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Shane Warne's bitter pill
By Dr Sanjiva Wijesinha in Melbourne
Shane Warne appeared righteously angry and claimed to be "devastated" by the report of the Australian Cricket Board's anti-doping committee. He reiterated that he has "never, ever, taken performance enhancing substances" - but admitted that he took the drug Moduretic "not knowing that it was a diuretic but believing it was a (sic) fluid tablet".

Moduretic is a pharmaceutical tablet made up of two different diuretics - amiloride and hydrochlorothiazide - and is prescribed by doctors for patients who need to lose excess body fluids. Diuretics are useful medications for patients who have high blood pressure (when reducing the amount of fluid in their circulation results in lowering of blood pressure) or heart failure (where a weakened heart is unable to pump blood efficiently, resulting in fluid leaking out into the lungs and feet). Patients with heart failure have swollen feet and a frothy cough, and an appropriate diuretic usually helps relieve their symptoms. Diuretics are also used in cirrhosis, ascites and liver failure to get rid of swelling from feet and the belly.

Moduretic is NOT a drug that is available over the counter like Panadol or Disprin - it can only be obtained on a doctor's prescription, because it can have serious side effects if taken for the wrong reasons. Since it promotes fluid loss, it can result not only in dehydration but also in the body losing essential electrolytes such as potassium. Anyone who saw Sanath and Marvan cramping up while batting in the recent World Cup match against New Zealand would appreciate how devastating fluid loss due to excessive perspiration in hot weather can be!

Unfortunately, diuretics can also be utilised for other reasons. Because they promote rapid fluid loss, they can be used by sportsmen and women taking performance-enhancing and body building drugs like Steroids and Testosterone to get rid of these incriminating drugs from their bodies. Sports cheats are well known to use diuretics before a scheduled doping test to flush out chemical evidence of banned drugs.
For all these reasons, diuretics are on the list of substances which sportsmen and women are banned from using.

But why would Shane Warne take a banned drug? Warne, after all, is the best spin bowler his country has ever produced - and arguably one of the best spin bowlers in the world today. He does not NEED to take performance enhancing tablets. Even our Muralitharan was quoted as saying the other day, "I don't think Warne is the kind of player who would take pefromance enhancing drugs".

But it wasn't to enhance his bowling performances that Warne took banned drugs. Warne had another reason for taking diuretics - or being persuaded to take diuretics, as his A$25,000 per day team of lawyers would have us believe.

The cricketing legend, who enjoys his junk foods, had been putting on quite a bit of weight in the recent past, and needed to get his physique back into trim - some say in order to look good for the TV cameras during the World Cup. Diuretics are among the medications used (or abused) by persons who want to lose weight fast, because losing body fluid can make you lighter and somewhat slimmer. It appears that Warne's mother Brigette had been in the habit of taking a diuretic tablet or two from time to time to improve her appearance and look slimmer - and Warne in his ignorance claims to have taken "a tablet" from her.

The fact remains that elite sportsmen today are expected to be responsible - and with the current emphasis on preventing illegal use of drugs in sport, NO sportsman should take prescription medications without first clearing it with their sports doctors. Taking a tablet bought on prescription from a pharmacy, after all, is not the same as taking some koththamalli for a cold or taking lime and ginger for an upset stomach!

If for example, Warne needed to be prescribed a short course of steroids (and there ARE conditions for which steroids can appropriately be used in patients) there is provision for his doctor to legally prescribe the drug and obtain permission from the ACB's anti-doping committee BEFORE he takes it so he can legitimately use the drug for a specific purpose and period.

What is wrong is to take drugs that one is not supposed to take - whether it is to mask a steroid or to lose weight or because one's knowledge of English is inadequate to know the difference between a "fluid tablet" and a "diuretic". Sadly, Warne's is the first drug charge made against an international cricketer - and the biggest drugs scandal to hit Australian sport.

The Australian public has been inclined to assume that Aussie cricketers are free of sin, whether it is with regard to drugs or to match-fixing, while those wily subcontinentals and crafty South Africans are generally considered guilty until proved innocent. The ACB's anti doping committee - comprising respected supreme court judge Glen Williams, sports medicine expert Dr Susan White and former test cricketer Peter Taylor - has after a lengthy hearing, taken the bold (and many believe correct) step of recommending a 12- month ban.

The fact has been established that this young man, one of the greatest spinners the world has ever known, made the mistake of taking a banned substance. Whether through ignorance or poor judgement, it is not the behaviour expected of a top sportsman and cricketing idol. It has certainly been a bitter pill for Warne to swallow.
- Dr Sanjiva Wijesinha is senior lecturer at the faculty of medicine, Monash University, Melbourne

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