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Drugs in sport: the pressure to perform
  1. C Jarvis
  1. Governing Body Medical Officer, British Cycling, Hon Medical Advisor, Commonwealth Games Council for England, The Old Rectory, Trevalga, Boscastle, Cornwall PL35 0EA, UK;

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    British Medical Association, London: BMJ Books, 2002, £15.95, pp 192, paperback. ISBN 0727916068

    The book was launched in association with an excellent one day conference held in London in 2002 and attended by the reviewer. It was researched and published before the publication of the IOC study detailing widespread problems with unlisted banned substances in supplements and undoubtedly the authors will mention this in any future edition. Not all the authors’ names will be familiar to British sports physicians, and some reference to their professional backgrounds would have been useful. That said, the assistance of the Anti-Doping Directorate at UK Sport is acknowledged in the preparation of the text.

    It is an easy read and laid out in such a way that those without a medical qualification will be able to bypass some of the more complex pharmacology and access the main data. It is a good primer for all involved with the care of athletes, and I would suggest that even the experienced sports physician will find some new information therein. Each chapter is well referenced and would enable the reader to research further specific areas of interest. On page 11, the book makes reference to the “1970s survey of elite US college athletes”. This is the questionnaire in which athletes provided their (theoretical) response to taking an undetectable drug that would guarantee a gold medal but would lead to their early death. I had always thought this to be a sports medicine urban myth—but to my surprise a reference is provided.

    The introduction briefly reviews the history, legal regulation, and ethics of doping agents and also athletes’ attitudes to the problem. The main categories of ergogenic drugs are then scrutinised, including their therapeutic categories, potential to enhance sporting performance, and their adverse effects in the short or long term. Further chapters deal with doping in elite sport and the use of anabolic androgenic steroids in British gymnasiums. A pedantic thought, should that plural actually be gymnasia? The three appendices at the back of the book detail the UK anti-doping programme, laboratory analysis procedure, and contact details of UK national governing bodies.

    One paragraph on page 85 is particularly topical: “ Sports medicine - is there a lack of control?” This refers to a 1988 Lancet editorial recommending that sports medicine should be brought under the umbrella of a recognised body with accredited training. Progress over the intervening 15 years has hardly been rapid, but at least there’s a joint government/profession working group currently taking this forward.

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