Thanks Mr. Walker

A friend and colleague ringside doctor sent me a link to this little snippet from Johnny Walker:

https://fansidedmma.com/posts/johnny-walker-doctor-magomed-ankalaev-video-01hm222tvw49

Johnny is a real gentleman, and I appreciate his comments deeply. Not for the vindication or approval – doctors are always making hard decisions the details of which are not always fully easy to understand or accept – but rather for making clear that we’re there, ringside, to take care of them, to make the best call possible.

Thanks Johnny, I owe you a beer.

UFC 294, Johnny Walker vs Ankalaev

Well isn’t THIS special? After years of not posting (largely because I haven’t really felt I’ve had anything to say that would interest anyone) here we go again!

Tiny bit of background: for the past three years I’ve done quite a bit of doctoring at various combat sports events, sitting ringside helping to take care of the fighters (including all UFC events in Abu Dhabi since July 2020). Make no mistake about it – I am not a fan of combat sports, but for various reasons, and the odd meanders of a career, this is a position in which i often find myself (it is a very compelling gig, and one I take extremely seriously).

Last night, during UFC 294 and on the ref’s request, I assessed Johnny Walker after he was struck on the head. I recommended that he stop the fight, which of course he did.

My assessment would appear to have provoked a mini-maelstrom of opinion and comment, and I think it only fair to explain the process by which I reached my conclusion in the octagon, and to make clear that in many respects this was the only possible, only safe, and only reasonable decision based on current understanding of head injuries. I want to help clarify the sometimes agonizing position the ringside doctor is in, and the way one of them (ME) reasons when faced with this type of decision.

First, let’s paint a picture of the situation. Johnny gets a blow to the head, is clearly staggered, and I stand up from my ringside chair, knowing that Dan (the ref) would call me in to assess the fighter. I had not seen the blow (my angle was not ideal) but saw Johnny’s reaction, and as I entered the octagon I saw the expression on Johnny’s face. You need to remember I’ve spent 25 years as an ER doc and anesthesiologist, and 16 years in Formula 1, and three years ringside – plenty of time to have assessed hundreds of patients with concussion – and enough time to know that look.

I approached Johnny, and asked him some standard questions. Often the precise answer is not important – it’s more HOW the subject arrives at the answer. Long story short, Johnny was disoriented in time and in space. Telling me he was in the desert was pretty good, but not good enough. And the notion that a language barrier prevented him from answering me correctly is either adorably naieve, or willfully disingenuous. Johnny KNEW what i was asking, but just could not answer it.

Why is this important? Well guys, the definition of a concussion is, roughly, “altered brain function after a blow to the head”. This can take several forms, transient amnesia (like forgetting where you are and having to improvise an answer) being one of the most frequent. Oh and Johnny did not remember for the life of him what round it was. Pretty sure most (non-concussed) fighters always know exactly what round they’re in.

Once we’ve accepted that we’re now dealing with a concussed athlete, the rest falls into place clearly, if painfully. Now of course if the diagnosis involved the persistence of symptoms (so we’d have “altered brain function one minute, five minutes, one hour, etc, after a blow to the head”) I’d have had to take that into account. But the definition of concussion does not depend on how long after the blow to the head we are. The SEVERITY of concussion will be partly judged by the persistence of symptoms, but that’s not the question here

Current consensus, in essentially every sport that has a concussion protocol – and I mean EVERY SPORT – is to immediately remove that athlete from further competition until carefully assessed. I’ll not be pedantic but I do need to emphasize: EVERY. CONCUSSED. ATHLETE. REMOVED. IMMEDIATELY.

Note that I said “until carefully assessed”. There are several ways to “carefully assess” a concussed patient, from computer-based neurocognitive testing to vestibular (balance) -based examinations , to detainled neurological exams- but all of them require time and expertise to carry out. And remember that current best-practice is that this athlete cannot return to this event, and perhaps even upcoming events, until this is done AND ALL SYMPTOMS OF CONCUSSION HAVE RECOVERED. That’s right – the athlete needs to have recovered completely before being allowed to return to competition. If you look at the concussion management protocols in sports, you will pretty much always see that the concussed athlete will almost never be allowed to return to the game/match/event in which he or she was injured.

