Team Physician Consensus Statement: 2013 Update

Nationwide Children’s Hospital Staff Physicians and ATCs
in “the Horseshoe” at the Ohio State University, prior to game.

Earlier this week, several sports medicine organizations released a statement with which all sports medicine clinicians should familiarize themselves:  the “Team Physician Consensus Statement:  2013 Update.”

The Statement represents, in its own words, “…an ongoing project-based alliance” of the major professional associations associated with sports medicine  in the United States.  These include the American Academy of FamilyPhysicians (AAFP), the American Academy of Orthopaedic Surgons (AAOS), the American College of Sports Medicine (ACSM), the American Orthopaedic Society for Sports Medicine (AOSSM), the American Osteopathic Academy of Sports Medicine (AOASM), and this journal’s affiliated professional group, the American Medical Society for Sports Medicine (AMSSM).

This is an update of a statement first published in 2000.  It includes sections which define the role of ‘team physician’;  describe the requisite education and qualifications; enumerate the medical and adminstrative duties and responsibilities; and explore the relevant ethical and medicolegal issues.

The entire statement is worth a read, but I find the ‘ethical issues’ section most interesting. 

The consensus statement cites as an example of an ethical challenge to the Team Physician: “Pressure to supply/administer, hide use of or provide counsel regarding illegal, illicit, or performance-enhancing drugs.”  I have no direct experience (Thank God) to share regarding the experience of being a physician involved in such doping,  but I have followed with interest such stories when, all too frequently, they show up in the media.

Perhaps the most prominent such story playing out in the United States right now involves the ‘fake’ doctor Tony Bosch, the owner of ‘Biogenesis’, the Miami anti-aging clinic which is at the heart of Major League Baseball’s investigations into the use of performance-enchancing drugs (PEDs).

Unfortunately, there have been all too many ‘real’ doctors who have been complicit in organized, systemic doping of the athletes who were their charges.  There is Michele Ferrari, the Italian physician who has been linked with the PED use of multiple bicyclists, including Lance Armstrong; Dr. Ferrari is serving a lifetime sports ban for numerous anti-doping violations.  There have been the statements and papers by Michael Kaliniski, a sports and exercise physiologist from the Ukraine (now at Kent State, in Ohio) who has written about the systemic, supervised, physician-enabled use of blood doping by Soviet Union Olympic athletes.

Now, it’s one thing to be a physician ministering to athletes and knowingly involved in doping.  It’s a different matter to be inadvertently complicit in an athlete’s use of PEDs.

The most poignant story I know about a physician associated with doping is the well-known story of Andreea Mădălina Răducan, the Romanian gymnast who won gold in the 2000 Sydney Olympics only to then lose it after failing a post-performance drug test.   During those Games the gymnast had developed cold symptoms, and the Team Physician administered a cold-remedy that contained pseudoephedrine.  Innocuous enough stuff….aside from the absolutely critical fact that the chemical is on the IOC/WADA Banned Substances list.

The Răducan case was adjudicated in the Court of Arbitration for Sport, which upheld the decision by the IOC officials.  The panel did concede that Răducan had not gained any advantage by taking the banned substance (i.e. that pseudoephedrine was not performance-enhancing for her sport), and she was simply following a Team Physician’s instructions.  The panel nevertheless held to a strict interpretation of the Olympic Anti-Doping code, noting that use of a banned substance warranted this sort of penalty in spite of an athlete’s intention, in spite of inadvertent use, in spite of the fact that it may not be performance-enhancing.

The Romanian physician, Dr. Ioachin Oana,  was able to keep his medical license but was expelled from the Sydney Games and was made to serve a ban from participation in the 2002 Salt Lake City Winter Games and the 2004 Summer Games in Athens.

This is sobering stuff.  I can’t imagine the devastation one would feel personally and professionally to have caused this sort of outcome in one of my athlete charges.  As a Team Physician for a local secondary school and one of a group covering an NCAA Division II University, it inspires me to pick up the laptop and along with my morning coffee read (carefully!) the list of NCAA banned substances and the newly published Team Physician Consensus Statement!

Be sure to share your thoughts on the Consensus Statement here in the comments section of the blog or on Twitter @cjsmonline with the hashtag #TPCC. Enjoy your weekend.  The Tour de France wraps up as does the British Open on Sunday.  It should be a great sporting day!