Canadian Medicine

You already knew the press went hog-wild with the Terry Schiavo story. Remember? Ms Schiavo (right) falls into a persistent vegetative state for years; family opinion fractures along 'She's brain dead'/'No she's isn't' lines; right-wing politicians glom on to the story and hold it up as proof positive of the evils of legalized euthanasia, bringing their agendas all the way to Congress; she finally dies in 2005 after a judge rules in favour of her husband, who requested her feeding tube be removed -- and all the while journalists spread the story around the world in various sensational iterations, fanning the flames of public outrage (and mass confusion) ever higher.

It may not surprise you to learn that those news stories were, as often as not, far from accurate. But you'll be shocked to learn just how extensive the errors were.

This latest review of the Schiavo media coverage is part of a by a team of neuroethicists from McGill and Stanford, published online on Wednesday in the journal Neurology (subscription required).

Looking at The New York Times, The Washington Post, the St.-Petersburg Times and The Tampa Tribune, the research team, led by Eric Racine, PhD, of the Institut de recherches cliniques de Montréal, found that 21% of articles claimed, incorrectly, Ms Shiavo's condition would improve (it didn't). The researchers also found:

Statements explicitly denying the PVS diagnosis were found in 6% of articles. Explanations of PVS and other chronic disorders of consciousness were rare ([less than] 1%). Most frequently cited descriptions of behaviors were that the patient responds (10%), reacts (9%), is incapacitated (6%), smiles (5%), and laughs (5%). Withdrawal of life support was described as murder in 9% of articles.

An earlier study of related New York Times articles published in 2005 found that fully 62% erred in explanations of "brain death," writes Dartmouth College neurologist James L Bernat in an accompanying editorial titled "Terry Schiavo's Tragedy and Ours, Too." He continues:

Because print and broadcast media reports influence public perception and opinion about medical conditions, they have a social responsibility to educate by accurately explaining the basic facts necessary to understand the issues.

The solution, conclude both Dr Racine and Dr Bernat, is to encourage broader engagement between neurologists and the public, via the press, when it comes to discussing complex cases like Schiavo's.

But can that solution really help? Dr Bernat admits that although "[s]ome responsible media outlets did attempt to educate readers, viewers, or listeners but many treated the dispute as entertainment."

After all, in an era of declining newspaper readerships and dwindling circulations, isn't entertainment increasingly becoming a priority for many news editors? Undoubtedly.

But perhaps studies like this one, which highlight and publicize the shortcomings and outright failures of large media corporations, might help to remedy the problem by making readers aware of the difference between responsible reporting and entertaining writing -- not that the two are mutually exclusive in the least, but the take-away message is that a balance must be struck, and entertainment mustn't be allowed to trump a full airing of the truth.

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While the top Canadian athletes compete at the Beijing Olympics this month, a small but important contingent of Canadian doctors are responsible for keeping the team and the staff in tip-top shape.

“I think it’s going to be fantastic,” said Dr Connie Lebrun, the Canadian Olympic Committee (COC) assistant chief medical officer and a former Olympian herself, before heading to China in early August. “We are privileged to be there.”

The COC’s core medical team consists of 10 physicians as well as a host of other health professionals, from massage therapists to sport psychologists. Along with other Canadian physicians accompanying individual sports teams, they are responsible for the care of the 600-odd Canadian athletes and support staff for the duration of the Olympics. With challenges running the gamut from smog and traffic to brutal schedules, no sleep and little to no pay, the job of an Olympic doctor isn’t all fun and games.

To read our profiles of some of Canada’s Olympic physicians, click here.

OLYMPIC MEDICINE
A day in the life of an Olympic doctor begins in the early morning; some doctors head directly to the Canadian team clinic, and others fan out to the various venues where Canadian athletes are competing.

“They’re long days,” says Dr Bob McCormack, the New Westminster, BC, orthopedic surgeon who has been named the COC’s chief medical officer for the Beijing Olympics and the 2010 Vancouver games. “It’s not heavy physical work, but it’s long hours. We typically open the clinic at 7:00am and close at 11:00 or 11:30 at night -- and then there’s more work to do, administrative work and emails and such.

Each doctor follows several Canadian teams. Dr McCormack, for instance, is responsible for baseball, women’s softball, men’s and women’s wrestling and the equestrian squad. The schedule can be grueling, shuttling between the Canadian clinic and the venues. “You get breaks at supper and lunch, and most days I try to get out for a half-hour exercise break.”

