13th August 2015
"KEEPING SPORTS CLEAN AND FAIR - THE MEDICAL CONTRIBUTION"
Tan Sri Dato’ Dr M Jegathesan
First of all let me thank the organisers for this esteemed honour that has been bestowed on me in being selected as the speaker at the Tunku Abdul Rahman Putra Oration this year.
Whilst there is a designated topic for the oration this year it will not only be appropriate but mandatory as well for me to spend the first few minutes talking about the honouree in this series of oration, namely our beloved “Bapa Merdeka”, the Tunku himself. I crave the indulgence of the audience to focus on my personal anecdotes of the man rather than to extract highlights of more hallowed biographies.
I first laid my eyes on the Tunku as a 14 year-old when my father ‘ordered’ me to return from school in Singapore to be present at the Dataran Merdeka in Kuala Lumpur on the 30th August 1957. My father a recently retired government officer implored: “a country is not born every day. You be here”. Dutifully I turned up. I was amongst the crowd that stood there and witnessed Malaya being declared an independent and sovereign nation and was totally mesmerised to see the Tunku standing on the podium and shouted “Merdeka” so convincingly. He certainly cut a larger than life figure. I was equally taken in by the new flag that rose slowly up the flag pole in tune with the rendition of the national anthem we heard for the first time. The song and the flag were to take on a very special personal meaning for me. I had by then been already primed to watch the Olympics held a year earlier where winners on the podium were honoured and their countries recognised by the raising of the national flag and the playing of the national anthem. Being already a budding school athlete at that time I resolved to work towards international success and I told myself at that instant that one day I will stand on the rostrum and have them raise the flag and play the anthem for me. I am happy to state I did realise this dream and enjoyed the hair raising experience eleven times in the years that followed.
Two personal anecdotes will illustrate the type of man the Tunku was. 10 years on from Merdeka day I had just reported for work at the General Hospital as a houseman and after a lunch along then Batu Road (later Jalan Tunku Abdul Rahman) I was waiting to cross the road to get to where my car was parked. A VIP motorcade passed by and to my total surprise it came to an abrupt halt in front of me. The VIP wound down the window and to my amazement I recognised the Tunku as the passenger. He smiled and said, “Do you need a lift somewhere” Wow the prime minister himself stopping to offer me a lift. Though almost rendered speechless I managed to croak “oh thank you so much Sir, I have managed to buy a car.” I should not have been over surprised though, because, in the intervening years during which I had made my mark as the leading sprinter in Asia, my efforts had not passed unnoticed by the sports loving Tunku who never failed to send a congratulatory message, by telegram or letter as was the social media of those times. Messages that read like, “well done Jega the country is proud of you”.
One year later enroute to the Olympic Games in Mexico I stopped in London to compete there and was invited by the Malaysian Embassy there to attend a function to honour the visiting Tunku. He spotted me in the periphery of the crowd, called me to come over and asked what I was doing in London. He then asked how did I do in the competition and I replied that I had injured a muscle and had to pull out of the race. He was abhorred and said I had to recover quickly to be in time for the Olympics and told me to come to his London residence at York House the next morning so that he could give me a massage machine. Once again needless to say I was indeed stunned by his caring attitude.
Therefore whilst I could have chosen many other topics to talk on today including some that reflected my many years of work in microbiology and infectious diseases I have chosen to speak instead of a topic which I have also been engaged with for many years in a parallel fashion, namely, about issues such as doping in sports, gender issues and age cheating. This would have been of interest to the sports fan in Tunku who came from an era where fair play and integrity in sport were a given.
So here goes:
It has long been accepted that medical and scientific input are a ‘sine qua non’ in today’s elite sporting landscape. Traditionally the medicos have been responsible for three major components, namely Athlete’s well-being through prevention, treatment and rehabilitation of illnesses and injuries; legitimate use of sports science to improve training methods and performance and keeping sports fair and clean. These objectives have essentially been achieved through provision of services as well as through bearing influence in formulating and/or changing sports rules.
This paper is dedicated to the discussion on the last of these and will be concerned with the issues of doping in sports, gender issues, gene doping and age cheating. Whilst these issues have been around for relatively a long time, there is now an urgency in desiring to tackle them in view of their even more emerging presence in the current sports scenario riddled with mega dollars and accompanying unbridled greed bringing on both ‘push’ and ‘pull’ factors for athletes to cheat.
