Doping in sport

In competitive sports, doping refers to the use of banned athletic performance-enhancing drugs by athletic competitors, where the term doping is widely used by organizations that regulate sporting competitions. The use of drugs to enhance performance is considered unethical, and therefore prohibited, by most international sports organizations, including the International Olympic Committee.

Historically speaking, the origins of doping in sports go back to the very creation of sport itself. From ancient usage of substances in chariot racing to more recent controversies in baseball and cycling, popular views among athletes have varied widely from country to country over the years. The general trend among authorities and sporting organizations over the past several decades has been to strictly regulate the use of drugs in sport. The reasons for the ban are mainly the health risks of performance-enhancing drugs, the equality of opportunity for athletes, and the exemplary effect of drug-free sport for the public. Anti-doping authorities state that using performance-enhancing drugs goes against the "spirit of sport".

Etymology

There are many suggestions as to the origin of the term doping. One is that it is derived from dop, an alcoholic drink used as a stimulant in ceremonial dances in 18th century Southern Africa. Another suggestion is that the word comes from the Dutch word doop (a thick dipping sauce) that entered American slang to describe how robbers stupefied victims by mixing tobacco with the seeds of Datura stramonium (jimsonweed) which contains a number of tropane alkaloids, causing sedation, hallucinations and confusion. By 1889, "dope" was used in connection with the preparation of a thick viscous preparation of opium for smoking, and during the 1890s this extended to any stupefying narcotic drug. In 1900, dope was also defined as "a preparation of drugs designed to influence" the performance of a racehorse.

History

The use of drugs in sports goes back centuries, about all the way back to the very invention of the concept of sports. In ancient times, when the fittest of a nation were selected as athletes or combatants, they were fed diets and given treatments considered beneficial. For instance, Scandinavian mythology says Berserkers could drink a mixture called "butotens", to greatly increase their physical power at the risk of insanity. One theory is that the mixture was prepared from the Amanita muscaria mushroom, though this has been disputed. The German missionary and doctor Albert Schweitzer wrote of Gabon in the early 19th century: "The people of the country can, having eaten certain leaves or roots, toil vigorously all day without feeling hungry, thirsty or tired and all the time showing a happiness and gaiety."

The ancient Olympics in Greece have been alleged to have been contaminated with forms of doping. In ancient Rome, where chariot racing had become a huge part of their culture, athletes drank herbal infusions to strengthen them before chariot races.

More recently, a participant in an endurance walking race in Britain, Abraham Wood, said in 1807 that he had used laudanum (which contains opiates) to keep him awake for 24 hours while competing against Robert Barclay Allardyce. By April 1877, walking races had stretched to 500 miles and the following year, also at the Agricultural Hall in Islington, London, to 520 miles. The Illustrated London News chided:

It may be an advantage to know that a man can travel 520 miles in 138 hours, and manage to live through a week with an infinitesimal amount of rest, though we fail to perceive that anyone could possibly be placed in a position where his ability in this respect would be of any use to him [and] what is to be gained by a constant repetition of the fact.

The event proved popular, however, with 20,000 spectators attending each day. Encouraged, the promoters developed the idea and soon held similar races for cyclists.

"...and much more likely to endure their miseries publicly; a tired walker, after all, merely sits down – a tired cyclist falls off and possibly brings others crashing down as well. That's much more fun".

The fascination with six-day bicycle races spread across the Atlantic and the same appeal brought in the crowds in America as well. And the more spectators paid at the gate, the higher the prizes could be and the greater was the incentive of riders to stay awake—or be kept awake—to ride the greatest distance. Their exhaustion was countered by soigneurs (the French word for "carers"), helpers akin to seconds in boxing. Among the treatments they supplied was nitroglycerine, a drug used to stimulate the heart after cardiac attacks and which was credited with improving riders' breathing. Riders suffered hallucinations from the exhaustion and perhaps the drugs. The American champion Major Taylor refused to continue the New York race, saying: "I cannot go on with safety, for there is a man chasing me around the ring with a knife in his hand."

Public reaction turned against such trials, whether individual races or in teams of two. One report said:

An athletic contest in which the participants 'go queer' in their heads, and strain their powers until their faces become hideous with the tortures that rack them, is not sport, it is brutality. It appears from the reports of this singular performance that some of the bicycle riders have actually become temporarily insane during the contest... Days and weeks of recuperation will be needed to put the racers in condition, and it is likely that some of them will never recover from the strain.

The father of anabolic steroids in the United States was John Ziegler (1917–1983), a physician for the U.S. weightlifting team in the mid-20th century. Ziegler learned from his Russian days that the Soviet weightlifting team's success was due to their use of performance-enhancing drugs. Deciding that U.S. athletes needed chemical assistance to remain competitive, Ziegler worked with the CIBA Pharmaceutical Company to develop an oral anabolic steroid. This resulted in the creation of methandrostenolone, which appeared on the market in 1960. During the Olympics that year, the Danish cyclist Knud Enemark Jensen collapsed and died while competing in the 100-kilometer (62-mile) race. An autopsy later revealed the presence of amphetamines and a drug called nicotinyl tartrate in his system.

