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What drugs - part 2

EmergBikerEmergBiker Posts: 85
edited September 2007 in Pro race
Modra in the in 'what drugs' forum got me thinking.

If someone like him decided to go out and take performance enhancing drugs what would people think about the role of his GP in this.

Say for instance he decided to take performance enhancing drugs, but being a sensible chap, went along to his local GP and told him that he was going to do it. What should the GP do? Obviously I suspect they would advise that he does not, but he might decide to do it anyway.

In acting in the patients (misguided) interest, should the GP endevour to monitor his haematocrit (EPO) or Liver function tests (steroids) etc, etc, or should he tell him to get lost.

This is really a question of ethics and my conflict of interest is that I am a doctor, though not a GP, and I think there may be a publication on the ethics of this dilemma sometime in the future. However, from an ethical perspective it is analagous to people like Morgan Spurtlock eating McDonalds for a month and watching his blood tests alter with his family physician. Or perhaps it is analagous to treating a smoker with lung cancer????? Your call.

So, what do you think that the doctor of the amateur doper would do, and what do you think they should do.

If the patient were a pro cyclist it is ethically different as it is clearer that the doc might be party to a fraudulent activity.

E
EmergBiker

Posts

  • carlstonecarlstone Posts: 602
    I think if you lived in the USA there would not be a problem, you would just pay your money and get the service required (like professional bodybuilders do). However in my experience with 'older' holier than thou GP's in England you would get short shrift. I think you are more likely to get some help from a GP who is a sportsperson or more open minded.

    It is a difficult call for any GP and you can understand why someone on a six figure salary wouldn't want to get involved in what is seen in this country as morally wrong.
  • Tom ButcherTom Butcher Posts: 7,137
    I think a responsible GP should tell the person that they are putting their health at risk and to stop taking the performance enhancing drugs, but that if they don't they can come back when they've got some symptoms. It's not the place of the NHS to cooperate in sports doping.

    it's a hard life if you don't weaken.
  • ParleeParlee Posts: 2
    There are some private practices in London that offer these services, they kind of advertise under the guise of testoterone level checking and the like, but I have heard from people that they are more than willing to help with doping programs in an advisory capacity.

    The ethical question from EmergBiker has me thinking. Although I am certainley no expert on medical ethics, but I guess anyone can comment on any ethical question, they are dynamic and consatantly changing, so opinion does matter.

    In my opinion it is more ethical to give someone advice on limiting the risks rather than just letting them go off uninformed and do all kinds of damage. I guess there are similarities to the whole needle exchange and ecstacy testing programs. Some of these certainley have trained medical staff working for them. Drug use is illegal, but the previous two cases suggest that there are better appaches than head burying. People are gonna do it, so perhaps the most ethical thing is to ensure that they limit the damage.

    What do you think? Maybe I am way off...dunno...EmergBiker what would you do?
  • I have never been in that situation (thankfully), and as an ED doc I am unlikely to come across it as an issue. Having said that Dr Fuentes was a gynaecologist I think so anything is possible! As yet there is not a specialist training programme for doping, though there is now a training programme for sports specialists, which I would hope must cover doping at some point.

    I have had to treat many individuals over the years as a consequence of the complications of using performance enhancing drugs, but that is usually for a short period, and is usually not the time or place for prolonged ethical discussions.

    If I was (and am) a specialist I would decline as it is not my field and it is important to practice within your own competencies. I think the problem would be greater if you were the patient's GP and therefore have more of a responsibility for maintaining their overall health and well being.

    In those circumstances I suspect that I might take the cowards way out and refer to a colleague who was prepared to do it. I'm not sure that I could support cheating.

    It's a bad analogy, but if a doctor does not agree in abortion they can decline to discuss it, but are expected to refer on to a colleague who is prepared to do so. Clearly not quite the same but a potentially similar process.

    Dr Death.....do you have any thoughts from a sporting docs perspective???

    E
    EmergBiker
  • lateraluslateralus Posts: 309
    I agree with Parlee about the dangers of head burying, but I'd be interested to hear from the doctors here whether supervision would actually be practically possible under the NHS system. Almost inevitably, I would think that a GP would feel the need to refer such a person to a specialist, but would such a referral be possible/funded? It's hardly essential medical treatment. It hardly seems to be a case of "genuine need" but, then again, is it in the state system's interests to spend a bit of money trying to prevent someone messing around with PEDs from making a real mess of themselves and then requiring more costly treatment?

    Like most questions of this type, the more you think about it, the more complicated it gets!
  • ukcraigbukcraigb Posts: 113
    It’s a tough one, but I think there are many cases that are equivalent examples to the question posed by EmergBiker already occurring.

