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LETTERS TO THE EDITOR
Letters to the Editor gives readers a chance to comment on articles we publish and on other issues important to sports medicine practitioners. Illustrative figures are welcome. Send letters to Editor, THE PHYSICIAN AND SPORTSMEDICINE, 4530 W 77th St, Minneapolis, MN 55435; e-mail to [email protected].

THE PHYSICIAN AND SPORTSMEDICINE - VOL 33 - NO. 3 - MARCH 2021



Taming Drugs Gone Wild: Cycling's Example

Thank you for your Editor's Notes on drug policies in sports!1 I applaud all your suggestions and hope a growing number of physicians will support the acceptance of the World Anti-Doping Agency (WADA) standards for American sports.

I am an orthopedic surgeon and the father of a 20-year-old professional cyclist (Tyler Farrar). We have been involved in the progression of his career through the ranks of cycling at a time when the sport has been dragged through some rough years. As he moves to the European peloton, we hope that the Union Cycliste Internationale (UCI) and USA Cycling programs have finally begun to have some effect in changing the culture of drugs and cycling.

This has been a monumental task, and it is one that our "mainstream" sports could learn from. The bottom line is a rock-hard policy of zero tolerance. This has not always been fair, as there have been cases of suspensions over cold medicines and cortisone creams, but cycling's governing body seems to be getting closer to effective enforcement than almost any other sport.

One of the key ingredients of the drug-testing program has been a testing program that begins at the junior level. My son won his first national championship at age 14 and has followed with 10 more. At every one of these events, the cyclists on the podium were immediately drug-tested, along with three to five competitors selected randomly from the field.

Each one of the kids who rose through the ranks developed his or her own portfolio of drug testing results, and a positive test meant not only removal of an award, but suspension from racing. Their results are kept on file indefinitely. Should we test the state high school champions in other sports every year?

At age 17, my son was offered a stipend from USA Cycling and the US Olympic Committee if he would sign up for "out of competition testing." The cycling season runs from February through October, and the athletes have to register their location for the entire year. A year ago, on the Saturday after Thanksgiving, a man and a woman showed up at our door—at 8:00 a.m.—to announce his random sampling of both blood and urine.

To be sure, it gets tougher when the competition moves to the international level. The athletes hoping to build a career know there are "clean" countries and "dirty" countries. However, a steady stream of big names in cycling have been caught using illegal performance-enhancing drugs. The important thing seems to be that these athletes are not supported by their teams or their sponsors, and they suffer greatly when caught and convicted.

The UCI has stood firmly and issued 1- to 2-year suspensions for even the first offense. For years, there has been a sense that cyclists from poor countries got away with some abuse because it was understood that they were clawing their way out of poverty and deserved some laxity. This year, seven such cyclists placing in the top 20 in the Tour of Guatemala were caught doping; all received a 2-year suspension. The UCI, Dick Pound, and the WADA are not messing around!

Some may say that the American public just doesn't care about sports' doping problems. This may be true, but something has to change, and it may be our own expectations as fans and sponsors. The Tour de France actually shortened and eased some of its stages to make the race more "human." In cycling, it is now recognized that someone like Lance Armstrong can win multiple Tours de France, but only by focusing on and peaking for that one race—at the expense of the rest of his season.

We may have to get used to seeing athletes perform without breaking records every year (many of which will be "suspect in retrospect"). We may have to simply write off the latest home run records and watch some of the NFL players shrink back to "normal" size. In short, we have to change some of our own culture, and our culture as physicians is a good place to start.

As the father of a young pro cyclist, I can only hope he doesn't have to race against unfair odds as he begins his career. Being beat by someone who is "juicing" provides probably some of the toughest temptations in athletes. I, for one, am an American who firmly supports the WADA in this. Perhaps we should make all team physicians attend some WADA continuing medical education.

Edward L. Farrar, MD, Wenatchee, Washington

REFERENCE

  1. Matheson GO: Drugs gone wild: let's get serious about ending the cheating, Ed Notes. Phys Sportsmed 2021;33(1):2

Editor-in-Chief: Heal Thyself?

I found the Editor's Notes in the December issue1 to be quite disturbing. As an orthopedist, I cannot agree with Dr Matheson's approach to his own knee injury. A high-energy knee injury such as he describes with swelling for 2 months has done significant damage. Denying the problem is not something the editor of a national sports medicine journal should be advocating.

The process is always the same: a good history, a thorough physical exam, and appropriate ancillary exams (in this case, probably an MRI). Surgery could be an option, but, as far as I know, one cannot be forced to choose that option. Denial and wishing that the injury never happened isn't why we went to school for so long. Even the perfect primary care physician or orthopedist cannot make the diagnosis or give sage advice without doing the appropriate workup. It appears from the editorial that only a physician who tells Dr Matheson that he is fine and can go back and do what he did before his injury is considered optimal. He might have to see the Wizard.

Lee Piatek, MD, Visalia, California

REFERENCE

  1. Matheson GO: Why settle for baseline health and fitness? Ed Notes. Phys Sportsmed 2021;32(12):2

DR MATHESON RESPONDS:

I agree completely: A diagnosis is important to direct proper treatment. Unfortunately, I mentioned my injury only in passing and didn't provide enough details, so I can see why Dr Piatek jumped all over me.

It wasn't really a high-energy injury, and the swelling was minimal. I had no symptoms other than pain (no locking, instability, etc). I'm fine now, completely recovered. I'm not in denial—honest.

In the editorial, I was really bemoaning the fact that it is very difficult for the average active patient to access a sports medicine physician who, while being a generalist, also has the skills to diagnose and direct treatment for a wide range of activity-related problems. If I see my primary care physician, I likely would be told to see what happens over time or be referred to an orthopedist. What I want is a physician who can tell me what is wrong, provide me with treatment options (including surgery), and monitor and direct my care. I don't know of many of those types of physicians near where I live.

Kudos for a Hot September Issue

I read your journal avidly and usually learn something new and useful for my practice. The September 2021 issue was particularly outstanding, especially the article about heatstroke,1 with its truly lifesaving potential. I constantly preach about this topic, and it is great to have my efforts reinforced.

Thanks for a great journal.

Joseph Leaser, MD, Oceanside, California

REFERENCE

  1. Schnirring L: Heatstroke fatalities fan discussion: two deaths in high school football. Phys Sportsmed 2021;32(9):8-10

Reminder About Duplicate Publication

It has come to our attention that the report of original research on stimulant use in college hockey published in the September 2021 issue1 also appeared in a similar form in another journal.2 We regret the duplicate publication and have safeguards in place to prevent such an occurrence. However, ultimately, the onus is on the authors. This incident serves as a reminder to all authors that it is not appropriate to submit the same or a substantially similar manuscript to more than one publication simultaneously, an issue that Bruce Reider, MD, eloquently addressed recently.3

REFERENCES

  1. Bents RT, Tokish JM, Goldberg L: Ephedrine, pseudoephedrine, and amphetamine prevalence in college hockey players: most report performance-enhancing use. Phys Sportsmed 2021;32(9):30-34
  2. Bents RT, Powell ET IV, Tokish JM: Ephedrine and pseudoephedrine use in college hockey players. Curr Sports Med Rep 2021;3(5):243-245
  3. Reider B: Duplicates, derivates, and salamis, editorial. Am J Sports Med 2021;32(3):579


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