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Performance enhancing drugs; damned if you do, and damned if you don't
  1. Charles Dean
  1. Glendale Surgery, Wooler, Northumberland NE71 6DN, United Kingdom

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    Editor,—I recently attended the BASM Annual Conference, and was interested by the obviously conflicting views on and attitudes towards performance enhancing drugs highlighted during the discussions.

    The divergence of opinion was extreme. In the blue corner was the “ban em and string em up” brigade and in the red corner the “lets forget about them and legalise them all” (well not quite so extreme).

    The facts surrounding performance enhancing drugs remain.

    • Athletes and recreational sportspeople use them, almost certainly, more than we imagine: as many as 2.8% of Canadian school children test positive for anabolic steroids.1

    • Unsupervised drug use increases the risks to the users immensely—for example, adverse effects, risk of infection.

    • Drug testing fails to identify the users of many of these drugs, because of clever dosage regimens, known adulterating mechanisms, and probably a less than total commitment to detect high profile users.

    • Harm minimisation can reduce the use of these drugs, remove the more toxic drugs from the user's repertoire, and monitor users medically to ensure that they are advised when detectable harm is observed.

    There is a duty of care to these users that is clearly stated by the General Medical Council (GMC): “it is …unethical for a doctor to withhold treatment from any patient on the basis of a moral judgement that the patient's activities or lifestyle might have contributed to the condition for which treatment is being sought. Unethical behaviour of this kind may raise the question of serious professional misconduct.”2 In the same document it is stated, “ …all problem drug misusers—irrespective of age, gender, race, and drug of choice—must have proper access to support from appropriate services –including primary care …”

    There needs to be a frank and open debate about these issues. It simply is not enough to say that this is banned so we can't address the issues.

    The GMC is to include the following statement in the next edition of Good Medical Practice, 2000: “Doctors who prescribe, or collude in the provision of drugs or treatment, with the intention of improperly enhancing performance in sport, would be contravening GMC guidelines and such actions would usually raise a question about a doctor's continued registration.”

    So “de-registered” if you do, and facing serious professional misconduct if you don't.

    This knee jerk reaction to the words “sport and drugs” will undoubtedly lead to a retraction from the GMC, as surely as the lawyers would grow rich on the legal definition of the word “collude”.

    The debate must move on. We must know how to monitor people using such drugs, we must be able to know how to reduce the use of the most harmful drugs, and we must recognise that even the government knows that “just say no” never works.

    The Council of the British Association of Sports Medicine proposed to the GMC that it “ …is of the opinion that doctors found intentionally involved in helping athletes and others to commit a doping offence, as defined by the IOC, are guilty of professional misconduct.”

    This is a step on the road of a rational policy towards this problem, but sports doctors and general practitioners need to learn more about this problem, not so that we can grow fat by association with the ultimate striving for success, nor in collecting fees for this information, but simply to improve the care we give to patients.

    Their obvious similarities to other drugs of abuse mean that there is a lot of information readily available and some of that is relevant to this select group of drug abusers. We do not have to invent the wheel, merely modify it.

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