Doping in sports: is it worth it?

                           Faster and stronger: the search for a competitive edge can put lives at risk.

Since sports were invented, people have cheated. From figure skaters breaking competitors' legs, to marathon runners disappearing into the crowd and taking the subway, scandal populates sporting history.

Lance Armstrong, retired American cycling hero and cancer survivor, was stripped of all his titles and banned for life in 2012; he took the fall, but was he just the scapegoat?

In November 2015, Russian athletes were banned from international competition after widespread, state-sponsored doping put sporting integrity and athletes' lives at risk.

Pierre Weiss, former general secretary of the International Association of Athletics Federations (IAAF), commented: "Not only are these athletes cheating their fellow competitors but at these levels are putting their health and even their own lives in very serious danger."

Sports bring people together, but their heady mix of pride, politics and big money can be lethal.

Stimulating substances: as old as sport itself

According to the World Anti-Doping Agency (WADA), the term "doping" probably comes from the Dutch word "dop," an alcoholic beverage made of grape skins that was used by Zulu warriors to make them stronger in battle.

Ancient Greek athletes used special diets and stimulating potions to improve performance, and 19th century endurance athletes indulged in strychnine, caffeine, cocaine and alcohol.

Thomas Hicks took raw egg, injections of strychnine and consumed doses of brandy during the race to help him win the 1904 Olympic marathon.

In the early 20th century, the term doping was introduced to describe illegal drugging of racehorses. In 1928, the IAAF became the first international sports federation to ban it.

Doping tests were introduced for the cycling and football world championships in 1966, and 1968 saw the first Olympic testing. By the 1970s, most international federations had followed suit.

WADA: setting standards in anti-doping

In 1999, WADA were set up to regulate standards in anti-doping, following a major drug scandal at the 1998 Tour de France. It aims to "promote, coordinate and monitor the fight against doping in sport in all its forms."

WADA produce and annually update the official list of banned substances or methods of doping. To be added to the list, an item must meet any two of the following three criteria:

§  It enhances or could enhance sporting performance

§  It poses or could pose a health risk to the athlete

§  It violates the spirit of sports.

The 2016 list is available on the WADA website.

What are the classes of banned drugs?

Six classes of drugs are banned by sports' governing bodies; stimulants, diuretics, anabolic-androgen steroids, beta-2 agonists, narcotic analgesics and hormones and peptides.

Stimulants

Stimulants increase alertness and ability to overcome fatigue by raising heart rate and blood flow. In training, they are used to increase the intensity of a session. They also induce aggression, which may or may not be an advantage during competitions.

Many stimulants, including amphetamines, ephedrines and cocaine, are banned in competition.

Research suggests that deaths have occurred in sports, due to amphetamine misuse.

Stimulants can raise the blood pressure, which, when combined with excessive physical activity and peripheral vasoconstriction, hampers the body's cooling mechanism. Overheating leads to dehydration and reduced blood circulation, potential organ failure, sudden collapse, cardiac or respiratory arrest and death.

Stimulants are also addictive.

Anabolic-androgen steroids

Sometimes called anabolic steroids, these help athletes to train harder, increase muscle mass and strength and to recover more quickly.

Risks include kidney damage, increased aggression and disturbing the natural balance of hormones.

Testosterone is the main anabolic steroid hormone produced by the body. It has anabolic effects, which promote muscle building, and androgenic effects, which are responsible for male characteristics, such as facial hair and a deeper voice.

Anabolic steroids can lead to baldness and low sperm count in men and increased facial hair and deepened voices for women, as well as other serious health consequences.

Glucocorticoids, such as cortisol, are catabolic steroids, which means they break down muscle mass, in contrast with anabolic steroids, which build it up. These steroid hormones are naturally produced in the adrenal glands, and their effect is anti-inflammatory.

Athletes use them to mask serious injury and to achieve rapid recovery after a hard workout by reducing muscle damage. It allows them to train harder and more frequently.

Working when injured can worsen the injury; glucocorticoids can also affect the metabolism of carbohydrates, fat and proteins, and regulate glycogen and blood pressure levels.

