OVERVIEW
ü^,„.,«,
c t > y l A.A.F.
DOPING - THE WRONG W A Y TO THE TOP
A r n e Ljungqvist
Although the word "'amateur" is still
often used in the sports terminology,
e.g. in the name of IAAF, the career
that takes an athlete to the national or
international top is. indeed, a professional one. It is professional in the
sense that it requires a more or less full
time commitment liy the athlete. To
climb to the top can be compared to the
career in any profession and includes
both basic and continued education,
practice and hard work. The basis of
the career consists of training, a word
with many facets. Training in this context means to prepare the body physically and mentally for top athletic performance. To get the maximum effect
of training the athlete has lo optimize
his life style. This includes, amongst
other things, adequate nutrition
through proper diet and abstention
from drugs with health hazards like tobacco, alcohol, narcotics, etc.
The career which leads to the top in
sport is, indeed, very demanding on
the alhlete. Il is no wonder, therefore,
that athletes sometimes are templed to
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try shorl cuts to reach that top. One
such shorl cut is believed by many
athletes to be the use of performance
enhancing drugs which In modern terminology is called doping. Doping is almosl as old a feature as is competitive
sport. Doping was known in ancient
Greece and Rome when sportsmen
tried to improve their performance by
taking various strengthening drugs
whilst other harmful drugs were smuggled into the diet of the opponents in
order lo lower their competitive capacity. In those days competitive sport
was, in fact, sometimes a fighl for life.
Sport is expected lo promoie both
physical and menial health. The physical training is believed to strengthen
the body. Strenuous training and competition on equal basis respecting the
rules is believed to promoie mental
health. Fair play is to be applauded and
cheating to be rejected.
Despite the high moral pnnciples of
sport, "victory at any cost" has become
an increasingly prominent feature in
competitive sport, particularly at the
international top level where economic
fortunes can now be gained. Alhleies
have started lo lake various lypes of
drugs or use other "artificial means"
such as blood transfusions In order to
improve their physical performance.
This Ihey do although they know that
there are great risks since, besides the
possibility of being detected al a doping control, dangerous medical side effects may occur. Il can be safd that doping is a built-in risk in today's competitive sport, particularly since sport
lends more and more to become a "full
lime job" which makes the competitor,
his coach and other people around him
economically dependeni on his success.
It is therefore not surprising that
modern doping started in professional
sporis. Professional cycling, a sport
wilh strong financial interests, became
particularly affected. Cyclists who
wanted to improve their physical performance in conneclion with a competition usually look stimulants. This type
of doping can, however, be fairly easily
controlled by doping tesls at the competitions. Over the past thirty years
doping tests have become increasingly
more frequent at major competitions
in various Sports. This is an efficient deterrent judging from the low number of
positive doping cases with stimulants
discovered in recent years. An exception is. however, ephedrine and ephedrine derivatives. These substances are
often included in low concentrations in
common cold drugs which can be
purchased over the counter and have
iherefore not infrequently been found
in doping tests.
The silualion changed dramatically
when hormones and hormone like substances gained access lo the sport's society. This probably happened in the
I95üs( Payne. 1975). and the first drugs
within this group to be reported were
the anabolic steroids. Not until some
10-15 years later did these drugs, however, become widely used. Since these
drugs stimulate protein synthesis they
are believed by sports people to enhance muscular growth during slrenglh
training, which is pari of the training
programme in most sporis. It is obvious that doping tesls al competitions
will not discourage athleles from trying
anabolic steroids since they are taken
during the training periods and therefore nol easily detectable by urine
analysis at a competition; the alhlete
only needs to stop taking the drug
some time before the competition. It is
therefore essential to conduct doping
tests also outside competition, during
the Iraining period if Ihe testing activity
is expected to be a deterrent.
