injuryupdate
19-04-2006, 01:53 PM
Drugs and Competitive Sports
Lippi, Giuseppe MD; Cesare Guidi, Gian MD
To the Editor: The recent article of Schweizer et al1 sensibly highlighted a critical and contradictory issue in sport medicine and antidoping testing. A track and field athlete who tested positive for salbutamol in urine during a competition received a 2-year ban for use of anabolic steroids. This should not be considered an exceptional case, nor should its consequences be underestimated. According to the most recent list of prohibited substances and methods issued earlier this year by the World Anti-Doping Agency (WADA),2 a positive test for salbutamol (urinary concentration >1000 ng/mL) is no longer considered an adverse analytic finding, provided that the athlete demonstrates that the abnormal result was the consequence of therapeutic use. The use of β-2 agonists is banned unless an athlete submits a request for an Abbreviated Therapeutic Use Exemption, which places a bureaucratic burden on athletes and physicians in the course of the treatment of a very common condition. Athletes might suffer from a wide series of common diseases, which require appropriate treatment to ensure prompt recovery and the prevention of further undesirable complications. There are anecdotal reports of athletes who withdrew from international competitions because they did not wish to use commonly prescribed, but prohibited, medications to treat conditions that occurred in the course of their participation (eg, insect bites, and other inflammatory or allergic reactions that would ordinarily be treated with glucocorticosteroids). Athletes, despite the provision for therapeutic use exemptions in the WADA code, have refused treatment with prohibited substances because of a fear that ultimately they may test positive and be disqualified.
The aim of antidoping organizations and committees is to keep sports doping free. However, we believe that when a repressive approach is pushed to an unacceptable limit, it might produce undesirable ethical and medical consequences. We should always keep in mind that the main scope of clinical and laboratory medicine is to prevent, diagnose, and treat diseases, not to ensure fairness of competitions. Therefore, we should be aware that carried to unreasonable lengths, approaches to the control of doping developed for laudable reasons may increase medical risk and eventually erode confidence in and support for antidoping measures among athletes and their physicians.
Giuseppe Lippi, MD
Gian Cesare Guidi, MD
Istituto di Chimica Microscopia Clinica Dipartimento di Scienze Morfologico-Biomediche Università degli Studi di Verona Verona, Italy
REFERENCES
1. Schweizer C, Saugy M, Kamber M. Doping test reveals high concentrations of salbutamol in a Swiss track and field athlete. Clin J Sports Med. 2004;14:312-315.
[Fulltext Link] [Medline Link] [CrossRef] [Context Link]
2. World Anti-Doping Agency. The world antidoping code. The 2005 prohibited list. 2005. Available at www.wada-ama.org/rtecontent/document/list_2005.pdf.
[Context Link]
Lippi, Giuseppe MD; Cesare Guidi, Gian MD
To the Editor: The recent article of Schweizer et al1 sensibly highlighted a critical and contradictory issue in sport medicine and antidoping testing. A track and field athlete who tested positive for salbutamol in urine during a competition received a 2-year ban for use of anabolic steroids. This should not be considered an exceptional case, nor should its consequences be underestimated. According to the most recent list of prohibited substances and methods issued earlier this year by the World Anti-Doping Agency (WADA),2 a positive test for salbutamol (urinary concentration >1000 ng/mL) is no longer considered an adverse analytic finding, provided that the athlete demonstrates that the abnormal result was the consequence of therapeutic use. The use of β-2 agonists is banned unless an athlete submits a request for an Abbreviated Therapeutic Use Exemption, which places a bureaucratic burden on athletes and physicians in the course of the treatment of a very common condition. Athletes might suffer from a wide series of common diseases, which require appropriate treatment to ensure prompt recovery and the prevention of further undesirable complications. There are anecdotal reports of athletes who withdrew from international competitions because they did not wish to use commonly prescribed, but prohibited, medications to treat conditions that occurred in the course of their participation (eg, insect bites, and other inflammatory or allergic reactions that would ordinarily be treated with glucocorticosteroids). Athletes, despite the provision for therapeutic use exemptions in the WADA code, have refused treatment with prohibited substances because of a fear that ultimately they may test positive and be disqualified.
The aim of antidoping organizations and committees is to keep sports doping free. However, we believe that when a repressive approach is pushed to an unacceptable limit, it might produce undesirable ethical and medical consequences. We should always keep in mind that the main scope of clinical and laboratory medicine is to prevent, diagnose, and treat diseases, not to ensure fairness of competitions. Therefore, we should be aware that carried to unreasonable lengths, approaches to the control of doping developed for laudable reasons may increase medical risk and eventually erode confidence in and support for antidoping measures among athletes and their physicians.
Giuseppe Lippi, MD
Gian Cesare Guidi, MD
Istituto di Chimica Microscopia Clinica Dipartimento di Scienze Morfologico-Biomediche Università degli Studi di Verona Verona, Italy
REFERENCES
1. Schweizer C, Saugy M, Kamber M. Doping test reveals high concentrations of salbutamol in a Swiss track and field athlete. Clin J Sports Med. 2004;14:312-315.
[Fulltext Link] [Medline Link] [CrossRef] [Context Link]
2. World Anti-Doping Agency. The world antidoping code. The 2005 prohibited list. 2005. Available at www.wada-ama.org/rtecontent/document/list_2005.pdf.
[Context Link]