Doping in Sports – What You Should Know

Editor’s note: The Spanish Courts upheld charges filed recently against Eufemiano Fuentes and Jose Marino Batres, the doctors at the center of a major doping investigation in cycling that busted Jan Ullrich, Ivan Basso, Francisco Mancebo and several others out of the 2006 Tour de France. Nearly 100 bags of frozen blood and equipment for treating blood were found in their clinic, along with documents on doping procedures performed on cyclists. Although proclaiming their innocence, it is clear that local police and investigators are beginning to take a stronger role in supporting WADA and USADA to level the playing field in competitive sports. Podium offers this insightful and educated insight from Dr. J. Morrow into doping in sports.

Ever since the late 1960’s, the sports world has been under increasing scrutiny in regard to performance enhancing “drugs”. That’s approximately when the word leaked out that certain countries like East Germany were “inviting” their most elite athletes to participate in innovative biochemical programs that promised them added success and acclaim. Prior to that time, the idea of supplementing blood sweat and tears in sport with high science seemed rather dubious and benign. Something akin to snake oil remedies, that is until the results surfaced from the Olympics and the world was able to see first hand the advanced competitors that these “supplements” had literally assembled. Since then, supporters and opponents have been waging an ethical, legal and biochemical war of “cat and mouse” that currently threatens to destroy the integrity of sport. The introduction to what is now referred to more generically as “doping”, has impacted every sport on every level including recreational athletics.

In early 2005, as baseball’s steroid scandal converged with other tragic doping stories, the United States Congress, House Government Reform Committee saw fit to initiate hearings on what they perceived to be a “national health crisis of epidemic proportions”. Under the guise of focusing on baseball, this forum of subpoenaed suspected players, medical experts, aggrieved parents, and baseball executives took on a much more integrated approach to the problem. And although critics of the hearings contend that “no surprises were revealed and nothing was accomplished”, doping was fortunately etched into the national consciousness forever by virtue of insistent front-page news coverage.

Doping encompasses a wide range of illegal behaviors which include the ingestion (oral, intravenous) and/or application of banned substances (gels, balms, drugs, hormones) for the sole purposes of improving athletic performance and reshaping physiques. Also implicated in the rubric are specific techniques and processes such as “blood doping”, which artificially supercharge athletes’ bodies by transfusing them with their own oxygen-saturated blood.

Although there are minor variations on the “outlawed” lists from sport to sport, a universally accepted set of criteria are generally used to determine whether to ban or approve a substance or procedure. This determination is based on a combination of legal, philosophical, historical and medical factors. In making their decisions, the governing agencies, such as the World Anti-Doping Agency (WADA) and the International Olympic Committee attempt to standardize the opportunities for competitors to succeed. That is, they try to keep the playing fields even without jeopardizing the participants’ health and/or well being and without violating the spirit of the sport by artificially distorting its archival context (records) and historical traditions. The four key elements that constitute the criteria for prohibition of a substance or procedure are: its legality, its health risk status, its effectiveness, and its likelihood of profoundly changing the continuity and structure of the game.

Oddly enough, the major sports (football, basketball, baseball, and hockey) in the United States had been the most reluctant to formally address the issue. This lag was initially due to an outright denial of a doping problem, which, when later acknowledged, was further delayed by protracted wrangling and posturing between the player’s unions, team owners and league officials. Purportedly, insiders have known that as far back as the mid 1970’s, several of the National Football League’s most successful teams were stocked with “juicers”, as they are idiomatically referred to. Yet, it wasn’t until 1987 that an anti-steroid policy was initiated by the NFL. Eventually, pressure from the media, the public, as well several notable politicians, forced the remaining leagues to capitulate and adopt formal protocols of random testing and stringent punitive consequences for guilty offenders.

The first types of drugs that were used in sports were illegal stimulants and painkillers such as methamphetamines, and morphine derivatives. These substances provided athletes with short- term bursts of energy and allowed them to play through marginal injuries. Even though they were not easily concealed, and were overtly distributed, there was little concern and league and agency officials dismissed queries regarding their intrusion into sport offhandedly. Since that time, pharmacologists have conspired to create scores of designer substances that are increasingly difficult to detect, more potent and far more menacing.

