Response to "An Unknown Soldier"

The front page story of the Saturday Globe and Mail was about Pte. Mark Graham who died in Afghanistan in a friendly fire incident. At first, I was a bit troubled that the Globe would open up a dead soldier's history like that - especially since there weren't a lot of good things to write about. However, I figured people on the Track Canada mailing list might have something to say about it and of course one of the first people to write in was my good friend Zeba Crook, a former national champion in the steeplechase. Here is what he wrote:

There is a very moving and disturbing article on Mark Graham on the front page of the Focus section in today's Globe and Mail. It goes a long way to anwsering the biggest question I had when I had heard he died: what the hell was an Oylmpian even doing in the army?

I am definitely not among those readers who think this story was disrespectful. I am deeply troubled by the claim that to criticise the war shows a lack of support for the troops, as if healthy democratic debate about issues as important as, say, international war, should cease in times of war.

So many people romanticise dying for one's country, as if doing so should protect you from any poor decisions you may have made in your life. It might be a good time for readers to return to Wilfred Owen's well known poem written in 1918. It ends

"My friend, you would not tell with such high zest To children ardent for some desperate glory, The old Lie; Dulce et Decorum est Pro patria mori."

The latin is a citation from the Horace: "How sweet and right it is to die for one's country." It is a fact that the children of society's wealthy and elite tend not to join armies; the overwhelming number of soldiers are poor with little future. Horace was an elite: his children never died for the Roman Empire. This is not a criticism of the Canadian Forces, as one Globe reader thinks, but a criticism of elite leaders who decide to send other people's children off to a war they would never send their own children off to.

What troubled me most about the news of Mark's death was trying to figure out why someone that accomplished would join the army, since it is a undeniably uncommon choice. In my opinion, Olympians have futures, they have all the potential in the world. Once you have competed in the Olympics, you have proven yourself capable of anything; the Olympics rescue us from lives of poverty. Perhaps I am glorifying the power of the Olympics. I never made the Olympics; it was sport in general that rescued me from a life of poverty and dead end jobs in small-town British Columbia. The article answered that question, and THAT is the point of the article. It's not an insensitive left wing attempt to smear the reputation of a glorious fallen soldier; it's certainly not because he was black; it's an attempt to understand why a man with what appeared to be Olympian sized potential joined the armed forces.

Zeb

2006 Chicago Marathon finish

Songs U2 wish they had written

From Q Magazine

The Edge: Wonderwall by Oasis

Larry Mullen: Block Rockin' Beats by the Chemical Brothers

Adam Clayton: Back to Life by Soul II Soul

Bono (couldn't decide on just one so he picked 7)
- Brownsville Girl by Bob Dylan
- Unfinished Sympathy by Massive Attack
- Live Forever by Oasis
- The Last Song I'll Ever Sing by Gavin Friday
- Lucky Man by The Verve
- Almighty Love by Emm Gryner (she is Canadian)

Children's marathon runs from poverty

After a poor four-year-old Indian boy sprinted into local record books for running 65km (40 miles) in seven hours in May, many children are following in his footsteps. (from the BBC)

Budhia Singh's run catapulted the little boy from the sleepy eastern state of Orissa into the national limelight and controversy with the country divided on the hazards of allowing children to run marathons.

Emboldened by his feat, other children in the state are running long distances for fame and money. Take for example, 10-year-old Anastasia Barla, a tribal girl from a remote village in the Sundargarh district.

She recently ran 65km and then, after a break of five minutes, went on to complete 72km (45 miles) - all in eight hours. Her target was to cover 105km (65 miles). Anastasia had trained hard - earlier in July she had run 60km (37 miles) in less than six hours.

Or take Mrityunjaya Mandal who actually fainted 11km (7 miles) short of a targeted 80km (50 miles) run recently. Although he failed to reach the target, Mrutunjaya could well claim that he surpassed the much-publicised Budhia Singh's 65km (40 miles) run.

Another child Dillip Rana from Pipli ran 90km (56 miles) during a practice session. The 12-year-old has now sought permission from the authorities to run 100km (62 miles) to set a new record - his coach says he has exceptional stamina.

High targets

A marathon race is usually a 42km (26 miles) run. But these sprinting children in Orissa are audaciously setting much higher targets - sometimes at 100km (62 miles) and at times, even more. Anastasia's original plan was to run 105km (65 miles).

