Olympic cheating

Wednesday, July 20, 2016

“Given that the Russian Ministry of Sport orchestrated systematic cheating of Russian athletes to subvert the doping control process; and that, the evidence shows such subversion in 30 sports, including 20 Olympic summer sports and Paralympic sports, the presumption of innocence of athletes in these sports, and in all Russian sports, is seriously called into question.”

-McLaren Investigation Report, WADA, July 18, 2016

Playing fields should be level. The same rules should apply to all participants. At the end of the day, the best athlete wins…or not, at least according to the World Anti-Doping Agency. With their report, old wounds are opened for Pamela Selimo, Martin Sundby, Wenxiu Zhang and the many other Olympians in London and Sochi.

Coming fourth by a fraction of a second is painful. No podium, no medal, no media. Punishing the Russian Olympic Federation and even current athletes does not restore the opportunity lost for those who finished fourth to a Russian medalist. Even if medals are reassigned, those who came fourth were denied their place on the podium, representing their country and perhaps hearing their national anthem played for all to hear. Financially, fourth place finishers tend not to be offered endorsements and other financial benefits that arrive on the doorstep of those who wear Olympic gold. Coping fourth hurts.

Demanding that athletes maximize their performance without the use of performance enhancing drugs seems fair and reasonable. The side effects of steroids, HGH, erythropoietin and other stimulants are life threatening. The trickle down to younger and younger age groups is inevitable if it is recognized that success demands the extra drug boost.

How much is that boost? Almost impossible to say but after the release of the WADA report, Martin Sundby might guess that it might be two tenths of a second, the difference between him and three Russians in the 50k cross country ski race in Sochi. Pamela Jelimo might think that it is only six one hundreds of a second, the blink of an eye between her and the Russian who won bronze.

The Olympic ideal of faster, higher, stronger has been under attack in the past many years and Rio may not offer a reprieve with the decertification and closing of Brazil’s testing lab. Once upon a time, an athlete’s reputation mattered and clean play was an expected norm. Perhaps it’s time to inject ethics into our Olympians instead of steroids.


With a little over two weeks to go, WADA announced the reaccreditation of the Rio drug testing lab . It had been closed because of nonconformity with International Standard for Laboratories, but now, it seems that all is well. According to the AP, Olivier Niggle, the director general of WADA was quoted as saying that “athletes can be confident that anti-doping sample analysis has been robust throughout the laboratory’s suspension, and that …the lab would be running “optimally” when the Olympics open.

Fans of the Olympic Games should remember that a false positive test can be devastating to an athlete’s career. Those who don’t indulge in performance enhancing drugs should expect 100% accuracy in their testing.


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lessons learned from the playing field

Monday, January 18, 2016

Learning about medicine from the playing field.

Randall Cobb of the green Bay Packers, leaps to catch a pass, lands awkwardly and sustains a pulmonary contusion, or bruised lung. After coughing up some blood, never a good thing but many times not disastrous, he is observed in hospital and is discharged home where his lung will slowly heal, just like any other bruise. The injury is a reminder that with chest trauma, and many people fall and hit their ribs, the x-rays done are to evaluate the lungs and not the bones. Doctors are more interested in whether there is a collapsed lung (pneumothorax) or lung contusion, while the patient is more interested in whether there is a broken rib. Regardless of whether the ribs are bruised or broken, the treatment is the same: pain control so that the patient can take a deep breath and expand the lung to prevent pneumonia, the most important complication of a minor chest injury.

Steeler receiver, Antonio Brown, suffered a concussion in the game against the Cincinnati Bengals and within 24 hours there were reports that he would be recovered within the week to play in the team’s next game. He did not. After his concussion, Green Bay Packer, Sam Shields took a month to recover before play9ing again. It is a reminder that there is no way to predict the brain’s path to recovery from concussion and there is no definitive test to determine that a brain has fully recovered and is able to withstand another blow. No matter the NFL protocols, concussion remains a diagnosis made at the bedside and return to play has no standard playbook to follow.

finger bony anatomy

Carson Palmer of the Arizona Cardinals had a new splint on the right index finger of his throwing hand to protect the PIP joint that had been dislocated. Fingers have three joints (the thumb has two), the metacarpophalangeal (MCP) that connects the finger to the hand, and the proximal interphalangeal (PIP) and the distal interphalangeal (DIP) joint. The PIP joint is commonly dislocated and can heal relatively easily but because of the complex anatomy of the hand, the bones can damage the tissues and tendons that surround the joint when they dislocate. Complications include a volar fracture of the thin plate of bone on the palmar surface of the joint can be broken, leading to joint instability and a boutonniere deformity where the tendons slide to the side of the joint and prevent the finger from completely straightening. It’s a reminder that hands are complicated and minor injuries may lead to major long term complications.

Joakim Noah of the Chicago Bulls dislocated his shoulder and will undergo surgery to stabilize the joint. In most people, surgery is not the first step in rehabilitation. They are allowed to undergo physical therapy to strengthen the shoulder and return range of motion before considering an operation. But in athletes or those who may not be able or willing to limit their activities, surgery is often the first and potentially curative step. Studies of young athletes and military recruits, that surgery after the first shoulder dislocation can prevent future dislocation 95% of the time. Without an operation only 5% will have stable shoulders. The reason has to do with the inherent instability of the shoulder. It is designed to have a wide arc of range of motion in all directions and for that reason, the surface area of bone in the joint is very small. The stability has to do with the soft tissues that hold the shoulder together from the capsule and the labrum to the ligaments and surrounding muscles.  When the shoulder dislocates, all these structures are damaged and stretched. Surgery, either arthroscopic or through an incision, is meant to tighten all the structures that have been torn apart. Rehabilitation takes months to return range of motion and power; Mother Nature does not like to be rushed when she heals soft tissues.

More lessons from the playing field next week.

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