Doping, Ethics, and the Sport Physician

• DOI: 10.1249/jsr.0b013e3182a4b877
• Publication Date: 2013-09-13T05:16:59Z
• Authors: Alan R. Vernec
• Keywords: Overtraining; Sports medicine

Sport physicians may become invested heavily in the success of their athletes, and even when there is no direct or indirect financial gain, sport physician push boundaries good medical practice (12). The ethical dilemmas with regard to return play conflicts interest have been described elsewhere (4,11), this commentary will focus on issue doping. Over years, who were involved doping athletes claimed that they monitoring properly simply assisting body's efforts at homeostasis. argument was if testosterone levels low from overtraining heavy competition, it could be boosted back up "normal" levels. Fatigue setting multiday endurance events cured a small blood transfusion judicious use erythropoiesis-stimulating agents. These doctors emphasized monitored strictly, thus, any risks minimal. "Only adequate safe controls can anabolic steroids viewed same light as antibiotics, anti-asthmatic other medications used daily life," stated U.S. Dr. Robert Kerr 1982, 8 years after androgenic banned. He eventually reversed his position upon realization often pushed drug extremes (1). This conclusion should not come surprise illustrated by British cyclist Tommy Simpson died Mont Ventoux during 1967 Tour de France while under influence amphetamines alcohol. "If ten pills kill you, I take nine," he reportedly said, calculating for conditions extreme heat dehydration (7). contested opinion relative harms substances continued expressed. In 1994, Italian Michele Ferrari quoted L'Equipe, "EPO dangerous, abuse is. It dangerous drink litres orange juice" (2). Nevertheless erythropoietin (EPO) has prohibited International Olympic Committee (IOC) since 1990. Some believed operating gray zone acceptable some historical contexts an argument. For example, early days transfusions, little concern over implications seen extension training method rather than ingestion substance. At time, concept had antidoping. Although first study transfusions 1945 (1), became more investigated widely 1970s which time began see performance-enhancing benefits (8). A steadying clamor arose ban reasons are banned — health fairness competition. debate summarized nicely 1982 N. Gledhill, although hemoglobin boosting rationalized being therapeutic, nevertheless analogous physiological gain artificial unfair increase performance. Therefore recommended IOC prohibit (3). Following 1984 Los Angeles Olympics, publicly acknowledged Cycling team, Medical Commission made first-ever (6). An increasing understanding related methods developed now defined World Anti-Doping Agency (WADA) Prohibited List Section M1; Manipulation Blood Components (9). sporting federations organizations certain starting 1928 Amateur Athletics Federation. IOC, spurred death Knud Jensen 1960 Olympics games, took leadership role antidoping harmonized list sports. After Festina cycling scandal 1998 concerns potential interest, evident need independent global authority. WADA, created 1999 funded half sports governments, responsibility maintaining 2004. published annually adopted 600 signatories Code. includes all almost international federations. few professional leagues own programs, but these many principles processes dialogue WADA. Central activities List. enumeration rules sport. Fair athlete's underlie reason existence rules. Once substance prohibited, becomes unequivocal athlete physician. Athletes (and physicians) found committed rule violation regardless intentions according principle strict liability (5). (In exceptional cases, sanctions reduced per Code.) claim carefully modifying physiology behavior specious one (13). risk particular methods, distorts notion level playing field sense reverberates through ranks Moreover, developing believe engage risky unmonitored) behaviors emulate stars and/or attempt reach elite itself cases far also wanting. Danger inherent element sports, wrestle improve safety, allowing desirable. large-scale social science studies, most accept encourage application There certainly continue academic debates what how best apply elaborate stakeholders, well individuals, suggest changes WADA periodic revisions Code Standards. point remains; once justification assist administer athlete. legitimate conditions, provisions where receive Therapeutic Use Exemption (TUE), clearly criteria Standard TUE (14). Doping undermines just fair attacks values beauty challenges pushing oneself limit, respect others, teamwork, winning honor, sadly diminishing art losing grace. always challenged difficult ethical/medical decisions beyond those doping, issues resolved verifying whether local anesthetics (not prohibited) different clinical/sporting situations return-to-play quite complex. "Do harm" still ultimate maxim guide physicians, must collective individual. Physicians responsible leaders promote spirit integrity rules, exist athletes. author declares does disclosures.