The American specialist in doping, Max M. Novich, wrote: "Trainers of the old school who supplied treatments which had cocaine as their base declared with assurance that a rider tired by a six-day race would get his second breath after absorbing these mixtures." John Hoberman, a professor at the University of Texas in Austin, Texas, said six-day races were "de facto experiments investigating the physiology of stress as well as the substances that might alleviate exhaustion."

Strychnine at the Olympics

Hicks and supporters at the 1904 Summer Olympics.

These "de facto experiments investigating the physiology of stress as well as the substances that might alleviate exhaustion" were not unknown outside cycling.

Thomas Hicks, an American born in England on 7 January 1875, won the Olympic marathon in 1904. He crossed the line behind a fellow American Fred Lorz, who had been transported for 11 miles of the course by his trainer, leading to his disqualification. However, Hicks's trainer Charles Lucas, pulled out a syringe and came to his aid as his runner began to struggle.

I therefore decided to inject him with a milligram of sulphate of strychnine and to make him drink a large glass brimming with brandy. He set off again as best he could [but] he needed another injection four miles from the end to give him a semblance of speed and to get him to the finish.

The use of strychnine, at the time, was thought necessary to survive demanding races, according to sports historians Alain Lunzenfichter and historian of sports doping, Dr Jean-Pierre de Mondenard, who said:

It has to be appreciated that at the time the menace of doping for the health of athletes or of the purity of competition had yet to enter the morals because, after this marathon, the official race report said: The marathon has shown from a medical point of view how drugs can be very useful to athletes in long-distance races.

Hicks was, in the phrase of the time, "between life and death" but recovered, collected his gold medal a few days later, and lived until 1952. Nonetheless, he never again took part in athletics.

Goldman's dilemma

Main article: Goldman's dilemma

Goldman's dilemma, or the Goldman dilemma, is a question that was posed to elite athletes by physician, osteopath and publicist Bob Goldman, asking whether they would take a drug that would guarantee them success in sport, but cause them to die after five years. In his research, as in previous research by Mirkin, approximately half the athletes responded that they would take the drug, but modern research by James Connor and co-workers has yielded much lower numbers, with athletes having levels of acceptance of the dilemma that were similar to the general population of Australia.

Stimulants

Stimulants are drugs that usually act on the central nervous system to modulate mental function and behavior, increasing an individual's sense of excitement and decreasing the sensation of fatigue. In the World Anti-Doping Agency list of prohibited substances, stimulants are the second largest class after the anabolic steroids. Examples of well known stimulants include caffeine, cocaine, amphetamine, modafinil, and ephedrine. Caffeine, although a stimulant has not been banned by the International Olympic Committee or the World Anti Doping Agency since 2004.

Benzedrine is a trade name for amphetamine. The Council of Europe says it first appeared in sport at the Berlin Olympics in 1936. It was produced in 1887 and the derivative, Benzedrine, was isolated in the U.S. in 1934 by Gordon Alles. Its perceived effects gave it the street name "speed". British troops used 72 million amphetamine tablets in the Second World War and the RAF got through so many that "Methedrine won the Battle of Britain" according to one report. The problem was that amphetamine leads to a lack of judgement and a willingness to take risks, which in sport could lead to better performances but in fighters and bombers led to more crash landings than the RAF could tolerate. The drug was withdrawn but large stocks remained on the black market. Amphetamine was also used legally as an aid to slimming and also as a thymoleptic before being phased out by the appearance of newer agents in the 1950s.

Everton, one of the top clubs in the English football league, were champions of the 1962–63 season. And it was done, according to a national newspaper investigation, with the help of Benzedrine. Word spread after Everton's win that the drug had been involved. The newspaper investigated, cited where the reporter believed it had come from, and quoted the goalkeeper, Albert Dunlop, as saying:

I cannot remember how they first came to be offered to us. But they were distributed in the dressing rooms. We didn't have to take them but most of the players did. The tablets were mostly white but once or twice they were yellow. They were used through the 1961–62 season and the championship season which followed it. Drug-taking had previously been virtually unnamed in the club. But once it had started we could have as many tablets as we liked. On match days they were handed out to most players as a matter of course. Soon some of the players could not do without the drugs.

The club agreed that drugs had been used but that they "could not possibly have had any harmful effect." Dunlop, however, said he had become an addict.

In November 1942, the Italian cyclist Fausto Coppi took "seven packets of amphetamine" to beat the world hour record on the track. In 1960, the Danish rider Knud Enemark Jensen collapsed during the 100 km team time trial at the Olympic Games in Rome and died later in hospital. The autopsy showed he had taken amphetamine and another drug, Ronicol, which dilates the blood vessels. The chairman of the Dutch cycling federation, Piet van Dijk, said of Rome that "dope – whole cartloads – [were] used in such royal quantities."