You see where I’m going with this, right?

Several of the officials and staff spoke to me after the decision, and while obviously not getting involved in the medical aspects of the decision, they often suggested that perhaps I should have given Johnny “some more time”. Let me throw this back – how much time? And after that time has elapsed, what am I looking for? So let’s say we decide five minutes. Great. We’re now five minutes later, and I ask Johnny what day it is. “October 21, a Saturday”. “We are at the end of the first round”. “This is Etihad Arena in glorious Abu Dhabi”. Well after you pick me up off the floor (there was no way on God’s green earth THAT was going to happen, remember I know a concussion when I see one), but even had this happened – was this enough to constitute a “complete and thorough assessment”?

The answer of course is no, not by a long stretch – but now consider the ringside doctor’s dilemma. Those three correct and elegantly phrased answers are pretty good evidence of marvelously rapid recovery. But if I’m officiating at an amateur bout, or a college football game (and these answers are given on the sidelines) I’m keeping this guy out until we do some REAL assessment. On the other hand, had those answers been offered last night by Usman, or by Alex, or by Johnny himself had the same situation occurred, I’d likely have let the fight continue. Not that I’m any less concerned (although massively reassured), but because I realize the context. The ringside doctor in high-level combat sports confronts this constantly. But always, ALWAYS, our duty to the guy in front of us outweighs anything and everything else.

And remember, this is not what happened. In fact, Johnny got a bit uncontrollable, something that fans love, but that is very rare, and that likely reflects a serious temporary deficit in impulse control. Something that, you guessed it!, is part of the concussive syndrome itself.

Just to reinforce what I’m saying, Johnny was foggy enough at his post-fight exam that he was required to be observed for some time to make sure that his recovery was well underway before clearing him back to the hotel.

You know, if Dan had called me into the ring for a cut, a bad one, to assess whether or not we could continue, my criteria for stopping the fight would have been different here, with these guys, on the main card, for this event, than if this was a college boxing match. I GET THAT. This is, after all, a form of showbiz, and stopping a fight is heavy with consequences. Again, I GET THAT. Criteria for a lot of stoppages are . . . adjustable . . . given that we’re dealing with mature consenting adults who take risks as part of their jobs. I GET THAT.

BUT NOT WITH HEAD INJURIES. Sorry, but here the criteria are absolute. I don’t care if this had been Muhammad Ali, for a world championship fight, I’d have made the same recommendation. Or your kid. You’re concussed? You’re finished for tonight. Period. Move on. That’s my job. You don’t like it? Sorry. That’s my job. You bet on the fight and lost? Sorry. None of these are my concern, none of these are my problem. My problem is Johnny Walker, his brain, his future, his wellbeing.

So there you go folks, this is pretty simple. I had a concussed fighter in front of me. One whose recovery could not be properly assessed in the timeframe necessary to allow THIS fight to continue. I owed this to Johnny. If it were your son or daughter, in another sport, any sport, I’d do the same thing. If this happened tonight, despite the opprobrium being heaped on me, I’d do the same thing. Getting a second concussion before the first has healed (and do not doubt for a moment that given his cognitive slowing Johnny was well on his way to being TKO’d – at best – or KO’d – at worst) can lead to the “second impact syndrome” where the athlete collapses, and usually dies, from massive acute brain swelling. That’s not going to happen on my watch, I promise.

Finally I want to thank Dana White for having said that my inexperience was responsible for my decision. It’s better than attacking me, for sure. I have acquaintances who have thousands of fights under their belts; I’m somewhere north of 500. But Sid Watkins and I started concussion testing – pre-season baselines and post concussion – with a computer based program, in the late 90s. THIS WAS DECADES BEFORE ANY MAJOR SPORT (except IndyCar) GAVE A DAMN ABOUT CONCUSSION. And again, my career involved caring for hundreds of “day to day” concussions. So actually not only am I not inexperienced, but in a certain way Johnny was damned lucky I was his doctor last night.

