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"Fatal Distraction" Supporting Notes and Documentation
"The Great Drug War" Supporting Notes and Documentation
Paying The Piper
Chemically EnhancedBy David Owen
I have a guilty secret. I think Ben Johnson’s “victory” in the men’s 100m at the 1988 Seoul Olympics is just about the most exciting 10 seconds of sport I have ever witnessed. Still.
I am not Canadian, though I was in Canada when it happened. And I was glad that “runner-up” Carl Lewis, the American super-athlete whom I had for some reason taken against, did not win. But what stood out for me mainly was the sheer bullocking power of Johnson’s sprinting.
In the light of this, it is scarcely surprising that I have long held inconveniently ambivalent views on drugs in sport. If performance-enhancing drugs can contribute to such a spectacle, then, in my view, we should think long and hard about whether it is really in the best interests of sport to ban them. Particularly if the product of “clean” sport is the bloodless affair that passed for the women’s 100m at the most recent summer Olympiad, in Athens in 2004. This was won by Yuliya Nesterenko of Belarus in a pedestrian 10.93 seconds, after a contest with all the international allure of an egg and spoon race.
My intention is not to defend Johnson. He broke the rules, even if he did recently complain he had been the victim of “sabotage” in Seoul, where he claimed his food and drink had been spiked.
What is more, the drug he tested positive for - stanozolol, an anabolic steroid - has been associated with serious side-effects. One website I consulted noted that in rare cases, “serious and even fatal” cases of liver problems had developed during stanozolol treatment. It is the sort of substance which, at the very least, one would want studied rigorously before any thought were given to easing present restrictions on its use by athletes.
Nonetheless, I have serious doubts about the present draconian but pettifogging approach to doping, under which scores of substances are prohibited and athletes are deemed responsible for whatever enters their system. These doubts have not been eased by five years as a specialist sports journalist. In fact, I have come to the conclusion that the system is flawed in several critical respects.
First, though good at catching unsophisticated or “one-off” dopers, I suspect present methods are less successful at weeding out recidivist cheats. Though there are times when the authorities manage to get ahead of the dopers - such as their 2003 discovery of THG, or tetrahydrogestrinone, a so-called “designer” steroid, that led to British sprinter Dwain Chambers’ positive test and subsequent ban - I believe there is often scope for the truly dedicated drugs cheat to thrive, particularly if armed with a good chemist and a good lawyer.
As Don Catlin, the University of California, Los Angeles, scientist who did the testing for the Salt Lake City Winter Olympics, once said: “Everything we do assumes the athletes are guilty, meanwhile the ones who are really clever get away with it anyway.”
The present approach also snares the careless and the unlucky. Scottish skier Alain Baxter, who lost an Olympic bronze medal in 2002 because of a stimulant ingested in a Vicks inhaler, is an example of the former. (He will have another chance to win a medal at this month’s Winter Olympics in Turin, having been selected once again for the British team.)
The “unlucky” doping category would apply to any athlete whose positive test stemmed from an authorised food supplement that has been contaminated by a banned substance. Of course athletes are not obliged to take such supplements. But, as long as they are permitted, you can hardly blame them - and their coaches - for worrying that they would be uncompetitive against their pill-chomping peers without them.
In addition, the system places constant and onerous demands on athletes. They are clearly well-advised to keep track of just about everything they ingest and in many cases they must keep authorities informed of their whereabouts, in case an out-of-competition drug test is scheduled. The International Association of Athletics Federations (IAAF), athletics’ governing body, requires athletes to “keep their whereabouts information on file on a quarterly basis” and to “notify the IAAF immediately that there is any change”. For the top-class athlete of today, spontaneity is an indulgence best avoided.
I can’t help thinking that those seeking to weed out drug cheats are banging their heads against a wall. The rewards of being the best are now so great in many sports that the temptation to secure an illicit edge over your rivals must be greater than ever. Rather than stamping out the use of performance-enhancing drugs, I suspect that the main result of the present game of cat-and-mouse has been to push their development underground. It must at least be worth assessing whether the achievements of the present drug control regime are worth the price we are paying in terms of unjustly tarnished reputations and diminished performance levels and entertainment value.
It is also worth underlining how present test procedures inflict some pretty striking indignities on those we are encouraged to see as national heroes. The IAAF’s procedural guidelines make clear that doping control officers collecting urine samples take “all necessary steps” to ensure the sample’s authenticity. “The athlete may be required to disrobe as far as is necessary to confirm that the urine has been produced by him,” the guidelines state. “This usually means the exposure of the body from the middle of the back to below the knees.” To some extent, the end may justify the means, but such intrusions really do make you wonder about the direction in which sport is heading.
That, then, is a summary of the view I had built up over the years, most as a fan, the last few as a sports writer. The trouble was, I found it difficult to come up with practical policy proposals. I could not see beyond a melancholy vision in which dwindling crowds, disillusioned by the mounting numbers of unmasked “drug cheats”, led to the eventual demise of the worst-afflicted sports, including athletics, in many ways the simplest and most natural sport of all.
That was until one day, while waiting for a meeting at Sport England’s London headquarters, I found myself leafing through some academic journals. One article, by British and Australian-based academics, jumped out at me. When I got around to reading it, I realised that it not only trenchantly articulated some of the same reservations about the present doping control regime that had occurred to me, but also had some suggestions as to how authorities might act in the light of them.
