Barry McCaffrey, it's really an honor to talk to the group of you today. I've got a long connection with orthopedic surgeons, having been wounded in combat three times and spent a couple of years in Walter Reed Army Hospital off and on with multiple surgeries for which I'm enormously grateful. Let me also thank Dr. Brett Owens for the invitation to participate today, a distinguished professor of medicine at Brown University Medical School, also an Army officer, an Army doc, several years at West Point dealing with the athletes there who are normally broken up either by varsity sports or intramurals. The only thing better than being assigned to West Point as an orthopedic surgeon would probably be Fort Benning, Georgia, where the Jump School and Ranger School provide a steady stream of young men and women who are busted up. But look, my own background, 32 years in the military, a lot of time in combat, a lot of time in political and military affairs, then I was appointed as the Drug Policy Director in the Clinton Administration and spent over five years in that duty. And it was a permanent graduate education in the science of the treatment of the prevention of drug and alcohol abuse. And by the way, let me just put everything in context. Why is any of this important to you as a physician, as a sports physician? First of all, you got the general background, you know, there's a well over 300 million of us in the country. You start looking at the principal health challenges to the U.S. population, it ends up is the substance abuse disorder. You know, 82,000 people dead last year from overdoses, a massive loss of life. And I might add 88,000 dead from some aspect of alcohol abuse. And the big killer, of course, well over 400,000 dead from some aspect of tobacco use, particularly smoking. So these athletes that you're dealing with are part of the general population. They're binge drinking, they're using pot and, you know, subjecting themselves to possible death from traffic accidents. So you as a physician have a role to play just in talking to the general nature of drug abuse. Then it comes to the sports situation. You know, I got involved in some doping in sports as part of my job as Drug Policy Director. We deduced that almost every aspect of sports had been contaminated by the cheating of using performance enhancing drugs. Starting with the Olympics and going down to looking at high school football teams that, you know, the average weight would be 225 pounds or basketball teams influenced by human growth hormones with kids that are grossly oversized for their age. We found out there were performance enhancing drugs for chess players competition, for pistol shooting to reduce the possible tremor in your extremities, that every sport had been contaminated by cheating. And you looked around the world and you found that the, you know, the former Soviets and the East Germans and others had wrecked tens of thousands of young people with anabolic steroids and their impact on their bodies. So the range of drugs that athletes were using was simply unbelievable. EPO, beta blockers, stimulants, diuretics, steroids, human growth hormones, you name it. And of course their impact on their physical bodies was atrocious in many cases. Liver and heart problems, prostate problems, impotence, blood cancer, crippling arthritis, increased aggression, particularly for the males, stunted growth for teenagers, simply unbelievable. The athletes, I was at our U.S. Olympic training village, would say, look, if you're a top tier elite athlete and you don't use doping, you're going to lose to a second tier elite athlete. So there was a compulsion to stay in the game. And we'd ask them on surveys and they'd say that they were willing to use performance-enhancing drugs even if they knew it would threaten their lives. Powerful compulsion. We needed to level the playing field. We needed to try and eliminate the inducement to use these drugs. And of course the athletes are using them, not just for performance, but to work through injuries and pain and stress and because of mental health problems. So it was a problem. We went after the head of the Olympic Committee as a starter. And boy, did I take some pushback. Samaranch. We finally got him out of office. I addressed the Worldwide Olympic Association in Switzerland. We were trying to organize a global community. The Australians were a huge help, as were the European Union nations. We said, we've got to do something about this. And I think we made some progress. We started the Dick Pound. We facilitated the Worldwide Anti-Doping Agency. We got Frank Shorter, the famous athlete, to help us set up the U.S. Anti-Doping Agency. We got testing. We tried to create an environment where if you were out there cheating and winning, and that later on in following years, we found a test that could prove it, we then retroactively go back and take away the honor of your athletic triumph. So, you know, that's where we were. And I think the whole thing is slipping again. The Olympics this summer, I'm very concerned about, you know, it looks to me like the testing global regime has fallen apart. They're going to get tested five days before competition. The Russians have been a gross violator, been allowed back into the Olympics under individual status. So we've got to be concerned. So U.S. physicians who are involved in, you know, creating these magnificent young athletes who have such an impact on children and how they think about their bodies, you have an opportunity to influence it. And, you know, our other studies indicate when a trusted adult speaks up, primarily physicians or coaches or trainers or parents, that young people will listen. So anyway, look, I'd be glad to talk about this issue with others in your organization, in other venues, but I did want to make these brief comments. You know, I'm used to being a college professor and speaking in 50-minute bursts, but hopefully this will be useful in stimulating your own commitment to reducing the impact of performance-enhancing drugs on athletes. So thanks for allowing me the opportunity to talk to you and I look forward to interacting with others of you in the future.

substance abuse disorders

athletes

doping in sports

physical health

performance-enhancing drugs