I want this to be read by a max of fight people who question the decision. Help me out in the comments as to the tags I use to make sure that they land here.

I welcome your comments – but keep it respectful, keep it fact-based, be normal. If not I’ll just can it. I won’t have massive amounts of time for a give and take, but those of you who’ve read me in the past know my commitment to furthering knowledge of head injuries of all types.

Well that was fun, it’s nice to be back!

Good bye Charlie

First of all, I want to send my condolences and all my sympathy to Juliette and the kids – you have a beautiful family, and you’re a wonderful dad. I know that you’ve already given your children the essence of yourself – honesty, a sense of fairness, tact, and a proper work ethic. This will live on in them, and is a legacy to be proud of.

I know this will embarrass you Charlie, but I honestly can’t conceive of Formula 1 without you. You’ve been there since I started, one of the first people Sid introduced me to. You were the Technical Delegate then.

This will also embarrass you, but think about it – how many people in the fraught and contentious environment of modern F1 are unanimously appreciated, respected, sought after, and admired? You don’t need half of one hand to count them. You’d be on all the lists. I don’t mean everyone agreed with every decision; that’s trivial. What I mean is that you’ve established  over the decades a foundation of integrity and credibility that has essentially never been seen in the sport.

Usually when it’s said about someone that he or she has a good political sense there’s a negative connotation. Obviously to have survived, and thrived, through the politics of F1,  through so many years, you have clearly had such a political sense. But in your case it’s been natural, not contrived. Not calculated. You just know how to talk to people – when to be hard and when to be soft. When to be a teacher and when to be a schoolmaster. You understand the art of taking your ideas and making the other guy think they’re theirs.

You, Max and Sid were the three people most responsible for the evolution in safety over the past 30 years. It was Max providing the impetus and the wherewithal, Sid the data-driven structure, but it was you Charlie who actually made sure the engineering hit the targets.

You worked hard, very hard, VERY VERY hard, but dinners with “Herbie” and others (Martin, Gerhard, the list goes on) were full of laughs and fun. And I’m pretty sure you always chose the wine.

Your memory staggers me – details of every corner of every circuit, details of incidents from years before and how they related to the incident under question at TODAY’S driver’s briefing. Hell, I never remembered who won the last race.

Your impact on the sport is so wide, and so deep, that I always wondered what we’d ever do when you retired. Your charisma, smile, lovely accent, and incredible silver gray mane always reassured me that that day wouldn’t come any too soon.

And now this.

We’re gonna miss you. Way more than you’d ever be comfortable with. Way more than most of us will ever be comfortable with. You were an advisor, a buddy, a boss. I can almost not bring myself to use the past tense.

Do me one favour Charlie. Open a great bottle of Brunello and split it with Prof. We’ll be happy knowing you’re both laughing and draining your glasses.

Bye Charlie. I’m privileged to have known you.

 

More shenanigans at the Medical Commission

It’s surely been a long long time since taking pen (read “keyboard”) in hand (read “hands”) but the time has come to once again howl at the moon. Ironic that it is on the first day of my new home Grand Prix!

I’ve just been made aware, by trusted and reliable internal sources, that the president of the FIA Medical Commission, my old friend Gérard Saillant, is in the process of removing Professor Hugh Scully from his seat on the Commission. This is most troubling on several fronts.

Let me first explain, to those of you who don’t know Prof Scully, just exactly who he is, and why this is important.

Hugh is a cardiac surgeon, one of the best, and is a past president of the Canadian Medical Association. He is also one of Sid’s greatest friends and allies, since the beginning. Their shared academic background and passion for motorsport would have predicted this, but at a time when it was easier and safer to oppose and obstruct, Hugh instead joined the train and helped make the changes we all know so well. I think it is not an exaggeration to say that without Hugh’s support and wisdom, Sid’s road would have been even more difficult than it was. Hugh also introduced Sid to his beloved wife Susan.

Professor Scully remained loyal to Sid, and continued active participation in the FIA even after Sid’s retirement. This was driven by both his fervent desire to continue Sid’s legacy, as well as his absolute commitment to the greater goal – improved medical structures and care for participants in racing. I should also add that his continued participation came at great personal cost.

