Doctors and other healthcare professionals have been involved in facilitating both legitimate and illegitimate performance enhancement in sport.1 2 The recent “bloodgate” affair in Rugby Union shows that healthcare professionals can be involved in producing fake injuries in situations where the apparent “injury” creates an advantage for the team.3

The incident happened last April at the semifinals of the European Rugby Cup match between Harlequins and the eventual winners Leinster. Normally in Rugby Union players cannot return to play once they have been substituted except to replace a player who has a “blood injury.” A Harlequins player produced an apparent blood injury through the use of a fake blood capsule so that a specialist goal kicker could be brought back on to the field to try to secure victory in the last few minutes. At the behest of the head coach, the team physiotherapist had purchased fake blood capsules in advance of the game and had delivered one to the player during …