In recent years a number of other
drugs and doping procedures have
been reported to be used in sport. Parlicular inieresi has been focussed on
growth hormone (Jiaynes. l9Sft) and
"blood doping" {Klein. 1985). Growth
hormone is used to promote muscular
growth and slrength. Blood doping is
the reinfusion of earlier lei blood in
order to increase the oxygen uptake of
the alhlete and thereby his capacily for
endurance sport.
To what extent du the doping
agents improve sports performance
Stimulants - The most important
stimulants in conneclion with doping
are amphetamine and its derivatives
and ephedrine and its derivatives. Amphetamine has been shown lo improve
sporis performance
(Smith
and
Beecher. I960: Smith. Weitzncr &
Beecher. 1969).
Regarding ephedrine the situation
is less clear. Experiences from some
sports indicate, however, thai high
dosage of ephedrine may. in facl, have
such a stimulating effect that sports
performances will be improved allhough side effects may be counteractive.
Hormone arul hormone like substances - There has been a vivid discussion as lo ihe effect of hormones and
hormone like substances, particularly
anabolic steroids and testosterone, on
sports performance. There is nol yel
any clear scieniific dala available indi-
caling any improvemenl of sporis performances by these drugs, but il is quite
probable that anabolic steroids can enhance slrenglh Iraining under certain
condilions and in certain athletes
(Haupt and Rovere. 1984). It must be
kept in mind that the steroids are taken
in very high amounts and any scieniific
investigation cannot be designed lo
mimic this fully (Ryan. 1981). Investigations have, however, been performed on a limited number of athletes
who have doped themselves, and in
them some features were recorded
which could account for an improved
sports capacity (Alen el al., 1984),
Moreover, there is a widespread opinion among athleles and coaches that
steroids do, in fact, have a clear effecl
in certain events, particularly when
muscular strength Is of importance
(Payne. 1975).
in the case of growth hormone there
is no information available on ils effects on sports performance. It should
be meniioned that any effecis In this respecl would probably require such high
dosages of the hormone that obvious
side effects would also occur.
Blood doping - Earlier experiments
have shown that blood doping will increase the oxygen uptake significanlly
(Ekblom el al.. 1972). Whether this
will be reflected by an increased sports
performance is doubted but there is
some support thai blood doping may,
in fact, improve sporis performance in
endurance evenis (Buick el al., 198U;
Berglund, 1987).
Side effects
Al! doping agents have unwanled
side effecis. Any aciive drug must, by
definition, also have certain side ef-
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feels. Without side effects, no effects!
When medical treatment is considered
for a particular patient, the expected
beneficial effects are always evaluated
against the unwanted side effects. One
drastic example is the use of cylostalic
agents in the treatment of cancer. This
group of drugs is known lo have serious, highly unpleasant and sometimes
dangerous side effects. The alternative
is, however, to die from cancer.
Stimulants may have serious side effects in that they will reduce the feeling
of tiredness. Tiredness is a protective
reaction from the body and prevents an
overload on e.g. Ihe circulatory system. The reduction or elimination of
this reaction may therefore be extremely dangerous and lead to circulatory collapse and death. Moreover,
some stimulants like amphetamine are
highly addictive and may lead to
chronic and devastating drug abuse.
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Hormones and hormone like substances have a large variety of side effects (Ljungqvist. 1986). In women,
the use of anabolic steroids results in
virilization (the woman acquires certain male characteristics such as beard
growth.
deepened
voice
etc.).
Menstrual
abnormalities
and
amenorrhea develop. In men reduced
or eliminated sperm production occurs
with temporary sterilily.
Possibly most serious of all may be
long term organ damage, unknown at
present but highly likely to occur considering the high doses of steroids over
long periods of time which is the practice in sport but unheard of in medical
treatment. Thus prolonged usecan e.g.
not be excluded as leading to permanent depression of sperm production
with testicular atrophy and irreversible
sterility. Moreover liver damage and
liver tumours have been reported.
