Doping And Drugs In Sport – A Complex Causation Perhaps More Societal Rather Than Just Sport Based

It is the time of year which is most enjoyable for me as an armchair sports fan – the Tour De France cycle race is on and for three weeks we are privileged to view an incredible sporting and human drama spectacle, where young folk push themselves to the absolute limit on a daily basis across the cobblestones of Holland and Belgium and across the mountains of France. Like many others, I became interested in watching the Tour during the Lance Armstrong era (and like many others, I am an ardent fortysomething occasional cyclist who gets on his bike as often as work constraints allows), and I remember being enthralled by all of his seemingly effortless individual performances when winning seven consecutive Tours, the strength of his team, and his larger than life personality which seemed during the late 1990’s to be everything a top athletic achiever should be. Sadly, like most folk I guess, while being aware of the doping allegations at the time, I wanted to believe in him and his performances, and was deeply disappointed when these doping allegations were confirmed in later years / more recently, along with revelations about a murkier / darker side to his personality and behaviour. My first scientific article, published in 1994 when I was busy with my PhD laboratory work, was a philosophical piece on doping in sport, and how it should be managed and viewed by medical doctors, in which I advocated a fairly liberal approach to both managing doping practices and athletes who use drugs during sport. I have to be honest and say while I am proud of each and every one of the research and scientific articles I have written or been involved with to date, this is perhaps the only one I would have written differently with the wisdom of hindsight and the changing viewpoint inculcated by increasing age and life experience. Doping and drug taking in sport is a problem that goes beyond sport, and given the impact of sport on our daily life and sport heroes on our young developing athletes, it is a problem which needs strong management and well thought out regulation.

Doping in sport (and indeed all aspects of competitive life) is not a new concept, and has been occurring for a long period of time. The reason folk take drugs is to gain an advantage over their rivals, and optimise their chances of winning whatever event they are competing in or have rivals for. Drugs are used to either increase strength or enhance endurance capacity. Historically, in Scandinavian mythology, their ancient warlike folk many centuries ago – the Beserkers – drank a potion, potentially incorporating mushrooms, which was thought to greatly increase their strength and power, at the risk of increasing their chances of insanity during and after a battle. In both World Wars, pilots were given amphetamine-like tablets (also known on the street as ‘uppers’ or ‘speed’) to keep them awake and theoretically increase their task attention and vigilance during aerial combat. Anabolic steroids were developed in the early part of the last century, and in the 1950’s and 1960’s came to the attention of athletes as an easy way to increase their strength and power output, and their use become commonplace in even Olympic events until they were banned in the 1970’s. In cycling, there is anecdotal evidence from even a century ago of competitors using a variety of doping products in order to enhance their physical capacity, from fairly innocuous sherry and other alcohol ingestion, to the use of both stimulants and later anabolic steroid use. Currently, a variety of drugs are used as doping agents, including stimulants and steroids, but also products like erythropoeitin, a drug which increases red blood cell capacity and therefore enhances oxygen delivery to the cells and thus performance, and a variety of other doping products, from cortisone (which enhances tissue recovery) to growth hormone (which enhances muscle growth) to asthma-related drugs such as clenbuterol, which enhances oxygen uptake in the lungs, and may also increase lean body mass.

The authorities who regulate the Tour and other sporting events responded to the use of all these doping agents by banning the drugs, and working with academic laboratories to develop testing procedures that detect these drugs, and if athletes are caught with any of these products in their body, they are banned for a period of time before being allowed to compete again. But these dope testing methods are never one hundred percent reliable, and what has developed has been something of a ‘cat and mouse game’ between the testers / authorities and athletes, who when a test is developed for a particular doping product that has good sensitivity and detection capacity, change what they use, either to new products, or ways of taking performance enhancing drugs. For example, when testing for erythropoietin became successful, cyclists started to remove their own blood before the Tour, and re-infused it back during the rest days of the Tour, in order to circumvent the laboratory tests. When a laboratory test that could prove that such re-use of own blood had occurred was developed, cyclists changed to using erythropoietin again but in micro-doses on a daily rather than weekly big dose basis, and once again it proved difficult to prove they were using the drug, given that levels were marginally higher than normal only, and it could not be proven that the results were not merely the result of statistical variability. The issue of testing is further made more complex by the need for and use (and abuse) of therapeutic use exemptions (TUE), where athletes theoretically with valid medical conditions who could not compete without taking medication are allowed to take their medication as long as they declare their use prior to competition time. This has become a ‘grey area’ for drug control, as a large percentage of cyclists now have at least one TUE and some many. For example, a high percentage of Tour riders say they have asthma and therefore must use asthma drug inhalers, but of course, it is not possible to prove if they definitively have asthma or are using the asthma drug inhalers as a doping product to increase their competitive advantage (from a scientific / medical point of view, it is very ‘odd’ that so many top cyclists profess to have asthma or allergies that need similar medication, given that it would be perceived that suffering from such medical conditions would attenuate one’s capacity to perform sport at a social level, let alone allow the development of elite athlete competitors who win / do well in the Tour de France). So as much as the race organizers and authorities try and combat doping in sport, the cyclists and athletes appear to always be trying to stay ‘one step ahead’ of whatever is put in place to detect their use.