The 1950s British cycling professional Jock Andrews would joke: "You need never go off-course chasing the peloton in a big race – just follow the trail of empty syringes and dope wrappers."

The Dutch cycling team manager Kees Pellenaars told of a rider in his care:

I took him along to a training camp in Spain. The boy changed then into a sort of lion. He raced around as though he was powered by rockets. I went to talk to him. He was really happy he was riding well and he told me to look out for him. I asked if he wasn't perhaps "using something" and he jumped straight up, climbed on a chair and from deep inside a cupboard he pulled out a plastic bag full of pills. I felt my heart skip a beat. I had never seen so many fireworks together. With a soigneur we counted the pills: there were 5,000 of them, excluding hormone preparations and sleeping pills. I took them away, to his own relief. I let him keep the hormones and the sleeping pills. Later he seemed to have taken too many at once and he slept for a couple of days on end. We couldn't wake him up. We took him to hospital and they pumped out his stomach. They tied him to his bed to prevent anything going wrong again. But one way or another he had some stimulant and fancied taking a walk. A nurse came across him in the corridor, walking along with the bed strapped to his back.

Currently modafinil is being used throughout the sporting world, with many high-profile cases attracting press coverage as prominent United States athletes have tested positive for this substance. Some athletes who were found to have used modafinil protested as the drug was not on the prohibited list at the time of their offence, however, the World Anti-Doping Agency (WADA) maintains it is a substance related to those already banned, so the decisions stand. Modafinil was added to the list of prohibited substances on 3 August 2004, ten days before the start of the 2004 Summer Olympics.

One approach of athletes to get around regulations on stimulants is to use new designer stimulants, which have not previously been officially prohibited, but have similar chemical structures or biological effects. Designer stimulants that attracted media attention in 2010 included mephendrone, ephendrome, and fluoroamphetamines; which have chemical structures and effects similar to ephedrine and amphetamine.

Anabolic steroids

Main articles: Ergogenic use of anabolic steroids and Anabolic steroid

Anabolic-androgenic steroids (AAS) were first isolated, identified and synthesized in the 1930s, and are now used therapeutically in medicine to induce bone growth, stimulate appetite, induce male puberty, and treat chronic wasting conditions, such as cancer and AIDS. Anabolic steroids also increase muscle mass and physical strength, and are therefore used in sports and bodybuilding to enhance strength or physique. Known side effects include harmful changes in cholesterol levels (increased Low density lipoprotein and decreased High density lipoprotein), acne, high blood pressure, liver damage. Some of these effects can be mitigated by taking supplemental drugs.

AAS use in sports began in October 1954 when John Ziegler, a doctor who treated American athletes, went to Vienna with the American weightlifting team. There he met a Russian physician who, over "a few drinks", repeatedly asked "What are you giving your boys?" When Ziegler returned the question, the Russian said that his own athletes were being given testosterone. Returning to America, Ziegler tried low doses of testosterone on himself, on the American trainer Bob Hoffman and on two lifters, Jim Park and Yaz Kuzahara. All gained more weight and strength than any training programme would produce but there were side-effects. Ziegler sought a drug without after-effects and hit on an anabolic steroid, methandrostenolone, (Dianabol, DBOL), made in the US in 1958 by Ciba.

The results were so impressive that lifters began taking more, and steroids spread to other sports. Paul Lowe, a former running back with the San Diego Chargers American football team, told a California legislative committee on drug abuse in 1970: "We had to take them [steroids] at lunchtime. He [an official] would put them on a little saucer and prescribed them for us to take them and if not he would suggest there might be a fine."

Olympic statistics show the weight of shot putters increased 14 percent between 1956 and 1972, whereas steeplechasers weight increased 7.6 per cent. The gold medalist pentathlete Mary Peters said: "A medical research team in the United States attempted to set up extensive research into the effects of steroids on weightlifters and throwers, only to discover that there were so few who weren't taking them that they couldn't establish any worthwhile comparisons." In 1984, Jay Silvester, a former four-time Olympian and 1972 silver medalist in the discus, who was then with the physical education department of Brigham Young University in the U.S., questioned competitors at that year's Olympics. The range of steroid use he found ranged from 10 mg a day to 100 mg.

