Doping refers to the illegal use of drugs to enhance performance in sport and is considered illegal by the International Olympic Committee (IOC) and the International Federations (IFs). The IOC rules against doping are contained in Rule 44 of the Olympic Charter. Basically the IOC has a proscribed list of medications that are considered to be illegal for use by athletes taking part in its competitions. After each Olympic Games, all medalists, and certain other randomly selected athletes, are chosen to submit a urine sample that is then tested for these drugs. If any of the proscribed drugs are present in the athlete’s urine in sufficient quantities, he or she may be disqualified from competition, pending further urine studies and, usually, legal hearings. In recent years, when these penalties have been handed out, they have virtually always been contested by the athletes and their lawyers.
In addition, it is considered unlikely that previous IOC methods of testing for illegal drugs were sufficient to prevent athletes from using drugs. This is because athletes, coaches, and their doctors were able to learn enough about the drugs in order to know how long they had to be withdrawn from the athlete before a competition. This would enable the athlete to pass frequent drug tests despite being habitual users of the drugs. This is now being circumvented by IFs, National Olympic Committees, and National Governing Bodies performing random, out-of-competition tests of athletes at all times of the year.
Doping is not new. In the Ancient Olympics, trainers gave athletes various concoctions that they felt would improve their performance. The first physician to be considered a specialist in sports medicine was Galen, who prescribed as follows: “The rear hooves of an Abyssinian ass, ground up, boiled in oil, and flavored with rose hips and rose petals, was the prescription favored to improve performance.” The name doping itself comes from the 19th century, when the Dutch term “dop” was used to describe a South African drink which was an extract of cola nuts to which was added xanthines (found in caffeine) and alcohol. The drink was intended to improve endurance and the term “doping” was derived from it.
Numerous doping scandals have existed in sports. The most famous occurred at the 1988 Seoul Olympics when the original 100 metre champion Ben Johnson tested positive for stanazolol, an anabolic steroid, and was disqualified. At the 1960 Rome Olympics, Danish cyclist Knut Enemark Jensen collapsed and died during the cycling road race. He was later found to have been given amphetamines (Ronital) and nicotinyl tartrate (a nicotine-type of stimulant). In the 1967 Tour de France, the great British cyclist, Tom Simpson, collapsed and died while ascending Mont Ventoux. He was found to have been heavily dosed with stimulants. In 1998, a major doping scandal enveloped the Tour de France, and many of the professional cyclists and their team trainers, notably the Festina team, were charged with legal action by the French authorities.
The deaths of Jensen and Simpson alerted the sporting authorities to the dangers inherent in drug use in sports. At the 1968 Olympic Winter Games, the IOC tested for drugs for the first time. The first athlete to be disqualified in the Olympics for drug use was Sweden’s Hans-Gunnar Liljenwall at the 1968 Olympic Games. Liljenwall was a modern pentathlete who had helped his team win a bronze medal. Prior to the shooting event he drank a few beers to help steady his nerves. This was commonplace among modern pentathletes in those days, but it cost him, and his teammates, a bronze medal.
In the 1970s and 1980s, the athletes of the German Democratic Republic (GDR – East Germany) were suspected of doping violations that were never detected (see Shirley Babashoff). No GDR athlete ever failed a doping test at the Olympics. After the fall of the Berlin Wall and the reunification of the two Germanys, former German athletes and coaches revealed that much of the success of the great GDR athletic machine was due to the systematic use of illegal drugs. In the 1990s, the Chinese women swimmers and runners were suspected of using similar practices to make great strides in their sports. Adding to this suspicion was the fact that several of the former GDR coaches were then coaching in China.
In the 1990s in the United States, a number of drug accusations centered on an enterprise called BALCO (Bay Area Laboratory Co-operative), based in the Bay Area of California. BALCO is led by a former musician, Victor Conte, who has impugned many well-known American athletes, including baseball players Barry Bonds and Jason Giambi, and Olympic athletes Marion Jones and Tim Montgomery, as users of performance-enhancing medications provided by BALCO.
In 1999, the IOC was instrumental in pushing the fight against drugs to a new level, by forming the World Anti-Doping Agency (WADA). Headed at its inception by Canadian IOC Member Dick Pound, WADA’s task is to oversee and monitor the use of drugs in international sport and find better methods of prevention and detection, as well as educating athletes to the danger and impropriety of drug use in sports.
The issue of drug use in sports is complicated and there are many people who write of and speak about the fact that this stringent testing may not always be in sports’ and the athletes’ best interests. It is not politically correct to be on this side of the argument, as politicians, sports administrators, and the media have come down strongly against drugs. But there are a number of issues that are discussed in this regard, and should at least be presented.
The list of prohibited substances is quite long, numbering well over 100. In medical trials of drugs, the gold standard is termed an RCT – an acronym referring to a Randomized, Controlled, prospective, double-blind Trial, in which the drug is compared on this basis to a placebo. Proof of improvement in athletic performance via RCTs, what is termed Level I evidence-based medicine, is certainly lacking for most of the drugs on the prohibited lists. The drugs that have been best studied, anabolic steroids, have had varying results when subjected to true RCTs, and even then, few of the gold standard-type studies have been done. Proponents of strict drug testing will demur, stating that it is “obvious” that these drugs enhance performance and this can be seen by looking at the improved performances. But that reasoning neglects the strength of the placebo effect and that its psychological effects may mimic the physiologic effects of performance-enhancing drugs. Further, because of the opprobrium that now surrounds many of these substances, even performing an RCT may border on being unethical and be difficult to get through an Institutional Review Board (IRB). In fact, WADA regulations now recommend that prohibited drugs not be given to athletes for medical studies. Thus, the political correctness of drug testing and the WADA regulations prevent the authorities from being able to conclusively prove that they are testing for substances that enhance athletic performance.
