Published 8/1/2008

PEDs, supplements—harmful or not?

I am thrilled that AAOS has decided to address the critical issue of [performance-enhancing drugs (PEDs)] affecting so many of our society. The American Orthopaedic Society for Sports Medicine symposium on PEDs will deal with the problem and ask that we, as a society, step up to the plate and stand against the use of these dangerous drugs by athletes. Everyone enjoys being a member of a winning team, but for many years team physicians have turned a blind eye to the use of these drugs by players.

We need to educate ourselves and our athletes to the dangers of these drugs. Most PEDs have not been properly studied in prospective randomized trials. Yet, evidence exists that many PEDs do provide an advantage. Clear evidence also exists that PEDs have significant dangers that are being ignored or minimized by athletes.

As team physicians, we have the responsibility to protect our athletes. We all recognize that participation in sports has inherent dangers. The team physician has the difficult task of holding a player out from competition when the athlete is injured—despite protests from the athlete, coaches, parents, and fans. It is not an easy task. We must also stand against the use of PEDs, which potentially can help the team win the big game, but are dangerous and potentially life-threatening to the athletes that we have the solemn responsibility to protect.

Edward R. McDevitt, MD
Annapolis, Md.

After reading the article on PEDs, I would like to recommend that fellows see the recently released movie “Bigger, Stronger, Faster.” I found it educational, and it raised some good points. With its documentary format and anecdotal style, it raises several issues the medical community needs to address further.

Female replacement hormone therapy and its variations have been accepted. Many of the original feared risks have not occurred, although their specific use remains controversial. I have also seen positive responses in some individuals who use some combinations of male hormone replacement.

The use of male hormone supplements in teenagers and as performance enhancer in any of the sports where they are banned should not be supported. Con­sent­ing and medically informed adults who make this choice, how­ever, are a different arena. Although the article dealt with PEDs, physicians lose credibility among certain patients by treating their use [of supplements] as illegal drugs with­out further study. The scientific data needs to be expanded among those using supplements for “prolonging some of their youth (as we are living much longer)”, [improving] the physical quality of life, selected use in physical therapy for muscle atrophy and other specific indications.

Douglas W. Jackson, MD
Long Beach, Calif.

Writing to Congress, too
The following is the essence of my letter to my Republican congresswoman after her vote against halting the payment decrease to physicians:

I can foresee the headlines of the Washington Post on July 4, 2030: Where have all the American doctors gone?

The author will begin with Lyndon Johnson’s Great Society and track legislation that resulted in the migration of some of the brightest minds in the United States into other fields of endeavor that allowed autonomy in pursing their dreams.

Those of us who preceded them will be rightly accused of having acquiesced to the bullying of the politically influential insurance industry...

We will hopefully be rightly accused of altruism, as we attempted to continue to care for [our] patients with the highest quality known in the world. A few will be recognized for continuing the cause and honored by the individuals they have touched with compassionate care under the duress of a central agency...

Society will pity physicians as less valuable than entertainers, athletes, lobbyists, and politicians. Children will choose better-rewarded opportunities. They will miss the reward of another’s life saved or improved, a reward that cannot be legislated into extinction.

[Did] anyone in Washington care what contribution a satisfied physician made to “the pursuit of happiness” on July 4, 2008?

David M. Bratton, MD
Franklin, Tennessee

AAOS Now welcomes reader comments and efforts to “set Now straight.” We reserve the right to edit your correspondence for length, clarity, or style. Send your letters to the Editor, AAOS Now, 6300 N. River Rd., Rosemont, IL, 60018; fax them to (847) 384-8033; or e-mail them to aaoscomm@aaos.org