Responses to questionnaire

Question	Yes (%)	No (%)	Other (%)
Have you taken anabolic steroids within the past six months?	61	39	0
Have you ever taken anabolic steroids?	68	32	0
Ethically, do you approve of anabolic steroids in athletics?	50	27	23
If a test could positively identify steroid users, would you favour banishment of the drug in sport?	48	35	17
Are you aware of any specific reason why athletes who have not attained full maturity should avoid anabolic steroid usage?	42	48	10
If you were a coach, would you commend anabolic steroid usage to (mature) athletes in your event?	45	35	20
Do you feel anabolic steroids have positively affected the performance of athletes in your event?	65	16	19
Do you feel that steroids have negatively affected the performance of athletes in your event?	6	61	33
Do you feel that steroids enable a person to gain strength faster than otherwise possible?	84	3	13
Do you believe that steroids enable a person to gain cardio-respiratory endurance more quickly than otherwise possible?	13	42	45
Do you believe that steroids enable a person to gain greater cardio-respiratory endurance than otherwise possible?	6	45	49
Have you ever gained localised muscular endurance faster when taking anabolic steroids?	48	42	10
Have you gained greater local muscular endurance faster when taking anabolic steroids?	32	22	46
Do steroids enhance mental attitude? Do you feel more in control of your life? Do you feel you will perform better in your event?	68	10	22
Has steroid usage appeared to contribute to injury problems?	26	32	42
Are you aware of the undesirable side-effects?	74	19	7
Do steroids increase body weight?	55	16	29
Are steroids difficult to obtain?	22	61	17

Dianabol is no longer produced but similar drugs are made elsewhere. The use of anabolic steroids is now banned by all major sporting bodies, including the ATP, WTA, ITF, International Olympic Committee, FIFA, UEFA, all major professional golf tours, the National Hockey League, Major League Baseball, the National Basketball Association, the European Athletic Association, WWE, the NFL and the UCI. However, drug testing can be wildly inconsistent and, in some instances, has gone unenforced.

A number of studies measuring anabolic steroid use in high school athletes found that out of all 12th grade students, 6.6 percent of them had used anabolic steroids at some point in their high school careers or were approached and counseled to use them. Of those students who acknowledged doping with anabolic–androgenic steroids, well over half participated in school-sponsored athletics, including football, wrestling, track and field, and baseball. A second study showed 6.3 percent of high school student Football players admitted to current or former AAS use. At the collegiate level, surveys show that AAS use among athletes range from 5 percent to 20 percent and continues to rise. The study found that skin changes were an early marker of steroid use in young athletes, and underscored the important role that dermatologists could play in the early detection and intervention in these athletes.

1988 Seoul Olympics

A famous case of AAS use in a competition was Canadian Ben Johnson's victory in the 100 m at the 1988 Summer Olympics. He subsequently failed the drug test when stanozolol was found in his urine. He later admitted to using the steroid as well as Dianabol, testosterone, Furazabol, and human growth hormone amongst other things. Johnson was stripped of his gold medal as well as his world-record performance. Carl Lewis was then promoted one place to take the Olympic gold title. Lewis had also run under the current world record time and was therefore recognized as the new record holder. In 2003, however, Wade Exum, the United States Olympic Committee (USOC) director of drug control administration from 1991 to 2000, gave copies of documents to Sports Illustrated which revealed that some 100 American athletes who failed drug tests and should have been prevented from competing in the Olympics were nevertheless cleared to compete, among those athletes was Carl Lewis.

Lewis broke his silence on allegations that he was the beneficiary of a drugs cover-up, admitting he had tested positive for banned substances but claiming he was just one of "hundreds" of American athletes who were allowed to escape bans, concealed by the USOC. Lewis has now acknowledged that he failed three tests during the 1988 US Olympic trials, which under international rules at the time should have prevented him from competing in the Seoul games. Former athletes and officials came out against the USOC cover-up. "For so many years I lived it. I knew this was going on, but there's absolutely nothing you can do as an athlete. You have to believe governing bodies are doing what they are supposed to do. And it is obvious they did not," said former American sprinter and 1984 Olympic champion, Evelyn Ashford.

East Germany

Main article: Doping in East Germany

In 1977, one of East Germany's best sprinters, Renate Neufeld, fled to the West with the Bulgarian she later married. A year later she said that she had been told to take drugs supplied by coaches while training to represent East Germany in the 1980 Olympic Games.

At 17, I joined the East Berlin Sports Institute. My speciality was the 80m hurdles. We swore that we would never speak to anyone about our training methods, including our parents. The training was very hard. We were all watched. We signed a register each time we left for dormitory and we had to say where we were going and what time we would return. One day, my trainer, Günter Clam, advised me to take pills to improve my performance: I was running 200m in 24 seconds. My trainer told me the pills were vitamins, but I soon had cramp in my legs, my voice became gruff and sometimes I couldn't talk any more. Then I started to grow a moustache and my periods stopped. I then refused to take these pills. One morning in October 1977, the secret police took me at 7am and questioned me about my refusal to take pills prescribed by the trainer. I then decided to flee, with my fiancé.

She brought with her to the West grey tablets and green powder she said had been given to her, to members of her club, and to other athletes. The West German doping analyst Manfred Donike reportedly identified them as anabolic steroids. She said she stayed quiet for a year for the sake of her family. But when her father then lost his job and her sister was expelled from her handball club, she decided to tell her story.

Ilona Slupianek in 1981.

East Germany closed itself to the sporting world in May 1965. In 1977, the shot-putter Ilona Slupianek, who weighed 93 kg, tested positive for anabolic steroids at the European Cup meeting in Helsinki and thereafter athletes were tested before they left the country. At the same time, the Kreischa testing laboratory near Dresden passed into government control, which was reputed to make around 12,000 tests a year on East German athletes but without any being penalised.

