CELEBRATING THE 20TH BIRTHDAY OF IAHN
JNEPHROL 2013; 26 ( Suppl 22): S198-S202
DOI: 10.5301/jn.5000371
The “Other” Olympic Games: the view of the
medical doctor
Athanasios A. Diamandopoulos
Panhellenic Society for the History and Archaeology of
Medicine, Patras - Greece
The medicalization of the Games
Introduction
The aim of this part of this article is to present evidence
about the relationship between the Olympic Games and
medicine. The subject is not original as several writers
have dwelt on it: to name but a few of the living ones, and
only those of Greek origin, I recall Prof. Lola's book titled:
"Medical Care at the Ancient Olympic Games" (ISBN: 960210-462-7), which was eventually transformed to a video
with the narration done by the late Oscar-award winner Sir
Peter Ustinov (1), Prof. Spyros Retsa's work “Medicine and
the Olympic Games of Antiquity” (2) delivered in the same
location, i.e., Ancient Olympia, and lastly, my own paper
“Medicine and the Olympic Games” read initially as the inaugural lecture at the opening ceremony of the 29th Congress of the International Society for the History of Medicine in Bari, Italy, in 2004 and published repeatedly (3). Two
relevant artifacts emphasize also the bond between the
Games and medicine. The first, an ancient one, is a gold
and ivory relief called “The Composition of the Contest,”
which lay originally at the temple of goddess Hera at Olympia. One end depicted Mars, the god of war and Agon, the
personification of the Games, together with Asclepius, the
god of medicine and his daughter, Hygeia (4).
The second is the very logo of our Congress, representing Zeus, the reverend god of the Games, together with
Asclepius, the god of medicine, albeit modified as the patron saint of nephrology. Thus, the subject has been well
studied and presented before in multiple forms. Here, we
approach it from a somehow different aspect: that is, the
medicalization of the Olympic Games and life in general,
the competitive nature not only of sports but also of any
social and scientific activity and the commercialization of
humanism.
S198
The Olympic Games started as a festival with a deeply
religious content honoring not only the specific dead but
the deities of the underworld in general, at the ravine
of the Kronaios hill. From that faraway era we have no
evidence, and there was probably no need for medical
support at the Olympic Games. At most we can hypothesize that some kind of first aid was given in cases of
injury. Medicine makes the first important steps toward
participation in the Games in the next Archaic period.
The athletes staying at Elis undergo medical examination to test their aptness to compete, receive intensive
physiotherapy with baths, massages, walking etc. Special diets are suggested for the competitors, as precursors of the contemporary complex dietary regimes followed by athletes. One such diet known to us consists of
the consumption of a large number of figs, to fuel their
energy with carbohydrates.
During the following Classical Era, the competition becomes
stronger and medicine follows suit (5). The first step consists
of the rejection of what we would call a Mediterranean diet,
with consumption that is primarily of fruit carbohydrates, such
as figs, and their replacement specifically for athletes, with a
large amount of animal proteins such as beef. Pythagoras is
said to be the first to have introduced this approach (6).
Hippocrates mocks this tactic, and it is interesting to note
the distinction he makes between true health and excessive strength, demonstrated by hypertrophic muscles (7). He
regards that “Gymnastics and medicine are by their nature
opposite, for gymnastics have no need to cause changes [in
the human body] but medicine has. For changes are not needed in the state of a healthy individual, but this is necessary
in the patient” (8,9). However, regardless of his contempt of
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428
JNEPHROL 2013; 26 ( Suppl 22): S198-S202
strenuous exercise, Hippocrates in his treatise On Joints (10)
describes a method of reducing a shoulder dislocation: “a
method simple and useful in the wrestling ring, as elsewhere.”
Aristotle, in the 4th century BC, describes the distortion
of athletes’ faces, which look like animals, due to the
special diets they follow for the augmentation of their
physical strength (11). These comments remind one of
contemporary athletes’ faces, distorted by the use of
growth hormones.