Hugh is a founding member of the International Council of Motorsport Sciences. This is a fantastically dynamic organisation, largely based in North America, and which hosts what is universally felt to be the most important annual motorsport medicine meeting in the world. In fact it has been a continuing source of embarrassment to many in the FIA that the FIA’s OWN meeting is laughably trivial compared to the ICMS. Several attempts at organising joint meetings were dashed by the FIA’s lack of competence and honesty.

The ostensible reason for the removal of Hugh from the Medical Commission is his age. Scully is 75. What is interesting is that the internal rules and regulations of the Medical Commission make no mention of an age limit to membership. In fact, unlike any structured body with important regulatory functions, the FIA Medical Commission HAS NO INTERNAL RULES AND REGULATIONS AT ALL! More on this in a bit.

I should point out that the Saillant himself is within striking distance of 75 (if not beyond). I’m certain that if Todt indeed runs and wins the FIA presidency again, Saillant will not use the age criteria to remove himself in favour of a younger person. In fact, Jean-Jacques Issermann, who is well into his nineties, still sits on the Commission.

It is troubling, and not coincidental, that Hugh is the last Sid holdout on the Commission. It’s funny (but not at all surprising, given the lack of competence at this level), but the FIA completely forgot to neutralise my password access to the private area of their website. This gave me a window, for some time after my removal, into the minutes of the Medical Commission. It was apparent that Prof Scully was a constant thorn in the side of the French hierarchy, always insisting on intellectual, scientific, and medical rigour in all aspects considered by the Commission. It is obvious, and very sad, that this is just the latest expression of Todt and Saillant’s desire to expunge all traces of Sid and his approach from the ranks of official motorsport medicine.

I’d also add that the FIA stopped uploading minutes to the website some years ago – perfectly consistent with their desire for opacity.

Another most troubling aspect of this sordid and clearly political move is that Hugh is one of the few high-level motorsport doctors who, despite his “age”, continues to push ahead the agenda of progress. It is obvious to any who are interested that for at least 5 years all notion of forward movement on the medical side of our sport has come to a grinding halt. This complacency, where the “perqs” of membership outweigh the raison d’être of the Commission, will continue unabated. Expect more removals of progressive elements, and their replacement by people who are valued more for their loyalty than for their competency.

Which brings to mind the lack of internal regulations of the Medical Commission itself.

Some years ago Saillant was an “advisor” to Max Mosley. Max was interested in streamlining and improving the functioning of all the FIA commissions, and asked Saillant to advise on the medical side of things. This was an appointment which Max later bitterly regretted, and was based on a misplaced sense of personal indebtedness . . . but I digress.

I suggested to Gérard that the Medical Commission needed a structure and some regulations regarding its function. Originally created to give an official imprimatur to Sid’s agenda, it had failed to evolve into a structure that would drive ahead progress on our side of things.

I pointed out that the members of the commission were chosen based on no criteria other than personal affinity with Sid (with perhaps an occasional political constraint added in). And I suggested that we use the model of the UN Security Council,in the interest of combining some notion of stability with a structural mechanism for changes. I suggested that the Commission have several permanent members, made up of motorsport powerhouse nations. This could be defined in several ways – e.g. countries that had hosted F1, world rally, and/or endurance events in 80% of the years the respective championships existed. In addition, a rotating roster of “lesser” countries would be brought in, in order to provide new ideas, dynamism, and truly global representation. Obviously it was not in the interest of entrenched powers to institute such a reform…

I only say this to highlight that there are not just personal, but structural reasons for the complete lack of progress on the medical front. And to give me a chance to once again return to some projects that I think would be extremely important for the future of medical and rescue coverage of racing events:

• Continued updating of the motorsport medicine manual, and creation of a real, modular motorsport medicine course
• Creation of a system for accreditation of motorsport medical and rescue personnel, with a pathway for acquiring and documenting competencies and experience
• Convening of a “Cockpit Out” conference, to define current best practice in creating the safest most ergonomically efficient driver environment for each type of racing, as well as regulatory reform making the cockpit the START of all technical regs for all series, around which cars would be built.
• Convening a conference to reconsider the structure of medical and extrication teams in the various levels and types of competition. The role of the circuit medical centre should also be re-analysed in light of progress in management of severe trauma.
• Sharing of the FIA resources and database for helmets with other organisations both sport and leisure (skiing, bicycling, etc) as well as professional (construction, etc).

