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Contents
IntroductionA. The present state of affairsB. Numerous determining factorsConclusionRecommendations
IntroductionPierre de Coubertin, founder of the modern Olympic games, was one of the first to point out the necessity of protecting sport from the dangers threatening it as an institution. In 1923, in a speech delivered in Rome, he denounced "the intrusion of politics into sports, the increasingly venal attitude towards championship, the excessive worshipping of sport, which leads to a belief in the wrong values, chauvinism, brutality, overworking, overtraining, and doping".The recent doping scandal of the last Tour de France cycling competition drew the attention of the media to practices which, until then, had remained covert. This media coverage has increased public awareness of this phenomenon. Indeed, due to their scope and sophistication, doping practices are a threat to more than just the world of sport. Though first considered to be no more than a cheating problem, the doping issue has reached such proportions that it now concerns society as a whole. As the stakes involved in sport grow higher and the phenomenon more widespread, the moral values attached to sport are increasingly called into question and the health of athletes increasingly at risk.Furthermore, the close link observed between doping and addiction underscores the former's social and sanitary impact. This report shows that far from being limited to the world of high-ranking athletes, doping is an important public health issue. A. The present state of affairs1. The scope of the problemA few examples are enough to give an idea of the scope of the problem: in 1986, a physician and two pharmacists were indicted for having sold over 2,000 phials of Tonedron, at 150 times their normal price. On December 2, 1995, near Lille, customs officers seized nearly 200,000 tablets and phials of anabolic drugs meant for the muscle-building club market. An article by P. Laure published in the magazine "Sport et Vie" n°44 (September 1997), analyzes in de tail the new opportunities offered by Internet: twenty-odd servers presenting all sorts of drugs, including anabolic steroids, corticoids and beta-blockers. A synthetic graph provides the market prices for these drugs — from 50 to 3,800 francs for the minimal dose — and shows that it is possible to obtain drugs listed among French prescription only drugs (lists I and II) as well as illegal drugs.However, the empirical data presently available does not allow us to accurately assess the phenomenon. In 1966, 37 champions from 2 sports federations were tested and 12 were tested positive. In this small sample, the percentage of doped athletes was 37%. In 1992, 8,000 tests were carried out in 56 federations and only 69 tested positive: in this case, the rate fell to 1%. Indirect data, such as the seizure of banned drugs, the dismantling of distribution networks, as well as the tragic fate of some champions — between 1987 and 1990, "18 Belgian and Dutch cyclist champions died, apparently due to the use of erythropoietin" (Laure, 1995, p.136) — lead us to believe that the low percentage of positive tests does not mean that doping has disappeared, but that it is now possible to hide it. The percentages of doped athletes given in the press vary from 10 to 90%. But the level of the athletes or even the precise source of these figures are never mentioned, which only shows that the extent of the doping phenomenon is impossible to assess. It is thus all the more difficult, except in very rare cases, to cross the dependent variable "doping" with the independent variables which are necessarily taken into account in a sociological approach to the issue. The variations of doping behaviour according to gender, age, sociocultural background, education and other characteristics are unknown.In short, the lack of objective data makes it difficult to carry out a sociological analysis of the issue; there is more information concerning opinions on the subject and efforts to control the phenomenon than on the phenomenon itself. There are several reasons for this: when carrying out a survey among people who are well-known, it is very difficult to maintain anonymity, since the questions asked concern the type of sport practised, the level attained, previous accidents, etc. Furthermore, there is the risk that revealing the phenomenon could possibly encourage its spread.II. The aimsIn order to enhance their performance, sportsmen use specific "methods" which optimize the qualities needed for their sport, on the basis of various physiological, biological, and psychological factors.According to a widespread opinion, "upstream" doping, used for the above-mentioned aim, is "bad" and should be distinguished from "downstream", or "good" doping, meant to help athletes recover their physiological and biological balance. In fact, both types of doping are complementary, since they artificially boost the