Picture of Domhnall MacAuleyDomhnall MacAuley is a CMAJ associate editor and a professor of primary care in Northern Ireland, UK

The circus came to town. The Giro d’Italia, one of the world’s great cycle races, started on Friday with a feel good story for Canadian fans. Svein Tuft, a 37 year old from British Columbia, crossed the line first in the team time trial which allowed him to start the next day’s racing wearing the pink jersey (Maglia Rosa) of race leader. In the post-race interview he revealed that the team had gifted him the lead as it was his birthday. A rare gesture in the ruthless world of cycle racing.

The “Grande Partenza” was in Belfast. Another feel good story as the city embraced the event, painted the town pink, and thousands of spectators lined the route. As part of the overall Giro fest, there was a film preview of “The accidental death of a cyclist”, on the life of Marco Pantani a celebrated Italian cyclist who captured the hearts and minds of cycling fans in the late 90’s (pantanifilm.com). His life had many medical references, the cycling haematocrit rule, his link with the Italian sports doctor and scientist Francesco Conconi, and the retrospective confirmation of EPO use. A troubled teenager with an immense talent, he achieved cycling’s greatest heights but tumbled from stardom and, as his sporting life disintegrated, he fell into drug abuse and eventually died after a two week cocaine binge. It was difficult not to feel some sympathy for this sad hero from a small Italian coastal town who embraced sporting greatness. The film, like the similarly named play by Dario Fo, leaves us to make up our own minds. Was Pantani, known as “the pirate”, a victim or villain?

Psychology and psychiatry now seem to form an essential component of improving sporting performance. In the post film discussion, James Erksine the director, gave an interesting perspective. Sport is about winning and losing. But, if you define your life in such absolute terms of winning or losing, then life can never be a success because real life is about losing. And, so it is with all elite sport. We fete the heroes, damn to dopers and forget the winners when they step off the podium. Surfing a wave of adulation, a career inevitably comes to a disappointing end. One Monday morning they awaken and it’s all over. Many of us involved in sports medicine know of athletes who cannot put their lives together again and whose subsequent life is a chaotic chronicle of dysfunction, divorce, drugs, or drink. They step off the podium into an abyss. Who is there to help them? Sport and exercise medicine is now intricately involved in helping people get to the top. But, where is the medical support when they are heading towards the bottom?