March 10, 2010
   
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Performance Enhancing Drugs in Sports
Maxwell J. Mehlman, J.D.
 
The report in the popular media(1) that some track-and-field athletes have been using a so-called "designer steroid" created to thwart drug testing regimens is the latest installment in the ongoing battle against doping, or the use of performance-enhancing technologies, in sports. Are sports organizations responding appropriately to these challenges, and what is the proper role of physicians in this controversy?

Background
According to the World Anti-Doping Agency,(2) the term "doping" probably comes from the Afrikaans word "dop," a concoction made from grape leaves that Zulu warriors drank before going into battle. In sports, the term was first used to describe the illegal drugging of race horses at the beginning of the 20th century.

Doping in sport now includes a range of practices, including "blood doping" (the practice of autologous or homologous hemoglobin transfusions) and the use of synthetic erythropoeitin (EPO) to increase the number of red blood cells; anabolic steroids and human growth hormone to grow skeletal muscle; stimulants to improve cognitive function and reduce fatigue; and nitrogen tents and "houses" to simulate the effects of sleeping at high altitude. The future holds the promise of more powerful and exotic interventions.

At a recent meeting of the American Society for Gene Therapy, for example, Barry Byrne, Professor of Molecular Genetics and Microbiology at the University of Florida, described a considerable amount of research currently underway to identify biological determinants of athletic performance, including vascular endothelial growth factor (VEGF) to increase vascularization; leptin as a fat metabolizer; myostatin to increase the number of muscle cells; and therapeutic antibodies and cytokines to reduce susceptibility to athletic injuries.

Additional enhancement interventions are expected from the knowledge gained by the Human Genome Project. In July 2003, for example, researchers reported finding that different versions of the alpha-actinin gene were associated with sprinting and endurance running,3 opening the door to genetic testing at an early age to identify promising athletes, and to potential biomedical interventions based on this genetic discovery.

Ethical Principles in Sport
Led by the international Olympic movement, organized sport has attempted to prevent the use of performance-enhancing drugs by banning them, establishing testing programs and punishing athletes caught using prohibited substances. The basic anti-doping principles of sport were laid down in 1967 by the International Olympic Committee:
  1. "protection of the athletes' health";
  2. "respect for medical and sports ethics"; and
  3. "ensuring an equal chance for everyone during competition."(4)
It might seem hard to disagree with the first principle, "protection of athletes' health." Clearly some performance-enhancing drugs are dangerous. Steroids, for example, are associated with a range of side effects, including heart attacks and liver cancer. But sports in general, and some sports in particular, are inherently dangerous. Athletes often injure themselves in training and in a ghoulish fashion. Indeed, for many people, it is the anticipation of beholding injury and even death that makes sports events fun to watch. Think of automobile or downhill ski racing, even football and hockey, not to mention boxing. If athletes are free to accept a certain degree of risk from dangerous sports, why shouldn't they be allowed to accept a comparable, or even greater, risk from enhancements?

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Readers Comments

Comment by: Anonymous Thu., Jan. 28, 2010 at 5:33 pm EST
i dont think there right

Comment by: bob Thu., Jan. 14, 2010 at 1:07 pm EST
except if we are cheating

Comment by: Steve Wed., Jan. 13, 2010 at 1:00 pm EST
Performance enhancing drugs are a great solution to all your problems

Comment by: RINGO Mon., Jan. 11, 2010 at 5:07 am EST
I agree

Comment by: tomboy Mon., Jan. 4, 2010 at 8:04 pm EST
weird


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