Other opponents of drug testing decry the lack of the athletes’ rights to privacy. Currently, world-class athletes in Olympic sports can be tested at any time of the year, at any time of the day. They are required to inform sports administrators of their whereabouts at all times. Failure to do so constitutes a “positive test in absentia.” In some countries, there are even moral and religious objections to providing urine or blood samples, but the athlete must still do so, or be considered in violation.
Furthermore, some authors have written that the current status of drug testing denies athletes due process, their right to be considered innocent until proven guilty. In fact, currently, if a positive drug test occurs, the athlete is considered guilty, and the onus is on the athlete to then prove his/her innocence. While this may be acceptable in some nations, in the United States it is not, and American athletes have fought the results many times using this argument. In addition, the publicity that ensues effectively convicts the athlete in the press, even if they are later exonerated. Paraphrasing the words of U.S. Secretary of Labor Ray Donovan in the early 1980s, after he was found innocent of charges made against him, “Where do [the athletes] go to get their reputation back?”
Finally, some argue that the fight against doping artificially draws a line against certain performance-enhancing techniques, while allowing others. Certainly, world-class athletes do many things in training and in their lives that are designed to make them better athletes. Not all of these are actually good for their health. While running and aerobic exercise enhances one’s health, nobody would argue that running 150 miles/week is good for one’s general health. In fact, modern athletic training is designed to push the body to the brink of breakdown, but never pass that line.
As an example of non-drug methods that enhance performance, consider the use of altitude sleep chambers. Many distance runners and professional cyclists sleep in these chambers, which lower the oxygen content and mimic training at altitude, usually increasing the blood count, or hematocrit. This is legal. But it is not legal to take erythropoietin (EPO), a drug that stimulates red blood cell production, and increases one’s hematocrit. Both methods have the same result, but arbitrarily, one is legal, while one is not.
Still even when viewing the arguments of those who oppose drug testing, it must be remembered that these world-class athletes are often role models to children and adolescents. More and more studies have now shown that drug use has infiltrated high schools and even lower levels of school, where pre-adolescent athletes use the drugs, emulating their athletic idols, in an attempt to enhance their own athletic abilities. There are no voices who consider this to be a positive result of using drugs in sports.
Concerning drug use in sports, one approach that is usually used by the media is to simply say the Olympics are the “dirtiest” of all sporting events, because more Olympic athletes are caught for doping than athletes in most of the professional sports. But what this argument fails to consider is that the IOC was the first sports organization in the world to test for drugs in sport (1968), it was the first to institute random, out-of-competition testing, and it still imposes the strictest penalties for anyone caught using drugs. By comparison, for four American professional sports (baseball, football, basketball, ice hockey) drug testing procedures are far less frequent, test for fewer drugs, and their penalties are relative slaps on the wrist compared to the IOC and WADA penalties. The NFL (National Football League) began testing in 1982, but not for anabolic steroids until 1987. The NBA (National Basketball Association) issued an anti-doping policy in 1983, while MLB (Major League Baseball) did not issue an anti-doping policy until 2003.
As an example, under the IOC and WADA rules, Olympic athletes, or athletes considered at a national-level of competitiveness by the IFs, are subject to random, out-of-competition testing at any time of the year – on a 24/7/365 basis. The penalty for a positive doping test is a two-year suspension, and a lifetime ban ensues for a second positive test. In major league baseball, until January 2005, the athletes were subject to one, announced test set for a specified time each year. The penalty for a positive test was probation and counseling, but no expulsion from the sport. The bans increased, but a lifetime ban did not occur until the athlete tested positive at least four times. However, there is one rather famous case in which an athlete was in legal problems for drug use at least seven times and continued to play major league baseball. (In January 2005, major league baseball passed stricter doping regulations, but still far short of those enacted by the IOC and IFs.). In the NFL, a first positive test results only in a four-game suspension – hardly punitive compared to the IOC penalties.
At the dawn of a new century, there are far more problems on the horizon. With the recent scientific analysis of the human genome, gene therapy and genetic manipulation of the human body is close to becoming a reality. Some of the gene therapies that are being studied concern building muscle to help people overcome diseases such as muscular dystrophy, multiple sclerosis, cerebral palsy, and other neuromuscular illnesses. But the gene therapies that would build muscle in these patients, would likely also build super-muscular humans, who may well be tempted to try the therapies as methods to enhance athletic performance. The therapies do not exist yet, but already this nightmare scenario is envisioned and being discussed by the doping authorities.
The controversy concerning drug use in sport is not going away. It will continue to be fought at the highest levels of sports administration, in the media, by the athletes, by the lawyers, and by the scientists. As is so often the case, the scientists and physicians, who should properly be at the forefront in this argument, will probably take up the rear in this fight, shunted aside by lawyers, by politicians, by the media, and by sports administrators. The final word is far from being written.