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LukasCPH

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Re: Meldonium
« Reply #90 on: March 10, 2016, 15:39 »
The issue with using GPs to prescribe drugs is taht they don't know whether they're banned or contain things that are banned. That is why athletes need specific advice on the medical rules that apply to their sport. I actually wonder whether the opposite is better, to have accreditation and regulation of medical personnel who will have to answer to any positive tests. The issue has always been accountability, there's an endless supply of athletes who are prepared to cheat so maybe it would be better to focus on cutting off the supply of enablers.
Yes. Right now team staff aren't really held accountable for a doping positive. They should have a share of responsibility - which doesn't lift responsibility from the athletes entirely.

I have no problem with drugs being taken for a medical condition, of course I don't. I think all prescription drugs should be on the banned list and an athlete shouldn't be racing or training, the drugs should be prescribed by an independent doctor and each course of treatment should require another consultation and a TUE. Which is then made public.

How about that? public TUEs, rider/athlete, drug and prescribing doctor? any objections?
Medical confidentiality should still be preserved - but using numbers or codes solves that issue, as you say yourself. :)
Give them a number, remove the name (that was probably a bit much). It removes a little accountability, but gives a little respect back, which is important.

Athlete number. Drug. Prescribing Doctor

Happy days.

I don't know about all prescription drugs being on the banned list. What about basic antihistamines during hayfever season? Or oral contraceptives in the female peloton? There are plenty of prescription drugs that you could be taking for things that don't relate to your ability to ride.

As for the rest of your points. Independent doctor giving out TUEs, rather than team staff? YES. Public database of TUEs given (even if the names of rider and/or doctor are redacted)? YES AGAIN.

It's an extension of AG's point about WADA. They took action on meldonium[1] reacting to a known situation that was being exploited. I would argue that the TUE system is a loophole that is being exploited by teams. So close the loophole - there is fine-print to be worked out, but I can't find a serious reason not to do it.
 1. Look at that, this post is almost on topic..!
I agree, not all prescription drugs. 'Chronic' prescriptions (oral contraceptives, antihistamines & similar) shouldn't need a TUE ... or only once, when you start taking it.
Everything else, blue-stamped by independent medical staff? YES. Public TUEs? YES.
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    cj2002

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    Re: Meldonium
    « Reply #91 on: March 10, 2016, 16:17 »
    Rafa Nadal has weighed in on the Sharapova case...

    http://www.theguardian.com/sport/2016/mar/10/rafael-nadal-maria-sharapova-meldonium

    Quote
    “I want to believe that for sure it is a mistake for Maria, that she didn’t want to do it, but it is a negligence so the rules are like this. It’s fair, so now she must pay for it,” Nadal said.

    So far, so good, right...

    Quote
    Asked whether he personally read all communications on anti-doping, the Spaniard replied: “To be honest I don’t read it. I have my doctor that I have confidence in. My doctor is the doctor of the Spanish tennis federation for a lot of years. He is the doctor of all the Spanish tennis players so I have full confidence in him. And I never take anything that he doesn’t know.

    Those are my italics... I need not expand on why...  :-x ;) :shh
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  • He shook his head sadly and told me that endemic drug use had compelled him to give up a promising career. "Even one small local race, prize was a salami, and I see doping!" - Tim Moore: Gironimo (Riding the Very Terrible 1914 Tour of Italy)

    Claudio Cappuccino

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    Re: Meldonium
    « Reply #92 on: March 10, 2016, 17:58 »

    Grey areas, always grey areas.
    Grey areas wouldnt exist if the sporting bodies would forbid athletes to take drugs/medicines without them having need to take them apart for health reasons. And if there would be a need for medicines there should always be a pre-dated prescription from a certified doctor. One needs cortico's: go see the doctor, take your shot and rest for a week. One needs Tramadol? Take 2 asprines and go to bed. One needs testosteron? Tough luck, no habla Espanjol.

