FIFA World Cup 2018 — Will There be Concussion Miscues Again?

FIFA World Cup apperances 1930 – 2018 Picture courtesy of Dufo, from Wikimedia Commons

Ah, the long, lazy days of summer have arrived….or have they?

With a caveat that I must be mindful that fellow colleagues in different parts of the world may be experiencing different workloads right about now, I have been feeling of late both a sense of lassitude and a sense of professional, shall we say, anxiety.

My children’s school year has wrapped up — they certainly are in the mode of being lazy.  The multiple school sports I cover as a pediatric sports medicine physician have largely wrapped their respective seasons too.  There is a bit of a lull in my clinics.

On the other hand, in the larger sporting world, the schedule is most definitely heating up.  I find this to be one of the most interesting times of the year for sport.  In the USA, we are in the midst of the NBA and NHL basketball and hockey finals, and MLB baseball offers multiple games daily.  To our north, the CFL has just started its season.  In Europe, the tennis stars Rafael Nadal, Garbine Muguruza and others are experiencing the joys of Roland Garros.  Golf’s U.S. Open is just around the corner.

And, of course, in less than two weeks, the FIFA World Cup kicks off in Russia. The quadrennial event — alongside the Olympics probably the biggest global sporting event on the planet — opens on June 14 and will continue for a month, until the championship game on July 15.

Like many of my colleagues, I am a fan of sport as well as a physician.  I care about who plays, and find myself cheering on certain teams and certain players [Vamos El Tri!]

Like many of my colleagues as well, however, I am also eyeing this World Cup as a doctor, and I approach the event with concerns over how concussions will be handled in 2018. Read more of this post

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Open Water Swimming

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Sunrise over Lac St. Jean, site of FINA 10K and 32K open water swimming events

Amazing to think that the Rio Olympics opening ceremony takes place a mere week from now.

I am, currently, enjoying the good fortune of mixing with Olympians from several countries who will be headed there for the open water swim events.  This weekend I am in Roberval, Canada (3 hours north of Quebec City), at Lac St. Jean — where the FINA/HOSA 10K marathon World Cup and 32K Gran Prix events are taking place.

I am a FINA medical delegate at these events.  I have written about this experience before in a 2013 blog post:  the 32K Gran Prix event coincides with an historic open water swim that has been done for decades on this lake, the Traversee internationale du lac St-Jean.

It is a great pleasure to be involved in an international sporting event like this one.  The local organizing committee does fabulous work.  I am privileged to work with fellow FINA representatives from New Zealand and France. Outside of the work hours, we get to socialize some and partake in the hospitality of the Roberval community.

I also greatly enjoy working for the athletes, watching out for their health and safety.  I genuinely enjoy getting to know them and experience vicariously the thrill of their competition. The joy and challenges of sport are a special dimension of human culture —  I am sure this is what leads many of us to sports medicine.

I think it is those broader, aspirational aspects of sport that lead many of us in the sport medicine community to push back on efforts toIMG_2210 cheat, such as doping.  And it’s no surprise that for an elite, international event like this one FINA has doping surveillance as part of its core mission.  One of the roles I play during my time on site is to supervise the excellent work done by representatives of the Canadian Centre for Ethics in Sport, which conducts post-race testing on select individuals many of whom, as I have indicated, will be swimming soon in Rio, where we already have had headline-making doping news before the games have even begun!

We have published frequently on the issue of doping in the pages of CJSM and these blog pages.  We hope you take this chance to click on those links and look at some of that work, in advance of the upcoming Olympics.  And, since it’s Friday, it’s time to follow something new — I would suggest the Facebook page of FINA, which is so well done, and will be hopping with information about this weekend’s Traversee and next month’s Olympics.

Enjoy the Games!  Let them be competitive, safe, and clean.

Sports medicine: a career for all genders?

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Dawn Thompson, covering Brighton Marathon

I am pleased to step aside from writing for the blog today and turn over the stage to Dawn Thompson, CJSM Junior Associate Editor and a member of the ECOSEP Junior Doctors Committee.

Dawn and I have a shared background in sports medicine, but she brings a unique perspective to today’s post:  she is a woman, she is young, and she is still in training.  I am none of these things!

If sports is a mirror of society, then it should come as no surprise that in our own professional world we may see phenomena such as gender bias.   And for those of us who benefit from male privilege (me), Dawn’s post is a great reminder of the differential burden our female colleagues may face when trying to perform the same job duties as a man.

Here in the USA, 2016 is a particularly poignant moment in time: the Democratic party’s presumptive candidate for president is Hillary Clinton.  Will that political ‘glass ceiling’ be shattered?  What of our sports medicine colleagues who are women?  Do they face their own glass ceilings?

I cede the dais to Dawn:

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DT: It’s 1.30am on a Tuesday morning and I am wide awake. Ideas, thoughts, concepts are racing through my mind at a rate I could only dream of during normal hours. I don’t normally suffer with insomnia but I have just completed a particularly gruelling acute medical block whereby in 4 months I have worked 8 full weekends and a total of 32 nights. So as you can see my body clock is totally up the spout. There have been times when I have wondered why I chose this profession and how compatible it is with any sort of family or social life and times when I have marveled at what I feel can be the best ‘job’ in the world.

During these 4 months, Junior Doctors like myself across Britain have taken part in 6 days of industrial action in response to the proposed imposition of a contract they felt to be unsafe and unfair to patients, themselves and the NHS. One of the many complaints with regards to the new contract was the impact it could potentially have on women taking time out for maternity or to work less than full-time to raise a family. Indeed the governments own equality analysis summarised –

“While there are features of the new contract that impact disproportionately on women, of which some we expect to be advantageous and others disadvantageous, we do not consider that this would amount to indirect discrimination as the impacts can be comfortably justified” 

I have never particularly considered myself a feminist but I do expect a fair contract and I don’t expect to be treated any differently to my male counterparts based on gender rather than clinical acumen.

Data derived from the Health and Social Care Annual Workforce Publication 2014 showed that 57% of all doctors in training are female.  However things have not always been this way, in 1985 the year I was born, women made up only 16% of practicing doctors in the US. Some junior doctors are concerned that an unfair contract would send us backwards in terms of women in Medicine.  Already prior to this new proposed contract, pay inequalities exist in medicine.  A study published this week in the BMJ concluded that women doctors in the US earn less than their male counterparts even after adjusting for hours of work and specialty.

So what about the role of women in Sports Medicine? Read more of this post

A Sharapova Moment

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.  Read more of this post

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