Richard Budgett: Olympic challengeBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2904 (Published 02 June 2010) Cite this as: BMJ 2010;340:c2904
Richard Budgett is masterminding the medical arrangements for the next Olympic Games from the London 2012 headquarters, on the 23rd floor of a skyscraper in Canary Wharf. From here 2012 is not such a distant prospect; the Olympic stadium and aquatic centre can be easily picked out two miles east across the horizon in Stratford.
Budgett, the chief medical officer of the London 2012 Olympic and Paralympic Games, is a veteran of these events; London will be his 12th. He won a gold medal for rowing in the 1984 Los Angeles games, alongside Steve Redgrave, and has attended many games as a doctor, mostly as chief medical officer for the Great Britain team.
He has the ambition you’d expect from a former elite athlete. He wants these games to be the “cleanest ever,” with arrangements in place to collect about 5000 samples for drug testing—a record number for the Olympics. He also pushes the notoriously hard message that the games are not just about the exercise physiology of elite athletes but the importance of exercise for all.
The immediate practical challenge for Budgett is the giant task of bringing temporary health care to 17 000 people living in the athletes’ village. The “jewel in the crown,” says Budgett, is the polyclinic, a 460 m2 facility on the eastern edge of the village that is due to begin construction late this year. It will house sports medicine facilities, physiotherapy, chiropractic services, osteopathy, dentistry, imaging services, a pharmacy, a hydrotherapy unit, a small accident and emergency unit, and general practice surgeries.
This is undoubtedly health care for the elite. Budgett’s team will shortly begin recruiting an army of medical volunteers to tend to the health needs of competitors, accredited team members, and spectators (see box). In the inner sanctum of the athlete’s village, competitors will be provided with an enviable spread of specialist services. “If someone wants to see a gynaecologist, cardiologist, or dermatologist that will be available. Because that is what the teams want. I was a team doctor for 14 years, and you want the services to be as near to your athletes as possible.”
Arrangements are in place with specially designated local NHS services to fast track athletes who need tertiary care, although the London Organising Committee of the Olympic and Paralympic—the body responsible for staging the games and for whom Budgett works—emphasises that the effect on local health will be minimal.
“It’s very important for us that our athletes and officials can be fast tracked from the polyclinic or venues, but the numbers are small, one or two a day. It will only be a few cases when we need an operation or something more major. The International Olympic Committee is adamant that it is business as usual for whatever health services exist around the Olympics.”
Around half of the national teams will have at least one doctor. “But there are a significant number of teams who don’t have medical support and so they will completely rely on us—such as teams from developing countries and very small teams. One of the huge challenges for a team is the limited number of accreditations, so they have to decide whether to have another coach or a physiotherapist. It’s quite a big judgment. But if they feel they are going to have very good medical care from us that helps them make that decision.”
In previous games, relatives of athletes and entourage members have reportedly used the opportunity to access high quality medical services not available back home. Budgett denies this could happen at London 2012. “They have to be an accredited member of the national team. We would be responsible for a spectator who falls ill in one of our venues, but outside of this people would have to use the NHS and have proper agreements to do so.”
But what of the much vaunted ripple effect? Budgett refers to the most ambitious success indictor—that of getting two million more people active by the 2012 Olympics. It’s a praiseworthy legacy goal, linked to improved public health, but won’t it be hard to attribute changes in behaviour to London 2012? A paper in the BMJ this week shows that there is too little evidence to determine whether major sporting events have any effect on public health.1
Budgett says: “It is very challenging to determine what’s causative, we can look qualitatively at the inspiration effect of the games, whether 2012 has had a catalyst effect on any programme, but to actually determine how crucial it has been is a judgment more than a science. The BMJ paper was difficult. You can probably show economic benefit but to show that the games has inspired people to get exercising is a hard thing to do.”
Easier to evaluate is the effect of the new specialty of sports and exercise medicine. “These new specialists will benefit the country twofold; first on the musculoskeletal side, by dealing appropriately with people with strains and sprains who are so often inadequately treated and don’t get back to sports and end up with some more chronic unstable ankle, for instance. Second, they understand the use of exercise as a health tool—it is the most underused therapeutic tool there is. The actual returns are less tangible—certainly by reducing orthopaedic waiting times and freeing up orthopaedic surgeons to operate, you can show an economic benefit, but the benefit of getting people exercising obviously takes longer to see.”