The International Amateur Athletics Federation suspended Slupianek for 12 months, a penalty that ended two days before the European championships in Prague. In the reverse of what the IAAF hoped, sending her home to East Germany meant she was free to train unchecked with anabolic steroids, if she wanted to, and then compete for another gold medal, which she won.

After that, almost nothing emerged from the East German sports schools and laboratories. A rare exception was the visit by the sports writer and former athlete, Doug Gilbert of the Edmonton Sun, who said:

Dr (Heinz) Wuschech knows more about anabolic steroids than any doctor I have ever met, and yet he cannot discuss them openly any more than Geoff Capes or Mac Wilkins can openly discuss them in the current climate of amateur sports regulation. What I did learn in East Germany was that they feel there is little danger from anabolica, as they call it, when the athletes are kept on strictly monitored programmes. Although the extremely dangerous side-effects are admitted, they are statistically no more likely to occur than side-effects from the birth control pill. If, that is, programmes are constantly medically monitored as to dosage.

Other reports came from the occasional athlete who fled to the West. There were 15 between 1976 and 1979. One, the ski-jumper Hans-Georg Aschenbach, said: "Long-distance skiers start having injections to their knees from the age 14 because of their intensive training." He said: "For every Olympic champion, there at least 350 invalids. There are gymnasts among the girls who have to wear corsets from the age of 18 because their spine and their ligaments have become so worn... There are young people so worn out by the intensive training that they come out of it mentally blank [lessivés – washed out], which is even more painful than a deformed spine."

After German reunification, on 26 August 1993 the records were opened and the evidence was there that the Stasi, the state secret police, supervised systematic doping of East German athletes from 1971 until reunification in 1990. Doping existed in other countries, says the expert Jean-Pierre de Mondenard, both communist and capitalist, but the difference with East Germany was that it was a state policy. The Sportvereinigung Dynamo (English:Dynamo Sports Club) was especially singled out as a center for doping in the former East Germany. Many former club officials and some athletes found themselves charged after the dissolution of the country. A special page on the internet was created by doping victims trying to gain justice and compensation, listing people involved in doping in the GDR.

State-endorsed doping began with the Cold War when every eastern bloc gold was an ideological victory. From 1974, Manfred Ewald, the head of the GDR's sports federation, imposed blanket doping. At the 1968 Mexico City Olympics, the country of 17 million collected nine gold medals. Four years later the total was 20 and in 1976 it doubled again to 40. Ewald was quoted as having told coaches, "They're still so young and don't have to know everything." He was given a 22-month suspended sentence, to the outrage of his victims. Often, doping was carried out without the knowledge of the athletes, some of them as young as ten years of age. It is estimated that around 10,000 former athletes bear the physical and mental scars of years of drug abuse, one of them is Rica Reinisch, a triple Olympic champion and world record-setter at the Moscow Games in 1980, has since suffered numerous miscarriages and recurring ovarian cysts.

Two former Dynamo Berlin club doctors, Dieter Binus, chief of the national women's team from 1976 to 80, and Bernd Pansold, in charge of the sports medicine center in East-Berlin, were committed for trial for allegedly supplying 19 teenagers with illegal substances. Binus was sentenced in August, Pansold in December 1998 after both being found guilty of administering hormones to underage female athletes from 1975 to 1984.

Virtually no East German athlete ever failed an official drugs test, though Stasi files show that many did produce positive tests at Kreischa, the Saxon laboratory (German:Zentrales Dopingkontroll-Labor des Sportmedizinischen Dienstes) that was at the time approved by the International Olympic Committee, now called the Institute of Doping Analysis and Sports Biochemistry (IDAS). In 2005, 15 years after the end of the GDR, the manufacturer of the drugs in former East Germany, Jenapharm, still finds itself involved in numerous lawsuits from doping victims, being sued by almost 200 former athletes.

Former Sport Club Dynamo athletes who publicly admitted to doping, accusing their coaches:

• Daniela Hunger
• Andrea Pollack

Former Sport Club Dynamo athletes disqualified for doping:

• Ilona Slupianek (Ilona Slupianek was tested positive along with three Finnish athletes at the 1977 European Cup, becoming the only East German athlete ever to be convicted of doping)

Based on the admission by Pollack, the United States Olympic Committee asked for the redistribution of gold medals won in the 1976 Summer Olympics. Despite court rulings in Germany that substantiate claims of systematic doping by some East German swimmers, the IOC executive board announced that it has no intention of revising the Olympic record books. In rejecting the American petition on behalf of its women's medley relay team in Montreal and a similar petition from the British Olympic Association on behalf of Sharron Davies, the IOC made it clear that it wanted to discourage any such appeals in the future.

