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Coaches and players may be focused on winning, but team physicians must provide education and counseling on medical issues, including supplements and performance-enhancing drugs.
Courtesy of Darrin Klimek\Digital Vision\Thinkstock

AAOS Now

Published 10/1/2011
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Peter Pollack

Looking for an edge: Steroids, supplements, and “vitamins”

Team physicians must help athletes to make smart choices; gauge risks

“Being a team physician may sound like a dream come true, but with the job comes significant responsibilities,” said Edward R. McDevitt, MD, “You want your team to win, but the safety of the players must come first.”

What’s the problem?
Speaking at the 2011 annual meeting of the American Orthopaedic Society for Sports Medicine, Dr. McDevitt discussed his experiences with coaches, players, and the pressure on players to use performance-enhancing drugs. Dr. McDevitt has served as a team physician for 15 years at the United States Naval Academy (USNA).

Offering an example, he related a story from his early days at the USNA, when he was confronted by a coach who attempted to talk around the issue.

“The coach said to me, ‘Doctor, I want you to give the boys vitamins,’” explained Dr. McDevitt.

“I said, ‘We do; we give them a daily multiple vitamin, as well as vitamin C, B-complex…’

“‘Doctor…doctor…vitamins. Vitamins that make them bigger and stronger. Vitamins that can help us compete.’

“‘Are you talking about steroids?’
“He said, ‘I’m not saying anything, but you know what your job is. You know what you have to do.’”

Following this encounter, Dr. McDevitt contacted a colleague who worked for a professional sports team and explained his reluctance to procure steroids for his players.

“What’s the problem?” the colleague asked. “Don’t you want your team to win?”

Risk vs. benefit
Dr. McDevitt explained that not only did he believe steroids to be unsafe for the players, but because the players were members of the U.S. Navy, they could be discharged from the military for unprescribed use of the drugs. Further, AAOS team physician guidelines state, “The principal responsibility of the team physician is to provide for the well-being of individual athletes—enabling each to realize his/her full potential.”

“Is the team physician’s responsibility to simply do whatever the coach wants?” he asked. “No, it isn’t.”

According to Dr. McDevitt, the team physician should provide appropriate education and counseling regarding nutrition, strength and conditioning, substance abuse, and other medical problems that could affect the athlete.

“This isn’t something that is taught during residency,” he said. “I did not receive this type of training, but I believe it is our responsibility as team physicians to learn the risk-to-benefit ratio of all aspects of the athlete’s life—including the food and any other legal or illegal drugs being used by our athletes.”

The situation, he said, is not always clear. Supplements such as creatine are not steroids, but can produce muscle-building effects. And although the governing bodies of many sports do not ban creatine as a performance-enhancing drug, players need to be made aware of any possible risks related to its use. Some studies have shown that low doses of creatine may be safe, but concerns have arisen that creatine may be linked to asthmatic symptoms and, in certain cases, possible kidney damage.

“Many athletes get their information from muscle magazines,” said Dr. McDevitt. “Often, the publishers of those magazines have ties to the vendors of the products the magazines are touting. Although supplements are becoming increasingly popular, relatively few scientific studies have been conducted to measure their effects. We need more prospective, randomized, double-blinded trials and long-term data about the impact these drugs and supplements have on the body.”

Dr. McDevitt urged all team physicians to research the risk-to-benefit ratios of any substances to which the players may be exposed.

“What drugs and supplements are your athletes likely to use?” he asked. “Take a look around your local retailers to see who is selling vitamins or ‘sports nutrition’ products. Stop in and see what’s available. Talk to the salespeople. You’ll be amazed at what they’ll tell you: how great and safe these supplements are.

“I encourage all team physicians to look at the science behind these performance-enhancing chemicals and focus on what is best for the long-term well-being of the athletes. Remember that ‘legal’ does not equate with ‘safe’ nor does ‘natural’ equate with ‘safe.’ Understand the risk-to-benefit ratio of any drugs that are being used. And keep learning, because things keep changing.”

Disclosure information: Dr. McDevitt—Nutramax, Biomet, Genzyme, Merck, Pfizer, Zimmer.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org

Bottom Line

  • Athletes are often exposed to nonscientific information regarding performance-enhancing drugs and supplements.
  • Despite pressure from coaches, parents, and athletes, team physicians should always first consider the long-term well-being of the athletes.
  • Physicians must learn continually to stay ahead of ever-changing trends in the development and use of performance-enhancing drugs.

Resources:

Athletes: Play Sports Clean, Hard and True - AAOS

If you’re not cheating, you’re not trying

The seductiveness of supplements

PEDs, supplements: harmful or not?

Is drug testing the answer?

PED use: Legal, natural, and deadly

Anabolic Steroids to Enhance Athletic Performance Position

Creatine Supplements - Your Orthopaedic Connection - AAOS

Use of ergogenic aids by athletes