Commentary on Australian Football is a cliché-ridden business, so much so in fact that insiders will often deliver the cliché with a sprinkle of post-modern irony: witness One Week at a Time. There is a martial origin for a lot of the clichés used in sporting and political life, but one cliché is conspicuous by its absence in the current Essendon FC supplements saga. I have heard nothing about on my watch, that tradition in naval history where commanders pay with their lives the debt they feel to their crew, ship and nation is not seen.

From all the published material it seems clear that at Essendon 34 young men were put at risk by a management structure that allowed subordinates to proceed unchecked with dubious ‘treatment’ regimes. This behaviour created a situation where the welfare and long-term wellbeing of the Essendon FC players was put in jeopardy. The knock-on effects go to the integrity of the club and finally to the standing of the code: this was all put forward in the AFL Notice of Charge Rule 1.6. So what supervisory failures at Essendon created the exposure to harm? The story is usually told in term of science run amok but that is not the truth.

A high performance group was employed by the club to revamp its training regimes. One of the people employed was Stephan Dank, someone often referred to in the press as a sports scientist, a supplements guru, a sports physiologist, or as Dr. Dank. Another was Dean Robinson, employed as a high performance physical conditioning coach. Both had previously worked together with NRL teams. The two provided a skills-mix of exercise physiology and biochemistry.

Stratagems for performance improvement are common in all sports. In the AFL the advent of high altitude training and the role of exercise nutrition regimes are two obvious examples. Aspects of both have been scrutinized by genuine science through being subjected to clinical controlled trials at Collingwood and the Adelaide Crows. In both cases players were recruited as research participants and the full scientific protocol, information, consent and supporting documentation was presented for Human Research Ethics Committee approval.

Public discussion of events that took place at Essendon in the period between 2011-13 has been coloured by comments made in Senate Reviews, Charge Sheets, commissioned reports and by sporting organisations. The impression uniformly given is that what occurred in the high performance program was highly experimental or pioneering science, pharmacologically adventurous or rogue medical science. That is a completely false impression. What Stephen Dank instituted and what has created the furor bears the same relationship to science that Groucho Marx does to Marxism.

The 34 Essendon FC players were asked to sign consent forms to signal their voluntary participation in a so-called treatment regime where they would be given one or more of four different substances. The forms were not information and consent forms that are conventionally used to enroll participants in human trials of treatments, devices and drugs. There was no scientific protocol prepared or presented and there was no ethics review body involved. The forms presented to the players and reviewed by this author on behalf of the AFL Players’ Association were headed, Patient Information/Informed Consent Forms. Superficially the consent forms resemble what might be given to a patient prior to a simple elective surgical procedure. Of course, if the players were in any sense used as novel-treatment guinea pigs to derive data that might be used to anecdotally support the use of some substance the that subterfuge would raise very grave concerns.

There was only one template-form used for all four substances. The information component in all four was afflicted with the same problem: all were on their face incoherent because they contained flatly contradictory statements about the risk profile of the substances involved. On any reading they failed to convey useful information on the basis of which a player might accept or reject participation in the treatments proposed. In my view they were ethically and legally void. But the main issue here is the regime under which they were presented to the players.

First, the author and the signatory at the end of the form, the person taking responsibility for the construction of the form, is Stephen Dank. Dank has no patients because he is not a medical practitioner or a health professional who might reasonably be said to have a practitioner/patient relationship with anyone. Why then would Essendon FC allow players to be presented with a document constructed by him and treating those players as patients? Presumably all 34 players had a doctor/patient relationship with Bruce Reid as the club doctor but none had that relationship with Dank.

What seems clear is that the club’s oversight of the wellbeing of its players was deficient: either nobody in management reviewed the documentation internally or if they did they failed to notice the manifestly misleading nature of the document template, its internal inconsistencies or the fact that it was proffering a putative medical treatment regime to patients offered by a non-health professional.

Presenting an information sheet and consent form to players headed as a patient information/informed consent form is one thing, and it is reasonable to believe that a club doctor might do that where some medically significant intervention was planned as optional for players who were suffering with a certain condition. But treatments are only appropriate where known medical conditions are at issue. The vast bulk of patient information and consent forms in circulation are used for voluntary consent to elective surgical procedures. The Essendon players were not sick, did not have an existing condition requiring treatment and should never have been presented with patient consent-to-treatment forms.

Responsibility for the presentation of the forms to the players lies with management. The author of the forms was Stephen Dank but the oversight of his program and the set of consequences that followed with off-site injection regimes lay with the administration: it occurred on their watch.

Associate Professor Brian Stoffell is Head of the Social Health Sciences Unit at Flinders University. An expert in medical ethics and health law, he is Director of SA Health’s Health Care Ethics Unit at FMC. He is also the inaugural HREC Chairperson for Bellberry Ltd, a national not-for-profit organisation providing scientific and ethical review of human research projects across Australia. Associate Professor Stoffell wrote an opinion for the AFL Players Association on Essendon Football Club’s supplement documentation and a paper, entitled Treated Worse than Guinea Pigs?: The AFL, Sports Science and HREC Review, delivered at the Australian Ethics Network Conference in November 2013.