Ethical Issues in Sports Medicine

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On a regular basis in sports medicine, we are faced with ethical dilemmas. Whether or not we should allow kids to play certain sports based on injury risk, performance enhancement and equipment advances, treatment interventions, return to play decisions, and conflicts of interest to name a few. These issues may cause disagreements between the athlete and the physician or even among physicians as to how to best deal with various situations.

During my pediatrics residency training, I had the privilege of learning from an ethicist who not only provided me with a process to improve my critical thinking and how to approach things from multiple views, but also was truly influential in shaping me into the physician I am today. Today on the podcast I have a pediatric physician who is considered a true expert on ethics. I hope you finish listening today with a new appreciation for ethics in medicine.

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Links from this Episode:

— Dr. Mark Halstead: On the Web — On X

— Dr. Norman Fost, MD, MPH https://www.pediatrics.wisc.edu/staff/fost-norman/

— University of Wisconsin Department of Medical History and Bioethics https://mhb.wisc.edu/

— Norman Fost Oral History Project https://www.hhs.gov/ohrp/education-and-outreach/luminaries-lecture-series/belmont-report-25th-anniversary-interview-nfost/index.html

— Lerner A, Fost N. Informed Consent for Youth Tackle Football: Implications of the AAP Policy Statement. Pediatrics. 2019 Nov;144(5):e20191985. doi: 10.1542/peds.2019-1985. Epub 2019 Oct 23. PMID: 31645457. https://pubmed.ncbi.nlm.nih.gov/31645457/

— Icarus Documentary https://en.wikipedia.org/wiki/Icarus_(2017_film)

Timestamps from this Episode:

03:15 Performance-enhancing drugs are essential for athletes’ competitiveness, as trying to gain an advantage is inherent in sports. Athletes have always sought ways to improve their performance, whether through training, nutrition, or other means, within the rules.

09:32 Controversy over carbon fiber running shoes in marathons.

11:52 Olympic double standard: drug use vilified, cheating praised.

13:44 Mark Maguire hit many home runs pre-steroids. He’s banned from the Hall of Fame.

19:05 Concern about steroids’ impact on kids in sports.

22:38 Testosterone has potential bad side effects, including prostate cancer concerns. Research suggests that athletes using steroids may have higher long-term mortality rates.

26:28 Meeting Alec Lerner, a former Badger football player and med student, sparked a discussion on sports ethics. It led to an article that addressed the ethical issues surrounding the risks of football, particularly related to concussion and long-term brain damage. The discussion was prompted by the AAP paper in 2015, highlighting the high injury and concussion rates in football and the long-term effects on the brain. The article emphasized the need for informed consent from both young athletes and their parents regarding the risks involved in playing football.

29:32 Concerns about kids in sports, consent trivialized.

32:32 Tackle football consent for kids should be reconsidered.

36:55 Questioning the necessity of extensive medical personnel in sports events, particularly comparing it to boxing and youth involvement.

40:25 Physician never felt pressured by NFL coaches, emphasizes ethics and independence.

44:11 Navigating sports medicine decisions and athlete autonomy.

46:40 Some athletes prioritize health over lucrative career.

49:00 Differing hockey injury data in Canada and US

51:41 Doctor Foss joined us for today’s podcast episode, and we are grateful for his mentorship. Thank you for listening and supporting us.

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The Host of this Program:

Mark Halstead:

Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine.

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Normal Fost:

Dr. Norman Fost, MD, MPH, is a graduate of Princeton (AB 1960), Yale (MD 1964) and Harvard (MPH 1973). He completed residency training in pediatrics and two years as Chief Resident at the Johns Hopkins Hospital. He was a fellow in the Harvard Program in Law, Medicine and Ethics 1972-73. Since 1973 he has been at the University of Wisconsin where he worked as a general pediatrician for 40 years and is now Professor Emeritus of Pediatrics and Bioethics. He founded the Program in Medical Ethics in 1973; was Chair of the Hospital Ethics Committee for 31 years, Chair of the Health Sciences IRB for 31 years; Director of the Pediatric Residency Training Program for 21 years; founder and director of the Child Protection Program for 33 years; and Vice Chair of the Department of Pediatrics and the Department of Medical History and Bioethics for 10 years

He has served on numerous federal committees and commissions on a variety of ethical and regulatory issues, including President Clinton’s Health Care Task Force. He is past chair of the American Academy of Pediatrics Committee on Bioethics and the FDA Pediatric Ethics Subcommittee. He was a member of the National Academy of Science Committee on Guidelines for Stem Cell Research whose report was published in 2005.

From 1994-1998 he was an elected member of the Princeton University Board of Trustees. In 1997 he was awarded the Nellie Westermann Prize for Research Ethics and twice was runner-up. In 2003, he was awarded the William G. Bartholome Award for Excellence in Ethics by the American Academy of Pediatrics. In 2006 he received a lifetime achievement award by the US Office of Human Research Protection for his work in protection of human subjects in research. In 2007 he was named the first winner of the Patricia Price Browne Award in bioethics. In 2011 he was inducted into the Johns Hopkins University Society of Scholars, and in 2016 he received the MacLean Prize from the University of Chicago, the largest prize in Bioethics.

Dr Fost has extensive experience in ethical and legal issues in health care. He has published numerous articles on human subjects research, genetic screening, euthanasia of handicapped newborns, access to human growth hormone, and youth tackle football. He has published extensively on ethical issues in the use of performance enhancing drugs, including the New York Times, USA Today, and the British Medical Journal.

He is a frequent guest on national television and radio shows, including National Public Radio, HBO “Real Sports”, ESPN “Sports Center, and ABC 20/20. He has been a guest on Nightline, Frontline, Crossfire, Donahue, Good Morning America, Larry King Live, and Oprah. He appears in the movie “Bigger, Stronger, Faster,” and the 2018 ESPN+ docuseries “Enhanced, and was a consultant for the 2018 Oscar winning documentary, “Icarus.”

From 1994-1998 he was an elected member of the Princeton University Board of Trustees. In 1997 he was awarded the Nellie Westermann Prize for Research Ethics and twice was runner-up. In 2003, he was awarded the William G. Bartholome Award for Excellence in Ethics by the American Academy of Pediatrics. In 2006 he received a lifetime achievement award by the US Office of Human Research Protection for his work in protection of human subjects in research, and in 2007 he was named the first winner of the Patricia Price Browne Award in bioethics.

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