DOPING IN SPORT: SOCIOLOGICAL ASPECTS.
Dr Ivan Waddington
This paper was presented to a special meeting of the European Commission called to investigate
doping in sport, Brussels, March, 1999.
Although we cannot be sure of the precise level of drug use in modern sport there is near
universal agreement that the use of performance-enhancing drugs by athletes has increased
markedly over the last three decades. Briefly, the evidence suggests the use of drugs has spread
from athletics, weightlifting and cycling - the three sports in which drugs appear to have been
most frequently used in the 1960s - to most other sports, and that it has spread from elite level
sport down to lower levels, with drugs even being used in fun runs and college sport.
In my presentation, I want to examine some of the reasons for this growth in the use of drugs.
As a preliminary observation, however, it is important to note that this striking increase in the
use of drugs is itself a clear indication that the anti-doping policies which have been followed
since the 1960s have been largely ineffective in controlling doping in sport; this must be the
starting point for any realistic assessment of the current situation, and it suggests the need to
rethink policies, rather than to continue with existing, and largely ineffective, policies.
How, then, do we explain the increase in the use of performance-enhancing drugs in the last few
decades? Clearly the greater availability and greater effectiveness - of drugs is an important
consideration, but the increased use of drugs cannot be explained simply in terms of
pharmaceutical developments. If we wish to understand why sportspeople have, in recent years,
increasingly used performance-enhancing drugs, then we need to examine some of the major
changes which have taken place in the structure of sporting competition. However, the increased
use of drugs in sport cannot adequately be understood simply by reference to changes within the
structure of sport itself, for sport is linked to wider social processes in a variety of ways. In
particular, the increasing use of drugs in sport has been associated with two key social processes,
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one within the world of sport and the other within the world of medicine. Let me begin with
some recent and relevant changes in medicine.
The Medicalization of Life
We have in recent decades witnessed what has been called the 'medicalizing' of much of daily
living. This has involved a number of processes, including growing dependence on medical
professionals and growing dependence on drugs, and has been associated with increasing
medical intervention in many areas of people's lifestyles, for example in the areas of diet, sleep,
work, marital relationships, exercise, tobacco and alcohol consumption, and in the areas of safer
driving and the fluoridation of water supplies.
The Medicalization of Sport
In the last three decades or so - that is, very roughly, the period coinciding with the most rapid
growth in the use of drugs - the medicalization process has encompassed sport. This process has
been most evident in the rapid development, particularly since the early 1960s, of sports
medicine, which embraces areas of clinical medicine and the appropriate allied scientific
disciplines, including physiology, psychology and biomechanics.
One consequence of the
development of sports medicine has been to make traditional methods of training for sporting
events increasingly inadequate as a means of preparation for high level competition. At the
higher levels of sport the image of the dedicated athlete training alone or with one or two chosen
friends has become increasingly outmoded. Instead, the modern successful athlete is likely to be
surrounded by, and to be increasingly dependent upon, specialist advisers, including specialists
in sports medicine. It is important to emphasise that the role of sports physicians is not limited
to treating injuries, for an increasingly important part of their role has been to provide
increasingly sophisticated systems of medical support to athletes in their efforts to run faster, to
jump higher or to compete more effectively in their chosen sport; indeed, at the highest levels of
competition the quality of the medical support may make the difference between success and
failure.
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Doctors have not, however, forced themselves upon innocent and unknowing clients. In the case
of sport, a number of developments have led athletes increasingly to turn for help to anyone who
can hold out the promise of improving their level of performance. The most important of these
developments are those which have been associated with the politicization of sport and those
which have been associated with massive increases in the rewards - particularly the financial
rewards - associated with sporting success. Both these processes have had the consequence of
downgrading the traditional value associated with taking part in sport, whilst greatly increasing
the value attached to winning.
The Politicization of Sport
Although the relationship between politics and sport is by no means exclusively a post-World
War Two phenomenon, there can be little doubt that sport has become increasingly politicized
since 1945.
Of particular importance in this context was the development of communist regimes in many
parts of Eastern Europe and the emergence of the Cold War and of superpower rivalry. Within
this context, international sporting competition took on a significance going far beyond the
bounds of sport itself, for sport became an extension of the political, military and economic
competition which characterized relationships between the superpowers and their associated
blocs.
