London, England
Monday 18th February 2013
Back in the 1980's, a researcher called Bob Goldman asked a group of elite athletes the following question:

"There is a pill in front of you.  It is a performance enhancing drug, that is illegal but also 100% undetectable.  If you take it, you will be guaranteed success in your chosen field, making you the best in the world.  However, it is also guaranteed to kill you in 5 years.  Are you prepared to take it?".

The Goldman Dilemma, as it has since been christened, was then repeated every two years over a 15 year period but always returned results consistent with the first study conducted in 1984 - that over half the athletes declared that they would take it.  This is in stark contrast to a study published in 2009, which asked the same question to a sample of 250 members of the general public, in which only 2 subjects suggested they would take the pill.

In light of the revelations concerning the state of the doping culture in professional sport in Australia, a group of researchers at the University of New South Wales in Canberra are repeating the study, sending out the survey across team sports in the country.  Interestingly a small pilot study conducted in Canada demonstrated an apparently huge shift in mindset, with less than 2% of competitors stating that taking the pill would be their action of choice. 

Does this mean that the message promoted by WADA that doping doesn't pay & that the stigma surrounding the use of illegal performance enhancing drugs is now starting to become more powerful, or does it simply mean that this stigma prompts the would-be cheats to keep their hypothetical indiscretions to themselves?  Given the evidence discussed in my last blog, unfortunately in certain environments it would appear the latter may be the more accurate assumption.

Yet now, the moral conundrum seems to be extending beyond the athletes.  Disturbingly, the very professionals charged by the sports clubs & organisations with safeguarding the health of their playing staff, are in some instances, being pressurised to apply their scientific knowledge & skills to more sinister effects.  In addition to the athletes, the sports scientists, doctors & sports physiotherapists are also now being asked what they are prepared to do in order for the team to achieve success on the sporting field of play.

In many cases, the individuals are strong enough & morally tough enough to make the right decisions, however, the reports of instances where the clinicians haven't been able to make the right calls under pressure are high profile & damaging.  

The "Harlequins Bloodgate Scandal" concerned the rugby team's physiotherapist, Steph Brennan, giving a fake blood capsule to a player & directing him to bite it in order to get a blood replacement player on the pitch during the end stages of a Heineken Cup game the team were losing in 2010.  As the opposition confronted the referee alleging foul-play, the player concerned panicked & coerced the club doctor, Dr Wendy Chapman, into cutting his lip in order to manifest an injury.

The physiotherapist was suspended, the doctor was suspended, the club was fined & Dean Richards, the Harlequin's Director of Rugby resigned & was banned from the game for 2 years for establishing an institution of bullying at the club.

Yet as a clinician working in sport, there is no training in place to prepare you for this type of pressure that you could potentially face in such environments.  It's effectively pot-luck for the professions involved, whether or not the individuals concerned are up to the task...& believe me, many of the professional bodies aren't geared up to supporting clinicians working in sport.  Critically, their advisers have rarely, if ever, been in these environments themselves & have no concept of the situations you are faced with working in such organisations.

Jason Mazanov, an anti-doping scholar at the University of New South Wales, in Canberra stated in an article in the Guardian on Friday that:

"We are servants.  We are contractors.  We do what we are told instead of what we are supposed to do.  Instead of acting in the best interests of the athlete, we are acting in the best interests of the sporting organisation."

Dr Karim Khan, editor of the British Journal of Sports Medicine, added in the same article that:

"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. & that's disastrous."

Absolutely disastrous, when, as I discussed in my blog regarding the confidence of the NFL Players' Association members in their medical care, many of the doctors see their work in the professional sports settings as a marketing tool for their private endeavours.  Is that link between a sporting role & a business practice, really a healthy arrangement & one that is in the best interests of the athletes playing in these teams?  I would argue not.

A further concern to all those intent on cleaning up the culture of doping in certain sports, is that there is massive investment in the doping industry.  According to WADA, this massive investment is supported by substantial muscle & muscle that has no scruples...organised crime muscle with huge financial interests in sporting corruption to be specific.  

Such is the concern regarding the problem of corrupt influences becoming involved in sport & directing operations in doping, as well as match fixing & insider betting, that WADA are calling for global law enforcement agencies to support their operations & establish a "sports integrity unit".

In the light of such information, it really is about time that the professional bodies supporting our clinicians, for example the British bodies of the GMC (General Medical Council), CSP (Chartered Society of Physiotherapy), HPC (Health Professional's Council) & BASES (British Association of Sports & Exercise Science), stood up & addressed how their professional members are protected, educated & advised when working in sporting environments.

Should the sports MSc qualifications include greater education components in their modules?  Should they be providing helpline numbers to support those backed into a corner & feeling isolated in their working roles?  Should they be educating their legal advisors regarding the idiosyncrasies of working in professional sport so that clinicians have access to affordable, appropriate & adequate support if they find themselves in a compromised situation?  These are just some of the questions that need to be asked in my opinion.

Comments below, please!!!

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