Domhnall MacAuley: Santa Claus and Lance Armstrong

Domhnall Macauley

Santa Claus and Lance Armstrong. From the moment you stop believing—it’s never quite the same. After ten years of outrunning his accusers, Armstrong says he is not going to fight a United States Anti Doping Agency case that claims he used performance enhancing drugs and implicated him in systematic doping of his tour winning teams. “I will no longer address this issue, regardless of the circumstances,” he said. Those who were looking forward to a major exposé, a high profile media show and tell, with his accusers ultimate vindication, will be disappointed. But, it is a sad day for cycling, for sport, and for the dreams of so many cancer sufferers. For, whatever you may think of Armstrong as a cyclist, his come back from metastatic cancer and subsequent fund raising is truly remarkable. He raised 500m dollars and gave hope to cancer sufferers worldwide.

First among equals, he was an exceptional athlete. Looking at his extraordinary career, we can only marvel at his achievements. As an American hero, he brought cycling to the world stage and into the consciousness of the non cycling public. But, I always felt uncomfortable. It was awkward. Patients, knowing of my interest in bike racing, would ask me about Armstrong, and it seemed petty to have doubts. He was the champion of cancer sufferers—he gave them hope of beating their disease. Not believing was not an option. My niggles were reinforced, however, when reading the views of David Walsh, a journalist of considerable integrity (who, although I have spoken to him on the phone, I cannot say I know). David asked difficult questions and his book, LA Confidential, attracted the full weight of the Armstrong legal juggernaut. When I heard him interviewed on radio this morning, Walsh was asked if it was a good or bad day for cycling. I could hear the hesitation in his voice. Even he seemed sad at the final capitulation.

From a medical perspective, I am sorry that the case is not going to proceed. Armstrong’s recovery from metastatic cancer is an incredible story. But, I would be very interested in the details: when did the alleged drug taking begin and what effect could these drugs have had on the development and recovery from cancer? We have only a few snippits in the media. It is alleged, for example, that he began injecting himself while still in hospital. He had a positive dope test for corticosteroids in 1999. He is thought to have taken various cocktails of  drugs—EPO, blood transfusions, injections of testosterone, cortisone, growth hormone. What effect could these have had on his disease? What was the involvement of our medical colleagues? The media suggest that it was only a small coterie of European doctors, but were his medical team in the US aware of this, and did they consider this in monitoring his disease. Who knows? We will never know.

Domhnall MacAuley is primary care editor, BMJ