Pharmacy Inside Jobs: sports pharmacist — transcription

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Joanna: Hello, and welcome to Pharmacy Inside Jobs, the PJ Pod series which aims to inspire you to take the next step in your career.

Whether you’re an experienced pharmacy professional or just starting out, our goal is to provide insights into the increasingly diverse roles that exist within the profession. 

In each episode, we’ll be joined by a guest to explore their career journey so far, and the opportunities, challenges and rewards that come with their role. We’ll also find out what skills are needed to succeed in their field, aa well as how you could follow in their footsteps if what they’ve said interests you.  

Joanna: I’m your host, Joanna Robertson, and in this episode, we welcome sports pharmacist Mark Stuart to the podcast.  

Mark was recently awarded an OBE, recognising his contribution to this field for more than 25 years.

In fact, Mark has really pioneered sports pharmacy as a specialism within the profession. So, we’ll hear all about his journey from hospital pharmacist to superintendent at the London 2012 Olympic Games and the work he does now, spearheading anti-doping initiatives worldwide.

Joanna: Maybe we can start with where you are now. You said you’re in Switzerland?

Mark: Yes, I’m currently working at the International Testing Agency [ITA], and the headquarters for that is in Lausanne in Switzerland, so I’ve been working for the ITA for about seven years now. But still very connected to the UK, I still spend a lot of time working from home at the UK and I guess having the best of both worlds. But, yeah, home is in Switzerland at the moment.  

Joanna: Tell us a bit about the International Testing Agency. What is that? What kind of work do you do?  

Mark: It’s a reasonably new organisation. It’s been up and running for about eight years now. It was put together by the Olympic movement really to provide an independent testing service and to provide anti-doping services to the Olympic Games. We do all the drug testing for the IOC [International Olympic Committee], for the Summer and Winter Games, for the Youth Olympic Games, and also for I think about 70 international sports federations. We do drug testing, not only at these big games, but also all around the world in just about every country in the world for athletes.

We do all the drug testing according to the rules set by the World Anti-Doping Agency, so we check for all the prohibited drugs, and the ITA processes those. We’ve got a big legal team here that processes any positive tests that might come out of that. We also have a big medical team here that processes therapeutic use exemptions for athletes who might want to take medications that are prohibited but might have a legitimate therapeutic reason to do so. We’ve also got a big science team and a big communications team, and one of the other things we do is athlete education. So, we’ll go out and teach athletes about anti-doping and how to keep clean, how to promote clean sport and the values around competing clean. It’s a huge organisation; it’s one of the biggest anti-doping organisations in the world now. So, [I’m] very privileged to have this role — a really interesting job.  

Joanna: So, you’ve been heading that up for how long now?  

Mark: I’m the head of the ITA Academy. Our department is responsible for workforce training, so we have developed different training courses for people to get involved in anti-doping. So, things like the training programme to become a doping control officer, and then the people at the front line actually taking the tests, collecting the samples and sending them to the laboratories, through to roles such as blood collection officers that take blood samples for the anti-doping tests.

And then other courses on how to become an educator, how to become a clean sport educator, how to go out there and educate athletes and healthcare professionals about anti-doping and clean sport. So that’s my specific role within the organisation.

But then also, I guess, as a pharmacist at the ITA, I’m the expert in drugs in sport; I’m the go-to person if there’s a query around whether something is prohibited or not. There may be cases that come up that they require some information about how drugs work, the pharmacokinetics of drugs. I also contribute on that level as well, as a pharmacist.  

Joanna: Tell us a bit about that then. What sort of conversations are you having to have? You mentioned athletes that take a drug for a therapeutic reason, but it might be banned. Could you take us through any examples of conversations you’ve had to have around that?  

Mark: I guess I’ve got a number of roles, as you know. My primary role is at the International Testing Agency, but my other work is with the International Olympic Committee, so I’m the pharmacist for the IOC. Some of those conversations that you mentioned in my role with the IOC really is around that, supporting athletes in some of the clinical decision-making and supporting their healthcare at the Olympic Games in the sporting context. And some of those conversations can be very interesting.