I’m going to finish with a heartfelt thank you to Hugh Scully – for being a friend, and for fighting the good fight. It’s been an honour.

 

 

Dear Mr. Putin, Let’s Play Chess

Beyond chilling.Beyond explosive. Uncorroborated thus far, but internally and externally consistent. Remember this post – it just might explode soon and god knows where the debris will land…

Patribotics

PART ONE: PAWN TAKES QUEEN

I have an overarching theory of Russia’s attack on America and the West. Here it is.

There have not been a series of attacks on America and Europe by Vladimir Putin. There has been one single operation; it is the same operation.

By 2008, possibly even earlier, according to John Schindler, a National Security expert formerly at the NSA, Russia had placed moles in the highest levels of US counter-intelligence. I take this as my starting-point, because all the subsequent facts bear it out.

Mr. Putin always wanted to use the strength of the West as a lever to attack it, because Russia is weak and poor. So he did, and he used a very old-fashioned and effective method. Spies inside the IC. He also believes in propaganda and mind-games. He uses them on the West, he uses them on Russians, in…

View original post 3,516 more words

Good bye Aki

It’s not right. But you’re gone, and we’ll miss you.

My deepest condolences go to Aki’s family, and to everyone whose paths were graced by crossing that of Aki.

You were someone in whose presence we felt inspiration and energy.

You were a remarkably gifted physician. One of my proudest moments was when you agreed with one of my diagnoses.

You were a scientist. A brilliant wonderful joyous human scientist, wanting to see the data, to make sure you had the best chance of helping.

When we first spoke about your ideas, I realised you could change the world. God you were so humble.

Aki you were brave and strong and beautiful. I’m lucky I knew you. I’ll sure miss you.

 

RIP Luis

It is always a tragedy to lose young, active healthy people to trauma – and the pain is of course shared even more widely when the victim is a sportsman in the public eye. I would therefore like to extend my deepest condolences to the family and friends, teammates and fans, of Luis Salom.

I have read the statement that was released detailing the medical management of this tragedy. I know Dr. Angel Charte, and have worked with him. His statement reads like a textbook of management of severe traumatic injury.

As to the use of ground transport as opposed to helicopter transfer to the receiving hospital, I think one crucial point must be kept in mind. Luis was in cardiac arrest on arrival of rescue services, and remained so during the intervention.

Angel no doubt had the helicopter moved to the scene to facilitate the most rapid transport possible IN THE EVENT THAT THE CARDIAC ARREST WAS RAPIDLY REVERSIBLE (airway obstruction, severe hypovolemia, etc). When Dr. Charte realised that the quality of CPR on the way to the hospital was going to be the determinant factor in Luis’ eventual survival, he astutely elected for an ambulance, where the availability of more space makes high quality CPR (a team effort) possible. This was an exceptionally mature decision by an experienced and unflappable clinician. Unfortunately, it was not to be…

It is reassuring to see that from a medical point of view, these guys are in very good hands.

Good bye Luis.

An open letter to the Bianchis

Today’s news (opens in new window/tab)

Dear Mr. and Mrs. Bianchi,

Forgive me for (once again) intruding into your lives.

Once again,  allow me to tell you that you have been examples of dignity and humanity in the face of unthinkable tragedy. While I cannot possibly understand the depth of the tragedy you have faced, as a father I can understand its immensity. And through it all, you have remained open and full of love and respect. You are marvellous people and you are forever in the minds and hearts of hundreds of thousands of Jules’ fans .

While it is not for me to judge “correctness” or propriety, I believe you are doing the right thing in seeking legal redress for the tragedy that has befallen you. It goes without saying that nothing will re-kindle the light that Jules brought us, but it goes without saying that your reasons lie elsewhere.