So what therefore can be done to attenuate doping in sport, and be sure that we are watching a ‘fair’ contest (though of course sport will always be absolutely an unfair environment, from the context that those who are fortunate enough to have inherited the most favourable genes and home and social environments will always have a greater chance of success than those who are less fortunate from either a gene or meme perspective). One way, which has been tried in all drug related enforcement work, is to increase the level of law enforcement involved in its ‘policing’, and to have custodial sentences for those who are either caught using or supplying doping products during and for sporting events, rather than just leaving its supervision to race organizers and sporting federations (who are notoriously lenient on their athletes who are caught using performance enhancing drugs, and whose athletes often are exonerated due to often bizarre legal technicalities and arguments). Indeed, cyclists became far more cautious (but sadly one would argue their drug use just became more technically smart) when French police became more involved and started arresting cyclists or team officials suspected of drug use in the early 2000’s, and it was the involvement of the FBI, and the threat of criminal charges, in the investigation of Lance Armstrong’s potential drug use a few years that finally led to admissions by him and his team members of culpability of performance enhancing drug use, despite him and his team-mates passing a large number of drug tests during their career. But like all ‘stick’ approaches, while this will work to a point, unless we understand why athletes take drugs in the first place, and try and remove the reason for doing so, it is likely that this approach will never completely work, and will rather just take the quest of athletes to find the ‘ultimate drug’ – one that works and which cannot be detected so they cannot be caught for its use – to a more technically efficient and / or more ‘underworld’ way of trying to find their doping products.

Perhaps also we need as armchair spectators and as members of the greater society to understand that we are as big a part of the doping problem as the athletes themselves. Since the 1800’s, when sport was popularized as entertainment for working and middle-class populations, sport has become increasingly important in our daily lifestyle. Sport has been used by country leaders to both engender and manipulate national pride, as a method of disciplining and preparing young adults for military activity, and as a way of providing mental and physical ‘toughness’ for the challenges in life. As societies became industrialized, the occupations of an increasing number of folk became sedentary and non-physical. It was perhaps because of this that sport in the last century became a means to maintain physical fitness, and sport was, and is used today, to maintain physical ‘fitness’ and / or aesthetic desirability. This trend was perhaps exacerbated by the media and advertising, which propagated the notion (based on our desire for it to be so) that athleticism in both men and women was and is a sign of social success and positive self-discipline. In the last few decades, the financial turnover in sport has decreased dramatically. As it became obvious that watching sport had become a form of relaxation and leisure activity for a number of societies, the economic sector realized that sport had the potential to be a source of revenue. With the advent of pay-channel television, sport has become a multi-billion dollar industry, and as a result athletes are able to become professionals and as a result devote their entire working day / life to their sport related training and activities (of course only if they were serial winners / successful in their chosen sport). Sport, and in particular success in sport, therefore has become the source of income for a number of athletes today, and this was almost certainly related to the increased incidence of the use of performance enhancing drugs in the last fifty years. As the financial and social rewards of success have increased, so has the pressure on athletes who livelihood and way of life is related to success in their chosen sport, to use performance enhancing drugs in order to do so, despite the potential negative clinical side effects of their use, and the potential damage that will be caused to their lifestyles and social status if they are caught using them, as described above. So each athlete must and surely does valence the risk / benefit of using performance enhancing drugs, and if the benefits to their current and future lifestyle are perceived to outweigh the potential negative side effects of either suffering physical harm from drug use, or being caught and branded a cheat, and having their lifestyle dramatically altered if being caught, then they will continue to use performance enhancing drugs, and always will do so.