At the Olympics, you get athletes coming up with a bottle of supplements, a bottle of capsules, maybe a multivitamin or a creatine product, and asking, “Is this safe? Can I take this? Is this prohibited in sport?”

Having those conversations with the athletes, working out, actually, is there a genuine clinical need for some of the supplements and things that they take? And also educating them about some of the risks.

I guess the other conversations are really looking at the particular clinical conditions and whether the drugs they’re taking are the safest and the right medications for sports injuries or illnesses. But then also how some of those medications can maybe affect their performance either in a positive or a negative way. 

Joanna: Is that something that’s become more common, do you think, people taking supplements, or do you think there’s growing awareness of how things might affect people’s performance?  

Mark: Yeah. I think a lot of athletes, probably most athletes, are taking some kind of supplement for either performance optimisation, for recovery, for general health to make sure that when they’re going to games like the Olympics that they are in peak physical health. And they do actually take a lot of supplements, I’ve seen some athletes [who] might be on five, ten different types of supplements in that environment. 

And although, some of the messaging from organisations like the World Anti-Doping Agency, where a lot of their education really is promoting safe supplement use and also educating athletes about some of the risks of taking those drugs in terms of contamination — some of those do actually contain prohibited substances.

Despite all that education, athletes are still taking large amounts of supplements. Maybe it’s just some vitamin C tablets, or on the other extreme, it might be combinations of ten different protein supplements, amino acids, vitamin mixtures, herbal mixtures, natural products.

And I think athletes really do look for, certainly at that level, anything that is going to make them as healthy as they can [be] in that environment and potentially improve or optimise their performance.

Most things that are proven to improve performance are prohibited. The World Anti-Doping Agency does a very good job at monitoring those drugs. But it’s everything outside of that, it’s looking at athletes trying to support their general health, and optimising their health is a real area that athletes focus on. But that’s certainly one of the roles of a sports pharmacist in that environment, to support athletes [to] make the right decisions and safe decisions.

Joanna: Yeah. Could the use of those supplements interact with other medications that they might be taking?  

Mark: Definitely. I think more so in the sports environments, we look at the performance effects of some of those medications. And I’m just thinking, potentially in a normal community pharmacy setting, [if] somebody came in with a runny nose or an allergy, handing over something like an antihistamine is what you would commonly do. But in this environment, giving an antihistamine to an athlete is something you really have to think about because the antihistamine could potentially cause drowsiness, that could impact their performance. And I think that’s one of the areas of sports pharmacy that really interests me in terms of thinking beyond just the treatment, looking how that actually affects performance. 

Joanna: Have you ever had to tell an athlete that they can’t participate because of a prohibited drug or something like that?  

Mark: It’s interesting. it hasn’t happened very often. It has happened a couple of times. One example is, we had an athlete come in, they were a bowling athlete, like a lawn bowls [athlete], and their product contained a diuretic. Now, diuretics are prohibited in sport. So, it was just informing the athlete of that. The athlete actually needed this drug, they had a medical condition, they actually needed this particular diuretic for their medical condition. But there’s a whole framework in place where athletes can actually apply for an exemption if they do have a genuine medical need for some of these drugs. And again, that’s also one of my roles at the Olympics, to give that information and support the athletes through that process.

So, an application can be made detailing the medical case, and there’s a panel, a therapeutic use exemption committee that’s put together with three physicians — pharmacists are sometimes part of that group — and they’ll look at that case and assess whether there is a need for that drug. They’ll also assess whether there’s any alternative drugs that might be used instead of the prohibited drug, and then they’ll give a decision to the athlete as to whether they can take that drug or not. And what that means is if the athlete tests positive for that particular drug, they won’t have a sanction, they won’t go through the sort of disciplinary process that usually would result if that exemption was not in place.  

Joanna: You touched on the idea of sports pharmacy more generally, and I know you’ve pioneered a few certifications in this field. Could you give us a little definition of what is sports pharmacy and what drew you to it in the first place? 

