicine setting, Dr John Orchard raised raised the concept in 2009. He’d read the book (didn’t wait for the Brad Pitt movie) and figured that team physios and team sports physicians could augment team performance. This appreciation, literally valuing of the sports medicine / fitness team would lead to great salaries for those individuals. At the conference Moneyball session, Liverpool Football Club’s Peter Brukner estimated that many soccer/football clubs in the English Premier League have annual player salaries over 100 million GBP but pay less than 0.5% of that for ‘maintenance’ – the sports medicine team. Seems crazy and I suspect that in Formula 1 the investment in the ‘asset’ would be much higher.

Security sit - ready for action - at Liverpool vs. Chelsea, November 20, 2011

Also in the UKsem session was power lawyer Mary O’Rourke, QC, who is clearly a pre-eminent sports lawyer in the UK. She emphasized the risk that sports physicians are at when taking care of players who might be earning over 100,000 GPB per week. Is your personal liability insurance in place for the 40 million GPB or so you might be sued for?  I didn’t realize that as Dick Steadman operates in Colorado, the legislation in that stats caps any medicolegal claim at $10 million. In the UK, there is no cap. Food for thought for both players, and physicians. Lots of players have value greater than $10 million.

There was also an introduction to the idea of clincians using agents to help them get better deals in this new world. Clinicians valued more = larger contracts = need for help with negotiation and for digging out the good gigs. Makes sense.

A great idea for future conferences in the UK and beyond. I can see it traveling very well at AMSSM in Atlanta 2012, the VSG (Netherlands), Australia, Switzerland, South Africa, and among the ECOSEP member countries.

For a detailed movie review and background to Moneyball click here please.

And on the subject of Liverpool Football Club, it seems like Brad Pitt is a fan!