body's abilities, the second type of doping aiming to make up for the negative effects of the former.Aerobic potential can be increased by increasing the blood's oxygen transfer capacity. This is very important in sports requiring staying power, rely on the body's energy metabolism, or require intense effort and varying sources of energy. After long-lasting or intense effort, glycogen reserves must be restored. A specially adapted nutritional strategy and drugs are then needed to modify the metabolic process. Methods include altitude training, self-transfusion, more recently, recombinant EPO, and of course glucocorticoids, etc.When the aim is to increase strength and muscular power and improve technique, protein, natural or synthetic anabolic agents are frequently used, in combination with hyperprotein diets and muscle-building exercises. The balance between the increase in muscle mass and the loss of fat mass can be maintained thanks to growth hormones associated with aminoacids or other drugs with anabolic properties (but whose initial medical purpose is other), or with nutritional supplements.To postpone fatigue and enable the body to reach its utmost limits, one can use antalgics, cardio-respiratory analeptics, central nervous system stimulants, several of which are strong anti-depressants and stimulants.IIn sports where body features or size, tall or short, are important, such as body-building, the shape of the body can be modified through hormonal manipulations.Various drugs are used to fight stress, facilitate sleep, remain in good physical shape, such as benzodiazepine derivatives and amphetamines, cannabinoids, alcohol, beta-blockers. For disciplines where it is important to stay alert, the sleeping-waking rhythm can be controlled thanks to amphetamines or more recent drugs.Last, cultural and invidual factors also play a role in drug-taking behaviour. On the one hand, as concerns men, value is placed on the mesomorphic body type and muscular strength; physical stereotypes are spread by the media and the athletic subculture. On the other hand, one must take into account factors such as low self-esteem, or other psychological problems linked to for example to one’s body image and which existed prior to drug-taking.Illicit drugs are of course taken on the sly. Several ways of hiding the fact exist: diluting urine, hemodilution, reducing kidney tubular secretions or the testosterone/epitestosterone ratio. III. The growing competition between technical and biological research and detection methods1. The rules enforced by the medical commission of the IOCThe definition of doping established by the medical commission of the "International Olympic Committee" is based on the prohibition of certain types of pharmaceuticals. This definition also bans new substances which may have been developed by laboratories specifically for doping purposes.In France, the list of banned substances and methods is given in an amendment to the appendix of the Convention contre le dopage of November 16, 1989, approved in Strasbourg on February 28, 1998, which entered in force on March 15, 1998.Table I shows the new list (decree n°98-464, Journal Officiel de la République Française, 17 juin 1998).
New list of banned substances and methods
1. List of banned substances
A. StimulantsB. Narcotics, both natural and syntheticC. Anabolic agentsD. DiureticsE. Peptide and glycoprotein hormones and analogs
II. Banned methods
A. Blood dopingB. Pharmacological, chemical or physical manipulation
III. List of substances under restriction
A. AlcoholB. MarijuanaC. Local anestheticsD. CorticosteroidsE. Beta-blockers
All physicians have access to the detailed list, since it is quoted on p. 6 of the 1998 edition of the VIDAL medical dictionary ("Banned substances and methods").2. Drugs which are detectable thanks to present testing methodsAll natural or synthetic doping drugs (a to e) have a common physical and chemical characteristic, which is low molecular weight (under 500) (see table II). They can thus be detected by the usual analytical methods, such as gas chromatography, together with mass spectrometry.The only problem with the detection of xenobiotics is the fact that analysts have to work with small samples, which are not always best suited to this type of testing. However, as concerns endogenous substances, their detection does not constitute sufficient proof of doping for the institutions in charge of enforcing the law.Table II: example of the molecular weight of several molecules
Type of active substance
Example of substance
Molecular Mass (Mw)
a. Stimulants
AmphetamineCocaine
135303
b. Natural or synthetic anabolic agents
NandroloneTestosterone
274288
c. Narcotics and analgesics
DextromoramidePropoxypheneMorphine
392339285
d. Beta-blockers
PindololAcebutol Propanolol
248336259
e. Diuretics and masking drugs
Ethacrinic acidFurosemideCanrerone
303330340
f. Peptide hormones
HGHLHEPO
22,40030,00030,400
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