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  • t-72

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    Re: Meldonium
    « Reply #93 on: March 10, 2016, 21:44 »
    I posted about meldonium before it became mainstream!  :shh

    (still think I didn't start this thread so guess the editors have been editing this putting my posts from the general thread on top.....)  :cool
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  • Joelsim

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    Re: Meldonium
    « Reply #94 on: March 10, 2016, 21:46 »
    I posted about meldonium before it became mainstream!  :shh

    (still think I didn't start this thread so guess the editors have been editing this putting my posts from the general thread on top.....)  :cool

    2006?

     :shh
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  • Havetts

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    Re: Meldonium
    « Reply #95 on: March 11, 2016, 15:21 »
    https://twitter.com/AP/status/708310718647508993


    Makes you wonder how many people were using it in the first place and then quit if that many people were STILL using it after it got put on the WADA list.
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  • cj2002

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    Re: Meldonium
    « Reply #96 on: March 11, 2016, 18:45 »
    I'm on a train so I can't put links or anything eloquent together. But, briefly...

    Head. What the actual flip? A racquet manufacturer questioning WADA. Just... Words fail me.
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  • LukasCPH

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    Re: Meldonium
    « Reply #97 on: March 11, 2016, 19:03 »
    I'm on a train so I can't put links or anything eloquent together. But, briefly...

    Head. What the actual flip? A racquet manufacturer questioning WADA. Just... Words fail me.
    Standing by their woman. ;)
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  • Kiwirider

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    Re: Meldonium
    « Reply #98 on: March 11, 2016, 20:57 »

    The issue with using GPs to prescribe drugs is taht they don't know whether they're banned or contain things that are banned.

    Not true.

    There is a wealth of information about drugs that is available to any doctor. That includes details of the composition, dosages under various conditions and for various treatments, contraindications, generics available, etc., etc. This information is comprehensive - which stands to reason, as it is one of the few safeguards between the doctor and prescribing something that will kill a patient (says I, as someone who is violently allergic to penicillin).

    Add to this WADA's prohibited list which clearly states the various compounds that are illegal - irrespective of the commercial name of the product.

    So, any doctor - be (s)he a team's embedded doctor, a specialist who supports professional sports teams (like my friend the orthopedic surgeon who used to regularly step in as game day doctor for an NHL team) or a GP - have a wealth of information to prevent the accidental mis-prescription of an athlete.

    All that it needs for that system to work is a conversation that goes something like this:

    Athlete: Doc, I'm feeling poorly, here are my symptoms
    Doc: OK, I think that you have (INSERT CONDITION HERE) and suggest that we give you (INSERT MEDICATION HERE)
    Athlete: That's great Doc, I'm feeling better already! Have you checked that it's not on the latest WADA list - I'd hate to get banned for life for taking drugs.
    Doc: Good point! I'll check right now ... (A short time later). All clear ... you're good to go!

    And if that fails, then the pharmacist is a further check - as in most medical systems, they have the ultimate responsibility for any wrongly prescribed drugs (since they actually dispense the product - doctors technically only "recommend" them). Again, personal experience says that this is a good check (eg., when locums have failed to read my allergy details on my records).

    Of course, I realise that the massive flaw in my logic is assuming that the drugs are actually prescribed - as opposed to bought via the back door of the pharmacy or factory ...
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  • Joelsim

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    Re: Meldonium
    « Reply #99 on: March 11, 2016, 21:30 »
    I'm on a train so I can't put links or anything eloquent together. But, briefly...

    Head. What the actual flip? A racquet manufacturer questioning WADA. Just... Words fail me.

    Head playing the long game. A cheap extended sponsorship, goodwill from MS... She'll be standing with a Head racquet and a Festina watch in no time.
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  • l29205

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    Re: Meldonium
    « Reply #100 on: March 11, 2016, 23:28 »
    Not true.

    There is a wealth of information about drugs that is available to any doctor. That includes details of the composition, dosages under various conditions and for various treatments, contraindications, generics available, etc., etc. This information is comprehensive - which stands to reason, as it is one of the few safeguards between the doctor and prescribing something that will kill a patient (says I, as someone who is violently allergic to penicillin).

    Add to this WADA's prohibited list which clearly states the various compounds that are illegal - irrespective of the commercial name of the product.