The champions, with their strength and their physical superiority exert a sensual power over the female, and male,
population of the Roman Empire, especially among the
upper classes. Athletes’ sweat, mixed with the various
oils they use and with dust from the ring, and was sold as
a balsam, a beauty product and an aphrodisiac. This was
the famed rypos (dirt). Medicine was quick to affirm the
value of the product, which is mentioned in official pharmacopoeias, such as that of Dioscurides (12).
This habit was taken to excess and even the humidity
from athletes’ statues or from ring walls was sold as a
therapeutic. The statue of Polyadamandas in Olympia
especially, which “sweated,” was regarded as an extremely potent therapy. Lucian satirizes this (13).
Galen, the most famous Greek medical writer of the 2nd
century AD had a very antiathletic attitude. He calls on
the confession of Euripides that “of the myriad evils in
Greece nothing is worse than the caste of the athletes”
and Hippocrates’ dictum that “to live a sporting live is
not natural, the healthy habits are superior in every way.”
He continues with a catapult of arguments: “We must
examine, he says, athletic performance naked, without
its external decorations” (14).
It is common knowledge that three kinds of assets exist. Mental, physical and external. Athletes have not even
dreamed about mental assets, and they are not even capable of understanding that they have a soul, since they
fill their bodies to a sickening extent with flesh and blood
and cover their souls with blackness. But they do not even
possess true physical assets as, as Hippocrates said, true
health is based on the restriction of one’s diet and the minimalisation of effort (15). In this period, the Ancient world is slowly approaching its
nightfall. The Olympic Games have in reality lost any religious or patriotic dimension and have become a theater
where wandering champions display their skills. They too
are approaching their end. Cicero was already mocking the
festivities at Olympia as the greatest shopping center in the
world – the maximus mercatus (16).
In the beginning of the 4th century AD, Julian the Apostate made a final effort to resurrect the institution. The most
important medical work of that era is a huge effort by
Orivasius, a famous doctor, and friend of Julian’s, who
wrote it at his order (17). He begins by commenting on
diet, saying that a restricted diet is the best guard of
health, with the exemption of athletes who are more interested in the enhancement of their strength than in their
health (18).
In modern times, De Coubertin’s effort to revive the Olympic Games was based on the desire for the renaissance of
the decadent – primarily French – youth of the Industrial
Era, for an international understanding, and finally against
medicine. Coubertin believed, not entirely without foundation, that the medical status quo tries to “inform” society in
such a way that even healthy, young men who exercise will
feel the constant need for a doctor. Thus the mutual lack
of trust between doctors and those participating in sports
events, expressed already by Hippocrates and Galen, was
continued.
Medicine can but follow this general trend. Athletes are not
motivated by their original aim to form a link with divinity,
nor by the will to honor their country, not even as much for
their own fame, as for money. Leroy Burrell, the sprinter, left
no doubts when he declared, “We no not participate at the
games because we want to, or because we want to get into
University. We are here to become rich” (19).
In this environment, medicine’s aim is to aid the acquisition of wealth at any cost. Primitive tricks, such as the
oldest known incident of doping at athletic races, the
consumption of sugar dipped in ether to increase the
stamina of the swimmers participating in the swimming
contest between the canals of Amsterdam in 1865 (19) do
not suffice. Even in that era of limited doping, we note the
death of a British cyclist in 1896 due to pharmaceutical
consumption (20).
During the 20th century, the revival of the Olympic Games
and the development of professional sportsmanship,
has been accompanied and marked by the spread of
doping, meaning the use of pharmaceutical substances
which is a result of the result of the extreme medicalization of sport and its incorporation in an industrial-consumerist society. A large number of expects (coaches,
doctors, chemists etc) work on the athletes and aim to
maximize their performance. The sports industry works
methodically, scientifically and sometimes, inhumanly
(21). Doping is placed within this context of organized
and of specifically focused exercise, as an action of disobedience, which does not conform to the rules of the
athletic system, an action not tolerated by the athletic
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428
S199
Diamandopoulos: Olympic Games
community and which is severely punishable by law.
