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BMA, London: BMJ Publishing Group, 2002, £16.95, pp 165, softcover. ISBN 0727916068
This is a paperback book produced by the British Medical Association and is touted as “an invaluable aid.” I would beg to differ, and, in addition to several factual inaccuracies, the overall impression was that this had not been written by anyone who had been involved in the care of the elite athlete. Many can write a text by reviewing relevant material, but you can tell if the authors have an intimate working knowledge of the topic. When I looked at the names of the editors and contributing authors, I could not recognise any name as a doctor involved in elite sports medicine in the UK despite this being a British book. Furthermore, the topic of doping is ever evolving, and it will become increasingly inaccurate with the adoption of the World Anti-Doping code for the 2004 Olympic Games. Doping is an area where accuracy of information is imperative. A lot of the information looks almost like a “cut and paste” from the IOC website, which, for accuracy at the time of production, is fine but the authors lack the ability to translate this into meaningful practical issues. For example, in discussing caffeine it states “because caffeine is so widely consumed in beverages…, the IOC permits up to 12 μg/ml in urine”. So what might this mean in practical terms for the athlete? However, this is no longer pertinent because caffeine is now not restricted, its use only being monitored. With regard to information on local anaesthetics, it says “local anaesthetics are permitted in sport, when medically justified and subject to certain restrictions, principally relating to the route of administration.” What exactly would this mean to the young sports doctor trying to decide whether to use an injection or not? Yet again the evolving doping world does not place restriction on the use of local anaesthetics now. The detail on the IOC’s requirement for evidence of asthma is so sparse that the doctor would not know what evidence is required. The process of therapeutic use exemption (TUE) which is now required for notification of β2 agonists and glucocorticoids and other substances on the banned list required for therapeutic reasons had not started when the book was published, but is now one of the major logistical minefields that sports doctors face. It correctly states that pharmaceutical, chemical, and physical manipulation are prohibited methods of doping, but is unable to give the reader any examples of what this might mean, how athletes have tried to beat the tests in the past, and why the regulations on the sample collection procedure had to evolve as a result.
I became increasingly angry and frustrated as I continued to read this text. The issue on confidentiality of information seemed black and white to the authors. The dilemma for the team physician when one of the players admits in confidence to anabolic steroid abuse before a major game and, if tested positive, would result in the team being eliminated provides a scenario that requires a greater challenge to the management of the issue. This is particularly the case if the doctor is employed by the sport to care for the athlete, and the athlete is funded by the World Class Performance programme with money paid to them by their sport. The notion that the National Sports Medicine Institute is a membership organisation is false (also sadly the organisation no longer exists!). The proposal to involve the Health Development Agency in education issues in doping is flawed, as they have no prior experience in this area. Carbohydrate loading using an intensive seven day training to deplete stores initially on a protein rich diet has not been recommended for some years. I could go on and on. Why oh why didn’t they have knowledgeable authors with working experience in the topic? To anyone other than those with a passing interest in what was happening in anti-doping a few years ago, it is potentially dangerous and should not be purchased.
Evidence basis 7/20
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