    So, any doctor - be (s)he a team's embedded doctor, a specialist who supports professional sports teams (like my friend the orthopedic surgeon who used to regularly step in as game day doctor for an NHL team) or a GP - have a wealth of information to prevent the accidental mis-prescription of an athlete.

    All that it needs for that system to work is a conversation that goes something like this:

    Athlete: Doc, I'm feeling poorly, here are my symptoms
    Doc: OK, I think that you have (INSERT CONDITION HERE) and suggest that we give you (INSERT MEDICATION HERE)
    Athlete: That's great Doc, I'm feeling better already! Have you checked that it's not on the latest WADA list - I'd hate to get banned for life for taking drugs.
    Doc: Good point! I'll check right now ... (A short time later). All clear ... you're good to go!

    And if that fails, then the pharmacist is a further check - as in most medical systems, they have the ultimate responsibility for any wrongly prescribed drugs (since they actually dispense the product - doctors technically only "recommend" them). Again, personal experience says that this is a good check (eg., when locums have failed to read my allergy details on my records).

    Of course, I realise that the massive flaw in my logic is assuming that the drugs are actually prescribed - as opposed to bought via the back door of the pharmacy or factory ...

    I have stayed out of the discussion up until now.  A GP while they may have access to the information about what is banned.  There is no guarantee that they will access the correct information for the year in question since they will probably tell a nurse or an assistant to look up the info for them (which is just one example).  What do they lose, if they prescribe a drug that is proven to work for the symptoms in question that maybe banned by the WADA?  Answer nothing.  Most GP's do a good job.  They are universally overworked and will not be bothered to do due diligence beyond figuring out if what they are prescribing to fixes the symptoms the patient describes.  WADA is not going to be on their minds.  They will know nothing of TUE's or related procedures. 

    Next question on using GP's versus team doctors.  Hypothetical situation, I live in the US.  I race for a WT team in Europe.  That means my normal GP is 6 time zones away.  I get in a crash.  I am unconscious and cannot communicate all of my potential medical issues and because of medical privacy laws in the US they cannot release them.  So would it not be beneficial to have a single point of contact that has worked through all the various laws and has complete access to all the doctors I see.  No, don't you can't give him that blood thinner to prevent clotting after the accident he is allergic or he is on a non banned drug that already acts as a thinner.  Just an example. 

    Finally, Pharmacists only know what is prescribed at the time.  If you go to multiple ones there is no means for them to check what is being prescribed by the others there are no other safe guards.  It is getting better in the US as the FDA cracks down on opiate farmers going from doctor to doctor for their prescription high   
     
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  • AG

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    Re: Meldonium
    « Reply #101 on: March 12, 2016, 00:04 »
    But

    a - if you crash and are unconscious, there are allowances for that (no fault etc)

    b - if you are riding for a WT team, you dont take drugs given to you by your GP back home, you go to the team doctor, (or if your argument is that there shouldnt be any team doctors, you find a local GP who can actually assess you.

    c - the reason that WADA, and most National Anti Doping Agency's have a hotline or web site is for you to ring or look up to ASJK if specific drugs are allowed.   You get a receipt, and if it turns out later that the drug was actually banned ... you get a free pass because you have a receipt.


    The problem is not with unhealthy athletes taking medicine to get well.

    The problem is with healthy athletes taking drugs to try and improve their performance, and ending up taking substances that are banned.

    If you push the boundaries ... if you choose to take supplements or drugs in order to increase your performance, you NEED to ensure that those drugs are not banned.

    Its that simple
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  • Kiwirider

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    Re: Meldonium
    « Reply #102 on: March 12, 2016, 00:27 »
    I have stayed out of the discussion up until now.  A GP while they may have access to the information about what is banned.  There is no guarantee that they will access the correct information for the year in question since they will probably tell a nurse or an assistant to look up the info for them (which is just one example).  What do they lose, if they prescribe a drug that is proven to work for the symptoms in question that maybe banned by the WADA?  Answer nothing.  Most GP's do a good job.  They are universally overworked and will not be bothered to do due diligence beyond figuring out if what they are prescribing to fixes the symptoms the patient describes.  WADA is not going to be on their minds.  They will know nothing of TUE's or related procedures. 

