Sports Physicians and the Doping Crisis in Elite Sport

Abstract

The participation of sports physicians in the "doping" of athletes with banned drugs can be documented as far back as the 1890s. Concern about the ethics and safety of doping elite athletes appeared during the 1920s and 1930s as sport became an increasingly important form of popular culture. While organized medicine has opposed doping as a matter of policy at least since the 1950s, sports physicians have never adequately confronted the conflicts of interest that arise when they choose to work with elite athletes whose first priority is performance rather than with healing in the traditional sense. Confronted with the demands of their athlete-clients, sports physicians have divided into two factions regarding the wisdom and propriety of administering doping drugs to athletes. While most physicians are, in all likelihood, unwilling to violate laws, regulations, and medical standards by doping athletes, a significant minority of doctors has used one or more arguments to justify doping athletes: drugs are necessary to compete effectively; athletes should be free to medicate themselves as they please; drugs do not differ essentially from other performance-enhancing techniques or equipment; and medically supervised doping is safer than self-medication by athletes. Physicians can also rationalize doping as an occupational requirement of some professional athletes. In summary, physicians have played a significant, and largely unacknowledged, role in the doping of many elite athletes over the past 50 years.

Sports physicians, ethics and antidoping governance: between assistance and negligence

“…After that, one can reasonably expect the physician to make themselves aware of the athlete's needs and act accordingly. Other researches show that these cases are not isolated incidents but symptomatic of a wider professional issue 24. Clearly, international federations have a duty to guide their athletes towards specialist sports physicians where this is possible, and where a higher duty of care can be expected.…”

Prioritising health in anti-doping: What Australians think

“…When asked to comment on the Spirit of Sport statement, no respondent singled out 'health' for comment. These findings are at odds with the call for a harm minimisation approach 4,11,12 to managing the role of drugs in sport. The only group that ranked 'health' as being relatively important was the one that did not follow sport (nearly all of whom also did not participate in sport).…”

“…This approach is more commonly known as harm minimisation, which reflects efforts in illicit drug research and policy to focus on secondary prevention through, for example, medically supervised heroin use, 8 needle exchange 9 and injecting rooms. 10 Applied to doping, harm minimisation is about limiting adverse outcomes for athletes through medical supervision 4,11 or ongoing haematological testing to determine whether substance use has rendered athletes medically unfit to compete. 12 This debate has been dominated by medical and sporting experts with little input from the general public; there is no evidence whether the public has a preference for either or neither of the "law and order" or harm minimisation approaches to anti-doping.…”

An Investigation of How University Sports Team Athletic Therapists and Physical Therapists Experience Ethical Issues

“…3,6,9,14 Additionally, our study focused only on university sports teams, whereas much of the discussion in the literature focuses on, or at least includes, professional sports. Some of the issues reported by participants in this study that are not discussed in the literature were related to the management of eating disorders and mental health.…”