Giulio Tarro
and Biotechnology Committee Chairman Virosfera
UNESCO Bioethics and Sport
Report to Congress "Youth Sport medical and social aspects" of
Marano Naples, May 29, 2009
"Moving is freedom" every day, in a thousand places on the planet, run, play, work, play a game, it also means to affirm the freedom and the fundamental right to movement, gesture or use the sport demand them. Feel free to move. In some cases it is as if the sporting gesture offered young people the chance to express themselves in a "different" to enable you to communicate with the world and realized. The sport is considered among the young people one of the wheels more important for the development of life, plays an important role in the formation, development and education, for many it is an opportunity to be taken in training the mind and body, for others a very important educational guide. The sport is tied to the passions, in no uncertain terms you choose who to support until the end, those who follow with bated breath, every sport has around a mass of fans who feel part of a special world where often the tone, language and the words are understood only by those who belong to you and it does not matter if "others do not understand." The important thing is knowing how to recognize, even among those who have never seen, and know, if only for a moment, to be part of a "small universe" where they consume common passions. Sport is an extraordinary plant continuous emotions, Sometimes we feel alone, sometimes in a small group: the sporting event, whether it be a big hit or a crushing defeat, is seen as a piece of individual and collective history, with all the emotions that follow.
But what does it mean for a young person succeed in sports?
It means setting goals, achieving them through our commitment and confidence in ourselves, it means enjoying a pleasant feeling of satisfaction, both during activity and when it ended.
A further point of explanation is the ability to live in a group, being part of a particular social context is one of the primary needs of each individual. In fact one of the main reasons dei giovani allo sport è legata al desiderio di vivere e di raggiungere obiettivi sentendosi parte di un gruppo.
L’evidenza formativa di questa abilità è fuori da ogni dubbio: saper rispettare le regole del gruppo e collaborare anche in un ambiente competitivo sono abilità interpersonali che ciascuno di noi deve avere.
L’attività sportiva rappresenta uno strumento indispensabile all’apertura dell’educazione all’ambiente locale, all’Europa e al resto del mondo; essa è particolarmente adatta agli obiettivi di lotta contro qualsiasi forma di discriminazione, di genere, persone portatrici di handicap e nella lotta contro il razzismo.
Lo sport è stato a lungo, in passato, vissuto as a prerogative of the elite: a charged were young men, people with available funding. Today sport is open to everyone, but the number of practitioners is steadily decreasing. According to Censis, the 39.6% of Italians who are 18 or over have a physical activity on an ongoing basis: up to 35 years this figure rises to 53%, between 56 and 70 can obtain a gratifying 23.1%. Women are much closer to the people as a percentage of practitioners in some disciplines are 47 sports in 100 men; 100 women 33. Countless would
angles to address a speech on sport. Since the speaker is a doctor who for decades has dealt on Bioethics, let me touch on some medical and bioethical aspects of the sport.
Sport is now a mass phenomenon that moves in our country tens of billions of euro per year. This gives rise to the spread of doping, a practice no longer confined to a few isolated athlete, but now he sees the active collaboration of pharmaceutical companies, and sports - it pains me to say especially - doctors, using the most innovative drug research, fuel a lucrative market.
The practice of doping is spreading to the rampant commercialization that is currently experiencing the sport, especially after the recent explosion of television rights associated with large sponsorship contracts. This market, with billions at stake derived therefrom, has led to a proliferation of sports competitions and reduced recovery time, which also causes the shortening of the life of professional sports. In this combined with the perverse effects of certain contracts between sports associations and their sponsors, who pay award in accordance with the results obtained.
The fight against the scourge of doping, as well as to require new legislation and drug investigation, led to important bioethical partly arising from the work of "the European Commission for Community support plan to combat doping in sport." Among the guidelines of the work of the Commission are: the right of all people, including athletes like all other categories of citizens, safety and health, the principle of integrity and transparency in the name of which must be ensured the regularity of sporting competitions, special attention must be paid to vulnerable people, particularly the young, particularly attracted by the professional sport today.