Athletes take a risk by using steroids at much higher doses than would be prescribed for a medical condition. Since these doses could not ethically be administered for research purposes, and also because the drugs are normally used in secret, the effects are not well documented.

Diuretics 
Anabolic steroids and diuretics are popular among bodybuilders, but at what cost?

Diuretics increase the rate of urine flow and sodium excretion in order to adjust the volume and composition of body fluids or to eliminate excess fluids from tissues.

Medical uses include treatment of hypertension, heart failure, liver cirrhosis, renal failure, kidney and lung diseases and reducing the adverse effects of salts and/or water retention.

Despite being banned in sports, both in and out of competition, since 1988, athletes have used diuretics for two reasons.

One is to remove water from the body, causing a rapid weight loss that can help meet a weight category - for example, in boxing.

The other reason is to mask other doping agents by reducing their concentration in urine and by altering urinary pH.

Dangers include severe dehydration leading to fluid and electrolyte imbalance, hypotension, circulatory collapse and thromboembolic episodes, cardiac arrhythmias, hypomagnesemia, gout and hyperglycemia.

Diuretics also increase levels of "bad," low-density lipoprotein (LDL) cholesterol and triglycerides and decrease "good," high-density lipoprotein (HDL) cholesterol. Interactions with other drugs can exacerbate the risks.

A number of bodybuilders have succumbed to the dangers of diuretics. Mohamed Benaziza, 33, died in 1992 following severe dehydration and cardiovascular failure. In 1996, Andreas Munzer died of liver and kidney failure after using diuretics.

Narcotic analgesics and cannabinoids

In medical terms, an analgesic narcotic is an opioid - a substance that acts pharmacologically like morphine. They are addictive.

Opioids mask the pain caused by injury or fatigue, enabling athletes to keep working in spite of damage, but training or competing while injured can lead to further damage.

Peptides and hormones

                                 EPO increases the number of red blood cells and therefore of oxygen.

Peptides, hormones and other growth factors used in sports include human growth hormone (hGH), erythropoietin (EPO),insulin, human chorionic gonadotrophin (HCG) and adrenocorticotrophin (ACTH).

Such therapies are used in cancer therapy to help people who were born preterm. EPO, Lance Armstrong's downfall, is used to treatanemia in cases of severe kidney disease.

EPO increases bulk and strength and promotes red blood cells. More red blood cells means more hemoglobin in the blood, higher oxygen levels and greater energy.

Inappropriate use of EPO can lead to thrombotic events, such asstroke, hypertension, heart attack and pulmonary embolism. It has also been linked to blood cancer and anemia.

EPO was banned by the International Olympic Committee (IOC) in 1990, but the lack of a reliable testing method made it hard to prevent until 2000, when an EPO detection test was approved by WADA. Meanwhile, from 1990-2000, it allegedly contributed to at least 18 deaths.

Gonadotropin, or hGH, is a hormone with an anabolic effect, used to improve muscle mass and performance, although studies have not confirmed any positive effects on strength or endurance.

It builds muscle but causes abnormal growth, heart disease, diabetes, thyroid problems, hypertension, blood cancers andarthritis. Other adverse effects include joint pain, muscle weakness, visual disturbances, enlarged heart and diabetes.

Alcohol, marijuana, local anesthetics and corticosteroids are all banned in competition.

Methods of doping

Two methods of drug administration are also banned: blood doping and gene doping.

Blood dopingBlood doping to increase hemoglobin is illegal and can lead to cardiovascular problems.

WADA define blood doping, or blood boosting, as the "misuse of techniques and/or substances to increase one's red blood cell count." The practice involves removing blood from the body and returning it later. It started in the 1970s and was banned by the IOC in 1986. It can lead to kidney and heart failure.

There are two types of blood doping:

Autologous: the athlete's blood is removed and subsequently re-infused to increase the level of oxygen-carrying hemoglobin.

Two units (approximately 2 pints) of the athlete's blood are normally removed several weeks prior to competition. The blood is frozen, then thawed and injected back into the athlete's body 1-2 days before the competition.