    Next question on using GP's versus team doctors.  Hypothetical situation, I live in the US.  I race for a WT team in Europe.  That means my normal GP is 6 time zones away.  I get in a crash.  I am unconscious and cannot communicate all of my potential medical issues and because of medical privacy laws in the US they cannot release them.  So would it not be beneficial to have a single point of contact that has worked through all the various laws and has complete access to all the doctors I see.  No, don't you can't give him that blood thinner to prevent clotting after the accident he is allergic or he is on a non banned drug that already acts as a thinner.  Just an example. 

    Finally, Pharmacists only know what is prescribed at the time.  If you go to multiple ones there is no means for them to check what is being prescribed by the others there are no other safe guards.  It is getting better in the US as the FDA cracks down on opiate farmers going from doctor to doctor for their prescription high   
     

    To add to AG's comments ...

    Firstly, the point in the Captain's post was that GP's don't have access - not that they wont access - WADA lists, etc. So your argument is off point.

    Second, your first paragraph has a few inconsistencies in it - not least saying that doctors pass off decisions about prescriptions to nurses and then later saying that doctors check the drugs before prescribing.

    Third, if that first paragraph describes the US medical system, then I think that's one more reason to add to my list of "why I'm glad that I live in Canada rather than the US" ... That said, I suspect that, given how litigious you folks are down that side of the 49th, you are probably not accurately reporting how doctors behave. If I'm wrong, I'll just say that my experience in other parts of the world where I have lived and worked is that GPs are better than what you describe - busy, but also better ...

    Fourth, the bit about pharmacists just makes no sense - unless you're making the same comment that I do in my last para that most drugs are sourced illegally?

    As for the emergency situation, as AG says, athletes can apply for a TUE if they have no control over what they were given or needed to have a banned substance. In fact, the latter applies regardless of emergency - that is the point of the TUE regime after all.

    Remember that none of this is happening in a vacuum. To take the Sharapova case the example in point, apparently she received five notifications that meldonium was going to be banned from 1 Jan. Athletes get a range of information from WADA, designed to help them avoid innocent mistakes.

    Sure, not all are the sharpest tools in the shed, but I would defy you to point to any athlete in any code who doesn't understand that they need to ask questions about what they're getting prescribed ...
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  • hiero

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    Re: Meldonium
    « Reply #103 on: March 12, 2016, 01:32 »
    . . .
    Third, if that first paragraph describes the US medical system, then I think that's one more reason to add to my list of "why I'm glad that I live in Canada rather than the US" ... That said, I suspect that, given how litigious you folks are down that side of the 49th, you are probably not accurately reporting how doctors behave. If I'm wrong, I'll just say that my experience in other parts of the world where I have lived and worked is that GPs are better than what you describe - busy, but also better ...

     . . .

    As you know, I'm in the US, and I don't think that para describes US doctors QUITE accurately, insofar as one can generalize.

    * Docs being busy and overworked: Well, there is a large tendency for doctors offices (usually some sort of partnership or umbrella firm, e.g. XYZ Medical Associates) to pressure docs to average 15 minutes per patient or less - or something like that. Too little time for a good patient relationship. The reason is billable hours, nothing more, nothing less. Now, the docs are getting paid, typically, 200K or better per year. GPs only 175 per yr avg. But still - pretty massively high pay scale if you ask me. Some will pass a light research task to an assistant, some will want to do it themselves. Many will do neither. If it hasn't come into their vision thru one of their regular social moments (partaking in a forum, reading a news feed, etc.) OR been shown to them by a pharma salesperson, they might never know. There are certainly too many drugs on the market for a physician, unless they are SuperMemoryDoc, to know them all. Even top pharmDs won't know a lot of them. If they have a call for it, or they have a condition presented that needs, they will do research.