Based on these ethical principles, the Commission in its two documents of 2007 brought a number of actions including the establishment of a specialized medical aid, psychological and information for athletes, the adoption of new Tools legislation on the protection of young athletes, particularly those who aspire to become professionals, encouragement of epidemiological research on the health of athletes, the organization of conferences on the subject of doping and the health of athletes, the inclusion in contracts between sports terms regarding the use of drugs and its prohibition, the adoption of a joint declaration equivalent to a code of conduct in sport, at the end of a European conference on doping. A problem of considerable interest
famacologico and bioethics is still to be considered as doping substances "tout court" and which ones, can be considered mere "ergogenic". As is well known For the former, such as anabolic-androgenic steroids, there are detailed tables, compiled and periodically updated by the national and international sporting committees, which identify them beyond doubt. Is much more nuanced, however, namely the position of ergogenic substances (eg caffeine), used in an attempt to improve the physiological, psychological or biomechanical. There are indeed concentration thresholds that define the scope of the two categories but, beyond the extreme difficulty of identifying them or even impossible to identify the substances naturally secreted by the body as synthetic ones - such as erythropoietin ( that, given the obstinacy of the pharmaceutical companies that produce it will not add substances that allow the tracing, identification is almost impossible) - are serious responsibilities of sports medicine in defining what substances and in what doses should be taken by the athlete to improve its performance.
In that regard, allow me to bring the thoughts of one of the most respected Italian sports doctors, which I prefer not to mention here: "I've had different experiences with so-called ergogenic aids for sports at various levels. When I was a college athlete, I have taken ergogenic substances for sports nutritional type, such as protein supplements in an attempt to increase muscle mass for football (rugby). As a marathon runner and ultramaratoneta, I made use of caffeine, a legal ergogenic substance, in terms of sports, to try to improve the capacity of aerobic life. As a coach, both in school and at college, I used ergogenic aids psychological in nature to try to improve the physical performance of my athletes (although I must admit that at that time, did not know them under the term "ergogenic psychological sport "). As a sports scientist for over 30 years, my research has focused on the ergogenic sport, including in this ergogenic aid for the sport of physiological, pharmacological and psychologically. "rises to this idea begs the question about what should be the insurmountable limit in the" performance improvement "of the athlete. You can define this limit as the very soul of a certain understanding of the sport is precisely to overcome the barriers?
The use of chemicals to enhance sporting performance is not a new phenomenon. Today, however, the athlete is increasingly obsessed with the leadership and performance beyond human limits. This is particularly true for the professional athlete, always driven to outdo, as urged by the pressure of the media and sponsors. To meet the needs of this type, the preparation of athletes had to achieve a degree of professionalism and scientific unknown in the past. And in this context, the sport has come to demand more and more frequently, help with medicine, in an attempt to overcome barriers and break the record until yesterday was considered insurmountable. If we add that we live in a society "farmacocentrica", aimed at finding solutions to the problems in medicine that have nothing to do with medicine, it will be clear that the doping is not simply a particular aspect of this " farmacomania. But in sports, the "farmacomania" acquires special significance: it appealing to the athlete breaks a fundamental law Sports and loyalty. Look, in a sporting event, to obtain benefits not allowed by methods, means biasing the results, even when the desired outcome is achieved.
It is, therefore, to determine the extent to which medical intervention is lawful and when, in fact, it exceeds the limits set by ethics and professional sports. Medicine, by its very nature, should only take action in preventing and treating diseases. In sport, the use of medical practice should be limited to the prevention of injuries and any medical conditions, competitive activity accordingly, the control diet and nutrition, as well as state control psychological and physical health of the athlete.