Comparisons of the number of Olympic medals won by the United States and the Soviet Union or, following the admission of separate teams from West Germany and East Germany from the
1968 Olympics, the medals won by the two Germanies - thus came to be very important, for the
winning of medals came to be seen as a symbol not only of national pride but also of the
superiority of one political system over another. As governments came to see international
sporting success as an important propaganda weapon, so those athletes who emerged as winners
came increasingly to be treated as national heroes with rewards - sometimes provided by national
governments - to match.
Sport and Commercialization
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If the politicization of sport has been associated with an increased emphasis on winning, this
development has also been facilitated by the growing commercialization of sport. In recent
years, the financial rewards associated with Olympic success have increased massively; in the
United States and increasingly in Europe, an Olympic gold medal may be worth several million
dollars from sponsorship deals, from television commercials and from product endorsement.
However, as Robert Voy, a former Chief Medical Officer for the United States Olympic
Committee has pointed out, such fabulous rewards are available only to those who come first; as
Voy has put it, 'second place doesn't count'.
As the rewards to be gained from sporting success have increased, so the emphasis placed on
winning has also increased. This process has, according to the US athletics coach, Brooks
Johnson, resulted in a situation in which many top-class international athletes 'wake up with the
desire and the need and the compulsion and the obsession to win, and they go to sleep with it'.
He added: 'Make no mistake about it, an Olympic champion is clinically sick'. I don't want to
take up the latter point, but Johnson's comment does graphically indicate the importance which
has come to be attached to winning.
The Sport/Medicine Axis
Over the last three decades there has, then, been a 'coming together' of two groups - athletes and
doctors - one of whom has increasingly demanded, the other of whom has increasingly been
prepared to supply, specialist medical advice in the search for improved sporting performances.
The 'coming together' of these two groups has been associated with two closely related
developments. One of these developments - which is generally viewed as wholly legitimate involves the emergence of sports medicine, the other - which is normally regarded as illegitimate
- involves the increasing use by athletes of banned substances to improve their performance.
Since, as I have stressed, the increasing use of drugs rests on the changing pattern of
relationships between athletes and doctors, it follows that the increasing use of drugs in sport
cannot be explained simply by focusing on the individual drug-using athlete, a focus which is, it
might be noted, central to most current anti-doping policies. Rather, it is the case that the
increasing use of drugs has been associated with the emergence, in both the world of sport and
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the world of medicine, of those who may be described as innovators or entrepreneurs. Within
the world of sport, it is hardly surprising that, given the increased emphasis which has come to
be placed on winning, some athletes - and almost certainly a growing number - have been
prepared to innovate by making illicit use of the fruits of pharmacological research. Equally,
however, it is clear that there are doctors - and again the probability is that their number is
growing - who may be regarded as medical 'entrepreneurs' in the sense that they are prepared to
stretch the boundaries of 'sports medicine' to include the prescribing of drugs with the specific
intention of improving athletic performance.
In this context, it is worth noting that many drug regimens, such as those involving 'stacking' - a
technique which is particularly used by weightlifters and which involves the use of several
different types of anabolic steroid concurrently - are very complex. Without overstating the
argument, one might reasonably doubt whether complex drug programmes of this kind have
been worked out by the athletes themselves, without access to specialized advice, whilst it seems
even more improbable that athletes have the specialized technical knowledge required to avoid
detection - as many undoubtedly do - without professional advice, for this necessarily involves
keeping one step ahead of what are becoming increasingly sophisticated testing procedures.
Most tellingly, however, there is a great deal of direct evidence of the involvement of doctors in
the use of drugs in sport. In this regard, the Dubin Commission of Inquiry, established by the
Canadian Government following Ben Johnson's infamous positive test at the Seoul Olympics,
proved something of a watershed, for it provided more systematic, more reliable and more
detailed information than had ever been available before about the network of relationships
amongst those, including physicians, involved in doping. Even before the Dubin Commission,
however, there was evidence, going back over many years, of the involvement of physicians in
doping.