Something yet that the same athletic system forces the
athlete to perform, with the tempting commissions it offers, for which the athletes do not hesitate to risk their
lives. Drugs are not sufficient for contemporary medicine
to fulfill their role as an aid to the dubious preparation
for the Olympics. The supposedly innocent nutritional
supplements, anabolics, beta-blockers, autotransfusion
and erythropoietin injections have given us the “pharmacogenic athlete.” And even this has not been enough to
satisfy the voracious appetite of an international audience that has converted the Olympics, as Helen Lenskyji
said, into the greatest Circus Maximus on the planet
(22). DNA manipulation will be able to give us embryos
with perfectly formed and developed particular groups of
muscles that will become excellent athletes at particular
sports, as already Flavius Philostratus, in the 2nd-3rd century AD, had envisioned (23).
Gene cloning has already started, either by introducing alien
genes into an athlete’s body (difficult to trace), or by manipulating his/hers own genes (impossible to trace). Cloning will
permit us to reproduce as many identical progeny as needed.
Athletes will then be born having the correct body proportions
for every contest. For example extreme height for basketball,
large feet for swimming and long legs for running.
Before starting to comment on this intrusion of medicine
into the pure athletic ideal, let us recall that this is only one
aspect of the general medicalization of society. Other big
events, such as the Oscar Awards, the industry of advertising, the troops at war and many others, are based on the
manipulation of their protagonists via medication, plastic
surgery, psychotropic drags, performance enhancers etc.
We have reached the absolute extreme of the Hippocratic dictum. He was saying that exercise is the opposite of
medicine, because the latter seeks to change the human
body, a goal a healthy person has no need of. Nowadays
medicine is successful in changing the body and our attitudes. Hence, if we accept that the Olympic Games at their
peak were the epitome of classical culture, and again if
Hippocrates epitomizes the ideal doctor in Classical Greece, we can say that current medicine distances itself from
the pure spirit of the Games.
Competitive nature not only of sports
but also of any social and scientific
activity
Modern society is leading further and further into an overall competitive attitude. This was always the case for a minority of unscrupulous leaders, but it was balanced by the
S200
compassion shown by large parts of the population. The
church, family, education and living mainly in small towns
and the country, helped toward this feeling of belonging
and caring for the unlucky ones. All of these institutions
are now in decline. Fierce competition of the market powers, aggressive foreign policy by the superpowers, and
selfishness at all the levels of society have replaced the
ideal of compassion with that of success. In this struggle,
everything is permitted. We take a pill for abortion, a pill for
sexual enhancement, a pill for painkilling, another one to be
happy or not to be sad, and eventually a pill is promoted
for euthanasia. The cultural background of all of these is the
struggle to be successful, and if we do not manage, to die.
In this milieu, medicine reins supreme. And its ambiguous
involvement in the Olympics is in reality accepted and encouraged. Actually, medicine itself adopted this feeling of
competiveness and a new idea, the Medical Olympiads are
flourishing. These continue the tradition of the ancient Olympic Games, where apart from the athletes, many humanists
competed there. However, a separated medical event with
the Olympiad trademark is a rather recent idea. The first
Medical Olympiad was organized by the late Prof. Spyros
Marketos in the island of Cos in 1996, together with the first
International Congress of the International Association for
the History of Nephrology (IAHN), our own society, there.
Since then a deluge of so-called Medical Olympiads have
been organized across the world from Iran to Britain, and
from the United States to Singapore (Tab. I).
Renal patients are also involved frequently in Olympic-style
events (Tab. II). It looks like the only place in the world that a
Medical Congress is not permitted to take place is the very
spot where the ancient Olympiad was held, as we had the
bitter experience when we were organizing this congress
here in cooperation with the EKONY (Hellenic College of
Nephrology and Hypertension).
