Sports physicians and the doping crisis in elite sport.

The participation of sports physicians in the "doping" of athletes with banned drugs can be documented as far back as the 1890s. Concern about the ethics and safety of doping elite athletes appeared during the 1920s and 1930s as sport became an increasingly important form of popular culture. While organized medicine has opposed doping as a matter of policy at least since the 1950s, sports physicians have never adequately confronted the conflicts of interest that arise when they choose to work with elite athletes whose first priority is performance rather than with healing in the traditional sense. Confronted with the demands of their athlete-clients, sports physicians have divided into two factions regarding the wisdom and propriety of administering doping drugs to athletes. While most physicians are, in all likelihood, unwilling to violate laws, regulations, and medical standards by doping athletes, a significant minority of doctors has used one or more arguments to justify doping athletes: drugs are necessary to compete effectively; athletes should be free to medicate themselves as they please; drugs do not differ essentially from other performance-enhancing techniques or equipment; and medically supervised doping is safer than self-medication by athletes. Physicians can also rationalize doping as an occupational requirement of some professional athletes. In summary, physicians have played a significant, and largely unacknowledged, role in the doping of many elite athletes over the past 50 years.