Mark: Yeah, I guess I got into it by accident. I was working in a hospital in Sydney — I’m originally from Sydney, Australia — and I was working, and they had a little newspaper clipping, looking for volunteer pharmacist for the Sydney 2000 Olympic Games. And I thought: “Oh, this looks really interesting.”  So, I applied, and I got a job. I think there were about 20 pharmacists working there at the Olympics. So, that really was my first introduction to working in this sort of sports world.  

Joanna: So how did you go from being a volunteer there to your role now working with the Olympic Committee?  

Mark: It was an interesting journey! Straight after Sydney 2000, I moved to London, and I was living in London at the time, and the Commonwealth Games were on in 2002 in Manchester.

And, interestingly, I wrote an article that was published in The Pharmaceutical Journal back in 2000 about my experience at the Sydney 2000 Olympics. It was through that article that I was contacted by the organisers of the Manchester 2002 Commonwealth Games, and [they] said: “Hey, we need a pharmacist to come and manage this and advise us and set up a pharmacy service.”

And I got into that rhythm really. At those games, there were some people from Athens 2004 Olympics, and I met them, and I ended up going over to Athens and advising on their setup of their pharmacy service, and I guess it just snowballed from there.

I was living in London for many years after that. There was a lot of large sporting events in the UK. We had the Glasgow 2014 games and London 2012. That was probably one of the games I worked most intensely on over a period of about four years. And then after London 2012, I was appointed to the International Olympic Committee Medical Expert Group. It’s a group of medical experts that advise organising committees on the setup of medical services for the Olympic Games. They’ll support the organising and the planning and then will be on site during the Olympic Games to make sure the medical services are running according to international standards and best practice, and really are the eyes and ears of the IOC at the games.

So, my role as the first pharmacist to be on this group for the IOC, that was probably a bit of a watershed moment for sports pharmacy as a whole. It was the first time the Olympic movement or the IOC had really recognised that pharmacy was an important profession within this multidisciplinary framework of the Olympic Games.

So, having the opportunity to really champion pharmacy from that time to until now has really been the basis of my work since London 2012.  

Joanna: What did working on [the] London 2012 Olympic Games mean to you?  

Mark: London 2012 was probably, I’d say, one of the proudest moments of my career, if you like. I worked on London 2012 for about four years.  

Joanna: So, in advance of the games, there was all of that preparation to do?

Mark: Yeah, literally, we built the pharmacy from the ground up.   

Joanna: So as soon as the previous games finishes, you’re there planning for the next one?

Mark: Yeah, not even. It was even before the previous games finished. So, I went to Beijing 2008 Olympic Games and spent some time at those games looking at the pharmacy services there to take lessons back that we could apply at London 2012, and it literally took four years to build London 2012. We literally built the polyclinic, the pharmacy premises inside it, selecting the drugs to be there in the pharmacy, setting up systems for importation of medications from all the visiting teams from around the world, setting up medical stations and pharmacy stocks in 40 competition venues across London, not only for the athletes but also for the spectators, even veterinary medicine for those Olympic Games…

Joanna: Of course, like horses and things like that.  

Mark: Yeah. The equestrian’s huge, I think there was something like 200 horses that were brought in from other countries into the UK… 

Joanna: And so, when you’re managing the pharmacy stocks, that includes veterinary medicines as well?

Mark: Yeah, yeah.  

Joanna: Wow.  

Mark: Which fall under completely different legal jurisdiction to human medicines in the UK.

And then we had a massive team. We had 100 pharmacists working at those games. We had three pharmacy sites. There was actually three Olympic villages, so we had to replicate everything three times — it was a massive undertaking.

But we won the Pharmacy Clinical Service of the Year for London 2012, as a result of some of the service that we delivered. I think London 2012 really did shape the standards and set a benchmark for Olympic pharmacy services that are in place now.  

Joanna: Yeah. And you were the superintendent pharmacist of those games?  

Mark: Yes, yes, yes. Yep.  

Joanna: So, no pressure, just the UK’s biggest sporting event [laughs].  

Mark: It was huge. I mean, just the volume of people that applied. We had 1,400 pharmacists apply for 100 positions at the games, and then we had a huge training programme as well for those pharmacists who were accepted.