Homologous: fresh blood, removed from a second person, is injected straight into the athlete.

Also banned in sports are artificial oxygen carriers, such as hemoglobin oxygen carriers (HBOCs) and Perfluorocarbons (PFCs), used for the same purpose.

Gene doping

Gene doping has developed from gene therapy, which involves injecting DNA into a person's body in order to restore some function related to a damaged or missing gene.

A synthetic gene is added to the patient's genome then reintroduced into the bone marrow. The new gene is expressed by the patient's cells and acts like a medicine, permanently incorporated in the bone marrow.

Gene doping would involve inserting DNA for the purpose of enhancing athletic performance, potentially altering the genetic makeup of the receiver to increase strength or speed. It is virtually undetectable.

WADA define it as the "non-therapeutic use of cells, genes, genetic elements, or modulation of gene expression, having the capacity to enhance performance."

Scientists have successfully produced EPO artificially and introduced it into the bodies of animals, but it is not known how far, if at all, gene doping has intruded into sports. Meanwhile, WADA are supporting global research efforts to find a way to detect it. If it is not here yet, it is just a matter of time.

The effects of gene doping have not been determined. Results from animal studies cannot be confirmed in humans for ethical reasons. The secrecy that would surround gene doping increases its mystery and danger.

Currently, only a muscle biopsy could provide the necessary evidence but this is not practical in sports. The US Anti-Doping Agency (USADA) state that it is not possible to detect gene doping with present technology.

USADA Science Director Mathew Fedoruk, PhD, told MNT:

"USADA, working together with our anti-doping colleagues such as the Partnership for Clean Competition, are proactively conducting research to develop new detection methodology, and keep our pulse on any new products or medical techniques, including gene doping, which could be abused in sport.

The inappropriate use of stem cell technology or gene silencing therapeutics which could allow athletes to compete in supraphysiological states, are two specific examples of gene doping which may have the greatest potential to become a reality in the future."

In the words of E. Brzezianska and coauthors regarding their research into the risks of gene doping in sports: "Gene doping makes it possible to create a 'super athlete,' but at the cost of breaking the rules of sporting ethics and undermining the principles of fair play in sports. It is also associated with a high risk of danger to the health of athletes."

How is doping detected?

                    Blood and urine tests do not reveal all types of doping in sports.

Detecting drugs in athletes is challenging on many fronts.

Tests are mostly carried out on blood and/or urine samples, collected under strict protocols, but the tests may not pick up all substances.

The wide variety of drugs and drug classes used, their different properties, sites of administration and mechanism of action makes it difficult to test for everything.

Some substances are not detectable. Byproducts may be so small that they do not produce a strong enough signal for detection. The use of patches or microdosing, for example, may reduce the detectable amount of a substance.

Blood testing is capable of detecting EPO and synthetic oxygen carriers, but it cannot tell whether a blood transfusion has taken place.

Timing of drug use can also help avoid detection. Previously, testing was only between 6 am and 11 pm, leaving a window of opportunity for microdosing.

In the past, different sporting organizations have carried out their own doping tests. New plans to defeat doping will include a new, independent body - not just to regulate, but to carry out all tests.

The Athlete Biological Passport

The Athlete Biological Passport (ABP) is an electronic document that was introduced by WADA in 2009 to help detect transfusions.

Instead of focusing on the banned substance or method itself, it allows monitoring of selected biological variables over time.

The Passport records markers at intervals of an athlete's career. Any dramatic changes or expected patterns may indicate doping, at which point the athlete would undergo specific tested, possibly leading to an investigation.

The IAAF have declared a "zero tolerance" approach to doping. WADA have approved stricter punishments from January 2016, doubling bans for athletes found guilty of doping from 2-4 years, and they are urging governments to criminalize doping. Countries whose athletes regularly dope may receive a blanket ban, as in the case of Russia.

But as technology advances apace, introducing ever more inventive ways of cheating and avoiding harder, will competitive sports even be feasible?

Cheating brings false glory; is it worth the shame?