Football (soccer)

There have been few incidents of doping in football, mainly due to FIFA's belief that education and prevention with constant in and out-of-competition controls play a key role in making high-profile competitions free of performance-enhancing drugs. The FIFA administration work alongside team physicians to fight for dope free competitions, having them sign a joint declaration that states they agree with having routine blood testing to check for blood doping before any FIFA world cup.

In 2014, the biological passport is introduced in the 2014 FIFA World Cup; blood and urine samples from all players before the competition and from two players per team and per match are analysed by the Swiss Laboratory for Doping Analyses.

Endurance sports

The use of performance-enhancing drugs in sport has become an increasing problem across a wide range of sports. It is defined as any substance or drug that, when taken, gives an athlete an unfair advantage relative to a "clean" athlete. The banning of these drugs promotes a level playing field and equality among athletes. The use of 'the suit' in swimming, which gives athletes an advantage in the way of hydrodynamics, has been banned from international competition due to the unfair advantage it delivered. The drugs taken by athletes differ widely based on the performance needs of the sport.

Erythropoietin (EPO) is largely taken by endurance athletes who seek a higher level of red blood cells, which leads to more oxygenated blood, and a higher VO2 max. An athlete's VO2 max is highly correlated with success within endurance sports such as swimming, long-distance running, cycling, rowing, and cross-country skiing. EPO has recently become prevalent amongst endurance athletes due to its potentcy and low degree of detectability when compared to other methods of doping such as blood transfusion. While EPO is believed to have been widely used by athletes in the 1990s, there was not a way to directly test for the drug until 2002. Athletes at the Olympic Games are tested for EPO through blood and urine tests. Stringent guidelines and regulations can lessen the danger of doping that has existed within some endurance sports. As of 2012, 18 pro cyclists in the last 15 years have died from using EPO.

Cycling

See also: List of doping cases in cycling, Doping at the Tour de France, and Doping at the 2007 Tour de France

The Convicts of the Road

In 1924 the journalist Albert Londres followed the Tour de France for the French newspaper Le Petit Parisien. At Coutances he heard that the previous year's winner, Henri Pélissier, his brother Francis and a third rider, Maurice Ville, had resigned from the competition after an argument with the organiser Henri Desgrange. Pélissier explained the problem—whether or not he had the right to take off a jersey—and went on to talk of drugs, reported in Londres' race diary, in which he invented the phrase Les Forçats de la Route (The Convicts of the Road):

"You have no idea what the Tour de France is," Henri said. "It's a Calvary. Worse than that, because the road to the Cross has only 14 stations and ours has 15. We suffer from the start to the end. You want to know how we keep going? Here..." He pulled a phial from his bag. "That's cocaine, for our eyes. This is chloroform, for our gums."

"This," Ville said, emptying his shoulder bag "is liniment to put warmth back into our knees."

"And pills. Do you want to see pills? Have a look, here are the pills." Each pulled out three boxes.

"The truth is," Francis said, "that we keep going on dynamite."

Henri spoke of being as white as shrouds once the dirt of the day had been washed off, then of their bodies being drained by diarrhea, before continuing:

"At night, in our rooms, we can't sleep. We twitch and dance and jig about as though we were doing St Vitus's Dance..."

"There's less flesh on our bodies than on a skeleton," Francis said.

Francis Pélissier said much later: "Londres was a famous reporter but he didn't know about cycling. We kidded him a bit with our cocaine and our pills. Even so, the Tour de France in 1924 was no picnic." The acceptance of drug-taking in the Tour de France was so complete by 1930, when the race changed to national teams that were to be paid for by the organisers, that the rule book distributed to riders by the organiser, Henri Desgrange, reminded them that drugs were not among items with which they would be provided. The use of Pot Belge by road cyclists in continental Europe exemplifies a cross-over between recreational and performance-enhancing abuse of drugs by sportsman.

Festina affair

Main article: Festina affair

In 1998, the entire Festina team were excluded from the Tour de France following the discovery of a team car containing large amounts of various performance-enhancing drugs. The team director later admitted that some of the cyclists were routinely given banned substances. Six other teams pulled out in protest including Dutch team TVM who left the tour still being questioned by the police. The Festina scandal overshadowed cyclist Marco Pantani's tour win, but he himself later failed a test. The infamous "pot belge" or "Belgian mix" has a decades-long history in pro cycling, among both riders and support staff. David Millar, the 2003 World-Time Trial Champion, admitted using EPO, and was stripped of his title and suspended for two years. Roberto Heras was stripped of his victory in the 2005 Vuelta a España and suspended for two years after testing positive for EPO.

Floyd Landis

Main article: Floyd Landis doping case

Controversial athlete Floyd Landis, shown here at the 2006 Tour of California, triggered a public scandal when caught doping to help his cycling.

Floyd Landis was the initial winner of the 2006 Tour de France. However, a urine sample taken from Landis immediately after his Stage 17 win has twice tested positive for banned synthetic testosterone as well as a ratio of testosterone to epitestosterone nearly three times the limit allowed by World Anti-Doping Agency rules. The International Cycling Union stripped him of his 2006 Tour de France title. Second place finisher Óscar Pereiro was officially declared the winner.