Budhia's coach says he now wishes to run nearly 400km (248 miles) from the capital city, Bhubaneswar, to Calcutta in the neighbouring state of West Bengal without a break. There are a dozen other children attending rigorous practice sessions to shape their future as marathon runners.

All of them hail from poor and rural backgrounds. Their parents do not have the means to support their athletic training. For instance, Budhia was born in a Bhubaneswar slum. Unable to feed him and his three siblings, his mother sold him off to a street vendor for 800 rupees ($18). Fortunately, he was bought back by his coach Biranchi Das who spotted his talent for running and began to groom him for success.

Household name

The others come from equally humble backgrounds. Dillip Rana is the son of a daily-wage earner, while Anastasia and Mrutyunjaya Mandal come from poor farming families. Many say these children are following in Budhia's footsteps in an attempt to run away from poverty. For, ever since his run, Budhia has earned fame as well as money.

Today, he is a household name in Orissa - several music companies have come out with video albums which show Budhia running on the highways and rugged roads, scaling hills and practicing judo with other children.
In a recent popularity contest, organised by a local TV channel, Budhia stood second after the state chief minister, Naveen Patnaik. But the Orissa government is not impressed by this display of physical stamina. Officials say the children are being made to run beyond their capacity and may suffer from early burnout.

They say strenuous exercise may also make them vulnerable to diseases like arthritis as well as liver and lung problems. Soon after Budhia's run, the state-run Child Welfare Council banned long-distance running by children. Budhia's coach has challenged the decision in court. The court has heard the arguments but is yet to deliver a verdict. Under these circumstances, Orissa Women and Child Welfare Minister Pramila Mallick says they are unlikely to grant permission to Dilip Rana for his 100km (62 miles) run.

"The state government has already imposed restrictions on marathon races by children. The matter is in court and under these circumstance, we cannot allow another child to undertake a long-distance run."

But the children carry on with their marathon runs in spite of the ban. When Anastasia embarked on her run, no government agency stepped in to stop her although she had announced her schedule a week before.

Sports lovers say it shows that the state government is not serious. "It prohibits children from marathon races, but on the other hand, it watches as a passive onlooker when children like Anastasia run and get exhausted on the way. The government must back its decision with sincere action," says sports enthusiast Rajendra Mohapatra.

Many people in the state say they want to see these children prosper as world-class runners and are calling on the government and private sponsors to come forward and support the children.

"These children are not ordinary. They are prodigies born to earn name and fame for themselves and the country as a whole. They need to be cared for and groomed and the government must facilitate it," says Saroj Sahu, a Bhubaneswar resident.

And the parents of the child "prodigies" want their children to make and break all records overnight.

"Running is a natural instinct with my son. He has the ability to run miles relentlessly. The government stipulation is certainly going to jeopardise his future," says Sukanti Singh, Budhia's mother.

Preventive or Preventative

Mark B. Johnson, Am J Prev Med

The word “preventative” is commonly and erroneously used in place of “preventive” when referring to the medical specialty, preventive medicine. This has led to confusion in both the lay and medical communities. Preventive medicine is a science-based specialty within organized medicine, whereas “preventative medicine” often refers to the use of unscientific or unproven medical activities. This commentary describes the problem and some of the untoward effects of this confusion and suggests a remedy for the use of these words in the medical literature.

“What’s in a name? That which we call a rose, By any other name would smell as sweet.”—William Shakespeare, Romeo and Juliet (II, ii, 1–2)

Shakespeare was wrong. Names do matter. Names and titles have a tendency to become a part of who we think we are. Most people probably overvalue their own name, but some names really do have monetary value. Federal Express paid over $12 million for the naming rights of the venues where the Washington Redskins and the Memphis Grizzlies play their home games. Reliant Energy paid $10 million to name the new sports venue in Houston TX, Reliant Stadium.

Some people just wouldn’t be the same with a different name. Cher would never have made it as Cheryl. Elvis would not have become a sex symbol if his name had been Ernie.

Although lacking the romance of Romeo and Juliet, the perceived value of FedEx and Reliant Energy, or the sex appeal of Elvis, the name about which I am concerned is that of my medical specialty, preventive medicine. Although this specialty was established more than 50 years ago and is a member of the American Board of Medical Specialties (ABMS), my colleagues and I have long had to put up with the erroneous appellation “preventATive medicine.” We see it in medical journals, newspaper articles, and pharmaceutical advertisements. We have found it on our stationery, our checks, and our business cards. I, for one, am finally fed up!