We designed a new computer dispensing system for those games from the ground up. We developed a whole suite of policies and procedures that were specific to pharmacy in the sporting context and developed a lot of national training resources that were available not only to the pharmacists working at those games but also to community pharmacists all around the country to maybe get interested in sports pharmacy.

But also recognising that athletes, when they come to a host city of the Olympics, they don’t stay in the village. They leave the village, they wander around the city, they might go into other pharmacies. So for us at those games, it was really important that all the community pharmacies in the Greater London area and also the pharmacies in the areas around the other two athlete villages also had a good basis for knowledge of drugs in sport and anti-doping, so that if that athlete did wander into their pharmacy and ask for advice, that pharmacy team would be able to deal with those particular athletes, and it certainly did happen.  

Joanna: If there are pharmacists listening or pharmacy students listening who are thinking, “I love sports,” or “This clinically sounds really interesting,” what is a good next step for them? Is there a particular experience they could get or training they could do to enter the world of sports pharmacy?  

Mark: Hmm. Sports pharmacy, it sounds very niche, but there’s actually a lot of little niche areas even within this sort of subspecialty. And just to mention a few of them, one is really the clinical management of injury illness management, looking at what the best treatments are for pain management, for wound care, for travel medicine, jet lag, even emergency medication protocols for field-of-play treatment. So, there’s that clinical sort of side of things as well, and that is certainly a field that pharmacists can get into. They’re experts in [that] already but applying that to the sports context.

The other aspect is this whole sense of performance recovery, optimising performance and athlete health, and this is where your nutritional supplements come in and sports nutrition, hydration strategies and looking at some of those risks that we spoke about before in terms of contamination in some of the supplements.

Then you’ve got the education side of things, supporting athletes to make those good decisions, to avoid doping, to know the processes if they do need to take a medication, then get those exemptions that we spoke about before. So, [there’s] a real mentoring, education role that some pharmacists get involved with. Some pharmacists are out educating teams, they might be visiting clubs or events, teaching athletes about safe medication use.

And then you’ve got the anti-doping side of it as well, looking at drugs that are prohibited in sport, helping athletes prevent inadvertent doping, and there’s a whole anti-doping industry that a lot of pharmacists get involved with.

In terms of some of those opportunities of getting involved, I mentioned my first opportunity was volunteering at the Olympic Games, and I cannot recommend the volunteering experience enough. A lot of people say: “Oh, I’m not getting money for it. I have to use my holidays.” But honestly, the people that you speak to that have worked in this environment, the people you meet from around the world, you’re working alongside some of the world’s best sports medicine physicians, other healthcare professions, you really are at the front line in terms of athlete care in that environment.

Some of those experiences, that knowledge you learn really is priceless and really does open doors. The people you meet in that environment and the learnings that you can bring back to your, regular practice, if nothing else, it really is priceless. So, I guess to sum all that up, volunteering is really my first recommendation.  

Joanna: What would a pharmacist wanting to volunteer at something like this, what makes a good application? What do they have to have to stand out?  

Mark: Being able to demonstrate some interest or experience or even knowledge of some of those areas that I mentioned. Knowledge of maybe treating injuries, maybe you work in an orthopaedic ward at a hospital, perhaps. Maybe you work in a community pharmacy that has a health promotion aspect of it. Maybe you simply… you’re an expert in selling, the braces and some of the physical therapy products that are available through a community pharmacy. If you’ve got experience in anti-doping or [have] got an understanding of drugs in sport, that really does help.

If you’ve done some of these courses… there is a pathway and some defined training that you can do, you come out the other end, and you can actually call yourself a sports pharmacist. So, I think it’s great now, coming from the organising side of the Olympic Games, having so many people with so many good skills, having pharmacists with this sort of knowledge base, we can really put together some of the best sports pharmacist teams possible to serve some of the best athletes in the world.  

Joanna: Yeah, and that sounds like a totally different landscape for sports pharmacy than when you started out, I guess.  

