SPORTS MEDICINE Recent Titles in Health and Medical Issues Today Obesity Evelyn B. Kelly Stem Cells Evelyn B. Kelly Organ Transplantation David Petechuk Alternative Medicine Christine A. Larson Gene Therapy Evelyn B. Kelly SPORTS MEDICINE Jennifer L. Minigh Health and Medical Issues Today GREENWOOD PRESS Westport, Connecticut ● London Library of Congress Cataloging-in-Publication Data Minigh, Jennifer L., 1971- Sports medicine / Jennifer L. Minigh. p. ; cm. — (Health and medical issues today, ISSN 1558-7592) Includes bibliographical references and index. ISBN-13: 978-0-313-33894-6 (alk. paper) ISBN-10: 0-313-33894-9 (alk. paper) 1. Sports medicine—Popular works. I. Title. II. Series. [DNLM: 1. Sports Medicine—Popular Works. 2. Athletic Injuries—Popular Works. 3. Doping in Sports—Popular Works. QT 261 M665s 2007] RC1210.M495 2007 617.1'027—dc22 2007021471 British Library Cataloguing in Publication Data is available. Copyright © 2007 by Jennifer L. Minigh All rights reserved. No portion of this book may be reproduced, by any process or technique, without the express written consent of the publisher. Library of Congress Catalog Card Number: 2007021471 ISBN-13: 978–0–313–33894–6 ISBN-10: 0–313–33894–9 ISSN: 1558–7592 First published in 2007 Greenwood Press, 88 Post Road West, Westport, CT 06881 An imprint of Greenwood Publishing Group, Inc. www.greenwood.com Printed in the United States of America The paper used in this book complies with the Permanent Paper Standard issued by the National Information Standards Organization (Z39.48–1984). 10987654321 CONTENTS Series Foreword ix Preface xi Acknowledgments xv Section One Overview 1The Field of Sports Medicine 3 Careers in Sports Medicine 4 Show Me the Money 9 Office versus Field Care 12 Managed Care 15 2 History of Sports Medicine 19 Ancient History 19 Jump to the 1900s 20 The Advent of Sports Medicine 20 Scientific Advancements 21 Onset of Sports Law 22 Confidentiality and Defamation 27 3 Common Sports Injuries 31 Injuries in Children 32 Injuries in Adults 33 vi CONTENTS Injuries in Disabled Athletes 33 Types of Injuries 33 Location of Injuries 36 4The Impact of a Sports Injury—Who Does It Hurt? 47 Athletes 47 Families 50 Team and Coaches 50 Insurance Companies 51 Physicians and Healthcare Professionals 52 Media and Fans 53 Society as a Whole 54 5Doping 57 Doping Strategies 57 Doping Substances 58 6The Future of Sports Science 61 Tissue Engineering 62 Gene Therapy 62 Designer Drugs 63 Bionics 64 Section Two Controversies and Issues 7 Issue: Informed Consent 73 Informed Consent in Sports Medicine 74 Implied Consent 76 Consent in Research 76 Playing Against Medical Advice 77 Coercion 78 Cases Involving Informed Consent 79 What Does This Mean for Team Physicians? 80 8 Issue: Who Has the Right to Play? 83 Preparticipation Examinations 83 Disabled/Handicapped Athletes 88 Athletes with Predisposition to Injury 93 AIDS and Hepatitis 97 Transgendered Athletes 100 CONTENTS vii 9 Issue: Are Sports Too Aggressive and Violent? 103 Science of Aggression 105 Game Aggression and Violence 106 Spectator Aggression 108 Aggression Off the Field 109 Roid Rage 109 10 Issue: Performance Enhancement 113 Anabolic Steroids 113 Gene Doping 115 Blood Doping 116 Growth Hormone 117 Stimulants 117 Painkillers 119 Beta-adrenergic Agents 120 Regulation and Testing of Substances 121 BALCO Investigation 123 Surgery 124 11 Issue: Who Is Liable? 127 Standard of Care 127 Malpractice and Negligence 129 Return to Play 130 Liability 132 Rehabilitation 134 12 Issue: Who Has the Right to Know and to Tell 137 Confidentiality 137 HIPAA 138 Defamation 139 Premature Release of Doping Results 139 13 Issue: Medical Advertising 143 Sponsorship 143 Selflessness 144 Untruthful Advertising and False Claims 145 Exaggerated Claims 146 14 Issue: Nutrition 149 What to Eat 149 Supplements 152 viii CONTENTS Sport Drinks 154 When to Eat 155 Safety and Regulation 156 15 Issue: How Much Is Too Much? 159 How Young Is Too Young? 159 No Pain, No Gain 162 Designer Athletes 165 Steroids 165 Evidence-Based Medicine and Innovative Therapies 166 Section Three References and Resources A Annotated Primary Source Documents 171 BTimeline of Sports Medicine Issues 237 C Glossary 241 D Further Reading 243 Index 249 SERIES FOREWORD Every day, the public is bombarded with information on developments in medicine and health care. Whether it is on the latest techniques in treat- ments or research, or on concerns over public health threats, this informa- tion directly impacts the lives of people more than almost any other issue. Although there are many sources for understanding these topics—from Web sites and blogs to newspapers and magazines—students and ordi- nary citizens often need one resource that makes sense of the complex health and medical issues affecting their daily lives. The Health and Medical Issues Today series provides just such a one- stop resource for obtaining a solid overview of the most controversial areas of healthcare today. Each volume addresses one topic and provides a balanced