Literary purists and Scrabble® lovers are correct when they point out that the word preventative is found in many dictionaries. Both of the words have been used since the mid-17th century, although preventive clearly preceded preventative. In modern dictionaries, though, even when the word preventative is found, it usually is identified as being a distorted or obsolete form of preventive. In his book, Modern English Usage,¹ the esteemed English grammarian H.W. Fowler stated that preventative was a “needless lengthening,” and declared that preventive was the proper form. Unfortunately, few people seem to have heard of Fowler, or don’t seem to value his opinion.

In an attempt to determine modern usage, I did an Internet (Google) search, and found 36.5 million references to preventive medicine, and fewer than 6.7 million references to preventative medicine. And yet it still seems to me that preventative is taking over. Perhaps I’m just too sensitive.

There are, however, some interesting differences in how the two words appear to be used on the Internet. The preventative medicine sites almost all fall into one of four categories: (1) sites that obviously mean preventive medicine, but the words have been misspelled or mistakenly interchanged, (2) sites that promote alternative or nonscientific modalities or treatments, (3) sites that are based in the United Kingdom or one of its Commonwealth members, and (4) sites dealing with veterinary preventive medicine. My favorite, which is hard to categorize, is a site with an article entitled, “Sport Preventative Medicine for Depression,” found on the Beer League Hockey’s website.²

Examples from the first category, obvious misspellings or misuses, included some rather impressive institutions. The website of the National Library of Medicine, National Institutes of Health, attributed a collection from the Gorgas Memorial Institute of Tropical and Preventive Medicine to having been created by the Gorgas Memorial Institute of Tropical and Preventative Medicine.³ Rush University’s Department of Preventive Medicine website search banner welcomes one to the Department of Preventative Medicine (www.rushu.rush.edu/prevent), and a web-page reference to Columbia University’s Social and Preventive Medicine course is displayed as “social-preventative-medicine.”

It is the second category, however, that is the most challenging for my preventive medicine colleagues and me. The specialty of preventive medicine works closely with the fields of nutrition, exercise physiology, and behavioral medicine, and uses many of the scientific research findings from the wholistic (spelled purposefully with a “w”) approach to health care. Unfortunately, these are fields that have also been used effectively by those who do not appreciate science- and evidence-based medicine. In this age of kinder and gentler political correctness, we no longer label anyone as a quack, but the health information and advice found on many sites promoting preventative medicine is alarming and can be downright dangerous.

Having one’s friends, medical colleagues, and patients fail to clearly differentiate between the evidence-based specialty of preventive medicine and that claimed by the purveyors of preventative medicine is problematic, and can be rather disconcerting. At a high school reunion, I was chatting with a friendly classmate. He had finished 1 year of college as a music major, and then dropped out and become a bartender. On the side, to augment his income, he sold vitamins and nutritional supplements. When he asked what I was now doing, I told him I was practicing preventive medicine. “Oh,” he excitedly replied, “so am I!”

To bring some order to the use of these words, at least in the scientific medical literature, I would like to make a suggestion that I hope will help to alleviate some of the confusion. My proposal is that the word preventive be used exclusively as an adjective, and the word preventative be used only as a noun. Thus such terms as preventive medicine, preventive cardiology, preventive maintenance, and preventive war, would be grammatically, if not necessarily politically, correct. So, too, would such statements as, “This immunization is a preventative for polio,” or, “Sunscreen may be a preventative to keep one from getting skin cancer.” We may not be able to get the rest of the world to conform, but we could at least bring some uniformity to the American medical literature and some peace to those of us who use preventatives in the practice of preventive medicine. My secondary proposal would be to just kill the use of the word preventative.

I am sure there are those who feel this is much ado about nothing. They feel I am obviously being much too sensitive. Perhaps I am, but names and titles have a way of becoming more than just mere symbols to those who own them. I have seen shrinks, and orthopods, and gas passers, and various sawbones get quite upset if they felt their specialties were not being shown the respect that was obviously their due. I am also pretty sure that before I started calling him a certified public accountant, my personal bean counter always over-estimated what I owed in taxes. I have paid dearly in gaining my understanding that some roses truly do smell sweeter than others.

Rising to the global challenge of the chronic disease epidemic

Lois Quam, Richard Smith & Derek Yach
Lancet, 268; 9453: 1221-1223

Last year, a study published in The Lancet showed how a global goal of reducing deaths from chronic disease by 2% a year, a target already attained in many wealthy countries, would avert 36 million deaths by 2015.¹ Most of the deaths averted would be in the developing world and just under half would be in people aged under 70 years. The journal's editor commented: “There is an unusual opportunity before us to act now to prevent the needless deaths of millions.”² An attempt is now being made to grasp that opportunity.