The commercialization of humanism
The fields of history, general or specific like that of nephrology, of archaeology, religion etc consist of what we call
the humanities. The moral background of these fields is the
desire of the human soul to be involved in areas without direct material profit or practical implementation.
They express only a love for the cultural and spiritual sides of humanity. On the same moral background stands the desire to help unfortunate humans, what generally we call humanism. The idea is commendable, and
over the centuries many noble acts have been accomplished in its name. However, during the last 2 centuri-
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428
JNEPHROL 2013; 26 ( Suppl 22): S198-S202
TABLE I
MEDICAL OLYMPIADS HELD WORL-WIDE DURING THE LAST FIVE YEARS
24th First [!] Medical Olympiad, The Nuclear Medical Society, Thessaloniki, 2011
9th ESFIE (SCGMS), Athens, Greece, 9-11 May 2003, 7th Medical Olympiad
IMO 2013 Indonesian Medical Olympiad 2013
The 2nd International Medical Olympiad, Thessaloniki, the British Nuclear Society
MedicSMSO 2012 (Sriwijaya Medical Science Olympiad) Competition day (Day 1)
Medical Olympiad, China National Convention Center in Beijing, between September 23-26, 2009
The Fourth National Scientific Olympiad for Medical Sciences Students in Iran, February 5-6, 2013
The First Regional Medical Olympiad, Faculty of Medicine Universitas Sumatera Utara, 2013
Talents for Future: Report of the Second National Medical Science Olympiad in Islamic Republic of Iran, 2010
Cor Nostrum: Olympiad for Medical Students, 11 June, 2013
The Third Medical Sciences Student Olympiad Kick Starts at TUMS, 2011
Singapore Junior Physics Olympiad, 2011
TABLE II
OLYMPIC-STYLE EVENTS WITH RENAL PATIENTS INVOLVED
Transplant patients compete in olympic-like games
http://www.theworld.org/2013/07/transplant-games Heart and renal transplant patients to represent Great Ormond Street Hospital in the British Transplant Games, 2012
http://www.gosh.nhs.uk/news/press-releases/2012-press-release
Transplant patients from Texas Children's Hospital to compete at Transplant Games of America, 2012
HOUSTON, July 25, 2013/ www.prnewswire.com/news-releases/transplant-patients...
http://blog.chron.com/...patients-head-to-olympic-style-competition
Transplant patient to carry Olympic Torch - Kidney Research UK
http://pressroom.ackura.com/kidneyresearchuk/1122-Transplant
es, if not starting earlier, it has partially become mixed
with the personal interests of those involved – frequently,
the material interests. Even our persisting fight to extend
a patient’s life with dialysis or by other sometimes futile means was denounced by the William Kolf, the father
of dialysis, when he commented on the widespread use
of regular dialysis with the phrase “the humanism for the
many turned out to be materialism for the few.” From that
point of view even noble institutions, such as the Paralympics may be considered as another aspect of the
commercialization of humanism. But things are not black
or white. Having served in the renal world for 43 years,
and having the courage to fail in many instances, as all of
my colleagues here have done, trying with them to keep
alight at least a fragment of the Hippocratic ethos, I am
not very pessimistic. Medicine in line with archaeology
and the Olympic Games, although marred by many instances, still can be considered, as Roy Caln put it, as
“the greatest benefit to mankind” (24). In the New Testament, we read that it is not necessary that we have a large
amount of faith in all that is good. Even if we just have a
seed of grain, we can move mountains.
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428
S201
Diamandopoulos: Olympic Games
Let us hope that the study of the history of nephrology
will aid us in retaining a small amount of faith, maybe
at least one seed of grain in the ideals of Olympia and
Medicine.
Financial support: There is not any conflict of interest.
