Published Online: August 4, 2016. doi:10.1001/jama.2016.11850.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Genel and Simpson report serving as expert consultants to the Medical and Scientific Commission of the International Olympic Committee. No other disclosures were reported.
Disclaimer: The contents of this article are solely the responsibility of the authors and do not reflect the priorities and policies of the International Olympic Committee or the views of its Medical and Scientific Commission.
Additional Contributions: Alison Carlson, San Francisco, a former sports coach, writer, and commentator and long-time collaborator contributed to the genesis and development of the manuscript. Further insights were provided by Malcolm A. Ferguson-Smith, MB, CHB, FRCPath, Cambridge University, United Kingdom, and Anke Ehrhardt, PhD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University. All, including the authors, were participants in the 1990 Monaco workshop, none of whom received compensation for their contributions.