Domhnall MacAuley: Some Olympic reflections

Domhnall MacauleyIt’s the smile that gives it away. The Olympic smile. Couch potatoes, academic nerds, fashionistas, computer geeks, and sporty types united. All bewitched. With life on hold for the last two weeks, its now back to the real world, but almost everyone one seems touched by a little bit of Olympic magic. So, what about the Olympic legacy—a few random reflections.

What if your life had been on hold, not just for two weeks but, for the last ten years and everything directed towards your Olympic performance? Gold medallists achieved their goal but few will make sufficient money to cushion the lives. Many will face a future they had not ever considered. The calendar stopped in August 2012. How do you cope when your life has been focused on one moment in time? Or when you return to a workforce where your contemporaries are ten years ahead in their career. Your greatest achievement is in your twenties—in your past. Will the rest of your life always be a disappointment?

The Olympics raised other interesting questions. What is the relative influence of nature and nurture, genes and environment, opportunity and talent. Television discussion focused on the success of sprinters of West African origin. Some suggested historical accelerated natural selection.  But, if 30,000 people, from a population of 2.5m, turn up for the school sports championships on the tiny Caribbean island of Jamaica, then everyone will want to be a sprinter. And, what about the success of East African runners in distant events? It cannot all be down to the coaching of Brother Colm at St Patricks High School in Iten, who inspired a generation of endurance stars.  Even Mo Farah’s origins are geographically not that far away.

Some performances were unbelievable. Sadly, experience tells us that sometimes the purity of the exceptional performance may indeed be beyond belief. There have been a few positive tests but, it often takes a long time for suspicions to surface. We can have absolute confidence in the testing but hindsight may show that we tested for the wrong substances or at the wrong time. Should we believe Victor Conte when he tells us that 60% of athletes were using banned drugs? Genetic engineering, undetectable medication, some uncomfortable asides, but little concrete evidence. Our enjoyment of the games has not yet been tainted. Only time will tell.

Will the public health legacy last longer than the feel good factor? Will there be investment in sports medicine with employment opportunities for those who recently completed or are still in professional training?

But, the most intriguing question of all—why do the winners bite their medals?

Domhnall MacAuley is primary care editor, BMJ

  • Jo

    Apparently a photographer once asked a gold medal winner to bite their medal and ever since then, everybody does it….

  • Following the creation of Sport and Exercise Medicine as a specialty in 2006 I was delighted to see that there was a career to pathway
    that I could follow in order to obtain the job I had always dreamed of. I had worked doing General Practice and hospital placements and often got frustrated at the lack of opportunity to educate both children and adults about the virtues of physical activity. I found that my consultations were so time demanding that there was never any expectation on medical professionals to promote and oversee the prescription of exercise as a tool to both treat and minimise the ranging affects of chronic disease. This was the job of a gym instructor, or a physiotherapist or a natural health practitioner.

    So move forward 6 years. We have had the most amazing Olympics to
    be held in the United Kingdom. Those that were lucky enough to be involved have left with memories that they will cherish for a lifetime. The success of both the organisers and the athletes has truly left a legacy, the defining aim of these Games. A legacy that stretches almost as far as Northern Ireland, but not quite. This coming August Northern Ireland will be left in the unenviable position as being the only region in the United kingdom without a training post in Sport and Exercise Medicine. The initial delight and impetus created in 2006
    with the formation of the specialty and the “Legacy” and hype provided by the Olympics alas can be measured by the solitary training post this region has seen since 2006.

    Following a letter asking the Northern Ireland Department of Health
    to explain this decision, they confirmed that they do not see a medical
    intervention as having a role to play in improving the populations’ physical activity levels. I believe that this is probably a reflection of Northern Irelands “special status” as being detached from UK national policy and not needing to echo UK government policy or the evidence-based proposals of the National Institute of Clinical Excellence. The Health department of Northern Ireland (and medical training deanery) apparent stance is in direct conflict with the Government of the
    United Kingdom, who have supported the NHS in promoting
    active lifestyles as a major initiative. Healthcare professionals should see improving activity rates and getting their patients moving as central to their work.

    Their stance is also in conflict with NICE guidelines that have clearly demonstrated that although a brief intervention for physical activity in primary care costs between £20 and £440 per quality-adjusted life year (QALY), when reductions on health problems are taken into account, the net costs saved by the health service (and society) per QALY gained are between £750 and £3,150.

    From previous blogs on this site I have read that there is a lot of work being done within the NHS with respect to SEM training, such as a £30 million capital grant to develop a National Centre for Sport and Exercise Medicine (NCSEM). I am however concerned that this little area of the United Kingdom would prefer to take their slice of that £30 million and use it to increase the number of training posts for bariatric surgeons (no offence to bariatric surgeons, but it really looks like we are making a bolt for the fence after the horse has legged it!). In a region that has such a proud sorting tradition, the decision not to provide further SEM training posts can only serve to force our most promising
    undergraduates to leave Northern Ireland to pursue their careers elsewhere.

    Alas, it seems that in this time of economic difficulties, policy
    makers in Northern Ireland believe the cost savings associated with brief promotion of physical activity are probably not relevant, unlike the
    rest of the United Kingdom who seem to think that improving the health of the population whilst saving money is an important goal. I propose we use the money they save on the promotion of physical activity and give them all a pay-rise, to show how much we appreciate their contribution to the increased levels of heart disease, diabetes, cancer rates, mental health issues and respiratory disease.