Mark: Definitely. None of this really was available when I first started out, and I think that’s been one of my driving passions. And I think some of the projects that I’ve mentioned, that I’ve been involved with over the years has really stemmed from me seeing that, actually this doesn’t [already] exist. You know, there’s not a set of drugs for athletes at the Olympics, so let’s build it, let’s create it. There’s not a postgraduate course for pharmacists to get into sports pharmacy, so let’s develop it. I think that’s been one of the things that I’ve loved about this journey is to being able to build some of these structures and create opportunities and raise the standards of how pharmacists work in sport.  

Joanna: You just mentioned that you have [had] the opportunity to work globally with athletes and with medical teams from all around the world, and I know we’ve spoken before about your work creating a single formulary for the Olympic Games. Could you talk a bit about that? Why is it so important to bring all that knowledge together, and have standardised care across all the games?  

Mark: Well, the Olympic and Paralympic Model Formulary was first published a few years ago now, and we updated it last year for the second edition. But basically, when I was working at all these games, every games I’d turn up to, there’d be a different set of drugs that the athletes would have access to, that the physicians would be able to prescribe. And there [was] so much variation between Olympic Games, between Commonwealth Games, between all of these events. So, this project was really to harmonise the availability and the selection of drugs at the Olympic Games. So that’s how it came into being.

And now there’s a single set of drugs. There’s about 250 drugs on it, and that is the mandatory list of drugs that every Olympic Games has to have in place now. And it means that as a team doctor from any country in the world, you know what you’re getting. You know that set of drugs has been selected based on good evidence, that they’re safe, that they’re the best medications that you could use for the injuries and illnesses that athletes experience. So, it’s a really harmonised approach to drug availability at the games. I guess similar to the World Health Organization Model Formulary, which is the basic set of drugs that every country has to have in place as minimum standards. So, we’ve done that for the Olympic environment. Massive piece of work, but [I’m] certainly very proud that that’s now the international standard really for drugs at the Olympic Games.  

Joanna: You mentioned the Paralympics earlier. Are there any particular pharmacy considerations in those games?  

Mark: So Paralympic athletes can have a different medical profile to other athletes as well, and it’s very personal to and specific to those individuals. In terms of the anti-doping rules, the same rules apply to para-athletes as well. So, there’s no difference in the list of prohibited drugs between the different groups of athletes. That really is harmonised. But the medical profile of individual athletes, they may be potentially on things like long-term analgesics. Some of those might be prohibited in sport. They may need exemptions to be able to take those drugs.

There may be a larger need for ongoing, chronic conditions, and I think one of the roles of pharmacists at the Paralympics is being able to support those athletes with the existing drugs they’re taking to navigate the anti-doping rules. They may be taking more medications than other athletes — or not! Generally, Paralympic athletes are very healthy people as well. They may have a physical disability, but often they’re very fit people as well. So, it varies, it is very much [an] individualised assessment of each athlete and their needs, particularly around the drugs that they take.  

Joanna:  Yeah. Amazing. You’ve obviously achieved so much in your career so far. You’ve recently been awarded an OBE. Congratulations on that. What’s next for you?  

Mark: I guess what I would love to see is the establishment of an international organisation for sports pharmacy, so the sports pharmacists around the world have a home, a place that potentially steers global policy, publishes standards and also harmonises the professional work of pharmacists in this field in the same way that the World Anti-Doping Agency harmonises the rules around anti-doping in every country of the world to have a place like that for pharmacists.

It will happen. There’s a growing body and movement of sports pharmacists now. Certainly, in the last ten years, there’s a lot of pharmacists working in this field around the world, and I think the next thing is to find a home for us, and to bring everyone together under a common mission and, maybe, organisation. So, that’s the next dream, if you like, Joanna.  

Joanna: Just a small one, [laughs] as the next step.  

Mark: Absolutely.  

Joanna: Are there any particular skills, or people, personality types that sports pharmacy might suit?  

Mark: Ah, interesting question. So, [for] a pharmacist working in sport, it’s quite a unique clinical understanding that is needed, not just about the action of a drug, but it’s also a broader thinking about the impacts on performance. For me, it’s almost a whole other level of thinking about medicines when working in sport, and I think for a pharmacist to kind of maybe think outside the box, I guess it’s care in a holistic way, not just how it treats the condition, but also how it affects the body, the performance, recovery. So, if you’re open to this broader, holistic sort of thinking in terms of working with athletes, that is certainly needed.

