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For weight reduction, e.g. boxers, jockeys: diuretics. These are also used to flush out other drugs in the hope of escaping detection; severe volume depletion can cause venous thrombosis and pulmonary embolism.

Generally, owing to recognition of natural biological differences most competitive events are sex segregated. In many events men have a natural physical biological advantage and the (inevitable) consequence has been that women have been deliberately virilised (by administration of androgens) so that they may outperform their sisters.

It seems safe to assume that anything that can be thought up to gain advantage will be tried by competitors eager for immediate fame. Reliable data are difficult to obtain in these areas. No doubt placebo effects are important, i.e. beliefs as to what has been taken and what effects ought to follow.

The dividing line between what is and what is not acceptable practice is hard to draw. Caffeine can improve physical performance and illustrates the difficulty of deciding what is 'permissible' or 'impermissible'. A cup of coffee is part of a normal diet, but some consider taking the same amount of caffeine in a tablet, injection or suppository to be 'doping'.

For any minor injuries sustained during athletic training NSAIDs and corticosteroids (topical, intraarticular) suppress symptoms and allow the training to proceed maximally. Their use is allowed subject to restrictions about route of administration, but strong opioids are disallowed. Similarly, the IOC Medical Code defines acceptable and unacceptable treatments for relief of cough, hay fever, diarrhoea, vomiting, pain and asthma. Doctors should remember that they may get their athlete patients into trouble with sports authorities by inadvertent prescribing of banned substances.11

Some of the isssues seem to be ethical rather than medical as witness the reported competition success of a swimmer who, it is alleged, had been persuaded under hypnosis into the belief that he was being pursued by a shark.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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