Doping in Athletes Part 1

23 Oct

We think it’s about time we take on the darker side of the sport of cycling (or any other sport for that matter) and by that we’re referring to doping. The sport of cycling has been under fire in the past few years for the proliferation of doping and what was considered as corruption in the governing body. Indeed, several athletes have fallen to the dark side in their quest for athletic excellence. This post describes the history of doping and it might surprise a lot that doping is quite as old as humanity itself. (The cyclists featured in the subsequent photos will include those who have tested positive, and/or were involved in doping controversies, but first, a disclaimer: this is in no way a hall of shame but rather an eye-opener to the prevalence of doping in the sport). This article includes excerpts from lectures and research material given by a distinguished faculty (Dr. de Rose) during our college days which in turn has been used by several doctors and professors to give lectures with regards to this sensitive topic.

Floyd Landis was fired from the Phonak team on 5 August 2006, after a test result indicated an abnormally high testosterone/epitestosterone ratio after stage 17 of the 2006 Tour de France. On 20 September 2007, he was stripped of his title as winner of the 2006 Tour and placed under a two year ban from professional racing, following an arbitration panel’s 2 to 1 ruling. He appealed the result of the arbitration hearing to the Court of Arbitration for Sport, which subsequently upheld the panel’s ruling. He remained suspended until 30 January 2009.

HISTORICAL ASPECTS

The use of doping is as old as humanity. It was even thought that doping started in paradise, when Eve gave the apple to Adam, to make him as strong as God. The first document related to the use of doping agents was a painting of the Chinese Emperor Shen-Nung, from 2737 BC, showing him with leaves of “machuang” (Ephedra). The Emperor is considered to be the father of the Chinese medicine and is believed to have introduced the art of acupuncture. He was also the first to classify medicinal herbs according to their pharmacologic effects.

In the ancient Olympic Games, at the end of the third century BC, according to Galen and other authors of the time, athletes believed that drinking herbal teas and eating mushrooms could increase their performance during competitions. Another interesting form of doping of this time was to prepare a powder with the oil, dust, and sweat of an athlete after a competition. This mixture was removed in the dressing room with the “strigilo,” a metallic instrument in the shape of an “L”. Athletes sold the mixture to other participants, who believed that by drinking the mixture they would have the same physical capabilities as the champion. This myth was not accepted, however, by Conrado Durantez, a Spanish historian of the ancient Olympics.

In South America, stimulants ranging from the harmless mate tea and coffee up to strychnine and cocaine were used to increase performance. Spanish writers report that the Incas chewed coca leaves to cover the distance between Cuzco and Quito, in Ecuador. In 1886, 10 years before the inauguration of the modern Olympic Games, the first fatality caused by doping was reported when a cyclistnamed Linton died after an overdose of stimulant in a race between Bordeaux and Paris.

David Millar of Great Britain was preparing for competition in the 2004 Tour de France and track events at the 2004 Summer Olympics when police searched his house in June 2004, finding used Epogen syringes. Millar confessed to the use of EPO on three occasions: in August 2001 before the Vuelta a España, in May 2003 before the Critérium du Dauphiné Libéré and in September 2003 before the World men’s individual time trial championships. He was handed a two-year suspension.

ORIGIN OF THE WORD

La Cava mentioned that the origin of the term “doping” is controversial, but seems to come from a South African dialect. For the Boers, it meant an infusion used in religious festivities, the “doop.” Burstin refers that during the construction of the North Channel, in Amsterdam, workers used the term “doopen” when they wanted to increase their capacity of work. In 1889 the term “doping” was referred to in an English dictionary with the generic sense of a drug used to stimulate horses. From the hippodromes it reached the stadiums, where today it defines any substance or method used to increase performance, being harmful to the health of the athlete or being against the values of the game. When two of these three conditions are present, a substance or a method can be banned by the List of Forbidden Substances of the World Anti-Doping Agency (WADA).