This doesn’t mean to say that there aren’t tensions between health promotion and sport. The organising committee has needed to raise £2bn (€2.3bn; $2.9bn) to stage the 2012 games (this is in addition to the £9bn from the public purse that is largely funding the infrastructure). The drive for sponsorship has led to partnerships with fast food giants and fizzy drinks manufacturers. Public health experts have said it is hard to reconcile the fact that McDonald’s and Coca Cola are the leading sponsors of the International Olympic Committee (IOC), although Budgett is sanguine.
“We have to accept the IOC sponsors, which includes McDonalds,” says Budgett. “There will be choice, some people do eat McDonalds and that is fine. It doesn’t matter if you eat McDonalds in moderation.”
“Regenerating east London is a fantastic health benefit—just look at the statistics of reduced life expectancy as you travel east in London. It is a worthwhile investment and a fantastic springboard, bringing forward investment that was going to happen anyway with the Thames gateway.” The polyclinic will be taken over after the games by NHS Newham and house general practice surgeries, outpatients, a children’s clinic, and diagnostic facilities.
But for now, immediate medical challenges are high on Budgett’s agenda. Anti-doping measures will be a crucial part in a successful games. Budgett sits on the World Anti-Doping Agency and feels “central” to these threats. “Erythropoietin, autologous blood and blood doping, and the anabolic agents are the big challenges.” Technological advances should help give 2012 an edge, he says: “The testing is getting more and more sensitive. The first growth hormone positive sample was detected at the King’s laboratory in the UK by Professor David Cowan’s team, and he will be our laboratory director. For years, growth hormone has been a real problem because it is difficult to detect but we are winning that one. In the next two years testing will get more sophisticated.”
He hopes a new key weapon in the anti-doping armoury for 2012 will be the athlete’s passport.
“The idea is that at regular two to three monthly intervals blood and urine is taken from an athlete, and in this way you can get a tighter and tighter margin of what is normal for that individual. This should help prevent the manipulation that goes on in some sports.” The passports are new and may not be in universal existence by 2012 games, but resources will be focused on those sports that tend to yield the most positive test results, such as cycling, athletics, and weightlifting.
“We want to have as clean a games as possible and we can do that by making sure that athletes know there is going to be really comprehensive testing before the games, in the weeks leading up, and during the games themselves. We are going to do more tests than ever before, around 5000 tests.” He refers to the Anti-Doping Administration and Management System—a secured, web based database system designed for athletes or their representatives to report information about athletes’ whereabouts. “Athletes have to specify approximately where they are 24 hours a day, and exactly where they are going to be for one hour a day. So they can be found and tested anytime during that one hour window.”
Budgett is realistic about the threats of gene doping—the non-therapeutic use of genes to improve athletic performance. “The consensus is that it is an important future threat but in practical terms won’t be an issue by 2012. In the future, possibly, but at present the technology is not there yet to enhance performance.”
But the use of experimental therapies is “very relevant” to 2012, he says. “There is always a pressure to use something that is new. And athletes are always looking for an ‘edge,’ so the appeal of experimental therapies is quite natural. The International Olympic Committee’s medical code is very clear: it is the responsibility of any medic looking after a team to use evidence based treatments. So certainly as an organising committee we will have protocols and procedures and use evidence based treatments.”
Budgett looks askance at the suggestion that many doctors think sport is an irrelevance. “I think that’s a very siloed view. I’d say that sport is relevant economically, socially, and culturally to this country, ranging from elite to recreational sport and just keeping fit—and it has the added fantastic bonus of a health benefit.
“Obviously people can live without sport, but I think it is a lesser life.”
Olympic doctors required
Much of the medical provision at the London 2012 Olympics will rely on a 2000 strong army of medical volunteers drawn from all over the UK. The organising committee has also linked up with the NHS, the Health Protection Agency, and emergency services as part of its preparations. Medical services will be provided not just for athletes and associated staff, but for spectators and media representatives. Pam Venning, the medical services manager of the London Organising Committee of the Olympic Games and Paralympic Games, said that although the main clinical action was likely to be at the polyclinic in the athlete’s village, there was considerable demand outside, at the main venues, and training centres, the sailing venue at Weymouth, and the rowing and canoe village at Egham.
“The athletes will require medical services at the training venues and we need to cover the field of play in case of injury. This requires a different set of skills [from the polyclinic]—emergency doctors or even paramedics with recovery skills. And then we need doctors responsible for spectators—“crowd” doctors from many different medical backgrounds, including GPs.”
Interested doctors who can guarantee a minimum of 10 days volunteer cover should contact the organising committee at firstname.lastname@example.org.
Cite this as: BMJ 2010;340:c2904
Competing interests: None declared
Provenance and peer review: Commissioned; not externally peer reviewed.