    I have some international exp w/ docs, but not a lot. My overall impression is that our docs are some of the best educated, but they also have their nose in the air about it - even the nice ones tend to think that they are a superior form of human life. Oddly, the ones I met that I thot WERE superior were also some of the most humble. Maybe there is a correlation there.
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    LukasCPH

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    Re: Meldonium
    « Reply #104 on: March 12, 2016, 02:01 »
    As you know, I'm in the US, and I don't think that para describes US doctors QUITE accurately, insofar as one can generalize.

    * Docs being busy and overworked: Well, there is a large tendency for doctors offices (usually some sort of partnership or umbrella firm, e.g. XYZ Medical Associates) to pressure docs to average 15 minutes per patient or less - or something like that. Too little time for a good patient relationship. The reason is billable hours, nothing more, nothing less. Now, the docs are getting paid, typically, 200K or better per year. GPs only 175 per yr avg. But still - pretty massively high pay scale if you ask me. Some will pass a light research task to an assistant, some will want to do it themselves. Many will do neither. If it hasn't come into their vision thru one of their regular social moments (partaking in a forum, reading a news feed, etc.) OR been shown to them by a pharma salesperson, they might never know. There are certainly too many drugs on the market for a physician, unless they are SuperMemoryDoc, to know them all. Even top pharmDs won't know a lot of them. If they have a call for it, or they have a condition presented that needs, they will do research.

    I have some international exp w/ docs, but not a lot. My overall impression is that our docs are some of the best educated, but they also have their nose in the air about it - even the nice ones tend to think that they are a superior form of human life. Oddly, the ones I met that I thot WERE superior were also some of the most humble. Maybe there is a correlation there.
    This pretty much holds true for doctors in Europe (well, Denmark and Germany) too.

    Many are doing a genuinely great job ... but in that 15-minute slot for a pro cyclist's niggling cold that he needs to get controlled, not much more than 'oh, you have a cold; here, take this' can take place.
    And with the wealth of information about medical conditions, illnesses, medicines etc., no doctor can know everything - and I don't think they'll even try. If it hasn't been presented at a conference, recommended by a colleague, or (every doctor's favourite) shown by a pharma seller, they won't know about it.

    That's no criticism; it's like that in many lines of work. But it's one of the reasons why having sports-specific medical staff makes sense: They will know the ins and outs and be up-to-date on the particular demands and regulations.
    It doesn't have to be team staff - it could be medical staff employed by national or international federations, to service all pro/semi-pro cyclists.
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  • Claudio Cappuccino

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    Re: Meldonium
    « Reply #105 on: March 12, 2016, 07:13 »
    But, on another note, when an athlete has a cold, he/she cant even take a coughsirop some non - athletes take because there is ephedrine in it, untill a treshold of course.

    Grey areas...
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  • SpokeyDokey

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    Re: Meldonium
    « Reply #106 on: March 12, 2016, 16:59 »
    I've written a piece attempting to explain the WADA code, where the grey areas & where some issues lie that may open the door for opportunists to enhance their performance 'legally'. The WADA code isn't perfect, but as things are at the moment & the money available, it's probably the best we can hope for right now.
    http://spokeydokeyblog.com/2016/03/12/wadas-grey-areas/
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  • l29205

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    Re: Meldonium
    « Reply #107 on: March 12, 2016, 17:32 »


    b - if you are riding for a WT team, you dont take drugs given to you by your GP back home, you go to the team doctor, (or if your argument is that there shouldnt be any team doctors, you find a local GP who can actually assess you.



    To get to the point of my response it was that there are no team doctors to go to.  You are a stranger in a strange land whom are you going to trust to guide you to a reputable that has knowledge of your ailments and the constants of the WADA code.  That is not even considering a language problem if you are an English speaking rider based in Spain or France for example.  Even a good conversational speaker of foreign languages can have difficulties with explaining medical issues and restrictions.  That has been my experience when aboard and going to a doctor in a foreign country.  So I guess what I am trying to articulate is that there are positives to having a team doctor.   
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  • LukasCPH

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    Re: Meldonium
    « Reply #108 on: March 12, 2016, 17:38 »
    Even a good conversational speaker of foreign languages can have difficulties with explaining medical issues and restrictions.  That has been my experience when aboard and going to a doctor in a foreign country.  So I guess what I am trying to articulate is that there are positives to having a team doctor.
    Hear, hear!
    I spent 16 years in Danish kindergarten and school, then lived in Denmark for 8.5 years. But I still found it easier to speak to someone about my conditions (physical and/or mental) in German.