Of the 58 million deaths in the world in 2005, some 35 million were from heart disease, stroke, cancer, chronic respiratory disease, and other chronic conditions. Chronic disease accounted for almost three-quarters of the burden of disease (measured in disability-adjusted life-years) in those aged 30 years or over. By 2015, deaths from chronic disease will be the commonest cause of death even in the poorest countries.

Despite this burden of chronic diseases, there is no Millennium Development Goal to address them.^{3 and 4} Currently, infectious diseases, perinatal conditions, and nutritional disorders are the major killers of the very poorest people, and that is why so much emphasis has rightly been concentrated on these problems—but we should not neglect chronic disease. Various myths have probably led to their neglect. Many still believe that these are diseases of affluence and are self-inflicted through indulgence in unhealthy lifestyles. In fact, chronic disease is a bigger problem in poor people because they do not have the resources to pursue healthy choices. Another myth is that little can be done about chronic disease, but deaths from heart disease have fallen by up to 70% in the past three decades in Australia, Canada, Japan, the UK, and the USA. About 50% of deaths from chronic disease are attributable to modifiable risks, including tobacco use, raised blood pressure, and poor diet. Raising tobacco taxes and treating people who have had a cardiac event are among the most cost-effective interventions for those in developing countries.⁵

The current Millennium Development Goals are appropriate for the poorest billion people in the world, but action is needed to better manage chronic disease for the 4 billion people living in China, India, Brazil, Egypt, South Africa, Poland, and other low-to-middle income countries. These countries are the global engines of growth. Reduced productivity in workers in these countries caused by early onset and poorly managed chronic disease harms households and nations.To date, the expectation has been that the same international funders of action against infectious diseases would start supporting a broader range of health issues. Realistically, it is unlikely that those funders will provide support for programmes on chronic disease given the pressure for investments in the poorest countries. These funders do provide modest support to tobacco-control programmes,⁶ but different approaches are needed that draw on new resources. The Lancet has argued that: “Sectors of society such as business, labour, and non-governmental organisations not traditionally included in the development of health policy can be recruited for prevention efforts. The global goal that offers is intended to challenge these sectors to become involved.”² The time has come to accept that challenge, but it requires a shift in the role of the corporate sector and in the attitudes of the public sector. Importantly, any shift will build on emerging initiatives by companies that see the gain to both public health and their businesses through the development and promotion of healthier products and lifestyles.

The food companies that have started to market healthier foods see their profits rise faster then those that do not. Further, the health-care companies that provide incentives and practical support to patients at highest risk for chronic diseases increase their profitability while improving population health outcomes. The potential to expand such approaches into other sectors remains largely untapped. Developments could include the reduction of the harm caused by tobacco by use of smokeless or cessation products, the creation of incentives to increase physical activity, or ensuring that people with diabetes or hypertension are diagnosed early and treated effectively.

We urge sceptics to judge partnerships on their ability to improve public health and not on ideological grounds. Policymakers in health tend to regard private-public partnerships as beginning and ending with the pharmaceutical industry. Many remain unconvinced about their benefits on product development, better ways of working, and novel approaches to increasing access to essential drugs. This narrow view has limited the potential to bring about change in a complex system.

Governments need to help if market-led solutions are to flourish. The regulatory system should reward innovative approaches that lead to health gains and penalise laggards who continue with practices that limit progress. Changes in the regulatory system will require a much needed debate about the optimum role of government in promoting health.

This week, at the Clinton Global Initiative,⁷ a spotlight was placed on the need for action on chronic disease. Participants were asked to commit to taking action. PepsiCo described how it is working to prevent diet-related aspects of chronic diseases, the World Health Federation announced plans to develop a polypill for the secondary prevention of cardiovascular disease and diabetes, and WHO outlined new efforts to implement the Framework Convention on Tobacco Control and tackle obesity. The World Diabetes Foundation announced new efforts to prevent diabetes in children and provide better care for those with the disease—starting in South Africa.