The most commonly recognizable category of doping agents are anabolic steroids. These are synthetic hormones that are similar in composition to testosterone produced in the male testes. Their function is to build pronounced muscle mass quickly and they were originally introduced to speed the recuperative process of the severely ill and injured. In addition to swiftly healing muscle tissue from strenuous workouts, which allow an athlete to work harder and longer, they also have psychotropic properties that make athletes more aggressive in the weight room and during competition. Sports that require explosive strength and speed are especially vulnerable to steroid abuse and this classification of “drugs” is constantly being reengineered, like the now infamous BALCO laboratory’s THG, to keep them one step ahead of the testing agencies and laboratories.

Erythropoietin, or EPO is another artificial hormone. It allows the blood to carry more oxygen, thus boosting endurance. It is more effective and less intrusive than the more primitive “blood doping’ method and doesn’t require the inconvenience of having athlete’s train at higher altitudes so that their blood can be extracted and later reintroduced at sea level. In producing an abnormal count of oxygen enriched blood cells, EPO offers a distinct advantage to marathon runners, cyclists, cross- country skiers and others of that ilk.

As with many other illegal and abused substances and procedures, Human Growth Hormone (HGH) was originally developed for beneficial purposes. HGH is the designer analog of pituitrin, which is the hormone secreted by the pituitary gland. Originally conceived to increase the stature of abnormally short, underdeveloped individuals, it is now used among athletes to strengthen joints, bones and restore lean muscle tissue. The effectiveness of HGH is similar to steroids, however, because detecting it requires much more sophisticated and invasive techniques such as blood testing, many doping experts consider it the most dreaded of supplements.

The aforementioned catalog of banned performance enhancers is hardly exhaustive but rather representative of the types of “drugs” available on the black market. Interestingly, there are a host of substances that are prohibited due to the idiosyncratic nature of a particular sport. For instance, sports that are based on weight classifications, like boxing and wrestling, forbid the use of diuretics and certain laxatives as a supplement to help shed excess pounds. Likewise, target sports like archery and the biathlon include beta blockers, which slow down the heart rate and in turn facilitate hand steadiness, as contraband.

Mitigating circumstances, however, sometimes complicate the process of separating the guilty from the innocent. For example, some over-the-counter cough, cold and herbal remedies contain banned stimulants such as ephedrine and, although the athlete ingesting them probably did not intend to “dope”, sanctions are nonetheless, generally imposed by arbitrators. This is because the question of intent is difficult to establish and is so often used as the knee- jerk explanation by violators of the anti-doping statutes.

Landmark research conducted in the late 1980’s offered the world an ominous view of the perspectives and priorities of international elite level athletes. In a survey conducted at the Seoul Olympics, the question ” Would you use prohibited drugs if you were guaranteed a gold medal in your event and the substance was undetectable, yet, its use would shorten your life span by ten to fifteen years?” was posed to competitors. Alarmingly, over seventy-five percent of the anonymous sample endorsed the item. This clearly corresponds with the short sighted achievement orientation of the respondents.

What exactly are the risks, other than being caught, involved in the use of steroids and other types of assorted hormones, stimulants, pain- killers, peptides and blood altering agents? One event in particular scandalized, and alerted the international athletic community during the naïve pre-doping, pre-testing mid 1960’s. During the Tour de France, a cyclist succumbed to a heart attack and autopsy results determined that the death was caused by an overdose of stimulants. The shock and surprise emitted from the public at the time were in stark contrast to the inured reaction one would expect today.

Over the years, a solid body of evidence has been collected which indicates that that all forms of doping are health compromising in one way or another. Side effects range from the unobservable life threatening (kidney and liver failure, arteriosclerosis, enlarged heart, tumors, immune system suppression), to the more visible (severe acne, abnormal bone growth in the head, hands and feet, atrophy of the testes and breast development in males, drastic increase in muscle mass), to the emotional (uncontrollable rage “‘roid rage”, depression and chemical dependency). Not incidental is the assertion that steroids have been responsible for several suicides among young adult males who have attempted to detoxify too quickly without medical supervision.

Clearly, athletes must not be forced to consider getting “juiced”, as an option. But regrettably, a clean athlete can not compete with one who has used banned performance enhancers, given equal resources and talent. They work. They’re hazardous, and this is precisely what delineates them from admissible supplements and procedures like Creatine, a synthetic amino acid that purportedly builds muscle and hyperbaric chambers, whose efficacy and toxicity are marginal, questionable or insignificant.