    What's an Aussie in Spain or Italy going to do?
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  • l29205

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    Re: Meldonium
    « Reply #109 on: March 12, 2016, 17:52 »
    To add to AG's comments ...

    Firstly, the point in the Captain's post was that GP's don't have access - not that they wont access - WADA lists, etc. So your argument is off point.

    Second, your first paragraph has a few inconsistencies in it - not least saying that doctors pass off decisions about prescriptions to nurses and then later saying that doctors check the drugs before prescribing.

    Third, if that first paragraph describes the US medical system, then I think that's one more reason to add to my list of "why I'm glad that I live in Canada rather than the US" ... That said, I suspect that, given how litigious you folks are down that side of the 49th, you are probably not accurately reporting how doctors behave. If I'm wrong, I'll just say that my experience in other parts of the world where I have lived and worked is that GPs are better than what you describe - busy, but also better ...

    Fourth, the bit about pharmacists just makes no sense - unless you're making the same comment that I do in my last para that most drugs are sourced illegally?

    As for the emergency situation, as AG says, athletes can apply for a TUE if they have no control over what they were given or needed to have a banned substance. In fact, the latter applies regardless of emergency - that is the point of the TUE regime after all.

    Remember that none of this is happening in a vacuum. To take the Sharapova case the example in point, apparently she received five notifications that meldonium was going to be banned from 1 Jan. Athletes get a range of information from WADA, designed to help them avoid innocent mistakes.

    Sure, not all are the sharpest tools in the shed, but I would defy you to point to any athlete in any code who doesn't understand that they need to ask questions about what they're getting prescribed ...


    First I never meant it to sound like the nurse or assistant is prescribing the drug.  I was trying to state that the doctor even if he was informed of the concern of the athlete that whatever is prescribed to him is not of the WADA list.  It would not be the doctor doing the look up.  My experience in health care is the doctor will pass off that responsibility to someone else while they go and check on another patient.

    As for your fourth point, it make sense in the context of the post I was replying to.  Which is below.

    Quote
    And if that fails, then the pharmacist is a further check - as in most medical systems, they have the ultimate responsibility for any wrongly prescribed drugs (since they actually dispense the product - doctors technically only "recommend" them). Again, personal experience says that this is a good check (eg., when locums have failed to read my allergy details on my records).

    So I am prescribed a drug in the US and I am prescribed a different drug in Spain.  Can you honestly say that the pharmacists are checking for drug interaction or over prescription.  In the US the biggest growing category of drug abuse is prescription drug abuse.  It is done by farming doctors and pharmacies.  Getting to the post I was quoting, how can a pharmacist know about every other pharmacist an athlete may go to therefore how can the pharmacist be a further check.

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  • Carlo Algatrensig

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    Re: Meldonium
    « Reply #110 on: March 12, 2016, 18:35 »
    That is not even considering a language problem if you are an English speaking rider based in Spain or France for example.  Even a good conversational speaker of foreign languages can have difficulties with explaining medical issues and restrictions.  That has been my experience when aboard and going to a doctor in a foreign country.

    You could end up doing what I did once in Spain when i went to see a doctor when I told him I had a pain in my beer rather than my head.

    I'd managed to mix up cerveza with cabeza. He looked rather confused until i realised my mistake and corrected myself.
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  • l29205

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    Re: Meldonium
    « Reply #111 on: March 12, 2016, 21:35 »


    As for the emergency situation, as AG says, athletes can apply for a TUE if they have no control over what they were given or needed to have a banned substance. In fact, the latter applies regardless of emergency - that is the point of the TUE regime after all.