summary of what is known. These volumes provide an excellent first step for students and lay people interested in understanding how healthcare works in our society today. Each volume is broken into several sections to provide readers and researchers with easy access to the information they need: • Section I provides overview chapters on background information— including chapters on such areas as the historical, scientific, medical, social, and legal issues involved—that a citizen needs to intelligently understand the topic. • Section II provides capsule examinations of the most heated con- temporary issues and debates, and analyzes in a balanced manner the viewpoints held by various advocates in the debates. x SERIES FOREWORD • Section III provides a selection of reference material, including anno- tated primary source documents, a timeline of important events, and an annotated bibliography of useful print and electronic resources that serve as the best next step in learning about the topic at hand. The Health and Medical Issues Today series strives to provide readers with all the information needed to begin making sense of some of the most important debates going on in the world today. The series will include volumes on such topics as stem-cell research, obesity, gene ther- apy, alternative medicine, organ transplantation, mental health, and more. PREFACE This title describes the turmoil seen in sports medicine when balancing scientific, legal, and ethical issues. In this book, sports medicine is defined not only by the customary defi- nition, but also by the issues surrounding the industry. Readers will gain a true appreciation for the complexity and intricacies of these issues that weave the tangled web of sports medicine. In the end, readers will under- stand the background and history of sports medicine, possess both sides of related scientific, legal, and ethical issues, and have a new respect for everyone involved in the field. Developed according to the guidelines of the Greenwood Press Health and Medical Issues Today series, this book was written as a reference for students and others who want to know more about sports medicine. As such, this book is different from other books on sports medicine in that it seeks to present both the science and the issues surrounding this field. Because a position is not taken on the issues, the information is balanced and thus ideal for those individuals who want an unbiased account. Section One (Chapters 1–6) lays the groundwork for sports medicine and the science, legality, and ethics involved. Section Two (Chapters 7–15) explains the various issues in sports medicine. Section Three lists the references and resources for further information. Chapter 1, “The Field of Sports Medicine,” defines sports medicine and details the careers, responsibilities, and working environment of a sports medicine professional. xii PREFACE Chapter 2, “History of Sports Medicine,” describes the historical evolu- tion of the sports medicine field, including the emergence of related scien- tific, legal, and ethical issues. Chapter 3, “Common Sports Injuries,” describes many of the most frequently occuring sports injuries and the sports in which these injuries occur. In addition, the often overlooked issue of injuries to disabled athletes is covered. Chapter 4, “The Impact of a Sports Injury—Who Does It Hurt?,” emphasizes the shock wave following the injury, not only for the injured athlete but also for the athlete’s family, team, and competitors. Issues involving insurance, medical care and care providers, the news media, and sports equipment are also considered in the light of sports injuries. Chapter 5, “Doping,” looks at the history and issues surrounding the use of performance enhancing substances. The chapter also provides an overview of doping strategies. Chapter 6, “The Future of Sports Science,” takes a look at what we will see in this field in the years ahead. Among the areas explored are injury prevention, gene therapy, new drugs, the frontiers of bionics, and the impact of science on sports medicine law. Chapter 7 tackles the issues of informed consent as it applies to sports medicine. Informed consent for injured athletes is an area where often conflicting interests are involved in decisions. This chapter reviews this complex aspect of athletics. Chapter 8 describes the issues involved with the right to play sports. It asks the question, “Who has the right to play?” Among the issues covered are physical fitness, the return to play following injury, and the many impacts of barring athletes from play. Chapter 9 asks, “Are sports too aggressive and violent?” The issues of aggression and violence are covered along with related topics as body chemistry, medications and drugs, and fan involvement. Chapter 10 covers the battles over performance enhance in sports. The topics covered include not only the widely known performance enhancing drugs, but also such topics as gene doping, blood doping, and the role of drug companies in this area.