Making that schedule additionally challenging are the inevitable problems with access to the venues. Security, not surprisingly, is incredibly tight at every Olympics.

“As the games get bigger, if an athlete is in distress it’s not always easy to figure out how to be there,” says Dr Alan Vernec, the medical director of Athletics Canada and an Olympic veteran. “At their time of need you might get blocked by a security agent, which is ironic because you’ve come across the whole world to be there with the athlete.

Beijing is unlikely to prove an exception to the doctors’ struggles with security guards, but Dr Vernec is prepared. He’ll show up at a venue ahead of time and do a test run of the security barriers to figure out the best strategy to get in; in Athens, the RCMP had to intervene with the 18-year-old Greek soldiers who had blocked Dr Vernec’s entrance to a stadium. “Sometimes,” he admits cagily, “we have to use other means to get in.”

ASIAN RENDEZ-VOUS
The Olympics are about more than just sports, of coure; the weeks-long games are a social event too.

“One of the pleasures is getting to know people from other countries’ medical crews over the years, and helping each other out,” says Dr Vernec. “I’ve received some emails already from people saying they’re going to Beijing -- ‘Looking forward to seeing you.’”

“That’s a fantastic highlight,” Dr Lebrun agrees. Her friends from past Olympics and international sporting events hail from Great Britain, Australia, New Zealand, Norway and the United States. “Quite often we have a mixer with other medical staff in the evening, to get to know them better.”

Just being a part of the Olympics tradition is a thrill for many of the physicians, several of whom were Olympians themselves.

In 1976, in Montreal, Dr Lebrun was a member of Canada’s Olympic volleyball team. “We finished eighth out of eight,” she recalls. “But it was great walking into the stadium. It gave me chills.”

Four years later, Canada’s decision to boycott the Soviet-hosted games in Moscow meant that Dr Bob McCormack, then a medical student, missed his chance to run track and field in the Olympics. “When I think back to the boycott in 1980, the Canadians traded more wheat with Russia that year than in previous years,” he says. “I think the athletes were used as pawns.

“I personally wish there was greater separation between politics and sport. The Canadian Olympic Committee never considered boycotting this year. We told the athletes the Olympics is not the place for that.”

He never have had the chance to compete in the Olympics, but Dr McCormack now has the opportunity to do the next best thing. “I work with a lot of teams now and I live vicariously through them.”

“IT’S NOT A VACATION”
Living in the Olympic Village in the heart of Beijing, being a part of one of the largest Olympics ever held, meeting top athletes and medical staff from around the world -- for many, it sounds like a dream job.

But being a doctor at the Olympics isn’t as glamorous as it sounds: 12-hour days, at a minimum; over a month away from home; no pay for most physicians; and endless bickering with the host nation’s security guards about access to the venues.

“It’s frenetic,” says Dr Vernec. “There is a sense it is once in a lifetime for the athlete. The anxiety level goes up, from the athletes to the coaches and support staff, to make sure everything is right, that the athlete is healthy and ready to go.”

That’s as much pressure as it sounds -- and then some.

“It’s not a vacation, even in the slightest,” Dr Vernec says. “It’s hard work. I don’t relax until the games are over.”

In fact, some doctors take a vacation after the Olympics end, just to recover from the whirlwind of work and travel.

According to Dr Julia Alleyne, another COC physician at this year’s Olympics, medical and support staff burnout is a major concern. “They have long hours and feel they are on duty constantly,” she says. To help keep the doctors, coaches, athletes and employees healthy, this year Dr Alleyne will be launching the first-ever Canadian Olympic Committee wellness centre.

CHALLENGES APLENTY
Canada’s Olympic physicians have all been granted temporary medical licences in China so they can order tests and prescriptions while they are there; the logistics of simply ensuring patients get appropriate medical care can be difficult. None of the Canadian physicians have been given hospital privileges. That means that although Beijing has hospitals and medical staff ready to help out in emergencies, if a serious medical problem arises the patient will likely be flown back to Canada. “We like to be self-sufficient,” says Dr McCormack.

That hasn’t always been the case. At the 2006 Winter Olympics, in Torino, Italy, Dr McCormack arrived at a local hospital to visit a patient and was surprised to find an Italian surgeon repairing a Canadian athlete’s broken ankle. After some negotiating, Dr McCormack, an orthopedic surgeon, scrubbed in and joined the surgical team.

