Faster. Higher. Stronger… performancing enhancing drugs and the limits of responsibility ~ David J. Adams

Lance Armstrong. The Operation Puerto trial in Spain. The Australian Crime Commission investigation into organized crime and drugs. Recent doping scandals are just the latest reminders that the problem of performance-enhancing drugs has not diminished. In a recent article in the Guardian, the World Anti-Doping Agency describes the levels of doping as “worse than ever” with wide-ranging corruption. In the same article WADA Director General, David Howman admits that the problem is getting “bigger and more serious… and too big for sport to manage.”

Photo by madaise. Used with permission. All rights reserved. Source:

Photo by madaise. Used with permission. All rights reserved. Source:

Faster. Higher. Stronger…The pressure to perform is not just limited to athletes. More and more, clinicians and team medical personnel at all levels are finding themselves facing moral and ethical challenges around doping. In another recent Guardian article, Jason Mazanov, an anti-doping scholar at UNSW, and several other sources inside the industry, state that “the commercial pressures of modern sport are having a corrosive effect on medical ethics. ‘Sports medicine has become beholden to the performance process,’ Mazanov says.”  Mazanov points out how medical personnel can become servants and contractors, bowing to the wishes of the organization. “’Instead of acting in the best interests of the athlete, we are acting in the best interests of the sporting organisation. And the best and only interest of the modern sporting organisation, is winning, and by winning, turning a profit.’”

Even though WADA and ASADA have always been quite clear that athletes must take personal responsibility for anything that they take, what are the responsibilities of team medical personal? In the same Guardian article, Karim Khan is clear about the answer. “‘You have to be prepared to be sacked for your principles,’ Khan insists. ‘Once a doctor compromises his or her principles because they are scared of being sacked from a prestigious job, then they are making decisions on the wrong basis. And that’s disastrous.'”

Caught between promoting health and promoting profits, what can one do? The team clinician has an extremely important role to play in the prevention and management of doping problems. The primary role of the team clinician should be education of team members. This should involve regular briefings, especially prior to the season. Topics covered should include…

  • The Prohibited List (available here)
  • Prescription drugs
    • Athletes must inform clinicians that they are subject to drug testing and ensure that the clinician confirms that the medication being prescribed does not contain any banned substance
    • If the clinician is uncertain, suggest contacting the national anti-doping agency for confirmation
    • Inadvertent doping
      • Checking the contents of all medications, especially over-the-counter substances and supplements
      • If uncertain contact the national anti-doping agency for confirmation
    • Drug testing protocols
      • Especially the importance of listing all medications, including supplements
    • Travel
      • Be aware while traveling in foreign countries that drugs with the same or similar brand names may have a different composition in different countries
      • Always ensure that you take your own regular medications with you

For a comprehensive summary of the issues and challenges around performance enhancing drugs turn to “Drugs and the athlete”, Chapter 66 of Clinical Sports Medicine.

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