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.”
Gut Check
October 18, 2016
After nearly eight years on the staff of the National Federation of State High school Associations, I accepted the challenge of leading an effort by a private business to consolidate the insurance needs of high school athletic associations and to control their coverages and costs through a self-insuring pool. My assigned goal was to assemble at least half of the 50 states in this fund. The need was so great at that time for comprehensive general liability and directors and officers insurance tailored to the unique needs of state high school athletic associations, that the group was quickly assembled and launched.
My time leading this effort was brief. In spite of the program's immediate success and continued growth, I became uncomfortable. The discomfort was born and grew in the fact that while I was out meeting with states, decisions were being made back at the home office that I was not involved with or aware of. I began to feel used ... my credibility was bringing in business, but changes were being made without my input; and I feared for my reputation. After a year of this, I resigned the position. That was 1981.
Nine years later, the companies' CEO was terminated when it was discovered that he used the construction of a company headquarters office to build himself a new house at the same time, burying his home construction costs into the books of the companies' capital expenses. Seven years after that, the companies' founder and namesake went to jail for operating from 1984 until at least 1993 what was determined to have been a Ponzi-like scheme.
I listened to my gut which, long before my head, knew something was not right. In fact, my gut seemed on alert well before things went wrong. This has happened at other crossroads and dozens of less dramatic moments in my professional and personal lives.
In this time of increasingly complex and difficult decisions, both personal and professional, the gut may be a good guide for us all.