Ovations announced that it would lead efforts to develop a network of Centers of Excellence to tackle chronic diseases in developing countries. This work will be initiated in a global summit hosted by Ovations in Washington, DC, in early 2007. These efforts will explore ways to build on the existing efforts in developing countries, to spread the outstanding success of the Finnish and other national experiences, and to partner the Oxford Health Alliance and other chronic disease initiatives. The network will work closely with those involved in addressing infectious chronic diseases such as AIDS and tuberculosis, because such diseases require a similar system-platform for success, and Ovations will contribute its business expertise of how to spread effective practices for chronic disease control to scale.

The commitments made at the Clinton Global Initiative and the enthusiasm of those present from governments, non-governmental organisations, and business suggest that the tide is at last turning in favour of chronic disease prevention and management.

LQ is the chief executive of Ovations and RS is the chief executive of UnitedHealth Europe, a sister company. DY is on the Board of the Oxford Health Alliance.

References

1 K Strong, C Mathers, S Leeder and R Beaglehole, Preventing chronic diseases: how many lives can we save?, Lancet 366 (2005), pp. 1578–1582.
2 R Horton, The neglected epidemic of chronic disease, Lancet 366 (2005), p. 1514.
3 P Boyle, The globalisation of cancer, Lancet 368 (2006), pp. 629–630.
4 V Fuster, Cardiovascular disease and the UN Millennium Development Goals: a serious concern, Nat Clin Pract Cardiovasc Med 3 (2006), p. 401.
5 R Laxminarayan, AJ Mills and JG Breman et al., Advancement of global health: key messages from the Disease Control Priorities Project, Lancet 367 (2006), pp. 1193–1208.
6 S Okie, Global health—the Gates-Buffet effect, N Engl J Med 355 (2006), pp. 1084–1088.
7 Clinton Global Initiative, Clinton Global Initiative NYC 2006

New Canucks: Luongo stings Wings

Iain MacIntyre, Vancouver Sun

Who are these guys, and what have they done with the Vancouver Canucks? Sublime goaltending. Clinical special-teams execution. A calm and competent defence of a third-period lead. Winning 3-1 in Detroit against the Red Wings in the teams' National Hockey League opener. These aren't the Canucks we've come to know.

The Alain Vigneault-Roberto Luongo era began impressively here Thursday as the Canucks, who choked away leads last season as if they had a gag-reflex disorder, built a three-goal cushion on outstanding special teams, then safely ran out the clock in the third period against a team capable of winning the Stanley Cup.

It was a style of play -- and result -- to which the Canucks are unaccustomed.

"Last year we were a fragile team and didn't play with a lot of confidence," veteran defenceman Mattias Ohlund explained. "Roberto gives us confidence. Look, I loved to play in front of Dan [Cloutier] and Alex [Auld], too. But, having said that, Roberto is one of the absolutely top guys in this league. He's very calm in the net. He's one of those guys who gives his team a chance to win every night."

"I thought he was unreal," Canucks' captain Markus Naslund said. "He made some ridiculous saves. He just looks poised back there and it rubs off on others."

Luongo, acquired in June from the Florida Panthers in a deal that cleaved Todd Bertuzzi from the Canuck roster and caused a seismic shift in the Vancouver organization, looked like a $27-million-US -- over four years -- goalie in his debut.

He stopped 27 of 28 shots while aided by the heightened commitment to team defence instilled by new coach Vigneault.

This is the look of the new Canucks.

But there was also the best part of the old Canucks evident, too, as the franchise's all-time leading scorers -- Naslund and Trevor Linden -- scored goals 21/2 minutes and the first intermission apart to send Vancouver on its way.

"I think guys realize in this locker room we have a good team and we definitely can be part of the top eight [in the NHL]," Luongo said. "Defensively, I thought we did a great job. You've got to put your body on the line if you're going to protect a lead, and guys were diving in front of pucks."

The Canucks gave up nine shots in the third period, but only three scoring chances. They defended with four skaters across the neutral zone and plugged the passing and shooting lanes while shorthanded, which they were nine times.

"We kept them to the outside, and we only gave them three chances in the third," Vigneault, 1-0 lifetime as the Canucks' coach, told reporters. "We were up 3-1 and did what we had to do to come into a very tough environment and win our first game of the year."

The Canucks' second game of the year is tonight in Columbus.

Linden will be looking for his 301st goal as a Canuck, Naslund his 299th.

"Once Nazzy scored, I figured I better get going," Linden joked.

Naslund, who went goal-less in the pre-season, scored like Zinedine Zidane to give the Canucks a 1-0 lead with 4.5 seconds remaining in the first period -- one minute after Luongo made a stunning glove save in traffic on Henrik Zetterberg.