Tag Archives: World Cup

gustavo_gussoGustavo Gusso, MD, PhD, is Assistant Professor of General Practice at University of São Paulo, and the Former President of the Brazilian Society of Family and Community Medicine


“Soccer is the most important thing of unimportant things” is a common expression in Brazil. It is attributed to Arrigo Sachi, an Italian coach and to Nelson Rodrigues, a Brazilian writer. Brazil will not be the same country after July 8th 2014 when the national soccer team was almost destroyed by the Germans. During the preparation for World Cup the most frequently discussed aspect was the “the legacy”. But this was not what we expected. Many patients I saw this week were very upset- just as if they had suffered a major personal trauma. Brazil has never really been at World War. The feeling is not of anger against the Germans. Not at all. Everybody is in shock, or what “specialists” might call “post-traumatic stress disorder -population based”. All my consultations this week began by asking patients about the game. The most common words used were “shame” and “pathetic”. Many of them told me they dreamed that it was not true.

The first responses on social networks were the jokes even before the game finished. It is one of the ways Brazilians deal with trauma. But now everybody in trying to understand what happened. Planning beat improvisation is the most common theory. But isn’t soccer an art? It is as important to train the basics as in ballet or in painting but surely talent is the most important part? It seems that this day is over.

Soccer is now more a business than an art - just as medicine. Medicine chose the evidence based path. Improvisation is linked more to communication, especially of risks and benefits, in supporting a shared decision. One might say that “medicine was art for centuries, then become a science for decades, and now it is business”.   Maybe that is unfair and there is still a vestige of art and science, at least in some doctors. In São Paulo it is not easy to find them. The main goal for good students at the University of São Paulo, with some exceptions, is to open a nice private office as soon as possible and charge R$ 1000,00 reais (US$ 400,00) for each consultation that may last from 30 to 90 minutes - like the famous professors.

People feel one reason for this tragedy is the organization of soccer and its shady relations with sponsors and television. There is too much corruption in the Brazilian Soccer Federation (the last president left the country and lives in Miami). It seems that in Brazil the soccer stakeholders use methods that are decades surpassed. The coach, Felipão is totally outdated. The German team planned well. Their current coach, Joachim Löw, was the assistant of the former coach and was not sacked even though he lost two World Cups (2006 as assistant and 2010 as coach). For this World Cup they built a quiet hotel close to an isolated and beautiful beach and now intend to sell it.

In conclusion, the lesson for now is that improvisation is not, or should not be, the most important player in modern world. It is true for medicine, for soccer, and for any “value chain” that attracts billions of dollars. For medicine as in soccer, the big question is to know the right place for art and improvisation. It still remains behind the medical consultation even in the current business model.

And, now we need all our professional skill and evidence based medicine to deal with the national post-traumatic stress disorder. Or not.

Domhnall MacAuleyIts not just the football. Sports docs watch the World Cup medical stories with great interest—which players are injured, what happened and how they are managed. Luis Suárez, suddenly infamous, scored two goals, effectively eliminating England, just weeks after an arthroscopy. And, with the current controversy over concussion and possible long term chronic traumatic encephalopathy, we are especially aware of head injuries. In 2010, team doctors of the 32 finalist teams reported 125 injuries in 64 matches with 104 injuries during training. Most of these injuries were not serious and the incidence of match injuries was lower than in the three preceding World Cups. So far, this year looks even better. The World Cup only offers a short window on acute soccer injuries, however, and it may be more important to look at the long term sequelae and, in particular, if soccer might lead to long term osteoarthritis. There is some evidence that it does but we await the findings of what may be the definitive study, Osteoarthritis Risk of Professional Footballers, undertaken by the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis—a major UK and international collaboration. The World Cup is also likely to generate other tangential papers such as to how it might influence the number of ER admissions or myocardial infarctions.

Exercise in treating arthritis initially seemed counter intuitive. Rob Petrella, now at University of Western Ontario, first brought this to my attention in a poster at a medical conference, and it led to his systematic review in 2000 asking if exercise was an effective treatment for osteoarthritis of the knee. At that time there were few sufficiently powered randomised controlled trials but, overall, the evidence seemed in favour. Last year, a similar systematic review showed overwhelming evidence in favour of exercise for lower limb osteoarthritis. This was a sequential meta analysis and, what was particularly important, was that there was sufficient evidence to show physical activity was beneficial as early as 2002. It can take a long time to change our minds and integrate evidence into practice.

Evidence in treating arthritis is not always what one might expect. Just a few weeks ago, Kim Bennell and her colleagues published a high quality randomized controlled trial on the effect of physical therapy in hip osteoarthritis. Patients had 10 treatments over 12 weeks comprising education and advice, manual therapy, home exercise, and gait aid if appropriate. There was, perhaps unexpectedly, no difference in pain or function compared with sham treatment. I cannot imagine that the findings of this study were welcomed by Kim’s physiotherapy colleagues. Its not just in football where the results can be surprising, unexpected and disappointing for the supporters.