When steroids are taken at a young age
the growth of the long bones may be relarded or stopped and the person may
remain abnormally short. Finally, a
large number of various psychologic
and psychiatric reactions have been reported in steroid users such as lethargy
TVi some instances, excitement and aggressiveness in others. Violent reactions beyond the control of the individual have occurred after moderate
alcohol consumption in alhletes taking
steroids (personal observation).
Growih hormone will cause acromegaly in adults (growih of fingers and
hands, toes and feet, chin, nose, ears,
etc.). This is an irreversible change. In
adolescence it will cause continued
growih of the long bones - "giant
growth". Growth hormone will also
cause 3 number of disturbances in the
endocrine system such as diabetes and
hyperfunclion of the thyroid gland.
Blood doping is not fully risk-free although it is the athlete's own blood thai
is reinfused (Klein. 1985). The reinfusion requires medical skill to avoid
complications from improper sterilization and lo minimize the risk of any unfavourable reactions like temporary
circulatory overload, acute allergic or
hypersensitivity reactions, etc.
Conclu.sion
Doping is an ethical. moral and medical problem which was earlier restricted to the top elite competitive
sport but which has nowadays expanded both to lower age groups and to
less elite orientated athletic groups. The
problem is ('//i/r«/since il is in tolal conflict with the basic principles of medical
treatment; drugs are intended lo prevent or cure disease, not lo be used in
healthy people to improve sporis performances. Doping is a moral problem
since il is in lotal confiici with the fundamental idea of competition on equal
basis; the greatest athlele should be
applauded not the greatest cheater.
Doping is a mciJ/cä/problem since high
dosages of potent drugs laken by healthy people can lead lo serious side effects.
It is obvious that doping is the wrong
way to the lop. Il is the responsibility of
everybody involved in sport to conduct
a fighl against doping.
REFERENCES
6. HAYNES. S.P.: Growth-hormones - a review. Austr. J. Sei. and Med, in Sport. 18: 310.1986.
7. KLEIN, M,G.: Blood transfusion and athletics. New Engl, J. Med. 312: 854-856, 1985.
8. UUNGOVIST A,: Misuse of hormones in
exercise. Scand, J. SportsSci:8:51-55,1986.
9. PAYNE, A.H.: Anabolic steroids in alhlelics (or Ihe rise of mediocrity). Brit, J. Sports
Med. 9: 83-88.1975.
10. RYAN. A,J.: Anabolic steroids are fool's
gold. Fed, Proc, 40: 2682-2688, 1981.
11. SMITH. G,M. and BEECHER. H.K.: Amphetamine, secobarhital and athletic performance. II. Subjective evaluations of performance, mood states and physical states.
J.A.M.A. 172: 1623, 1966.
12. SMITH. G.M., WEITZNER. M, and
BEECHER. H.K.: Increased sensitivity of
measurement of drug effects in expert swimmers. J. Pharmacol. Exp. Ther. 139; 114,
1960.
i, ALfiN. M,. HÄKKINEN, K. and KOMI.
P,V,; Changes in neuromuscular performance and muscle fiber characterislics of
elite power athleles self-administering androgenic and anabolic steroids. Acta
Physiol. Scand. 122: 535-544, 1984.
2, BERGLUND. B,: Communication
at
World Symposium on Doping in Spori. Florence, 1987,
3. BUICK. F.J., GLEDHILL, N,, FROESE,
A.B,,SPR1ET,L, and MEYERS, E.G.: £/feel of induced erylhrocylhemia on aerobic
work capacity. J. Appl. Physiol,. 48: 636642. 1980.
4, EKBLOM, B.. GOLDBERG. A.N. and
GULLBRING. B.: Response lo exercise
after blood loss and reinfusion. 3. Appl.
Physiol. 50: 175. 100. 1972.
5. HAUPT. H,A, and ROVERE, G.D.:
Anabolic steroids: A review ofthe literature.
Am. J. Sports Med. 12: 469-484, 1984.
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