But the ban of use of doping has also bioethical nature. The athlete performs an act that violates unfair, regardless of whether the benefit in terms of sporting performance is genuine, doubt, or even nonexistent. I believe that sport should still be subject to some general principles, both within the amateur in the professional field. As long as sport is sport and entertainment, the fairness of competition is one of the most important of these principles. When football, athletics, cycling and other sports, major and minor, will be treated as any other performance art, then everything is permitted, subject to the condition not to harm the health of the protagonist.
The sports doctor who drugged and implement practical, simply to increase the potential of the athlete, if they require a pathological situation, task, thus, an act certainly wrong from the point of view of bioethics. In fact, any choice in medicine should be evaluated in terms of the relationship between the individual and the benefits to the health risk involved for the same. Even if it knew the risk involved - and often is not fully - it is clear that the benefit of the maneuvers is zero doping, with regard to the health of the athlete. The athlete is a healthy individual, although at risk of developing acute or chronic, resulting in its activities. In this medicine, understood as practices which may affect the physiological responses of the individual, not to support the provision of care in other ways that optimizing nutrition and training methods. The issue of doping, and then goes beyond the bioethical aspects in order to become ethical. And in that regard it is interesting to observe the evolution of this issue known in the reformulation of the medical code of ethics that have followed in recent years. The Code of Medical Ethics
approved January 7, 1978 did not include any article specifically devoted to sports medicine. Significantly, the Code of Ethics adopted July 15, 1989, reserved no less than 6 items for Sports Medicine (Article 102 Article 107). Among these are the last three very interesting. In particular Article 105 stated: "The physician should not give its cooperation in sports activities which have as their goal the pursuit of serious physical injury of the contenders." It is a norm among the most specific and meaningful Code of 1989. If a high organization notes that medical practitioners are heavily involved in sporting activities, both for the implications inherent in the protection of health that are their own and for the continued provision of a medical opinion, ruling the recognition aptitude tests, there is, secondly, the unequivocal position taken by the Federation ordinistica before a phenomenon which limits tend, with growing evidence to fade in the unlawful practice, where the sport is mixed with the elation and agony of violence and aggression. Even without any explicit reference is raised, therefore, it is clear how the code of ethics intended to emphasize how the guarantee to promote the health and well-being, which is the end of every sport, is not satisfied with the activity properly boxing, having to your doctor so refrain from offering their cooperation in such eventualities.
Only in the Code adopted in October of 1998 expressly refers to the particular sport which "may lead to psychological and physical damage to the integrity of the athletes." "The doctor has an obligation, under any circumstances, to assess whether a person may undertake or continue athletic training and competitive performance. The physician must request that its assessment is accepted, especially in sports that may involve damage to ' athletes' physical and psychological integrity, denouncing the non-acceptance to the competent authorities and with professional bodies. " (Article 75)
It is however a different approach with the Code of Conduct 1989. Article 106 of the Code of 1989, in fact, states: "The physician should not use pharmaceutical or other treatments that can artificially influence the performance of an athlete, especially where such interventions act directly or indirectly by changing the natural balance of physical and psychological subject. Medication or other aimed at improving the performance of athletes can not be kept secret. The sports medicine physician is obliged to inform the doctor intends to submit the process by which the athlete. "
Article 107 concerning doping expressly states:" The doctor can not advise, prescribe and still make use of treatments Doping of "Interesting how the definitions of doping behind this articles is the difference between: doping a crime (fraud) in itself and as a doping offense for public health. In the same vein, the definition of doping on a committee set up specifically to study the problem in doping, there are two essential elements: a) "the use of pharmacological interventions in the athlete healthy (including hematology, endocrine, etc.) ... in the absence of a therapeutic necessity, b) the intent to commit fraud in order to improve competitive performance outside the bio-physiological adaptation of the training. "
E 'has been rightly pointed out that one should not forget as well as conflicting with the classics canons of ethics sports .. also the possibility (and in some cases probably even when certainty) that the use of these substances which are profiles of production situations of danger to personal health and legal significance of medico-legal ".