Beijing’s infamous smog, although certainly not an ideal environment for high-performance athletics, doesn’t appear to disturb Canada’s medical staff as much as it has the international press, who have been breathlessly reporting particulate-matter readings and futuristic (but mostly ineffectual) Chinese efforts to bend the weather to their will. “We are preparing for the worst but I am optimistic it will not be that bad,” says Dr McCormack. “Even if the air is compromised, it’s not really a health issue. It may be uncomfortable and some people can get exacerbations of asthma, though I personally feel when we get to the games it will not be as bad as past times we’ve been to Beijing. I’ve been there when you could see the building across the street but nothing behind it. This is a very important event for the Chinese and they have spent an enormous amount of money to clean up the air, and have made great strides.”

For the Canadian Olympic team, whose own embarrassing doping incident is now 20 years past, performance-enhancing drugs remain a concern -- as they do for every other team. “It is the same as any field of human endeavour,” says Dr McCormack. “There are people who are not honest on their taxes every year. There will always be people who cheat, and it’s the same with doping. A small percentage will always be cheating.” The COC takes a hard line on doping: whereas there are rumours that other countries have received positive doping tests from their athletes and used them as “educational tools,” Canada has all its testing done independently and externally. “We don’t need another Ben Johnson fiasco,” he says.

Although significant strides have been made in developing effective testing standards, new and more advanced forms of cheating are being developed. Gene doping, which the Montreal-based World Anti-Doping Association has warned about, is “on the horizon,” Dr McCormack says. “It’s a game of cat and mouse.”

AMATEUR PROFESSIONALS
One aspect of the Canadian doctors’ Olympics experience that typically goes unmentioned is the matter of pay -- or rather, the lack of pay.

The COC doesn’t pay its physicians at all. Other Canadian Olympic physicians, however, and even some of the COC core medical team, have financial agreements with the various national sports federations, independent of the COC. (For instance, Dr Alleyne is paid by the figure skating team during the Winter Olympics.) What that means is that some of the Canadian physicians at the Olympics are being paid while others draw no salary whatsoever. That discrepancy has created a degree of frustration and tension, several doctors confirmed in interviews.

“It does create a little bit of a thought at the back of your mind,” says Dr Lebrun of the discrepancy in pay. “But nobody would say I won’t go because I won’t be paid. It’s not a problem for us in our day-to-day work.”

“It is a concern,” Dr Alleyne says. “[The absence of a COC salary] is a limiting factor on how many times you can volunteer, and who can volunteer. Basically, you are taking vacation time to do work elsewhere and you can only do that so much in a year.”

The Canadian Academy of Sport Medicine has published guidelines for physician remuneration, but they stop short of explicitly demanding that all physicians are paid for their work at amateur sporting events like the Olympics.

The topic of the pay discrepancy is somewhat uncomfortable for some of the physicians to discuss (one would only discuss it off the record) but it hasn’t soured the physicians on the Olympic experience.

Dr Lebrun says, “We are privileged to be there. Our transport and everything is paid for -- and we get the uniform.” For her, the matter of money is outweighed by the value of the experience. “It’s not something you can buy.”

“Regardless of pay there have been good people involved, because it is satisfying experience, you are treated well and you gain skills,” says Dr Alleyne. “You come home and your patients know you were an Olympic doctor. That goes pretty far in promoting your practice. There are so many benefits learning from this that I can rationalize in my mind this is a beneficial experience for me.”

Photo: Beijing's Olympic Stadium, known as the Bird's Nest

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Canadian Medicine spoke to seven Canadian physicians who are working at the Summer Olympics in Beijing this month. Here are their stories:

Dr Bob McCormack
Team Canada’s chief medical officer, Dr Bob McCormack, a New Westminster, BC, orthopedic surgeon affiliated with UBC, got into sport medicine after his track and field career was cut short by the Canadian boycott of the 1980 games in Moscow.

Treating elite athletes can be fun -- now that his competitive sports days are over, Dr McCormack says, he lives vicariously through the athletes he cares for, including those on the BC Lions football team and the Vancouver Whitecaps soccer team -- but it can also be a real headache at times.

