A quack heard around the world

Iused to be a rusted-on Essendon Football Club supporter. Now I am witnessing the spectacle of the club falling apart under the weight of its own hubris.1 Despite attempts to control the dark side of human achievement, as epitomised by the Olympic motto of citius, altius, fortius (faster, higher, stronger), the slogan that Essendon produced at the start of the season — “Whatever it takes” — is probably the vulgar form of that motto.

From a parochial activity graced by extraordinarily gifted performers, where amateurs could become world champions, sport is now a globalised industry. Gifted performers still exist, but now so does the temptation of using whatever genetic, physiological and chemical products scientists can provide, and of delving into the realms of quackery to improve performance. Some products work, some do not. Those that do have four possible outcomes: an improvement in fitness without side effects; a short-term improvement in fitness but with longer-term side effects; no change; or an impairment in fitness, even to the extent of poisoning the sportsperson.

A raft of other participants have also come into the field: sports scientists, psychologists, trainers and sports medicine doctors. There are clues to the emergence of the sports medicine doctor. In my teenage years, doctors who also excelled at the top level of sport, such as Roger Bannister, David Theile (Australian Olympic backstroke dual gold medallist) and John Solomon (Wallabies captain), continued in clinical work. This has changed, with the demands of working across two professions compounded by the identification of potential champions at school. When you are expected to look forward to 10 000 hours of training, what hope is there of also doing a medical course? The part-time sportsperson–part-time doctor is a thing of the past.

As sport has become increasingly competitive and professional, there has been a need for a more knowledgeable full-time commitment from the medical profession. The emergence of sports medicine has been accompanied by improvements elsewhere, such as in orthopaedic surgery, that can prolong sporting careers. However, at the other end of the scale have come problems such as chronic head injury, the sequelae of which are left for geriatricians.

At the same time, there have been major improvements in sport technology, such as running shoes, tennis racquets and bicycles. But excelling in sport is now also intrinsically associated with a training regimen that includes drug-taking, whether it be vitamins, supplements or steroids — all of which have themselves seen “improvements”. While the murkier side of bodybuilding caricatures that industry’s dedication to self-image, more insidious is the quest for the extra 5% from the test tube — a monkey gland peptide perhaps? Which doctor or witch doctor?

The recent announcement that a single federal minister will hold the portfolios of both health and sport in Australia perhaps recognises a paradoxical link — that of injury. Injury blocks both high performance and healthy lifestyle. This combined political approach may yet be a prescient move that brings sport, medicine and training of both sportspeople and doctors into the same arena and ensures injuries and sport “supplements programs” are managed with appropriate medical oversight.

However, just as Australia’s apparent failure at the 1976 Olympic Games saw the establishment of the Australian Institute of Sport, in the aftermath of revelations about inappropriate supplement use in the major football codes, it may be timely to put forward a new thesis wherein medical involvement in sport and training does not focus only on the elite athlete.

In the Australian Alps, popular for skiing, snowboarding and mountain biking (all of which are overrepresented in terms of injury), the frontline doctors are experienced and practical general practitioners who impart their snowfield expertise to a range of younger doctors. Teaching is part of their service commitment, from medical students onwards. These services remove the practice of sports medicine from the elite conditioning of athletes in an institute of sport, where few may venture, to a place where everyday exercise and injury are close by.

Professor Jim Best, Head of Medicine at the University of Melbourne, has shown interest in exploring a broader involvement in sports medicine. The university could become a lead agency in developing a training facility at the ski resort of Falls Creek in north-eastern Victoria that would combine the current medical service and teaching arrangements with a new model for year-round sports training in a “clean” environment. Falls Creek has been suggested as a possible site because of its accessibility. Discussions so far have culminated in an unpublished report that could form the basis of a serious look at how best to build up such an environment of service, teaching and research.

The other side of the ledger involves the University of Melbourne taking the lead in getting major sporting bodies to support such a facility. There is already a lot of training at altitude in summer, but this facility would be a year-round extension of a highly ethical winter medical service, coupled with a culture of teaching, research, sports medicine and training. The broader and more important objective is to move outside the clubroom and put the culture of sports medicine on an open, sustainable and safe platform. Such a facility, with its mixed role and staff with different competencies, could be a place for doctors to undertake workshops to improve their expertise. A year-round facility where staff are attuned to the needs of part-time sports doctors should also help ensure they are taken more seriously.

Much work has to be done, but it is time to leave behind the spectre of young footballers being injected off-site by untrained people.

And for Essendon, it may be just the tonic.