Integrity is one of the other skills or attributes that is really essential for a pharmacist working in this environment. You’re dealing with the realities of athletic performance. Obviously, athletes want to know what they can take legally to optimise performance. Sometimes pharmacists might be put under pressure to help an athlete achieve more, even push themselves beyond natural barriers. So, I think really having integrity as core of your set of values is really needed in this role. Pharmacists are there to support their health, to restore health of the athletes, without pushing them into this unethical performance enhancement kind of boundaries.

But then also understanding that at elite level, athletes will have one shot of a gold medal event. And so, it’s being aware of what an athlete’s thinking and what’s going through their mind. Maybe, they’re happy to take a bit of a risk or push themselves a little bit harder in that environment. If you’ve got an athlete with a minor strain that has got a gold medal race at the Olympic Games, try telling that athlete to pull out of that event and rest up in bed for the next three days and miss potentially the gold medal track event. The athlete’s not going to do it. Some of these athletes have high sponsorship deals, withdrawing from competition may affect the revenue coming in from sponsors. There’s a lot of pressures, from coaches, from family. It really is awareness of all the different pressures and the thinking that goes through an athlete’s mind. Athletes are going to do what they want to do, and being able to support them doing [that] in the safest way possible is really what us as sports pharmacists really need to promote and support that athlete to make the right decisions to be able to do that.  

Joanna: Does having a passion for sport help, do you reckon, or do you think you’ve got to be an athlete yourself?  

Mark: No, I don’t think you do. I mean, I like sport. I’m not a sport fanatic. To be honest, when I’m working at the Olympic Games, I don’t see much sport. I wake up in the morning, I’m down in the office for our first meetings of the day at 8:00 a.m., looking at all the cases from the previous 24 hours. I’ll be out at the venues, behind the scenes, maybe in the medical rooms, talking to the venue managers about their drugs, giving them a bit of education. And we may get a couple of hours in the evening, once things quieten down, to go and watch some sport, which I absolutely love, and that’s one of the perks, if you like, one of the amazing things of being in that environment. But it is very hard work, and you’re not always there on the field of play with those athletes actually watching the sport. It’s kind of a different side to sport, I guess.  

Joanna: Would you say now’s a good time to get involved in the field of sports pharmacy?  

Mark: Absolutely. Now is a better time than ever. There’s so many opportunities to get involved. I mean, just look at the Olympic Games coming up, which are every two years, obviously winter and summer. We’ve got LA 2028. We’ve got Brisbane 2032. We have the Commonwealth Games every four years. Lots of opportunities to volunteer.

There’s lots of really good courses now to do as well. I mentioned those two courses from the International Olympic Committee. Definitely check those out. Check out some of the local universities as well, some of those do have short courses on drugs in sport. And I think, becoming a part of this sports pharmacy global community and becoming part of some of those discussions and part of this professional community, which is really I think now in the last few years, really standing on its own two feet. It’s a very exciting time to get into sports pharmacy. And I hope some of these listeners might be inspired to do so.  

Joanna: What a great conversation with Mark. He’s clearly so passionate about what he does. I had no idea about all the behind-the-scenes work that goes into something like running pharmacy services at the Olympics. And what an incredible opportunity he’s had to see the world and learn about different ways of doing things in pharmacy.  

It was fascinating to hear about the growing use of supplements and how a pharmacist’s expertise really helps athletes think through what’s going to be helpful for them, where a medication might impact their performance, and when doping concerns emerge, what can be done about them.  

We’ll put links to all those resources Mark mentioned and more in the show notes, so please do check that out.  

And get in touch if there’s an area of pharmacy, you’d love to learn more about, or if you know an inspiring pharmacist doing something interesting, we want to hear that too. Our email address is in the show notes.  

Thanks so much for listening, and thanks again to Mark for sharing his story with us. See you next time. Bye for now. 

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