Are the Doctors to be Trusted?

• by Paul Gardner , Sep 25, 2011

By Paul Gardner

LONDON -- These are the words of Alex Ferguson: "Manchester United has some of the best sports medical staff in world sport ... they are brilliant. The doctor, his five physiotherapists, the sports scientists, all fantastic."

A surely unarguable statement of some obvious facts. It figures that Man United, the richest club in the world, one that employs some of the world’s best players, would not stint on spending money to ensure the health and fitness of those players.

Yet we have a dissenting voice. Dissenting and disturbing, a voice that deserves to be listened to. That must be listened to.

Owen Hargreaves was a ManU player for four years. Years that were mostly agony for Hargreaves as he battled severe tendinitis in both knees. In those four years, he made only 27 appearances with ManU’s first team.

In November 2008 he had a major operation on his right knee; and barely two months later, had a similar operation on his left knee. How did things get that bad when all the while Hargreaves was being treated by the team that Ferguson defends as among “the best in world sport”?

Hargreaves, an intelligent, articulate man, now 30 years old, alleges that it was a series of injections, administered by the ManU staff, that caused his recovery to be so slow and painful, that caused his knees to become “significantly worse.”

“They said [the injections] would help and that I wouldn’t have any side effects. That obviously wasn’t the case.” Without any signs of bitterness or hostility -- indeed, he makes a point of calling all the ManU people “lovely” -- Hargreaves talks of being used as “a guinea pig”.

Eventually, ManU released Hargreaves and he was signed by Manchester City earlier this year. A different medical team took over, and two weeks ago Hargreaves played nearly a full game, and scored a goal for Man City in a Carling Cup game. A career that had promised so much -- it had led to England’s 2006 World Cup team and the signing by ManU -- and had then looked as though it was finished by injury, was suddenly reborn.

Different doctors, different treatment. Did the ManU medical people get it wrong, then? Never mind what Hargreaves thinks, what did the other doctors say -- did they believe that errors had been made at ManU? “Absolutely,” was Hargreaves’s reply.

A situation that ought to be inconceivable. But Hargreaves lived through it, his version -- whatever may be the justifications from ManU -- tells us what happened. And we should not be shocked. We have seen a top medical department getting things wrong before. In July 2003, Gabriel Milito was on the point of signing for Real Madrid, when the Real medical department stepped in and nixed the deal. Milito, they said, had a suspect knee (already operated on in Argentina), and their verdict was: "After carrying out exhaustive tests, Real Madrid's medical team believe ... the player's maximum performance cannot be guaranteed over the next four seasons,"

Milito, spurned by Real, joined Real Zaragoza instead -- and played four full seasons for them, before moving on to Barcelona.

There are, for sure, many other examples of faulty judgments and treatments that we don’t hear about. I’m having difficulty recalling any instance of a soccer player suing his club’s medical department for malpractice.

Medicine -- including sports medicine, even when practiced at the highest level -- is not a perfect science. We ought to know that -- subconsciously we probably do -- but doctors practice from a position of strength. We want them to succeed, we want them to cure us, hence we must have faith in them.

Hargreaves, looking back, wishes he had not agreed to have the injections. But on what basis would Hargreaves refuse them? That he knew better than the medics? The vast majority of patients trust their doctors and do as they are told. And for the vast majority, that trust is rewarded.

But there is always the possibility of mistakes. And the discipline of sports medicine will have its share of these. Its errors will not often be career threatening. It rarely, if ever, has to deal with matters of life and death, because it treats mostly very healthy young athletes for a limited number of disorders. But there is always the possibility of pressure to get a player fit in time for an important game (pressure not only from the clubs, but from the players themselves, who may well hide or belittle injuries). And sports medicine is linked, like it or not, with the area of fitness and health ... an area that is fertile ground for suspect practitioners and even more suspect treatment regimens, an area that, in fact, may spread out to make contact with the murky world of doping.

It would be quite amazing if sports medicine -- particularly in this era of alternative medicine -- were able to avoid some of the excesses of the gurus and the personal trainers.

That does not constitute an overall indictment of the ManU or the Real medical departments. Of course they are good at what they do. But are they as good as they evidently believe they are?

Is it ever a good idea for opinions to reign unchallenged? Does that not inevitably lead to arrogance, and ultimately, misjudgments?

Science, including medicine, has never quite divested itself of the arrogance that it acquired in the 19th century when it made amazing advances in discovering the secrets of nature, when its practitioners had a habit of being so sure of themselves that they quickly dubbed newly discovered principles as Laws. You will have come across them in high school, Boyle’s Law and Charles’s Law and Gay-Lussac’s Law and so on. (It’s worth pointing out that soccer, in 1863, joined in this headlong rush for confident certainty, by codifying the sport under the title Laws rather than rules.)

Things are not so immutable these days. The notion of a “second opinion” in medicine is based on the acceptance -- by every one, including the medical profession -- that judgments can be wrong. But I wonder when was the last time that any soccer club agreed to seek a second opinion on the verdicts of its own medical department? Come to that, how many young athletes would have the nerve to ask for a second opinion?

Take the injections that Hargreaves incriminates. One of the most curious things about this story is that we don’t know what they are. I have read 37 different reports on the case, and not one of them gives any details. The closest to any identification is a story that talks of “pain-killing” injections. Quite possibly -- one would expect them to be either that, or maybe an anti-inflammatory steroid.

We are on dangerous ground here, or rather the medics are. Administering drugs that mask pain but do nothing to cure the underlying cause of the pain, is greatly frowned upon if used as an ongoing treatment rather than as a short-term emergency measure. Obviously, such treatments, if persisted with, can be harmful.

What worries here is Hargreaves’s remark about his being a guinea pig. Which contains the unavoidable suggestion that he was being given new treatments whose effects were not yet fully established.

It must be unthinkable that the ManU medics would do that. That is what I believe. Even so, I would like to know what was in those injections given to Hargreaves.