Most importantly, multiple components of the safety structure of current race practice must be reviewed and reformed. Your action will no doubt catalyse that long overdue process.

The issue closest to me is that of the medical and rescue services, the medical regulations, and the level of competence and experience of the Medical Delegate. Please do not misunderstand me. I have done my time in motorsports medicine. I have given what I can to improve how we take care of our boys and girls when they get into trouble. I am no longer angry about no longer being involved, and do not seek to once again travel the world in that position.

I am, however, bitter at the glaring lack of consideration for the quality, experience and competence of the person who has ultimate responsibility for medical and rescue decision making for the FIA’s flagship series.

This is not a “vanity” position. And while thankfully the need for medical and rescue services has become astonishingly rare, the weight of this responsibility is enormous. The decisions that must be made by the Medical Delegate often have dramatic consequences…as you have so horribly and painfully experienced.

As I’ve mentioned before (limiting myself to that with which I am intimately familiar) the crucial element as concerns the tragedy of Suzuka lies in the fact that meteorologic conditions precluded use of the medical helicopter. As the minutes of numerous meetings of the FIA Medical Commission will confirm, helicopter regulations are a constant subject of debate and concern.

According to the current regulations (authored by the Medical Delegate himself), under the conditions at Suzuka that day, with the medevac helicopter grounded, the only way that racing could have continued is if it had been demonstrated that ground evacuation to the designated receiving hospital took 20 minutes or less. I needn’t remind you that, in fact, this transfer actually took 45 minutes, more than double the allowable time.

I am not a lawyer but I think your legal team should, in their efforts to uncover contributory elements to your tragic loss, explore the following issues:

• was there a simulated evacuation to the receiving hospital, and if so what was the time of the transport?
• if there was a simulation, was it carried out under “real world” conditions of race day traffic, and what if any allowance was made for the atrocious meteorologic conditions present on Sunday?
• if there was no simulation, how was a predicted ground transport time calculated? All experienced pre-hospital care providers know to use an average ambulance transport speed of 30 km/h AT BEST. Even this is often optimistic, especially under the conditions mentioned above.

It would be normal to ask the question as to whether this could have changed things in Jules’ case. While this is of course impossible to know with any certainty, I would encourage your legal team to speak widely to experts in the acute care of head-injured patients to ask the following question;

Could a difference between a 20 minute transport time and a 45 minute transport time to definitive care have been important in contributing to the outcome of a deeply comatose victim of a head injury?

Other facts can be raised, not directly relevant to this case, but rather to hammer home the lack of experience with modern pre-hospital trauma care. One of the most important of these would be the extrication strategy of the FIA. This strategy is so out of touch with current practice that several Chief Medical Officers of circuits of the F1 season worry that by following the FIA’s own regulations they are putting themselves at risk of malpractice because of deviations from standards of care. This is so critical that some have even gone on record with their concerns.

I fully expect a vicious response from certain elements at the FIA. After attempting to have my employment at my previous hospital terminated, and after threatening (almost comically were they not actually “serious”) legal action against me, I now expect worse. But no matter – I devoted a large part of my career to caring for our drivers, and I will continue to do everything I can to make sure that the legacy of my mentor Sid Watkins is not sullied.

I am available to you for any assistance or expert testimony I can provide to help you on your painful and courageous quest for answers, and more importantly, changes, to make sure that others do not suffer as you have.

With all my respect, sympathy, and love,

-Gary Hartstein

 

It’s not you, it’s me . . .

It’s over. We’re officially on a break. It’s gotten to the point where there’s less pain separating than staying together. I never, ever, thought it’d get to this. But what’s going on just makes no sense, seems perfectly conceived to drive us all away, and is shameful and embarrassing. Maybe we’ll get back. But it’s not possible to think of that now. Good bye. Good luck.

No need to rehash the past, but let me just put some of the why’s on “paper” – it’ll make me feel better about this, help ME to put my thoughts in order. Maybe to convince myself that I’m doing the right thing by walking away. It might be a bit disjointed, a bit rambling. Sorry for that. I’m pretty emotional about this.

