Michael Clarfield M.D., C.C.F.P. Diploma Sport Medicine

Transcription

1 Michael Clarfield M.D., C.C.F.P. Diploma Sport Medicine

2 CYCLING TEAMS UCI WORLD GROUP (18) UCI PRO CONTINENTAL(22) UCI CONTINENTAL (~150)

3 CYCLING TEAM BUDGETS PRO million The rest 2 7 million

4 TEAM PHYSICIAN USADA: Lance Armstrong paid Ferrari more than $1 million Ferrari could face criminal charges in Armstrong case

5 TEAM PHYSICIAN Spanish doctor Luis Garcia Del Moral denies helping Lance Armstrong in doping scandal crossing the line

6 TEAM PHYSICIAN Low or no pay contra No home games Athletes scattered around the world Language barrier s grueling race days a year

7 UCI REQUIREMENTS PHYSICAL One Every Three Months

8 UCI REQUIREMENTS HEART ECG ONCE EVERY YEAR ECHO EVERY OTHER YEAR STRESS ECG EVERY OTHER YEAR ALTERNATE WITH ECHO

9 UCI REQUIREMENTS BLOOD EVERY YEAR Lytes, Ca, Urea, Glucose, Total Cholesterol, HDL, Triglycerides, Total Bilirubin, Alk. Phos., Gamma GT, CPK, TSH EVERY THREE MONTHS CBC, Ferritin, ESR, Reticulocytes, Creatinine, Total Testosterone, Basal Cortisol, Urine stick

10 UCI REQUIREMENTS BLOOD PASSPORT

11 PRE SESASON TRAINING CAMP PHYSICAL BLOOD HEART TESTING AS REQUIRED VACCINATIONS PULMONARY FUNCTION TESTING VISUAL ACUITY IMPACT NEUROPSYCH TESTING REPORT TO UCI

12 IN SEASON MEDICAL COVERAGE Riders all over the world Often split up into two or three sites Local medical coverage variable Each race has medical coverage Rider physician network especially in Europe

13 IN SEASON MEDICAL COVERAGE Pro teams have full time physicians at every race European trained physicians do more than just medical better trained in physiology

14 IN SEASON MEDICAL COVERAGE Most teams do not have budget to have physician with them most of time Travelling medical kit correspondence with riders, management, local physicians Bring riders home if persistent problems for thorough evaluation and treatment

15 TRAVELLING MEDICAL KIT Antibiotics Anti Histamines Antibiotic creams Anti Inflamatories Gravol Anti emetics Salbutamol Proton pump inhibitors Pain medication

16 EVENT COVERAGE Develop relationships with team Time with riders to go over any chronic issues medical or MSK Can do UCI required physicals Understand what riders experience every day

17 EVENT COVERAGE FEAST OR FAMINE EMERGENCY MEDICAL KIT

18 EVENT COVERAGE Anti Doping UCI strictest protocols of any sport (really) ADAMS

19 UCI DOPING Long History 1923 Tour de France winner Henri Pelissier admits use of drugs (cocaine, chloroform, and horse tranquilisers) 1960 Knud Enemark Jensen dies at the Olympics in Rome (amphetamines) 1967 Tom Simpson dies on the Tour de France stage over Mont Ventoux (amphetamines and alcohol)

20 Tour De France 23 of last 26 Tour winners have tested positive/ confessed or implicated in doping

21 Speed of Tour de France

22 UCI DOPING PROGRAM 1960s first Anti Doping Rules / Prohibited Substance list 1992 UCI Anti Doping Commission established 1997 introduction of health tests / no start rule first IF to introduce urinary GCS/rhEPOtests 2004 first IF to introduce blood anti doping tests 2008 Biological Passport pilot project Urine / Blood

23 UCI DOPING PROGRAM In and Out of competition testing) In competition tests Urine 5,247 Blood 1,221 Out of competition tests Urine 2,067 (all includingepo) Blood 4,981 EPO tests 3,169 (of the total 7,314 urine tests) TOTAL 13,516 tests Testing in 2010: figures AFLD Annual Report Tests in cycling by NADO (AFLD) Only Federation to use the Biological Passport: to monitor biological parameters and establish individual profiles to trigger targeted traditional doping controls to establish an anti doping rule violation based on an abnormal profile Practically: In and out of competition tests Daily whereabouts through ADAMS

24 UCI DOPING PROGRAM All riders contracted to a UCI ProTeam All riders contracted to a UCI Professional Continental team with a Wild Card Label Other riders selected by the UCI = 950 riders in 2011

25 UCI DOPING PROGRAM Results Management Step 1 Each week, all updated profiles which exceed the 99% specificity level are sent to experts for review: Usually about profiles each week 99% = 1 in 100 likelihood of occurring in the normal population 99.9% = 1 in 1000 likelihood of occurring in the normal population Results Management Step 2 Experts provide independent evaluation Normal Possible medical condition Possible doping more information required Targeted testing UCI provides extra information Whereabouts race schedule, strange journeys Laboratory documentation packages Medical information

26 UCI DOPING PROGRAM Deterrent effect 8 athletes have been suspended 2 years CAS has confirmed in all 4 appeals The validity of the passport to convict an athlete That some changes in the profiles are typical of blood extraction (for a transfusion ) 25 athletes found positives for EPO or similar Some athletes are not hired by teams because of abnormal profiles = natural selection Improvements Agreements with NADOs to share tests and profiles (three so far) Additional modules (urinary steroids; hgh)

27 UCI DOPING PROGRAM CADF annual budget: CHF 7.5 million Biological Passport: CHF 4.3 million In competition testing: CHF 700,000 Out of competition testing: CHF 300,000 Education: CHF 250,000 Operating costs: CHF 1.1 million Average 60 cases prosecuted per year

28 Athlete Biological Passport (ABP) Designed to look at different blood parameters over time Looks at the effects of doping as opposed to for the actual substance Done in and out of competition WADA guidelines for Collection, Transportation and analysis see Zorzolli

29 WADA guidelines for ABP standardized procedures in: blood sampling (3mL EDTA, >2hrs after training, sitting for 10 min) transport/storage 2 12 o C in sealable, tamper evident containers analysis w/in 36 hrs (ask re: altitude, blood losses, donations, and t/f s) Uses longitudinal model and central processing

30 ABP parameters Hgb RBC Hct% MCV MCH Ret% Retic count MCHC

31 Biological Passport

32 Suspicious Blood Passport

33 UCI DOPING PROGRAM Education is key True Champion or Cheat Information available of UCI website targeting young riders Changing the culture Increasingly riders are ready to co operate and tell us about cheats There s more open talk in the peloton about the issue recently New rules Understanding the athlete What makes them unlike normal people The different triggers that lead to doping Conclusion Making History Testing, sanctions, education and cooperation are pillars of innovation From Doping culture to anti doping culture Cycling has become a role model for change

34 CONCUSSION QUIET ROOM What quiet room?

35 CONCUSSION Good preseason evaluation and concussion history Education of athletes and management

36 CONCUSSION Peloton does not wait Cyclists mentality to get up and get on to peloton ingrained Not perfect answer at present Cyclists at risk!!!!!!!!!

37 CONTRA