The positioning of doping in sport as a major global problem is certainly acknowledged, evidenced from the massive media attention and coverage that these stories attract to the inclusion of a statement in no less than the hallowed Olympic oath and the ever growing and pervasive visibility of WADA, the World Anti-Doping Agency. And why this attention? Because of the need to preserve the sanctity of sport in the spirit of olympism, because these drugs can damage health and because sports persons are role models for the youth of the world. Athletes take drugs to enhance performance through specific action on strength, on stamina, to stimulate and to mask.
Athletes who do get caught though are not all willful drug takers. Many fall into the category of the ‘innocent’ who have actually made a mistake through ignorance or carelessness. Yet others fall into the category of ‘victims’ being induced or coerced to do so by people in authority over them. For long, in sanctioning, this has not been acknowledged within the context of the strict liability rule. This is however about to change with modifications to the WADA code which will recognise the philosophy of proportionality of fault and applies sanctions with corresponding flexibility.
Meantime, the thrust of the anti-doping global strategy hinges on four pillars, namely, education, rules and regulations, testing in and out of competitions , and deterrence through sanctions. The battle is however far from being won and faces many challenges ranging from perception to reality of failing to catch the cheats, an ever emerging armamentarium of new drugs, inability to test for all those already known and cleverer methods of avoiding detection. Legal challenges and their attendant costs are an increasing worry. These are being countered by a slew of measures including the widening of the definition of anti-doping rule violation, the broader use of non-analytical violations, rewards for whistle blowing, criminalization of sources of supply, introduction of new approaches such as the athletes biological passport as much as increasing direct funding for research to find improved analytical methods for detection.
Another issue that occurs from time to time is “suspicion “that an athlete in a women's event is not really a female. The emergence of the Press “sisters” as runaway winners in athletic meets in the 60's could be said to have heralded attempts to introduce 'gender verification at games as a condition for participation. Such tests evolved from rather crude attempts to visually examine athletes physically and then moved on to the less intrusive chromatin (or Barr body) test performed on cells derived from buccal smears. Those athletes who 'passed 'the test were issued 'femininity certificates' and allowed to compete. Those who failed were ignominiously thrown out of the games. Such tests held sway for almost a decade before they fell into disrepute and were abandoned as a conditional pre-games requirement. This is not to say the problem disappeared and challenges of an athletes' gender continued with different sport organisations dealing with them within their own procedures or rules. Whilst lead authorities have had various conferences and issued consensus statements the solution to the problem is far from systematized and can be considered to be evolving. The IAAF has come up with new rules and regulations which appear to have gained some traction amongst interested parties and is now subject to the jury of international opinion. The new procedures are addressed at tackling the issue of ‘females with hyperandrogenism’ and are directed at keeping out of women's events athletes who have a male hormone profile. Such athletes will go through a three step examination process and if found ineligible will still have possibilities of returning to the fold if appropriate medical procedures are undertaken to reverse this advantage. What is most important is that all of these are conducted with the greatest respect to the athlete's confidentiality recognizing the sensitivity surrounding the subject of gender identification and the oftentimes unfortunate circumstances that lead the athlete to be in this position in the first place.
Age related competitions bring to the fore the question of authenticity of an athlete’s age eligible to participate within the age range defined for the competition. Whilst some cases possibly could be attributed to genuine mistakes caused by delays/in accuracies in birth registration within certain jurisdictions, there is no doubt there are indeed cases of willful fraud and cheating to enhance chances of winning. Such practices can be individual or group initiated to gain advantage and enhance potential for success and all the rewards they carry nowadays. Clearly, such practices cannot be left unchallenged and apart from investigating birth documents and the like the medical fraternity is being called upon to assist in coming up with tests that can verify true age. There are indeed methods for age determination such as radiometric measurements of bone, long bone ossification , fusion of epiphysis, dental development, however they all lack precision in terms of sizable biological variation often related to ethnicity, genetic makeup, nutritional status etc. such variation can extend from 12 to 18 months. However some sports bodies have introduced such tests and have disqualified athletes based on results not without controversy.
Whilst sports bodies are still grappling with these time honored issues, new challenges emerge, most notable amongst these is the very real spectre of 'gene doping' techniques already exist to make this a imminent if not already existing possibility and have been visibly proven in mice at least. The authorities are also proactive in watching out for this as WADA has already included in this in its list of prohibited methods and expert groups are in place to come up with detection methods.
There are thus these many challenges to the integrity and sanctity of high level sport a la the spirit of olympism. The positive news is that there is little tolerance for this amongst the authorities and measures are in place, albeit in some instances in an evolving way. Whilst many may say that the war is far from being won, most believe that progress is being made and efforts must not be let up. Education, awareness, rules and regulations, sanctions on those who break them must continue unabated in ensuring a level playing field for the majority of athletes who believe in fair play.