    For example, Methadone is given to recovering heroin addicts as a substitute, yet it is more addictive and in many cases people can just end up using methadone to supplement their addiction and carry on using heroin.

    Another example (not sure if its NHS or government funded) is Frank, where you can be told the risks of taking drugs but if your intent on taking them they also advise you what precautions you should take to make is as 'safe' as possible.

    What’s the difference between those two examples and monitoring a doper? None so far as I can see.

    That’s not to say I agree that GPs should monitor them, because I don’t. Took me 5 months to see a consultant demonologist and I usually cant get to see the GP for 5-3 days (at least) unless I'm seriously ill,

    Don’t see what dopers who inflict this on themselves should leach from the state.

    But on the flip side if they get seriously ill even more money will need to be spent on them. It’s a tough one!
  • What is a demonologist??? Sounds rather exciting!

    From a referral point of view it would not be easy as who would you refer to? There is a new programme of training for sports docs, but there are very few around and I would have thought that ethics would be a big thing for them. I must check and see if doping features in the curriculum.

    For example If you took
    testosterone would you see an endocrinologist.
    EPO a haematologist
    Stimulants a substance misuse specialist
    etc .etc.

    In fact when these people go and see 'a doctor' do they realise that they may have no subspecialist knowledge in the field at all.........?

    S
    EmergBiker
  • What is a demonologist??? Sounds rather exciting!

    From a referral point of view it would not be easy as who would you refer to? There is a new programme of training for sports docs, but there are very few around and I would have thought that ethics would be a big thing for them. I must check and see if doping features in the curriculum.

    For example If you took
    testosterone would you see an endocrinologist.
    EPO a haematologist
    Stimulants a substance misuse specialist
    etc .etc.

    In fact when these people go and see 'a doctor' do they realise that they may have no subspecialist knowledge in the field at all.........?

    S
    EmergBiker
  • lateraluslateralus Posts: 309
    EmergBiker wrote:
    For example If you took
    testosterone would you see an endocrinologist.
    EPO a haematologist
    Stimulants a substance misuse specialist
    etc .etc.

    Isn't Fuentes a gynecologist :?: :!:
  • Dr_DeathDr_Death Posts: 1,262
    MIssed this discussion intially but interesting question....

    Difficult as I would find it awkward to be complicit in this fictional persons actions but the doctor in me would want ot make sure they were OK. Agree that the 'new' sports physicians would probablt be the people in the know. One of my new consultants is running the sports doc training programme in the NE, I'll see what he thinks and whether this would be covered in their curriculum....
    Steve

    Trust me, I'm a doctor!

    http://www.vimeo.com/DrDeath
  • As a GP and rider I can hopefully answer your original question. We see lots of people who are endangering their health ,smoking,alcohol,drugs of whatever kind.From a legal point of view we have to provide all appropriate advice and monitoring of the effects these drugs have on them.I would not see a place for referring them to a Specialist unless they developed complications,in the same way we refer smokers/alcoholics etc.
    So far I have yet to see a cyclist using performance enhancing drugs but have seen young men on steroids from the local gyms!
  • Dr_DeathDr_Death Posts: 1,262
    Sorry about the delay, I've been on holiday and never quite got round to answering.


    I spoke to the Doc who is designing the curriculum for the sports medicine trainee's in the North East. He says that they will spend a fair amount of time covering the subject of doping and what should be done both with regard to prevention and monitoring. He referred me to the guidlines by the World Anti-Doping Agency, which basically states that whilst we should advise participants against using drugs, as we would people smoking etc, we have a moral obligation to check that they are not doing any harm. However this does not mean that we should be checking their Haematocrit on a weekly basis to ensure that they are within the legal range to ride. We would have no more obligation to check there blood any more often than we would other peoples, i.e. only if we suspect a problem.

    Also useful would be the official curriculum from the royal college of physicians - http://www.rcsed.ac.uk/site/CMD=VIEW/DO ... fault.aspx .

    He also told me that he would expect the newly trained SEM docs to be the chosen port of call for any GP/A&E doc who had any problems with this sort of thing / was unwilling to get involved.


    Steve
    Steve

    Trust me, I'm a doctor!

    http://www.vimeo.com/DrDeath
  • Thanks for all the posts folks. I guess I agree that there is a balance to be drawn between being complicit in the performance enhancement and recognising that you have to support people even if they are doing something potentially dangerous.

    It has not happened to me in the way described, but I have certainly seen many patients following the use of performance enhancing drugs.

    tachyarrythmias from stimulants
    collapse from GHB and insulin use (used by bodybuilders)
    Psychosis from steroids

    etc.

    In the acute event it is easy and there are few ethical problems. However, I think our GP and SEM docs will face some tricky challenges in the future.

    S
    EmergBiker
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