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Drugs in sport: one year on, where are we now?

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Dr Peter Larkins*

According to some it was our ‘blackest day’. A day where the dark underbelly of elite sports was exposed, revealing a culture of widespread supplement use involving coaches, players and other club officials.

Twelve months on, with our innocence seemingly lost and the lines of what constitutes sports medicine blurred, what have we learnt and where do we go from here? 

 There is no doubt the past year will go down in history as one of the most difficult for sports medicine professionals at the elite level.

Sadly, we are in the midst of an era where some sporting administrators are either ignorant, or in blatant disregard, of the ethical and clinical principals which dictate sports medicine professionals’ decision making.

 Over the last year we have seen a number of cases where medical decisions relating to player health and wellbeing have been made by some with no clinical qualifications and without medical consultation.

While it must be stressed that it is only a small minority of rogue individuals working under the label ‘sports scientists’, these controversial cases highlight the extent to which sports medicine professionals have been marginalised by clubs and coaching officials in pursuit of the competitive edge.

The role of the sports medicine professional, and in particular the team doctor, is one of utmost importance at the elite sporting level.

The concept of medical decisions being made by non-medical personnel is fraught with danger, and poses serious risks to the health and wellbeing of players, particularly in relation to issues such as injury management and nutrition supplementation. 

The fact that these ‘sports scientists’ were able to gain employment at the highest level of sport in Australia without any accountability to a code of practice or similar ethical standards, highlights the lack of respect for the importance and responsibility of the sports medicine team in some elite sporting environments.

The resignation of several leading and long-serving team doctors from a number of NRL clubs reinforces the severity of the situation, and is symptomatic of the broader governance issues plaguing the elite sports world that have emerged over the past year. 

The key takeaway from the past 12 months should be just how critical a role the sports medicine team should, and must, play at an elite sporting level.

Doctors, allied health personnel and coaches must work as a collaborative team, with the welfare of the player as their number one priority. All medical decisions must be made in consultation with the team doctor.

In order to protect the safety of our sportspeople and the integrity of the games we love, we must ensure that all practitioners at the sporting club level are accountable for their actions in the same way that qualified sports medicine practitioners are accountable in their practice.

The release last week of the AFL’s new anti-doping code is a positive step in that direction, and one that should be commended.

However, I have always considered it to be totally inappropriate that anyone other than a qualified club doctor would be administering injections to players.

The AFL’s decision to appoint an Integrity Officer is one that should also be commended, and illustrates the AFL’s commitment to increasing ethical standards in order to protect the safety of the players and the integrity of the game.

 Similarly, it is vital that all doctors associated with sport familiarise themselves with the World Anti-Doping Agency (WADA) drug code and keep their sports medicine, drugs and supplements knowledge up-to-date.

It was undoubtedly a difficult year, but there has been progress, and there is positive work to be done.

In Australia we have a fantastic culture of providing sports medicine care at both the elite and community level, and we will continue to work to ensure our approach and culture is reflected at a club, coach and governance level.

* Dr Peter Larkins is a sports physician and spokesman for Sports Medicine Australia.