“One of the things you have to be careful about is that the athletes are supremely driven,” he says. “Somebody did a poll in Sydney [at the 2000 Summer Olympics]. They asked the athletes, ‘There is a drug that guarantees you a gold medal but you will be dead in five years.’ Fifty percent said they would take it.”

Elite athletes are an unusual bunch. They’ll do just about anything to win, so Dr McCormack has a dual role: “I am there to help them but I must also be an advocate to make sure they don’t make decisions that will hurt them in the long term. We have to be that sober second thought, which is not easy for them. My responsibility is to the individual, not the team.”

Dr McCormack’s competitive drive hasn’t disappeared, though. “For example, I had an individual with a torn meniscus we could have repaired, but by repairing it they couldn’t be in the Olympics because of the rehab, so they chose not to have it repaired, which puts them at increased risk of arthritis,” he says. “I felt uncomfortable with that, but they ended up winning a medal. If that athlete hadn’t won a gold medal, I would have had more second-guessing.”

It’s a fine balance, and requires extraordinarily thoughtful informed consent from the patient, but Dr McCormack says in some cases, the limits of traditional medicine can be stretched to accommodate the need for one day of high performance.

Dr McCormack has already been named the chief medical officer of the Canadian Olympic Committee for the 2010 Vancouver Winter Olympics.

Dr Julia Alleyne
Dr Julia Alleyne, a well-known Toronto sport medicine specialist and a veteran of the Salt Lake City and Torino Olympics, has a motley set of responsibilities at this year’s Olympics, including caring for the trampoline, badminton and shooting teams.

Asked about the first-ever Canadian Olympics wellness centre, which she’s launching this year in Beijing, she rattles off a list of items she’s either packing to take with her, or that she plans to pick up in China. They’re mostly things you might not normally associate with medical treatment at the Olympics:

• a dreamcatcher
• candles
• a stereo that plays relaxing sounds of the ocean
• bean bag chairs
• sleep masks, for the power nap room
• yoga videos
• hammocks
• motivational posters

The idea for the wellness centre was based on a “needs assessment” Dr Alleyne helped conduct. “The number one reason athletes felt they could not reach top performance is they couldn’t get the best sleep.” The same goes for the staffers, too: “They get burnt out, the coaches and support staff,” says Dr Alleyne. “It’s intense and grueling, it’s hard financially and culturally, they’re away from their families. We hope to reduce the feeling of burnout.” Physicians and other medical staff, who sometimes suffer from the same stress as the coaches and support staff, will be welcomed to the wellness centre as well.

Besides stress and the struggle to get a good night’s sleep, says Dr Alleyne, a major concern for the medical team is the unlikely but not impossible event of a terrorist attack -- especially in light of a recent strike by Islamic separatists in western China that killed 16 police officers, and threats of further attacks. “When you are going onto the world stage like this, in a time where there are a lot of high emotions, a number of different crises, you worry about safety and security.” RCMP officers are assigned to protect the Canadian team, but in the event of a disaster or an attack Dr Alleyne is prepared to take charge of triage for the Canadians’ disaster-planning. “If you have lots of supplies available and a low number of casualties, you can give one type of care. But if you have low services and a mass casualty incident, you have to consider who will have the greatest chance at survival,” she says.

Dr Alan Vernec
At the moment, Montreal physician Alan Vernec, the medical director of Athletics Canada and a COC physician, isn’t in Beijing getting ready like most of the other physicians and staff are; he’s in Singapore, where the track and field team is holding its training camp. They wanted to get everyone acclimatized to the August heat in East Asia and let everyone’s jet lag wear off, but Beijing’s air was deemed too polluted to subject the athletes to for longer than is necessary.

“We’ll get used to the heat with no pollution and without the chaos, the frenzy that will be in Beijing,” Dr Vernec says. It’s a lot easier to book training facilities in Singapore than Beijing, where you are competing logistically with the glut of other teams in the city at the moment.

Another benefit of staying in Singapore for the first two weeks of August is the food. “Singapore has the best food in the world,” says Dr Vernec. “It’s the new France, I’ve heard.”

One of the toughest jobs in the Olympic Village is keeping the kids calm. “The problem is as people finish events they change into a party mode. We insist strongly that Canadian athletes have to be on their best behaviour, not to disrupt other athletes. It’s party time to some degree for young athletes. but they’re aware of the stresses, and we tell them to expect the unexpected.”