Even though each sport’s testing protocols and policing bodies differ, the procedure typically involves procuring urine and/or blood specimens from the athlete and splitting them into two identical samples so that the tests can be replicated by alternate approved laboratories, if need be. This helps to insure reliability. The degree of supervision during the collection process and the random spontaneity of testing sessions also strongly contribute to the reliability and validity of the process. Athletes who dope are ingenious and sophisticated in their attempts to avoid being exposed. Most have been counseled by self-taught experts and experienced peers, so that cycles of drug use, and cessation can be either adroitly masked by another drug, or cleansed from the system before scheduled dates. Therefore, unanticipated, unannounced visits by anti-doping institutions, especially during off-season, must be mandated as the standard policy of a program to make it truly substantive

In an equally resourceful manner, athletes have been known to substitute their “dirty” urine with clean samples they have obtained. Quite often this switch involves some repulsive and demeaning behavior, further underscoring the notion that many elite athletes will undertake almost any dehumanizing excess in order to achieve their goals. So once again, the policing agencies must outwit the athlete by remaining vigilant throughout the entire specimen collection episode, even if this means that social norms regarding privacy are often violated.

Most anti-doping agencies, with the exception of the major professional leagues in the United States, use the stringent World Anti-Doping Agency Code as their prototype. This Code states that athletes testing positive for a doping infraction who wish to dispute the finding have a right to arbitration. If the arbitrators determine that a violation of the Code has been committed, the offending athlete is disqualified from competing for two years and any awards and titles are rescinded. A second offense results in a lifetime suspension. The National Football League, National Basketball Association, and Major League Baseball have adopted much more lenient sanctions, offering many more chances to repeat offenders along with shorter suspension times. This seems to serve in their best interest since polled American fans indicate more interest in seeing their favored players compete rather than in ruminating about how they got that way or whether they should be cast as unethical cheaters.

Some wonder, if this response from the public is so equivocal and lacking the full force of condemnation, why bother to regulate? Discounting health and unfair advantage, are there any other causes for concern? Sports purists and social scientists have equally strong arguments to counter this more libertarian, hands off position.

One of the many entertaining aspects of sport, states the purist, is in the examination of historical records of performance and achievement. Archival statistics reveal how athletes from different eras compare and inspire much friendly discussion and storytelling. But, because doping is so effective, it has artificially inflated ability which, in turn, has distorted the record books and made comparisons meaningless. Was Marion Jones faster than her predecessors? who knows. The purists contend that since athletes are competing not only with their contemporaries but also with history, the standards “of old” should apply so as to maintain a semblance of tradition.

A proposal, using the sport of bodybuilding as a model, where two formal classifications, clean and “juiced” would openly exist, has been offered. This alternative draws the ire of educators, child psychologists and sociologists because, they argue, any position less than complete condemnation would suggest tacit approval, citing the “athlete as role model” principle. Their concerns are not unfounded since approximately eighty percent of the steroids that are consumed are not for purposes of performance enhancement by athletes but by male adolescents for purposes of vanity. And although high schools often test for recreational drugs, steroids and other doping agents generally remain undetected due to budgetary constraints and privacy concerns.

As an alternative attempt to fill this void, California, as well as several other states are developing certification programs for high school coaches so that they can become more observant, informed and proactive. The logic behind this trend assumes that since adolescents are not emotionally equipped to make uninformed life and death decisions, all options must be introduced in order to stem the tide. Painkillers, as a class of addictive substances, have developed as one of the major threats to an athlete’s enduring health, while also significantly altering an individual’s social and occupational functioning.  Exemplary treatment for these conditions have been found in California painkiller treatment centers.

Iconoclastic visionaries are quick to note that biotechnologists have already teamed up with kinestheologists, opthalmologists, and geneticists to produce a futuristic generation of performance enhancers that “make anabolic steroids seem pre-historic”. Start up companies are already investing time and money to develop artificial muscles, zoom vision and customized “gene doping” which can reconfigure DNA to optimize musculature, explosiveness, lung capacity and even personality. Sport is clearly at a bioethical crossroad, weighing whether the pursuit of the perfect, super endowed athlete is a potential step towards dehumanization of the species.