It started for me in 2008, with my demotion and replacement by someone who not only had never cared for an accident victim of any sort, but had only ever attended two or three races . . . as a spectator. At the time, I was told by the president of the FIA Medical Commission, “We still need your knowledge and experience, though. You’re our life insurance policy.” Can’t be clearer than that, eh? We need to wait a few years for the consequences to play out, but they do, and the price is awful. A grievously injured driver, barely clinging to life, spends three quarters of an hour on soggy roads in a creaking ambulance, before receiving proper care. It still sickens me.

Here’s a scoop: there will soon be published, in an international peer-reviewed journal, a scientific paper demolishing the current system of extrication that has not been changed in over 20 years, despite dramatic advances in this field. The lack of knowledge and experience at the medical lead is so blatant that several Chief Medical Officers of the F1 season are worried that by following existent FIA protocol they are making themselves vulnerable to medico-legal consequences by failing to follow current standards of care. Read that again. This from a sport that purports to be at the leading edge of everything.

I’ve ranted about this before, and stayed faithful to the sport. But there’s more.

The qualifying debacle currently playing out to the shame of all concerned is the proximate cause. Think back – the problem years ago was an empty circuit when meteorologic conditions were such that running wasn’t advantageous. True to F1 form, complication was chosen over simplicity. Rather than a simple rule constraining teams to get their cars out there or be penalised, all manner of contrivances were instituted. Only to wind up with . . . an empty circuit at the end of quals, arguably what should be the most exciting moments of all. I can’t say who gains by this, but I sure know who loses.

What about safety car procedures? I’ve never understood the delta times, never understood keeping the car out there for two or three extra laps so that “lapped cars may unlap themselves” All I know is that under conditions that by definition are some of the most dangerous, when the entire circuit is covered by yellow flags (need I quote again the regulation concerning driving under yellows?) we have guys driving flat out. Remember Fernando’s accident at Brazil? He used the first of his thankfully many lives there . . . under the safety car. And it’s only gotten worse. Once again, why do simple when we can do complicated. And the public (who want racing once the accident has been cleared, not cars unlapping themselves) be damned.

What about grid penalties? These were treated with humour last season, but seriously? Hundreds of places of grid penalties with a grid you can count on two hands and two feet? Who is kidding whom here? Who is mocking whom? I’m sick of being mocked.

What about engine tokens? With a brilliant and potentially transferable technological formula for energy recovery, we institute a byzantine system in a half-assed attempt to control costs. Complicated, when simple would do.

We’re not complicated, we the fans. We just want good racing. We want to see the skill and cleverness and bravery of drivers battling for position. We’ve all known for years that sophisticated aerodynamics makes for incredible cornering speeds, but makes overtaking more and more difficult. Everyone smart and savvy has been clamouring for years for less aero and more mechanical grip. Huge slicks and small wings – and let the drivers do the rest. What do we get? More aero in the next version of the tech regs, and a promised 4 to 5 second fall in lap times. Do any of us care about fast processional laps? That’s what I thought. The sport is not only not listening to us, but like a petulant child it’s thumbing its nose at us. How long must we endure that?

Should I mention tires? And the absurdly complicated allotment system, the engineered degradation “to make the racing more interesting”?

In a way, these are details, but they are telling. More importantly, MUCH more importantly, is what is going on with the circuits. The circuits are where it all plays out. Where we are reminded, season after season, of the glorious history of the sport. Where, depending on the stroke of the architect’s pen, we are either treated to almost two hours of thrills, or relegated to 305 kilometres of boredom. What about the circuits?

They are being strangled. They are being charged money, much too much money, for the privilege of hosting this soon-to-be farcical spectacle. They are signing contracts that guarantee multi-million dollar losses, and this despite often fantastic attendance. They are forced each year to beg, cap in hand, for a pittance to keep functioning, to continue to host a sport where BILLIONS are earned and distributed. And finally, one after another of the temples of this sport are throwing in the towel. Now Monza is under dire threat and may not be on the calendar in 2017. The only places who can meet the current levels of parasitic pricing are those with governments that are either flush with petrodollars (not sustainable anyway in the current market) or flush with corruption.Or both. Bernie and todt getting touchy-feely with Putin was and is an abidingly nauseating spectacle. Who are they kidding? And who is losing out here? Yep – we the fans. I’m sick of it.

todt has proven that, since becoming FIA president, he either has no idea how to make sure his flagship championship flourishes, or just doesn’t care. Either way, his term has been a shameful example of (almost laughably ineffective) self-promotion. Of blatant abdication of his roles and responsibilities. Of cowardly acquiescense to others.