For example, there is evidence that at the 1984 Olympics at least some team doctors were
involved in blatantly exploiting a loophole in the doping regulations. Although beta-blockers
were not at that time banned by the IOC, team doctors had to fill in declarations for all athletes
using betablockers and state the doses used. If competitors produced a doctor's certificate stating
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that they needed the drugs for health reasons, they would not be disqualified if drug checks
proved positive. However, when urine specimens were screened there were several positives in
the modern pentathlon contest. To the amazement of officials, team managers came forward
with doctors' certificates covering whole teams. In October 1984 Colonel Willy Grut, the
secretary-general of the world body governing the modern pentathlon, challenged the IOC to
reveal the names of those athletes who 'clearly took dope, not for medical reasons, but to
improve performance'. What is of importance in the present context is not the fact that these
athletes took drugs but that the drugs were taken with the knowledge of team doctors who then
protected the athletes against disciplinary action.
It was, however, the Dubin Commission which provided the clearest picture - at least until the
1998 Tour de France - of the network of relationships between doctors, athletes (and coaches) in
relation to doping.
The Dubin Commision noted that the 'names of physicians willing to prescribe anabolic steroids
and other performance-enhancing drugs circulate widely in gyms' and, describing the situation in
Canada, it noted that:
The Commission .... heard evidence from many other athletes that they received anabolic
steroids directly from physicians. Clearly, there are physicians in most major centres
across the country who have at one time or another been involved in prescribing anabolic
steroids and other performance-enhancing drugs to athletes (Dubin, p. 357).
Though the Dubin Commission did not take evidence concerning the situation in Europe, it did
note that the situation in the United States was similar to that in Canada, with Robert Kerr, a
California sports physician, claiming there were at least seventy physicians in the Los Angeles
area alone who prescribed anabolic steroids to athletes. Evidence provided to the Commission
on the situation in Australia also indicated that in that country drugs were readily available from
physicians, with one witness suggesting there were between ten and twenty physicians in Sydney
who prescribed drugs for athletes. It would be naive in the extreme to imagine that the situation
is radically different in Europe and, indeed, the 1998 Tour de France cycle race provided clear,
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unambiguous and incontrovertible evidence of the systematic involvement of team doctors in
doping.
If the Dubin Commission marked one watershed in the history of doping, it may be that the
doping scandal in the 1998 Tour de France will come to be regarded as a second watershed,
particularly in terms of the amount of information about the organisation of doping in
professional cycling which was made publicly available during and after the Tour. Moreover,
this information made it unambiguously clear that, once again, team doctors were heavily
implicated in the organisation of doping.
Perhaps not surprisingly, almost all of the media coverage of the doping scandal in that Tour was
heavily emotive and did little to enhance our understanding of the processes involved. One of
the few exceptions, and one which brought out particularly clearly the involvement of team
doctors, was a piece written for The Times by James Waddington, a novelist who is also a
cycling fan. Waddington pointed to the enormous physical demands which the Tour makes upon
riders - he described the Tour as 'not just healthy exercise' but 'close to punishment and abuse'
and suggested that, in the attempt to keep their team members in the race, the team doctors will
draw upon an exhaustive knowledge of a range of substances - nutritional, hormonal and
anabolic. He continued:
It is a complex regime, with maybe 20 different components ... Only the team doctor has this
exhaustive knowledge, and thus the average professional cyclist with no scientific background
becomes not a partner but a patient. He opens his mouth, holds out his arm, and trusts. That trust,
not the reflex shriek of 'drugs, the excrement of Satan', should be the crucial point in the whole
discussion (Times, 25 July, 1998).
One might perhaps take issue with Waddington's characterisation of professional cyclists as passive
participants in the doping process, but he does make a point which is of fundamental importance; if we
wish to understand doping in sport then it is crucial that we understand the centrality of the relationship
between elite level athletes and practitioners of sports medicine.
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This point was, perhaps, brought out most forcefully by an American journalist in his report on the use of
blood doping by the United States cycling team at the 1984 Olympics. After the Olympics it was
revealed that most of the American team, which had dominated the cycling events, had been blood-doped,
and shortly afterwards, the technique was banned by the International Olympic Committee.
The
journalist wrote:
In the national euphoria after the games, no one thought to pry out any secrets. The US team had
won nine medals, dominating the cycling events. 'Great riders 'Great coach....' 'Great bikes said the
press, reporting the daisy chain of back pats. No one thought to add, 'Great doctors…’
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