Therefore, perhaps we need to understand that by paying for the TV channel that allows us to watch the wonderful spectacle of human drama which is the Tour De France, it creates a wealth generation chain that ultimately allows the successful athletes that compete in the Tour De France to be paid the huge salaries they currently are, and consequently we are to a degree part of the problem of doping in sport, and are contributing to its continuation. In my first philosophical academic piece described above, I suggested that because of this, we would never really ever completely ‘win’ the ‘fight’ against doping in sport, and that we needed to think either of introducing a salary cap and paying all cyclists the same wage irrespective of their results / performance outcome (though obviously in the current free market world this is an impossibility, or at least highly unlikely to happen in the visible future), or legalize the use of drugs in sport to at least allow the use of the performance enhancing drugs to be clinically monitored to ensure the health of those that use them to maintained. But of course this is, and was when I wrote it, a far too simple way of looking at what is an extremely complex phenomenon, and the obvious criticism of this viewpoint would be (and was by a number of folk who criticized my article then, and with whom I now agree) that it would mean then that those who did not want to use performance enhancing drugs would be forced to do so, even if monitored, to be sure they were ‘playing on a level playing field’, even if it was a drug-fuelled one. I now perceive that increasing the societal awareness of the problem and education of athletes about the use of drugs, coupled with the threat of receiving a custodial sentence for their use – ie the classical ‘carrot and stick’ approach – is perhaps the best way forward and method of dealing with the issue. Interestingly, a study in Australia, where a big anti-drug education program is active, showed that positive results seem to be occurring as a result of it. A few years ago, when athletes there were asked if they took a performance enhancing drug that would ensure success in their chosen sport, but also ensure they died because of its use within five years (known as Goldmans’s dilemma / test), up to fifty percent of athletes said they would do so. But, after the education programs (or whatever well Australia is doing in this field of sport doping prevention), the numbers of respondents who answered this question positively was far lower, and not much different to the results found for the general population of Australia.

However we do it, we need to keep on working at trying to attenuate what is a very difficult problem, and perhaps assist younger folk embarking on their athletic careers to understand the cost-benefit ratio of using performance enhancing drugs, and hopefully this will help reduce the culture of drug use, which was seemingly endemic to cycling (and probably a lot of other sports) a few years ago, even if no intervention is likely to completely eradicate performance drug use in sports as long as big salaries are paid to the athletes who participate in them, and as long as we keep on watching them. And us armchair sport fanatics perhaps need to understand that we are potentially a causal part of the problem simply by enjoying watching the great spectacle of young folk pushing themselves to levels of pain and stress which would be intolerable to most, and the vicarious pleasure we get from watching them doing so, which may be related to our psychological requirements to have champions, winners and losers in society in order to satisfy our own interests and perhaps unsolved psychological needs (though this is of course another complex / different discussion for the future), which take pleasure in seeing others either suffer or be successful. Long live the passion and endeavour that makes young folk on a yearly basis nearly destroy themselves to be successful on one of the most gruelling sporting stages, though hopefully their efforts are carefully considered cost-benefit ratio wise. Long live us older folk whose best athletic days are long past sipping a cup of tea and watching them doing so from the safety of our armchairs, but hopefully with an understanding of why these young folk have the potential to turn to performance enhancing drugs, and why we are in some way complicit in them doing so. Long live the Tour De France and the vicarious pleasure we get from viewing it. Vive La France! Allez Allez Allez!

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About Alan (Zig) St Clair Gibson

Professor Alan (Zig) St Clair Gibson MBChB PhD MD - Associate Dean (Research), Faculty of Health and Science, , University of Essex, United Kingdom View all posts by Alan (Zig) St Clair Gibson

4 responses to “Doping And Drugs In Sport – A Complex Causation Perhaps More Societal Rather Than Just Sport Based

  • andrewrenfree

    Good article Zig. I think it’s fairly easy to understand why people use PEDS. The rewards are potentially high, whereas the risks in terms of both getting caught, or being ‘punished’ are relatively low. If you get caught, then most of time the outcome is simply that you can’t continue to make a living through your chosen sport for a while (and I’m not in favour of prison sentences for dopers). If we take the case of e.g. The East african distance athletes whose motivation is reported to be primarily economic, then it could be seen as a no brainier – what is there to lose? I’m sure this will continue to be the case while monetary rewards for sporting excellence remain high.

    I also don’t think things are helped by the slightly wooly definition of doping. I believe it is something along the lines of ‘use of a physiological substance with the intention of gaining an unfair advantage’. Carb loading? Why is use of creating (a physiological substance produced naturally in the body) allowed, but EPO (a physiological substance produced naturally in the body not)? But sleeping in a nitrogen house is fine!
    I never competed at the absolute top level, but did at a decent national level. Perfectly happy to admit that I experimet with caffeine (via coffee) and bicarbonate. Neither of these are banned, but could be classed as physiologically acting substances (for what it’s worth I found caffeine to be very effective, but didn’t persevere with bicarbonate as it made me feel sick and sluggish). Very common to see athletes at this level swallowing pro plus prior to races as well. there is a very fuzzy line between the legal and illegal.
    Part of me thinks that sport will never be a level playing field, and PEDs should be considered a technological enhancement in the way upgrades to F1 cars are. My reservations surface though when my two kids start showing an interest in sport (they are doing a track and field meet this week). I wouldn’t want them to end up in a position where they were compelled to risk their health in order to achieve their goals. This to me is the primary reason why PED use needs to remain prohibited

  • Carl the Truth

    Great article Zig…slightly disappointed that age and life experience has tempered your liberal views on most subjects contentious. Looking forward to your next article on the affect of crazy parental involvement on kids sporting development. CTT

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