Bernie, a man I love(d) and respect(ed), has apparently lost the plot. Or lost the ability to influence the plot. The man who created the modern sport of F1 can find nothing better to do than to slag off on it publicly. Can anyone remember the last constructive idea he has had, the last time we actually said “Thank God he’s around”? I sure can’t.

His business model, with floats and bonds and all manner of other financial manoeuvring too complicated for someone like me to understand, has created a monster. A monster whose driving force is profit . . . to the detriment of the fans. I’m not one to bemoan the role of money in global sport. Tennis, golf, football, etc are all multibillion dollar enterprises. BUT THEY CONSISTENTLY ACT IN THE INTEREST OF THEIR FANS BECAUSE THAT’S WHAT KEEPS THE DOLLARS COMING IN. Not F1. Soooo not F1. And I for one am sick of yacht-owning, Gulfstream-flying, Maybach-riding preadolescents bickering and yapping while the sport that made them rich burns. And while the fans who made them rich cry.

There you go. I’m out. Maybe if enough of us do the same they’ll realise where the true power is. But I have no intention of trying to start a movement. I just can’t keep investing emotionally in a sport that has no concern, demonstrably none at all, for us.

I’ll continue to follow all my F1 related twitter feeds.I’ll continue to love Lewis and Jenson and Fernando and Max and all of them. Continue to respect and admire their skill and courage. Continue to pray for them to be safe. But I won’t watch. I can’t. Not unless things change.

 

Luca di M’s statement

I have no idea at all what, exactly, Luca di Montezemolo means when he says that the news is not good. I’ve read speculation that actually he said something like “there’s no good news”, and that this has been mis-translated into “news that is not good”.

I assume that had Michael died, it would not be a furtive comment by a relatively distant ex-friend that would reveal this to the world.

We are now over two years since the injury. Despite the family’s silence, one can safely assume that were there to have been ANY good news, we’d have gotten it. After all, the family “allows” close friends to make statements (e.g. “he’s still fighting”, etc).

What we know is that two years after a severe head injury, a patient’s clinical status is (with near statistical certainty) not going to change. Given that the family’s own statements define what we call a “minimally conscious state”, this obviously is about as bad as news can be. What else can go wrong?

Because patients in a minimally conscious state have lost many of the body’s built-in “maintenance” functions, their life expectancies are significantly shortened compared to age-matched controls. Highly skilled and motivated nursing and medical care can forestall many or most of these, but they remain constant threats. The kind of things that happen to people in this situation are:

• muscle loss. This is both an expression of the effects of lack of activity, as well as a key factor in several other complications
• pneumonias. MCS is often associated with difficulties swallowing, and ineffective coughing to clear the normal secretions that our bronchi constantly produce. The loss of coordinated swallowing places the patient at risk of inhalation of oral and gastric contents, leading to repeated bouts of bronchopneumonia. This is a near constant in this group of patients, so much so that it’s virtually certain that Michael is fed through a tube inserted directly into his stomach or small intestine (a gastrostomy or jejunostomy tube).
• urinary stones. These are also extremely frequent, and can lead to repeated urinary infections. These infections can lead to septicaemia, and are a frequent cause of hospitalisation.
• pressure sores. Because these patients usually do not move much spontaneously, long-duration pressure on various parts of the body (back of the head, sacrum, heels) can compress the capillaries and lead to tissue breakdown and sore formation. No doubt the extraordinary care that Michael is receiving goes a long way to avoiding this problem.

Long story short? It’s possible that Luca di M is talking about one of the above complications. Anything worse? Could be, but I suspect that should this be a REALLY significant turn for the worse, the family might actually consider the millions of people who pray every day for Michael and say something.