Despite his perorations on safety and level-headedness, however, Dr Vernec expects there’ll be some trouble. “You have to go there with that attitude. You expect difficulty sleeping or transporting, or your cleats are stolen two hours before your race.” There’s plenty of fun to be had at the Olympics, but in some regards it’s always chaos.

Dr Connie Lebrun
Dr Connie Lebrun, a University of Alberta physical education and recreation prof and the Canadian Olympic Committee’s assistant chief medical officer, was disappointed that the Canadian beach volleyball squad failed to qualify for the Beijing Olympics. She was on the Olympic volleyball team back in 1976, at the Montreal games. “We finished eighth out of eight,” she recalls. “But it was great walking into the stadium. It gave me chills.”

A five-team Olympic medical team veteran, Dr Lebrun’s jobs this year will include caring for the field hockey, tennis, fencing and archery teams.

As part of her administrative work, she has been thinking about Beijing’s air pollution. “Obviously we are a bit concerned about the weather and air quality, and we have tried to prepare for it a bit, but the Beijing officials are trying to do something about the pollution --alternating licence plates on alternate days and shutting down factories,” she says.

“Knowing the air quality might be a problem, we are making sure our athletes with asthma or exercise-induced asthma are being tested, and people who have a family history of asthma and high-risk people are getting tested in Canada.” Those tests have been fruitful: Dr Lebrun and other medical staff have already identified as high-risk some athletes who had not before been diagnosed with respiratory problems.

Dr Babak Shadgan
If he has any time between gathering research on wrestling injuries, observing doping control procedures and tending to patients at Team Canada’s clinic, Dr Babak Shadgan, a muscle and mobility researcher at UBC, says he’d love to visit the Great Wall.

It’s more likely, though, that after he finishes collecting samples with the doping program at 9:00pm every day, he’ll put sightseeing on hold and head back to the Olympic Village to file daily research reports and analyze the data he’s collected.

“As you can see, it’s a tough job, but I like it!” he enthuses.

When the games end he’ll present his research to the International Wrestling Federation with hopes that what he’s gleaned from tracking injury trends in elite wrestlers will guide rule changes and educational activities to minimize injury risks.

Originally from Iran, Dr Shadgan looks forward to seeing his countrymen throw down on the wrestling mats, “but as a physician it doesn’t matter what the nationality of the athletes I’m treating is.”

Dr Renata Frankovich
“I think the Chinese have a very different culture, and they’re trying to expose themselves to the world through the games,” says Dr Renata Frankovich. “I was in Beijing in 2001 for the World University Games and there have been huge changes to the city in the course of seven years, so it will be interesting to see exactly what’s gone on.”

After traveling with Team Canada to Athens in 2004, this year Dr Frankovich says she’ll know what to expect as the physician standing by on the sidelines for Canada’s synchronized swimmers, divers and men’s water polo team.

“The group of doctors that I’ll be working with is the best at what they do,” she says. “When you put everyone together you’ve got a lot of skill, and connecting with your colleagues to swap stories and knowledge is great.”

But Dr Frankovich doesn’t have to reach far for her own stories about working with elite athletes. Her sport medicine practice, based at Ottawa’s Scotiabank Place, treats members of the Ottawa Senators. “I’m from Hamilton and we hated Toronto growing up,” she says, “so getting behind the Sens was easy.”

Dr Andrew Pipe
Dr Andrew Pipe has cared for Team Canada at nine Olympic Games. “I never dreamed that medicine would take me to these places. Each has been a unique experience,” he muses.

“I have some very special recollections. Many of them tie to magical performances at the ’76 Olympics in Montreal” -- his first games as a physician caring for Canadian athletes. “It was such an unbelievable setting. As a doctor you’re in the midst of it, and you get to see sports men and women up close.”

This year Dr Pipe is intrigued by the Chinese cultural environment “that will be an ever-present factor at the games.”

And he worries for some Canadian athletes: “If you turn up for a game and the pollution index is pretty high,” he says, “one has to expect that performance will be affected.

“There are a large number of athletes who may begin experiencing respiratory problems that they never knew they had.”


For more on Canada's Olympic doctors, check out our behind-the-scenes look here.

Profiles of Drs Pipe, Frankovich and Shadgan were written by Graham Lanktree.

Photos courtesy of the Canadian Olympic Committee. Photo of Dr Shadgan from the University of British Columbia.

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