Summer Olympics' chief physician has a marathon task
By Deborah Gesensway
For much of the summer John D. Cantwell, FACP, is changing the white coat of his cardiology practice for a special red-sleeved polo shirt identifying him as a doctor doing a job of Olympic proportions.
As chief medical officer for the 1996 Olympic Games in Atlanta, Dr. Cantwell will oversee 4,000 medical workers including nurses, emergency medical technicians, dentists, massage therapists, lab techs, public health experts, medical geneticists, researchers and 650 physicians ranging from sports medicine specialists to gynecologists. It will be his job to make sure all 10,000 athletes and 1.4 million spectators from 197 countries stay healthy in the Atlanta heat.
Dr. Cantwell is director of preventive medicine and cardiac rehabilitation at Georgia Baptist Medical Center and clinical professor of medicine at Morehouse School of Medicine, jobs he has continued part time for five years since his appointment to the International Olympic Committee's (IOC) medical commission. An amateur athlete himself—he played basketball and baseball at Duke University before attending Northwestern Medical School and finishing his residency at the Mayo Clinic—Dr. Cantwell has been an Atlanta Braves baseball team physician for 21 seasons. This spring, he ran the Boston Marathon.
Dr. Cantwell talked to ACP Observer in the final weeks before the Centennial Olympic Games about the clinical and logistical challenges of providing medical services for the 17-day event, as well as his views on how internists might encourage more Americans to add more exercise to their daily regimens.
ACP Observer: During the Games, what will you actually be doing?
Dr. Cantwell: The IOC medical commission, comprised of about 35 to 40 people from all over the world, meets every evening during the Olympic Games. We review all medical aspects of that day, including any positive drug testing. (All medal winners are tested.) If we detect a positive, the athlete and his or her representative are brought in front of our group, and then we vote as to what we recommend to the IOC executive committee. We decide whether to recommend that they be banned from the Olympics or have their medal taken away. It can be a pretty testy experience.
We also review trends. For instance, if there was a significant spike in the episodes of gastroenteritis that day, the obvious question is, "Is there any food poisoning going on?" We have public health people on the scene who can investigate and advise us whether there might be a problem we need to research and act on.
Other issues come up. We have a formulary of approved drugs that the athletes can use and a list of those that are prohibited and those that are restricted, which means if an athlete is going to take them, our commission must be notified. The restricted drugs include some of the asthma drugs. We will be looking for trends. Are these drugs being abused? Could they be used to try to enhance performance? If every athlete on a particular team is taking medicine for exercise-induced asthma, you wonder if there isn't something else going on there. This really comes up.
Gender testing (required of each female athlete) also is an issue. If there are abnormalities, how do we resolve those? Is it a genetic mosaic that doesn't give the athlete any particular advantage, or is the athlete advantaged because of her androgenicity? And how do we deal with that?
The interesting thing about my position is that you are dealing with so many things. One minute you are talking about combating disaster problems and having hazardous materials people fly in to treat this or that. The next minute you are talking about gender testing.
Don't the teams bring along their own physicians?
Many do, but we help them expedite whatever they need and fill in the gaps. If they need an eye doctor, we will supply that. At the Polyclinic (the Olympic Village's 24-hour medical center, which after the Games reverts to being the student health center for Georgia Tech), all medical specialties and a pharmacy will be available. Each hospital in Atlanta has adopted one of the 26 sports venues as its responsibility.
As we recruit physicians (who are all volunteers), it makes you appreciate general internists, because they can take care of a variety of things that will come up. Recently, we had an Olympic meeting here and a woman from Africa had acute malaria. People are flying in from all over the world, bringing with them problems we have to recognize. A general physician is so valuable to our needs. We can assign them anyplace. It's not like urologists—we just need a few of those.
Are there differences in the kind of medical attention American athletes get compared to that in other countries?
In this country, in sports medicine, they tend to use a lot of MRIs. In some other countries, they still rely on ultrasound for muscle problems and diagnostics. So we have had to scrape around and bring in people expert in ultrasound to have the service available for the doctors from other countries. If that's what they want, we'll provide it for them. But we'll also recommend that they might want to look at our way too.
Since there are athletes from countries where acupuncture is common, if a doctor contacts me and wants to find a local acupuncturist, we'll try to help with that. It's not officially part of our medical service, but if they request it, and we think it's a reasonable request, we'll try to help them.
We do want people to see medicine being practiced as it should be practiced, not be accused by people saying, "Well, that's America. They overdo everything." For instance, we'll have dentists, but we're not going to do complete dental reconstruction on athletes who have chronic conditions. But we do want to try to help athletes who come from disadvantaged countries. There's a balance. Sometimes, also, physicians from a poorer country might try to stockpile medicines from the Polyclinic, so we have to be alert to that.
One of our goals is to leave legacies, like trying to educate people coming here about the hazards of cigarette smoking and the importance of prudent eating and exercise habits. We've tried to encourage spectators to participate in the activities of the city by either jogging or walking. We've had some general mailings with the tickets. We have been stressing that these are smoke-free games.
What is being done to address concerns about potential health effects of Atlanta's summer heat?
Fortunately, a benefactor in town donated $1.5 million to be used for water, shade structures and toilets. That will help a lot because we want to have a lot of free water available so we can push people to drink a lot of fluids. We want to have shade structures and maybe some misting areas where they can cool off.
In past Olympic Games, what kinds of medical problems have been encountered?
The athletes are pretty healthy. The problems are usually more with the entourage that comes with the athletes. There will be a lot of older people, and they come with a variety of diseases. They can have GI bleeding, acute MIs and they come with pacemakers.
In Olympic history—I've enjoyed reading a lot of the history of the Games—there have been only two deaths in the Summer Games. In 1912, in Stockholm, a runner from Portugal got heat stroke in the marathon and died the next day. And then in 1960, a cyclist died, and it was probably related to amphetamines. Those are two examples of things we will have to deal with here—the heat situation and making sure people aren't taking stimulants.
Are there some lessons from the Olympians for your internal medicine and cardiology patients?
I think the main thing is that you just try to encourage people to be the best that they can be. That's what the Olympians try to be. That's what we try to impart to the cardiac rehab patients. Don't try to keep up with your neighbor. Don't set unrealistic goals.
Get down to your proper weight. Get your cholesterol level down. Get your fitness level up. Make sure you are not overstressed. There are a lot of similarities. You are talking about the human function curve, where stress up to a point improves performance, but then it starts to tail off if you get overstressed. That applies to the athlete as well as to the cardiac patient.
The current exercise recommendations seem pretty reasonable—about 30 minutes of moderate-intensity-type activity just about every day. For a while, people were saying 30 minutes three times a week, just have a walk. But we test a lot of people, and that's not enough. To get better at something, you need to put in the time.
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