Tyler Hamilton won the gold medal in the men’s individual time trial at the 2004 Summer Olympics in Athens. That medal was placed in doubt on 20 September 2004, after it was revealed that he had failed a test for blood doping (receiving blood transfusions to boost performance) at the Olympics. Two days after the announcement of his positive test result at Athens, the IOC announced that Hamilton would keep his gold medal because results could not be obtained from the second, backup sample. The Athens lab had frozen the backup sample, which made it impossible to repeat the blood doping test. Hamilton also tested positive for blood doping at the 2004 Vuelta a España, where he won April 8 stage. In April 2005 he was banned for 2 years for blood doping. The UCI summary of ‘Decisions on Anti-Doping Rule Violations made in 2006’ stated that for Homologous Blood Transfusion he would be sanctioned to “disqualification and ineligibility for 2 years”.

Doping in the Olympic Games from 1886 to 1932

The modern Olympic Games were inaugurated in 1896 in Athens, Greece, by Baron Pierre de Coubertin. The philosophy of the Baron considered competing more important than winning, and because of that the incidence of doping was very low, restricted to some contamination in cycling and track and field. The substances used to increase performance were a mixture of cocaine, ephedrine, and strychnine. Cyclists used at that time, besides this mixture, an elixir made with leaves of coca and wine, invented and produced by the Corsican chemist Angelo Mariani.

In 1928, during the Winter Games in Saint Moritz, sport physicians from many countries decided to create the International Federation of Sports Medicine, to preserve the Olympic athletes and to provide a forum to discuss their problems. The first international sports federation to ban the use of doping agents in sport was the International Association of Athletic Federations (IAAF) in 1928. Until 1932, nine Olympic Games were regularly held, excluding the years of World War I.

In Germany, Hausschild developed pervitin in 1934, and in England, methedrine was synthesized. Both were used for night flights, long marches, and other endurance events during World War II. Amphetamine was produced by the first time in 1938 and was used as stimulant during the war.

Alejandro Valverde has been linked by documentary and DNA evidence to the Operación Puerto, a blood-doping affair which erupted in 2006 against doctor Eufemiano Fuentes and a number of accomplices. It uncovered doping products, bags of blood and code names that appeared to link top athletes, including 60 cyclists, to a highly-organized system of doping, which relied heavily on blood transfusions.

The Olympic Games from 1936 to 1964

From 1936 to 1964 six Olympic Games were held, excluding only the period of World War II. The significant aspect of this cycle was the use in the Olympic Games in Berlin as a political instrument, to promote the Aryan race and political systems of Germany. Together with the political aspects, it is important to mention that the commercialization of the Games also started in 1936. These facts changed the ideal of Coubertin, and winning was now more important than just competing.

The substances most used after World War II were amphetamines and anabolic steroids, a synthesized substance similar to the male hormone testosterone. Anabolic steroids were used during the postwar time, when physicians of the United States Army treated depleted prisoners of concentration camps. After many trials, they came to the conclusion that the male hormone was the only form to increase their muscle mass.

In 1954, Soviet athletes started to use anabolic steroids to increase muscle mass and power. Soon, after weightlifting and bodybuilding, this substance reached the athletes of all track and field events, and then the other sports.

At the Olympic Games of Rome (1960), a cyclist from Scandinavia died in the road competition after an overdose of stimulant. He had used several tablets of isopropylamine and amphetamine, ingested with coffee.

Because of bad press for the Olympic Movement, Lord Porrit was appointed to create a Medical Commission in the Executive Committee of the International Olympic Committee (IOC). In the Olympic Games of Tokyo, doping control was performed in cyclists during some competitions, but because of many difficulties, it could not be totally implemented. After that fact, Albert Dirix wrote a letter to Avery Brundage, president of the IOC, demanding strong actions against doping in sport.

Ivan Basso of Italy was suspended by Discovery Channel on 24 April 2007 when the Italian National Olympic Committee (CONI) reopened his case on behalf of his involvement in the Operación Puerto doping case. On 30 April 2007 Team Discovery Channel announced that Basso would be released from his contract on Basso’s request. While still claiming to never have actually engaged in blood doping, Basso admitted contacting Dr. Fuentes’ clinic with the intention to engage in blood doping. On 15 June 2007, Basso received a two-year ban. The time he had already spent under team suspension whilst riding for CSC and temporary suspension since leaving Discovery were taken into consideration which meant his ban would end on 24 October 2008.

