Doping: Illicit and Unhealthy

No world-class sporting event, it seems, can do without a doping scandal. Whether winter or summer Olympics, Tour de France, world or European championships: Unfairness is apparently as much a part of it as the much-cited Olympic spirit or the “eleven-friends-must-be-you” group happiness.

Faster, higher, further – at any price?

Those who dope act unfairly and harm themselves. First, using illicit means to enhance performance is unfair. This ethical and moral side of the coin affects not only the athletic community, but is a problem for society as a whole. Second, as has happened in the past, doping can cause massive damage to health. In addition to the often long-term consequences for athletes, doping-related late effects now also entail criminal consequences under the aspect of bodily injury. But obviously neither the one nor the other keeps athletes, coaches, trainers and officials from recognizing the natural performance limits of highly trained top athletes.

Doping is…

… according to the framework guidelines of the Main Committee of the German Sports Federation (DSB), the attempt to enhance performance through the use (ingestion, injection, or administration) of substances in the prohibited substance groups or through the use of prohibited methods (e.g., blood doping). Accordingly, there is a long list of prohibited substances, which includes, among others, stimulants, narcotics, anabolic substances, diuretics, peptide hormones and compounds that are chemically, pharmacologically or by the intended effect related. In addition, other substances and groups of substances, e.g., alcohol, sedatives, psychotropic drugs, beta-blockers, may be listed under doping substances if they are used appropriately in sports.

An old problem

Power athletes such as weightlifters, discus and hammer throwers in particular, but also cyclists, runners and swimmers are among the repeated doping offenders. Yet the history of doping is as old as the Olympics themselves – attempts to enhance performance already existed in ancient times, where wrestlers, for example, tried to gain extra strength by eating bull testicles. The term “doping” was first used in 1899. An English dictionary entry referred to the administration of a mixture of opium and narcotics to racehorses under this term.

Anabolic agents

From the experience of animal breeding, then, come some of the doping agents illicit in athletes, such as agents with anabolic effects, which, together with increased food intake, lead to increased muscle mass and strength. The term “anabolic” comes from the Greek and means “muscle-building”. It is known that anabolic steroids can lead to growth retardation in adolescents, severe liver damage or even liver cancer, inhibition of sperm production in men, and masculinization in women, especially due to the late effects of anabolic steroids in athletes from the former Eastern Bloc countries, which have become known in the meantime. Psychological consequences have also been reported. Nevertheless, anabolic steroids are still used in doping today because they are used during training and between competitions, but then discontinued in time before the sporting event. Detection is hardly possible in this way, which is why random doping controls are now often required even during training phases. Since 1989, there has been a catalog of the Medical Commission of the International Olympic Committee (IOC) containing the doping substance classes and doping methods. It must be updated regularly. These substances include:

  • Stimulants
    These substances, increase alertness and performance. They delay fatigue, but also lead to an increase in aggressiveness and a decrease in self-control. Amphetamines and drugs with a strong excitatory effect on the central nervous system are among them. These substances are very similar to the natural substance adrenaline, which has been increasingly released by the body in humans since time immemorial in situations of extreme danger. At the highest levels of physical stress, even a “normal” dosage can be fatal. However, because cough, cold or circulatory medications may contain these substances, they may only be taken after consultation with the responsible physician of the professional association and must be discontinued at least three days before the competition.This class of substances also includes caffeine and ephedrine, which is used, among other things, as an allergen for hay fever and asthma.
  • Narcotics
    Narcotics are painkilling substances that are misused. They include codeine, which is used in analgesic medications and cough suppressants. However, this substance is now no longer banned.
  • Diuretics are substances that increase urine excretion (diuresis). They are used in medicine for the treatment of hypertension, for the treatment of abdominal dropsy and to flush out cellular fluid in edema. In doping, diuretics are used to achieve two main goals: On the one hand, the increased fluid excretion is supposed to ensure rapid weight loss in martial arts with weight classes. In addition, the aim is to reduce the concentration of doping substances in the urine and thus prevent their detection. Patients with heart failure, for example, who regularly take diuretics, know that such an intervention in the electrolyte balance must be strictly monitored. This is because the balance of electrolytes in the body is closely linked to water balance and – if it gets out of whack – can lead to anything from severe dysfunction to death.
  • Peptide and glycoprotein hormones and analogs.
    These include the growth hormone HGH (human growth hormone, somatropin) and erythropoietin (EPO). While there are no actual performance-enhancing effects with HGH, it can lead to severe damage even after the growth phase is complete. An enlarged heart, in particular, can then cause athletes major problems. EPO is formed naturally in the kidney as a glycoprotein, a compound protein. It regulates the rate of synthesis of red blood cells. This can increase the oxygen uptake capacity of the blood and thus achieve a higher performance in the endurance range (20-30 minutes). Especially in cycling, this substance is therefore often used without permission. However, EPO also leads to a thickening of the blood, as a consequence of which it can lead to clogging of the arteries (thrombosis) and thus to death. Genetically engineered erythropoietin has been used since 1989 to treat anemia in chronic renal failure (renal anemia), in which the body’s own EPO production is also affected. However, this substance can hardly be distinguished from the body’s own, which has led to problems in detecting doping. A drug developed further since 2001 now ensures, on the one hand, that the active substance remains longer in the body in patients with renal anemia and that the substance is better distinguishable from the body’s own EPO.

Groups of active substances whose approval is restricted

Alcohol, marijuana, local anesthetics, corticosteroids and beta-blockers complete the list. Local anesthetics (except cocaine) may be used if medically indicated under information of the IOC Medical Commission. Corticosteroids may only be administered as ointments or as injections when medically unavoidable. This also applies to beta-blockers, i.e. blood pressure-lowering agents. Substances belonging to the banned substance groups may only be administered to athletes in competition if their use is expressly permitted by the IOC Medical Commission. However, the list of banned substances includes not only substances, but also the methods by which they are used. These include blood doping, in which the banned substances are administered as a sort of “autologous blood re-transfusion”. This can lead to kidney damage and other side effects. Of course, manipulation of the urine sample used for doping control is also not allowed.

Gene doping

So-called “gene doping” will become increasingly interesting in the coming years. Scientists and critics expect therapeutic developments in this field to be misused in sports. Modification of the genetic makeup has not yet been included on the doping list. However, it is expected that therapeutic developments in this area will in turn be misused in the future to enhance performance. What sounds like distant dreams of the future has already been successfully practiced in animal experiments.In December 2001, an American biotechnology company was granted a patent for a method of treating anemia in which the body’s cells are induced to produce EPO by injecting genetically modified viruses. Unlike the artificially produced substance, this form of EPO would no longer be detectable, and the overproduction could simply be declared congenital. However, this manipulation could probably be proven by DNA analysis. Doping, the great cat-and-mouse game between athletes and the anti-doping agencies, harms everyone. There can be no real winners in doping.