The Code of Ethics was approved in 1995 devotes three articles to the theme of Sports Medicine. Article 92 says: "The physician should not use medication or other nature that may artificially influence the performance of an athlete, especially where such interventions act directly or indirectly by changing the natural balance between mind -physical entity. The doctor can not prescribe or recommend treatments of "doping". The sports doctor is obliged to report any treatment to the doctor. The physician must report any prescription or with professional recruitment suggestion made by doctors or no doctors, drugs, "food supplements" or substances referred to in the first two paragraphs of this article.
Not only there was an amalgamation of articles from the previous code, but also asks the doctor to report to the Order any prescription or suggestion made by doctors or medical substances that would alter the psycho-physical treatment of the subject or doping. It is explicitly pointed out not only the prescription, but also the suggestion involves reporting to the Order, which is assigned an important role in the fight against doping. The articles of the Code in relation to the issue of doping are justified by the fact that "one must always consider that the risks to which the individual is exposed are never proportionate to the objectives. Any consent given by the person can never relieve the doctor from his responsibilities, given that the individual's health is in question, as is known, is not a disposable good. "
The Code of Conduct approved in October 1998 three articles devoted to sports medicine. In particular, one of them is specifically dedicated the doping issue (Article 76), while limiting the back to the first paragraph of Article No. 92 of the Code of 1995. Briefly we can say that from the standpoint of the ethical duty of the physician is to protect the health, mental and physical integrity and life of the subject, not to prescribe drugs without therapeutic necessity, obtain informed consent of the beneficiary, to remind himself to his clients that the assets are not available, including health and life. This second
the drafters of the Code justifies the prohibition of prescription drug treatments or otherwise altering the natural balance psco-being of the subject. From the ethical point of view we can certainly say that "Doping distorts the human and ethical bases of sport, whether it is entertainment whether it's racing. Debases the human being frustrating the benefits from practicing a sport. It transforms the person into an object of the athlete : he is used, manipulated and exploited for different purposes, for purposes which are not those of the sport. ... Aiming to artificially improve athletic performance, the use of stimulants attacks one of the basic principles of competitive activity, which is to encourage fair competition and fair, <> ".
On the issue of doping its conflict with the principles of medical ethics: autonomy and beneficence / nonmaleficence, the principle of justice and the moral integrity of the profession.
The first principle, that of autonomy, claims that the doctor complies with the requirements of the assisted formulated in a free and informed and that food and promote the decision-making autonomy of the patient. It could be interpreted as the legitimate desire of an athlete through pharmaceutical preparations to improve their performance, aware of health risks that this entails as informed about the doctor. This, then, leans in favor of the morality of the prescription and taking of drugs.
The principle of charity demands that physicians face the good of his patient, removing the evil that struck him and prevent future suffering. The principle of nonmaleficence claims that the doctor does no harm to his client. The doctor is then called to promote and safeguard the health, well understood as essential to his client. Under this principle, physicians should oppose the request of the sports administration of substances that may in a longer or shorter time to cause damage. The principle of justice demands that we evaluate the impacts, social consequences (ie positive or negative effects on third parties) of a clinical decision in the interests of a patient and shall share equally the disadvantages, benefits and overall costs ( current and future immediate and long-term) derived from an originally designed and built within the doctor-patient dyad. The disturbance of the regularity of sporting competitions, or the mere suspicion of race fixing cast a stigma on the whole sporting world, with devastating consequences on his credibility. You turn away from it not only the spectators and fans, but it is likely to promote a sports mentality willing to do anything to get the results. The social consequences of the use of performance-enhancing drugs show the moral unlawfulness of their prescription and recruitment.