EDITOR’S NOTE:

Since the writing of this article by Dr. Morrow, Floyd Landis has been investigated for high levels of synthetic testosterone in both his A and B testing sample taken on the day of his resurgence in the 2006 Tour de France. Clearly, this issue won’t go away as Tyler Hamilton has resumed racing at the World Championships after completing his 2 year suspension from the sport. How ironic is it that The Danish newspaper Politiken reported on 8/20/06 that Hamilton has been implicated in “Operacion Puerto”, the Dr.Eufemiano Fuentes blood doping scandal that saw Jan Ulrich, Ivan Basso and a host of others tossed from the race the day before it started?

There are those of us who naively want to think that ‘cycling’ is the culprit and that the culture breeds such insanity. I think not, however.

Anytime there is big money, sponsorship, fame and fortune on the line, it is my considered opinion that the forces influencing the human condition are at work. Lance Armstrong intimated that a conspiracy might be afoot when L’Equipe accused him of using performance enhancing drugs last year. Who is to say that that’s not possible? Are these labs, couriers, and scientific analyses beyond question? What’s to be done? How deep does it go? Where does it end?

This is what he had to say –

PROVOCATION:

DISCUSSION – FORUM
By J Morrow Ph.D.

Maybe it’s time to give up the ghost – that is, in terms of doping at the elite levels of international and professional sports. As of late, stories regarding doping are demanding far more attention than actual sport competition. Interest in actual athletic events and accomplishments have been displaced by news stories related to the use of illegal performance enhancers by some of our most revered cultural icons. Suspicions, allegations and lab results continue to swell the airways of sports radio talk shows, replacing the time that was usually spent discussing scores, strategies and personal feats-So waddya say we move on, it’s the 21st century and it’s time to accept the fact that the world just ain’t what it used to be.

What’s needed, even more than new, improved detection tests is a new, sea change of a mind set. The rewards stemming from top level athletic achievement have spiraled upwards at a dizzying pace and just as it always does, attached to the wealth and fame comes a Faustian offer. But when you make a deal with the devil you should anticipate some down side results, one being the price you have pay nowadays to be great. Who cares who’s to blame for this situation…it’s just so.

This “win at any cost” mentality was best been illustrated by questioning a sample of participants at the Olympic Village at Seoul in 1988. The one question posed in this seminal bit of research went something like, “if you could be assured of winning the gold in your event by ingesting health compromising substances, even though death within five years was a certainty, would you agree to do it?” My memory of the precise percentage of the respondents in agreement with the statement escapes me, but I do remember it was well over eighty percent.

Athletic supremacy favored over an extended life, now that’s cold, but the incentive certainly does explain the never ending efforts of endocrinologists, chemists, geneticists, nutritionists, physicists and the like, to explore fresh, undetectable, performance techniques, substances and masking agents. Progress can’t be anticipated and the process of invention is neither smooth nor linear. So then, what we are left with is a never ending cycle of “cat and mouse” or, if you prefer, “spy versus spy” (a.k.a.MAD magazine), with the scientists proactively pushing the envelope while the doping agencies are relegated to the unenviable task of forever attempting to play “catch up”.

Furthermore, what specifically are the basic criteria that we use and will continue to use in the future to separate the legal from the illegal? For example, how might we view genetic engineering or the implanting of computer chips and artificial tissues? Will this determination be based on equal accessibility for all or health risk factors? The attempts to level the playing fields for all are unrealistic. Some athletes, some countries, some teams, simply have more incentive to succeed and more resources at their disposal, and because of this, they will continue to “go to the well” to seek the competitive edge. You can’t legislate against human nature. We’ve seen unsuccessful attempts at prohibition before.

The time has come to accept doping as a given and then, by putting that behind us, we can focus on the truly pertinent core questions, such as: how do we address role model issues? How do we redesign our anti-drug campaigns in light of what seems to be hypocrisy? Or, what necessary procedures and protocols do we establish in distinguishing youth, high school, and intercollegiate sports from the play for pay venues?

It’s payback time. From now on, by ignoring the questionable and potentially dangerous necessities to compete, we will have established a type of parity, since top level pro athletes will now have to pay, by jeopardizing their futures in exchange for today’s fame and fortune.

Obviously this is only one, albeit provocative solution to the problem of doping which currently scandalizes a great portion of sport. The position is a “work in progress” with many holes and bugs that need tweaking and fine tuning. As Denise Miller often says after a rant, “Of Course I may be wrong but that’s my opinion.”

By Dr J Morrow

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