    Sorry missed this earlier.  Who cares about a TUE?  Yes an athlete can apply for a TUE after the fact in emergency situations.  But what I am talking about is the total health of the athlete.  I am unable to communicate that I have an issue with blood clots.  I am on X blood thinner for blood clots and I get a major contusion to my quad in an accident.  One of the standard courses of treatment could include a blood thinner to prevent clotting.  Who in the chain of command here has any clue if the standard course of action is correct or could kill me by doubling up on prescriptions?  I am just saying there are situations where team doctors are beneficial.   
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  • Kiwirider

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    Re: Meldonium
    « Reply #112 on: March 12, 2016, 21:40 »

    First I never meant it to sound like the nurse or assistant is prescribing the drug.  I was trying to state that the doctor even if he was informed of the concern of the athlete that whatever is prescribed to him is not of the WADA list.  It would not be the doctor doing the look up.  My experience in health care is the doctor will pass off that responsibility to someone else while they go and check on another patient.

    Well on that point we'll just have to differ ... as my experience is that it is always the doctor who has checked my prescriptions ...

    And even if it isn't the doctor, that same information about the drugs and about the presence or absence on the WADA list or any interactions or allergies or whatever is available to that NP or whoever else could be checking. Presumably they have a basic level of competency - ie., so that they're not killing patients, which would have nasty criminal consequences for the doctor as well as the "drug checker" - so they certainly can find out the necessary info to protect the athlete.


    So I am prescribed a drug in the US and I am prescribed a different drug in Spain.  Can you honestly say that the pharmacists are checking for drug interaction or over prescription.  In the US the biggest growing category of drug abuse is prescription drug abuse.  It is done by farming doctors and pharmacies.  Getting to the post I was quoting, how can a pharmacist know about every other pharmacist an athlete may go to therefore how can the pharmacist be a further check.

    Again, you are miles off track ...

    Whether a person has 1 or 101 prescriptions is irrelevant to the question of whether a current prescription is for a banned substance.

    The pharmacist is a check for the prescription in hand - which is the one that counts each time, unless, as I said at the end of my original post, the athlete deliberately decides to source black market drugs ... in which case the whole question of GPs and access to information that started this is irrelevant.

    Pharmacists have a huge database of medications, which have a vast range of information in each case - including whether the product is a banned substance.

    What the athlete needs to do is say:
    "Hi, I'm a top sportsperson.
    I have been given this prescription for my sore knee ... but I want to make sure that it isn't on the WADA banned list.
    Can you please check it for me before you fill the prescription?
    And if it is on the banned list, can you please recommend something that I can ask the doctor to prescribe that wont cause me to breach the code and get suspended. Thanks!!"


    None of this is rocket science ... and is all in line with what WADA and the various national ADAs recommend athletes do ...

    https://www.wada-ama.org/en/questions-answers/athletes-and-medications


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  • Kiwirider

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    Re: Meldonium
    « Reply #113 on: March 12, 2016, 21:44 »
    Sorry missed this earlier.  Who cares about a TUE?  Yes an athlete can apply for a TUE after the fact in emergency situations.  But what I am talking about is the total health of the athlete.  I am unable to communicate that I have an issue with blood clots.  I am on X blood thinner for blood clots and I get a major contusion to my quad in an accident.  One of the standard courses of treatment could include a blood thinner to prevent clotting.  Who in the chain of command here has any clue if the standard course of action is correct or could kill me by doubling up on prescriptions?  I am just saying there are situations where team doctors are beneficial.

    Again you are mixing issues ...

    The topic in question is if GPs have access to information to stop them prescribing banned substances ...

    The question of whether team doctors have benefits over doctors outside of the teams - be they GPs, specialists, whatever - is another topic. An interesting topic, true, but a different one to what was raised in the post that you were replying to ...
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  • l29205

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    Re: Meldonium
    « Reply #114 on: March 12, 2016, 22:17 »
    Again you are mixing issues ...

    The topic in question is if GPs have access to information to stop them prescribing banned substances ...

    The question of whether team doctors have benefits over doctors outside of the teams - be they GPs, specialists, whatever - is another topic. An interesting topic, true, but a different one to what was raised in the post that you were replying to ...