Address for correspondence:
Prof. Athanasios Diamandopoulos
St. Andrew Street
Horio Romanou
Patras 26500, Greece
[email protected]
Conflict of interest: No financial support was given for this article.
References
1.
Lolas Ch, Petritsis G. Markopoulos Y, Ustinoff P. Hippocrates in Olympia (NTSC). 2002. Available at: http://www.CelebrateGreece.com. ISBN-13: 978-0-9815714-3-0. ISBN-10:
0-9815714-3-3.
2. Retsas S. Medicine and the Olympic Games of antiquity. Sports Journal. 2011. Available at: http://www.thesportjournal.org/
3. Diamandopoulos A. Medicine and the Olympic Games.
Humane Med. 2005;5:1.
4. Pausanias. Hellados Periegesis (Eliaka) [in Greek]. Athens:
Ekdotiki Athinon, , V,20:3.
5. Retsas S. Medicine and the Olympic Games of aniquity.
Proceedings of the 1st International Medical Olympiad, Cos.
Marketos. 1997;1:15.
6. Oribasii collectionum medicarum reliquiae. Collectiones medicae, 1.40.t.1. Leipzig: Teubner; 1928-1933.
7. Oeuvres completes d’Hippocrate. De morbis popularibus,
6.3.18.Amsterdam: Bailliere; 1962.
8. Oeuvres completes d’Hippocrate. De prisca medicina, 1.4.5.
Amsterdam: Bailliere.
9. Oeuvres completes d’Hippocrate. De locis in homine, 35.1.
Amsterdam: Bailliere.
10. Hippocrates. De Articulis, sect. 4, and l. 1 (Περí ´Aρθρων)
Oeuvres completes d'Hippocrate, edr Littre, E. publ Bailliere.Paris, 1844.republ. Hakkert, Amsterdam, 1962, sect. 4,
and l. 1.
11. Aristotelis de generatione animaliu. GA 768b. 27.Oxford:
Clarendon Press; 1965.
12. Pedanii Dioscuridis Anazarbei de materia medica. Libri quin-
S202
que, 1.30.6.1. Berlin: Weidman; 1958.
13. Lucian. Deorum concilium, 12.5. Cambridge, MA: Harvard
University Press; 1936.
14. Galens Protreptikos. Fragment. Geschichte der Naturwissenschaften und Medizin; 1935:4.3, 1,9,29.
15. Galens Protreptikos. Fragment. Geschichte der Naturwissenschaften und Medizin; 1935:1.10.5015.
16. Cicero, Tusculanarum disputationum Ad M Brutum Libri
Quinque, Kessinger Publishing, 2010, 5.3.
17. Oribasii collectionum medicarum reliquiae. Collectiones
medicae, 1.1.1.1. Leipzig: Teubner; 1933.
18. Oribasii collectionum medicarum reliquiae. Collectiones
medicae, 3.1.13.1. Leipzig: Teubner; 1933
19. Gutmann A. The Olympics: a history of the modern games.
Urbana: University of Illinois Press, Champaign, Illinois;
2002:177.
20. Vittozzi, L. (1997). "Historical Evolution of Doping Phenomenon". Ioa.org.gr. p. 68. Retrieved 30 March 2013.
21. Georgacopoulos P. [The use and abuse of pharmaceutical
substances by Greek athletes] [doctoral dissertation] [in
Greek]. Laboratory of Experimental Pharmacology, Medical
School, Athens University, 1998.
22. Lenskyji H. Inside the Olympic industry: power, politics, and
activism. Albany: State University of New York Press, N.Y.;
2000:ix.
23. Flavii Philostrati opera, 25.1. (1871) (Latin Edition). Carl
Ludwig Kayser, republ: Kessinger Publishing, LLC; 2010.
24. Porter R. The greatest benefit of mankind: a medical history
of humanity from antiquity to the present. London: Harper
Collins; 1997.
Accepted: September 27, 2013
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428