Is it ever okay to take a performance-enhancing drug?
Gary I. Wadler, M.D., FACP, FACSM, FACPM, FCP, is an internist with special expertise in the field of drug use in sports. He is the lead author of the internationally acclaimed textbook, Drugs and the Athlete. Dr. Wadler currently serves as the Chairman of the World Anti-Doping Agency's (WADA) Prohibited List and Methods Sub-Committee and serves as an ex-officio member of WADA’s Health, Medicine, and Research Committee. Additionally, he has served as a Medical Advisor to the White House Office of National Drug Control Policy, a Trustee of the Board of the American College of Sports Medicine and of the Women’s Sports Foundation. Among his other sports medicine activities, he has served as Tournament Physician of the U.S. Open Tennis Championships.
For his groundbreaking work in the field of drug abuse in sports, Dr Wadler received the International Olympic Committee's President's Prize in 1993. He is a frequent lecturer on the subject and his opinions are widely sought by the print and electronic media nationally and internationally. In 2007, he was selected by the Institute for International Sport as “One of the 100 Most Influential Sports Educators in America” and serves Chairman of the Communications and Information Committee of the American College of Sports Medicine. In addition, he is Chairman of the American Ballet Theatre's Medical Advisory Board where he oversees the development of medical guidelines for the healthy and sound training of dancers in the United States. Dr. Wadler is the Chairman of the College Council of the State University of New York at Old Westbury. Dr. Wadler maintains a private practice in Internal Medicine and Sports Medicine in Manhasset, New York and is a Clinical Associate Professor of Medicine at the NYU School of Medicine.
Question: Is it ever okay to take a performance-enhancing drug?
Gary Wadler: First of all, I think it’s very important to understand we don’t want to take somebody who has some sort of medical condition or disability that requires drugs and say he cannot participate at an elite level. So there is a process in place which enables an athlete who will be starting below the level playing field to come up to the level playing field but not exceeding it. And so if you have a disorder which requires a medicine that is otherwise banned, what do you do? Well, the process is called a therapeutic use exemption process. Basically the athlete would present evidence from experts who take care of him or her saying that a certain disorder exists. That would go to an independent panel of experts with the name redacted out and they would look at the data, the medical data in support of the diagnosis for which the athlete was seeking a permission to use the drug. So step one is for the panel to agree there was a disorder. Step two is to ask the question is there an alternative drug that can be used to treat that condition which is not prohibited? If the answer is yes and does not compromise the athlete’s health, then the answer is you can’t use the prohibitive substance; you have to use the alternative. If it turns out you can only use a prohibited substance, then they will get an approval or get an exemption for therapeutic use, they can use it for therapeutic purpose, therapeutic use exemption. And the exemption will stipulate the drug, the dose, the duration and then the monitoring so that one doesn’t use- for example, they had a problem and then abused the right that they got through the exemption. So if a certain the dose was okay, they’d say, “Well, I’ll take three times’ that amount,” or, “I got an approval so I can now”- so we monitor that. And that’s a tedious process, but it’s trying to assure that we are not in any way making it impossible for somebody who’s sick to participate; quite the opposite. For the most part, we should take our hats off to these people because they’ve overcome disabilities. But for it to work, it has to be very carefully administered, it should be a before the fact decision. Independence is a very important part of it, anonymity is a very important part of it and it’s been very effective.
Recorded on: 04/25/2008
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