A Sharapova Moment

Maria Sharapova https://commons.wikimedia.org/w/index.php?curid=15070905

The world of sports medicine is never boring, but who knew things could get this interesting?

In the first weeks of March, there have been at least two major stories that have transcended the borders of ‘sports medicine’ and become topics of debate for the world at large — I speak of the proposed ban on tackling in schoolboy rugby (and the continued debate on tackling in American football) and Maria Sharapova’s admission that she failed a drug test at the recent Australian Open.  For both stories, the boundaries of the discussion have gone well beyond the lines of the playing fields and the walls of the academy.

Social media has seen these topics trending. The mainstream media have been profiling the issues as well.  The Economist weighed in on the debate about tackling. And this morning I found the New York Times prominently featuring Ms. Sharapova’s story, including articles on the drug meldonium [for which Sharapova tested positive] and on the issue of the World Anti-doping Agency’s (WADA) use of emails to notify individuals about changes on WADA’s banned substance list.

Many people have an opinion on the subjects.   We’ve been running a poll on this blog regarding the issue of tackling, while our friends at the British Journal of Sports Medicine (BJSM) have been running a Twitter poll on the Sharapova issue: who is responsible, the player or her support staff [currently the poll is 74%/26% stating it’s the athlete’s responsibility].

In the New York Times article and in the BBC, former WADA-president Dick Pound has stated his opinion that Sharapova’s failed drug test was ‘reckless beyond description.’

I must say I take issue with this and empathize with Ms. Sharapova, who stated that she received in December the WADA email noting that meldonium was now on the banned substance list, but “…I did not look at that list.”  Meldonium was a PED legal until 2016, when it was placed on the ‘banned substances list.’ As a professional inundated with emails, alerts, pronouncements, and more, I confess to a certain degree of information overload even when it comes even to items vital to my licensure and ability to practice.  Have I ever received an email from the Medical Board that I have deleted?  Have I ever received notification from my hospital staff office of some new change in policy which I glossed over?  Yes and yes.

Regarding the WADA emails, other athletes in the NY Times article have offered this opinion: “Some dismissed the messages as irrelevant to their own regimens or too complicated to be useful.”  That certainly resonates with me and my professional world.

I am not writing this to absolve Ms. Sharapova, and I applaud her for her prompt and open admission of personal responsibility. That stance is right and proper.  But I would hardly deem her action “reckless beyond description.”

In CJSM we have published over the years several studies on banned substances. One of the pieces of original research just published in our March CJSM sheds some further light on this issue, I think: Dietary Supplements: Knowledge and Adverse Event Reporting Among American Medical Society for Sports Medicine Physicians. The focus of the paper is not on drugs, but dietary supplements are found to be a not infrequent, attributable cause of failing a screening test [as well as causing adverse events] and most if not all medical support staff and athletes understand the importance of staying aware of what is in the supplements that they use.  The authors of the paper looked at several outcomes.  Two of the findings that I found especially noteworthy: only 51% of surveyed physicians stated they had a reliable source of information on dietary supplement safety, and only 10% had ever reported to an agency an adverse event that had occurred under their care.

The authors conclude, “The significant gaps in physician knowledge regarding how and where to report such events indicate a need to educate physicians on this subject.”

I don’t have any simple answer for the issue of knowledge transfer when it comes to banned substances.  I applaud WADA in its efforts to push back on what is undoubtedly a large number of people (athletes and staff) who are intentionally trying to skirt the rules (more than 60 athletes have failed tests for meldonium in addition to Sharapova).  But as the organization casts its nets, I do think undoubtedly they will catch athletes who unintentionally are using banned substances.  At the end of the day, I do think the athlete him/herself needs to take responsibility.  But are they reckless?  Are they guilty in a different way than others?  And more to the point, might we be more interested, I hope, in prevention than punishment?

I can’t help feel as I do when a physician makes an error in the hospital — how do we prevent a repeat of the mistake?  Is it in assigning blame and punishment? Or is it in addressing systemic gaps in knowledge, execution, and performance?  The evidence in the reduction of medical errors is quite clear:  preventive systems that work, not individual punishment after the fact, is the answer

I have to believe if ‘we’ are serious about helping other sincere athletes avoid a Sharapova moment, we can rely on other systems than email to get the job done.  After all, email is so…..2000.