The principle of integrity of the profession calls for the respect the autonomy of the physician. He should decide on their knowledge and belief. The doctor is therefore not a mere executor of his clients' requests, but is called to assume moral responsibility for his actions, also with regard to the possible effect of them against the medical profession. The doctor then must reject the use of substances that are beyond the purpose of their medicine-prevention, diagnosis, treatment, rehabilitation, and preserves the proper sense of the profession.
in resolving the conflict between these principles, it should be noted that there are goods which we consider not available, although not absolute. Life is among them. It should also be remembered that the doctor does not configure its performance only as a technical act, but work full of ethical imperative.
As already mentioned the spread of doping goes beyond the boundaries of professional sports. The use of artificial aids to improve physical performance has spread so widespread among amateurs, amateurs in gyms, even in schools. E 'last summer's survey sponsored by the ASL of Milan, using the formula of the anonymous questionnaire, was able to highlight how young people between the city's schools is widespread use of doping substances; to play football or to make up in the pool or gym. As mentioned above, this grave situation has arisen in a conception of practice obsession with sport as a direct result, an idea prevalent among many sports instructors, always looking for new talent. A culture amplified by the media, newspapers and television stations, which continue to cover sports events on which to weigh heavy suspicion. A culture that spreads the idea of \u200b\u200bcompetitiveness to maximum thrust, which bans most reprehensible behavior: just follow any sports media to realize this. However, there is another conception of sport that I think should be of interest to the doctor. Sport as a game, as exquisitely playful moment, a reading which, inter alia, refers to the true roots of this activity (the word "sport" is derived from Boccaccio "Boaters for pleasure and entertainment from one place to another").
E 'common belief that sport was born in antiquity, in Greece, the land of the Olympic games. In reality the differences between the ancient and the modern racing games are such as to exclude any possible comparison: just think of the sacred character of the Greek games, which were conducted within the framework of festivals and religious ceremonies. In reality, the modern concept of sport, according to historian and a German sociologist Norbert Elias, was born in the shadow of the great political transformations of the eighteenth century England, when, with the advent of parliamentary dialectic in the twenties, the conflicts began to lose some of their ferocity. Then finally defeat policy did not coincide more with the personal destruction, indeed it gave a new impetus in view of revenge. It was then that the propertied classes gave rise to the "sportivisation" of their pastimes.
In 1751 was founded the first institution of sport, the Jockey Club, to regulate horse racing. The ancient and often cruel games of the nobility became within a century home and were subjected to specific and universal rules are inspired in the spirit of fair play. The term now much in vogue, of fair play simply did not show fair play. In view of the noble classes UK it was an indication of the recognition rules of the game, often guided by the hardness (the founding fathers of football discussed long before excluding the lawfulness of the kick in the shins), and at the same time the ability to conceal the sufferings for the defeats and the enthusiasm for victories. Moreover, the education of young gentlemen of the Victorian era and an ethic of self-imposed sacrifices necessary to face the ruthless economic conflicts and to fulfill the task of leadership of an empire cut off.
This is the concept of sport that our society has inherited and which still forge the unbridled competitive spirit behind unethical practices such as doping.
But there is another concept that sport is one of the game in which one experiences the comparison with each other and with their limitations, we learn respect for rules and the taste of the commitment. Sport as an activity that carries with it a fascinating and extraordinary charge of humanity, of generosity, of conquest, of courage, patience, making adventure filled with signs, targets, hope. Sport as an activity that carries with it a fascinating and extraordinary charge of humanity, of generosity, of conquest, of courage, patience, making adventure filled with signs, targets, hope.
Allow me at this point to end this report with a quote: "All the body parts that have a function, if used in moderation and exercised in the activity to which they are assigned, they become more healthy, well-developed and age more slowly, but if they are not used and left idle, they become easy to get sick, defective in growth and premature aging "The importance of these words is that they were uttered by Hippocrates, the "Father of Medicine" who lived about 2500 years ago in ancient Greece were known to these concepts, not for nothing that the Greeks invented the Olympic Games.
Prof. Giulio Tarro