Lance Armstrong doping case

Main article: History of Lance Armstrong doping allegations

Lance Armstrong was world number one in 1996. In the same year he recovered from severe testicular cancer and continued to break records and win his seventh Tour de France in 2005. After beating cancer and breaking records he was accused of doping. Team mates of Lance had been caught taking EPO (Erythropoietin) which made the accusations against Armstrong stronger.

On 22 October 2012 Lance Armstrong was stripped of his Tour de France titles since 1998. As a response to the decisions of the USADA and UCI, Armstrong resigned from the Lance Armstrong Foundation On 14 January 2013, Armstrong confessed to doping in an interview with Oprah Winfrey which was aired on 17 January on the Oprah Winfrey Network.

Other endurance sports

In triathlon, 2004 Hawaii Ironman winner Nina Kraft, was disqualified for a positive test to EPO. She remains the only Hawaii Ironman winner to be disqualified for doping offences. Sports lawyer Michelle Gallen has said that the pursuit of doping athletes has turned into a modern-day witch-hunt.

Non-endurance sports

In sports where physical strength is favored, athletes have used anabolic steroids, known for their ability to increase physical strength and muscle mass. The drug mimics the effect of testosterone and dihydrotestosterone in the body. They were developed after Eastern Bloc countries demonstrated success in weightlifting during the 1940s. At the time they were using testosterone, which carried with it negative effects, anabolic steroids were developed as a solution. The drug has been used across a wide range of sports from football and basketball to weightlifting and track and field. While not as life-threatening as the drugs used in endurance sports, anabolic steroids have negative side effects, including:

Side effects in men

• acne
• impaired liver function
• impotency
• breast formation (gynecomastia)
• increase in estrogen
• erectile dysfunction
• increased sex drive
• male pattern baldness

Side effects in women

Side effects in women include:

• hair loss
• male pattern baldness
• hypertrophy of the clitoris
• increased sex drive
• irregularities of the menstrual cycle
• development of masculine facial traits
• increased coarseness of the skin
• premature closure of the epiphysis

In countries where the use of these drugs is controlled, there is often a black market trade of smuggled or counterfeit drugs. The quality of these drugs may be poor and can cause health risks. In countries where anabolic steroids are strictly regulated, some have called for a regulatory relief. Steroids are available over-the-counter in some countries such as Thailand and Mexico.

Reaction from sports organizations

Many sports organizations have banned the use of performance-enhancing drugs and have very strict rules and penalties for people who are caught using them. The International Amateur Athletic Federation, now the International Association of Athletics Federations, were the first international governing body of sport to take the situation seriously. In 1928 they banned participants from doping, but with little in the way of testing available they had to rely on the word of the athlete that they were clean. It was not until 1966 that FIFA and Union Cycliste Internationale (cycling) joined the IAAF in the fight against drugs, followed by the International Olympic Committee the following year. Progression in pharmacology has always outstripped the ability of sports federations to implement rigorous testing procedures but since the creation of the World Anti-Doping Agency in 1999, it has become more effective to catch athletes who use drugs. The first tests for athletes were at the 1966 European Championships and two years later the IOC implemented their first drug tests at both the Summer and Winter Olympics. Anabolic steroids became prevalent during the 1970s and after a method of detection was found they were added to the IOC's prohibited substances list in 1975.

Over the years, different sporting bodies have evolved differently in the struggle against doping. Some, such as athletics and cycling, are becoming increasingly vigilant against doping. However, there has been criticism that sports such as football (soccer) and baseball are doing nothing about the issue, and letting athletes implicated in doping away unpunished.

Some commentators maintain that, as outright prevention of doping is an impossibility, all doping should be legalised. However, most disagree with this, pointing out the claimed harmful long-term effects of many doping agents. Opponents claim that with doping legal, all competitive athletes would be compelled to use drugs, and the net effect would be a level playing field but with widespread health consequences. Considering that anti-doping is largely ineffective due to both testing limitations and lack of enforcement, this is not markedly different from the situation already in existence.

Another point of view is that doping could be legalized to some extent using a drug whitelist and medical counseling, such that medical safety is ensured, with all usage published. Under such a system, it is likely that athletes would attempt cheat by exceeding official limits to try to gain an advantage; this could be considered conjecture as drug amounts do not always correlate linearly with performance gains.

Anti-Doping organizations and legislation

Main article: World Anti-Doping Agency

• In February 2011, the United States Olympic Committee and the Ad Council launched an anti-steroid campaign called Play Asterisk Free aimed at teens. The campaign first launched in 2008 under the name "Don't Be An Asterisk!".
• In October 2012, the USADA released evidence to corroborate their doping claim against cyclist Lance Armstrong. According to USADA CEO Travis T. Tygart, the evidence against Armstrong includes, "...scientific data and laboratory test results that further prove the use, possession and distribution of performance enhancing drugs".
• On 1 November 1989, US Senator Joseph Biden introduced S. 1829, The Steroid Trafficking Act of 1989. The purpose of the act was simple: It would "amend the Controlled Substances Act to further restrict the use of steroids. By designating anabolic steroids as a Schedule II controlled substance, the bill would crack down on illegal steroid use". (Senate Judiciary Committee, 2002, p. 282).