The Fight Against Doping in Europe

Antidoping measures were initiated by Austria in 1962. In 1965, the Council of Europe defined doping, and Belgium, France, and Greece adopted antidoping legislation. The International Cycling Union and the Fédération Internationale de Football Association started their doping control programs in 1966.

The IOC passed a resolution against doping in 1962. Lord Porrit resigned his membership to be appointed Honorary Member, and the young Prince Alexander de Merode of Belgium was appointed to chair the Medical Commission, and to fight against the use of doping in sport. The members of the Medical Commission were named and, under his chairmanship, held the first meeting on September 27, 1967, in Lausanne, Switzerland. Dopingcontrols started with the Winter Olympic Games of Grenoble and the Summer Olympic Games of Mexico City in 1968.

Erik Zabel of Germany, on 24 May 2007, admitted having used Erythropoietin (EPO) in preparation for the 1996 Tour de France. In the press conference he said that he experimented with EPO for a week, but then stopped due to severe side effects. Zabel also publicly apologized for having lied about his use of EPO in the past.

The Olympic Games from 1968 to 1980

Prince de Merode, chairman of the newly created IOC Medical Commission, invited to be members the following sport physicians: Giuseppe la Cava, President of the International Federation of Sports Medicine, from Italy; Ludwig Prokop, Vice President of the International Federation of Sports Medicine, from Austria; Albert Dirix, Vice President of the International Federation of Sports Medicine, from Belgium; and Eduardo Hay, Chief Medical Officer of the Olympic Games of Mexico City. Arnold Becket, from England, chairman of the first antidoping laboratory, was also invited to join the group.

The IOC Medical Commission published in 1967 the first list of banned pharmacologic classes, including the following substances:

    1. Psychomotor stimulant drugs 

    2. Sympathomimetic amines

    3. Miscellaneous central nervous system stimulants

    4. Narcotic analgesics

Italy and Uruguay adopted antidoping legislation in 1971. The first control of anabolic steroids was done in London in 1974 by Raymond Brooks. In 1975, just before the Olympic Games of Montreal, anabolic steroids were added to this list.

For the Olympic Games of Montreal in 1976, the same list was maintained and two β2-agonists were permitted: salbutamol and terbutaline. The IOC Medical Commission had to be informed previously of their use, however, marking the origin of the therapeutic use exemption (TUE). During this period, doping was found in all Olympic Games, except the Games of Moscow (1980). The control of anabolic steroids in Montreal (1976) is considered an important cornerstone in the fight against doping, because this substance was widely used by athletes for more than 20 years.

Sources:
[1] Csaky T.Z.:  Doping.  J Sports Med Phys Fitness 12. (2): 117-123.1972;  Citation
[2] Loriga V.:  Il doping.  CONIRoma1988.
[3] Mottram D.R.:  Drugs in sport.  Human KineticsChampaign1988.
[4] De Rose E.H., Nobrega A.C.L.:  O doping na atividade esportiva.   In: Lasmar N., Lasmar R., ed.  Medicina do esporte,  Editora RevinterRio de Janeiro2002: [in Portugese]
[5] Montanaro M., et al:  Il propblema del doping.   In: Venerando A., ed.  Medicina dello sport,  UniversoRoma1974:
[6] Gasbarrone E., Leonelli F.:  Il doping.   In: Silvy S., ed.  Manuale di medicina dello sport,  Editrice UniversoRoma1992:
[7] La Cava G.:  Manuale pratico di medicina sportiva.  MinervaTorino1973.
[8] Burstin S.:  Cinq ans de contróle médical antidopage au millieu sportif.  Medicine du Sport . (4): 204-208.1972;
[9] Muller N.:  Pierre de Coubertin: textes choisis (II).  WeidmannZurich1986.
[10] De rose E.H.:  A medicina do esporte através dos tempos.   In: Oliveira M.A.B., Nobrega A.C.L., ed.  Tópicos especiais em medicina do esporte,  Editora AtheneuSão Paulo2003:
[11] Dirix A.:  Doping: theorie et pratique.  Br J Sports Med . (1,2): 250-258.1972;
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