    Disagree, It is the same topic different angle.  GP's don't have the info not because it is not available to them but because of the pressures of the job prevents them to doing all the due diligence.  They see the athlete in question.  Treat symptoms.  But they will move to next patient while some else looks up the WADA list.  If they do that much.  What does the doctor lose?  Nothing, I prescribed a drug that was legal for the treatment of X symptom.  I had my staff research if it was a drug that is on the WADA banned list.  They made best effort.

    Probably, we need to exorcise the talk about doctors to a different thread.

    ON topic for once.  Opinion article from CNN in the US.

    http://www.cnn.com/2016/03/11/opinions/maria-sharapova-banned-drug-vox/index.html

     
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  • AG

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    Re: Meldonium
    « Reply #115 on: March 12, 2016, 23:27 »
    I do agree with you L29205 that team doctors have their place.

    For many of hte reasons you have listed.  Having access to a doctor that knows you, knows your circumstances and history, knows your goals (ie not just to be healthy but keep your body at a level of high performance) and what the rules are about what you can take - not just medical contraidications that all doctors know, but separate rules about whats allowable in sport.

    BUT

    Those doctors do not override the 'athletes are personally responsible for what they take' rules.   The reason that the ATHLETE must be responsible is because otherwise they could hire a dodgy doctor, take whatever they want and let the doctor take the fall.

    The situation in Australia with Essendon is a great example - the Team and Doctors were the ones pushing and administering the drugs - but ultimately its the players who are still responsible.

    Back to Meldonium - obviously Sharapova's doctor knew what she was taking, and that her "health issues" were all about increasing her performance and not correcting some medical condition .... amd he/she have stuffed up by not stopping the treatment once it was banned - but that doesnt mean that Sharapova herself not responsible.   She employs this doctor, she agrees to take medication pushing the boundaries, and she is responsible for the consequences if things go wrong.
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  • l29205

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    Re: Meldonium
    « Reply #116 on: March 13, 2016, 00:15 »


    Those doctors do not override the 'athletes are personally responsible for what they take' rules.   The reason that the ATHLETE must be responsible is because otherwise they could hire a dodgy doctor, take whatever they want and let the doctor take the fall.



    Sorry if my posts seemed to remove personal responsibility from the equation.  It was not my intent.  Everyone is responsible for what goes in and out of their body.  Whether that means a drunken liaison that gets you an STD or even worse a poor planned marriage.  The person responsible is not the WADA but the one looking back in the mirror.   Sorry way too many cliches.   :D 
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  • FreeWheelin

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    Re: Meldonium
    « Reply #117 on: March 14, 2016, 05:12 »
    I have not read all of this conversation regarding team doctors, but have skimmed through it... apologies if I'm repeating what has been said.



    I think of it this way.  If I was running a cycling team and I wanted it to be clean, what would I do? I would be employing a team doctor and I would be insisting that all my riders saw that doctor for any medical issue.  If they needed to see a specialist in another field then the team doctor would go with them, or at least follow up with the specialist about the diagnosis and treatment.  If there was any sort of tablet that a rider was taking that was not given to them by the team doctor then they would need to explain very fast as security would be escorting them out the door.  I dont wnat my riders going to someone and takeing the wrong thing by antecedent or deliberately.

    So yes, team doctors can but used in a dodgy way, but i think that they are equally the best protection a team could have if it wants to be clean also.
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  • just some guy

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    Re: Meldonium
    « Reply #119 on: March 16, 2016, 12:37 »
    Again you are mixing issues ...

    The topic in question is if GPs have access to information to stop them prescribing banned substances ...

    The question of whether team doctors have benefits over doctors outside of the teams - be they GPs, specialists, whatever - is another topic. An interesting topic, true, but a different one to what was raised in the post that you were replying to ...
    No, that is the topic you turned into.

    I was trying to have a conversation that was real world and your reply went of on a tangent of what is theoretically possible. I was losing the will to live when the subject of 'Independent Doctors' was raised, whatever they might be. Your lengthy contribution on what GPs are theoretically able to deliver just moves the discussion backwards because no-one in their right mind would rely on a GP to provide that service in practice, in the UK or presumably elsewhere.
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