Test methods

Under established doping control protocols, the participant will be asked to provide a urine sample, which will be divided into two, each portion to be preserved within sealed containers bearing the same unique identifying number and designation respectively as A- and B-samples. WADA's Executive Committee and Foundation Board clarified at a meeting on 19–20 November, that an athlete whose A-sample has revealed the presence of a prohibited substance or method to request the analysis of his or her B-sample:

"The B-sample helps confirm that an anti-doping rule violation has occurred and protects the rights of the athletes", said WADA Director General David Howman. "It should be stressed that anti-doping is one of the few types of controls in society in which a confirmation procedure is used in order to protect individuals, and the very rare cases in which the analysis of the B-sample did not match the results of the A-sample have shown the usefulness of such procedure."

Re-testing of samples

According to Article 6.5 in the World Anti-Doping Code samples may be re-tested later. Samples from high-profile events, such as the Olympic Games, are now re-tested up to eight years later to take advantage of new techniques for detecting banned substances.

Cheating the tests

Athletes seeking to avoid testing positive use various methods. The most common methods include:

• Urine replacement, which involves replacing dirty urine with clean urine from someone who is not taking banned substances. Urine replacement can be done by catheterization or with a prosthetic penis such as The Original Whizzinator.
• Diuretics, used to cleanse the system before having to provide a sample.
• Blood transfusions, which increase the blood's oxygen carrying capacity, in turn increasing endurance without the presence of drugs that could trigger a positive test result.

Validity

Donald Berry, writing in the journal Nature, has called attention to potential problems with the validity of ways in which many of the standardised tests are performed;^{[subscription required]} in his article, as described in an accompanying editorial, Berry

argues that anti-doping authorities have not adequately defined and publicized how they arrived at the criteria used to determine whether or not a test result is positive [which are] ...calibrated in part by testing a small number of volunteers taking the substance in question. [Berry argues] ...that individual labs need to verify these detection limits in larger groups that include known dopers and non-dopers under blinded conditions that mimic what happens during competition.

The editorial closes, saying "Nature believes that accepting 'legal limits' of specific metabolites without such rigorous verification goes against the foundational standards of modern science, and results in an arbitrary test for which the rate of false positives and false negatives can never be known."

Defense

G. Pascal Zachary argues in a Wired essay that legalizing performance-enhancing substances, as well as genetic enhancements once they became available, would satisfy society's need for übermenschen and reverse the decline in public interest in sports.

Sports scholar Verner Moller argues that society is hypocritical when it holds athletes to moral standards, but do not conform to those morals themselves. Fox Sports writer Jen Floyd Engel stated in an article, "We live in a pharmacological society. We live in a society of short cuts, of fake this and enhanced that, and somehow we keep trying to sell the line that sports has become this evil empire of cheating. The reality is athletes are merely doing what so many of us do and celebrate and watch every single day of our lives."

Sociologist Ellis Cashmore argues that what is considered doping is too arbitrary: Transfusing blood cells is not allowed, but other methods of boosting blood cell count, such as hypobaric chambers, are allowed.

Legal

Anti-doping policies instituted by individual sporting governing bodies may conflict with local laws. A notable case includes the National Football League (NFL) inability to suspend players found with banned substances, after it was ruled by a federal court, that local labor laws superseded the NFL's anti-doping regime. The challenge was supported by the National Football League Players Association.

Athletes caught doping may be subject to penalties from their locality as well from the individual sporting governing body. The legal status of anabolic steroids varies from country to country. Using performance-enhancing drugs in mixed martial arts competitions like the UFC could find the guilty fighter charged or sued once Bill S-209 passes.

Under certain circumstances, when athletes need to take a prohibited substance to treat a medical condition, a therapeutic use exemption may be granted.

See also

• Gene doping
• Stem cell doping
• BALCO scandal
• Concussions in sport
• Doping at the Olympic Games
• Doping in pigeon racing
• Equine drug testing

Further reading

• Franke WW, Berendonk B (July 1997). "Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government". Clinical Chemistry. 43 (7): 1262–79. PMID 9216474.
• Mottram, David (2005); Drugs in Sport, Routledge. ISBN 978-0-415-37564-1.
• Murray, Thomas H. (2008); "Sports Enhancement", in From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns.
• Waddington and Smith (2008); An Introduction to Drugs in Sport, Routledge. ISBN 978-0-415-43125-5.
• Sports Doping: From the Laboratory to the Playing Field. Radio and

External links

• Anti-Doping Sciences Institute
• Banned Substances Control Group
• World Anti-Doping Agency
• Anti-Doping at the International Association of Athletics Federations