The broad thrust of the piece, which you can find at www.bjsportmed.com, is summed up in its title, “Why We Should Allow Performance Enhancing Drugs in Sport”. The actual argument is not quite as radical as this suggests, though radical enough. It is that while unsafe drugs should still be banned, the prime focus of sports authorities should be the health of the athlete. “If a drug does not expose an athlete to excessive risk, we should allow it even if it enhances performance.”
Under the present world anti-doping code, drugs can be put on the prohibited list if they meet two of the following three criteria: they enhance, or have the potential to enhance, sport performance; they represent an actual or potential health risk to the athlete; and they violate what the code calls “the spirit of sport”. Explanatory comments set out why none of the three criteria alone is deemed sufficient grounds for adding a drug to the list. “Using the potential to enhance performance as the sole criteria would include, for example, physical and mental training, red meat, carbohydrate loading and training at altitude.”
The article’s authors justify their stance in a number of ways. First, they say, the battle against performance-enhancing drugs cannot be won. “In a few years, there will be many undetectable drugs.” Second, performance enhancement is not against the spirit of sport; it is the spirit of sport. Opening the door to what they refer to as “biological manipulation” would make sport “less of a genetic lottery”. Third, in some cases, allowing performance enhancing drugs would actually be fairer. They cite the example of erythropoietin (EPO), a natural hormone that stimulates red blood cell production, hence aiding the delivery of oxygen to muscles, a key determinant of an individual’s ability to perform well at sports. EPO is currently banned at concentrations significantly exceeding the level normally found in humans. The authors argue that it is not EPO itself that is potentially dangerous to the athlete, but raising the percentage of red cells in the blood to too high a level. This, therefore, is what authorities should turn their attention to. The sport of cycling already prevents cyclists from competing if their blood cell count is deemed too high. Moreover, there are other - legal - ways in which athletes can raise their blood count: altitude training and use of a hypoxic air machine, which reduces the amount of oxygen breathed by the user.
But these tend to be more expensive than using EPO, unless an athlete happens to live at high altitude. In this case, the authors argue, “by allowing everyone to take performance enhancing drugs, we level the playing field”. Fourth, the present system tends to incentivise the development of undetectable drugs, rather than safe ones. A regime founded on monitoring athletes’ health would change these priorities. And fifth, yes, the level of performance would improve. The authors note that classical musicians commonly use a category of drugs known as beta-blockers to control their stage fright. “Although elite classical music is arguably as competitive as elite sport... there is no stigma attached to the use of these drugs.” And yet beta-blockers are prohibited in competition in a range of sports including billiards, bridge and gymnastics.
I bounced some of the paper’s ideas off Olivier Rabin, science director at the Montreal-based World Anti-Doping Agency. This did little to dent my regard for the article, even though as you would expect, he clearly didn’t agree with its main theme.
Asked, for example, if it would be easier to ban drugs only if they were detrimental to health, he said governments and sports authorities - “what I would consider smart people” - had concluded that prohibiting a substance on the basis of one sole criterion would be “too limited... This is why today you have got what I believe is the nice combination that has been adopted in the world anti-doping code.”
Regarding EPO, he acknowledged, as the authors of the paper asserted, that its effect on the blood was the same as the legal methods of stimulating red cell production, but said EPO was “much more potent”. Hypoxic conditions might increase an athlete’s natural production of EPO by “a few per cent”. However, “when you take EPO shots, you are going to multiply by two or three the amount of circulating EPO you have got in your body”. Presumably, though, if athletes were restricted to a maximum count of red blood cells, the potency of the EPO surge that took them to this ceiling would be immaterial.
Our exchanges on THG, meanwhile, seemed to underline the good sense of the approach sketched out in the article. “When you talk to the athletes who have taken THG... they don’t care at all [about health],” Rabin asserted. “So we have to care for them about it.”
But is THG harmful to health? I asked.
“Well, it’s an anabolic steroid that has never been properly tested... “
So we don’t know if it’s harmful to health, but it has not been proven safe?
“Yes. What we know is that those products that circulate - designer drugs - ...are not purified substances, [but contain] a whole bunch of side-products that can be really toxic.”
A few days later, I am sitting in the freezing Oxford office of Julian Savulescu, lead author of the doping paper. Trim, dark-haired and fortyish, he is the Uehiro professor of practical ethics at the university. After lunching on mushroom strudel in the dining hall of St Cross College, we have settled down to establish just how liberal he thinks the drugs regime should be, and discuss the related subject of genetic doping.
He plainly thinks sport’s puritanical approach to performance enhancing drugs is the product of an old-fashioned mindset. “Pharmacology has developed so we can create safe drugs, administer them in safe doses and monitor them in a way we couldn’t in the past,” he says. “The world of sport has not yet caught up with advances in pharmacology in recent years. Very little in the world is as well studied as medicinal substances and drugs. The problem arises when you have backyard preparations that are not subjected to trials.”
But how far could we responsibly go in permitting the use of previously banned substances? Should we allow athletes to take the most demonised of all performance enhancing drugs - anabolic steroids?
He gives a careful reply. “The risks of anabolic steroids - although real - may in some cases have been overstated and in any case have to be put in the context of various aggressive forms of training and the risks we allow people to entertain every day of their lives.” When I raise the subject again, however, he is more forthright. “I would prefer my child take anabolic steroids and growth hormone than play rugby,” he says. “Growth hormone is safer than rugby. At least I don’t know of any cases of quadriplegia caused by growth hormone.”
By the time we move on to genetic doping, the room has grown so cold that Savulescu is bending down every now and then to tinker with a malfunctioning radiator. Athletes resorting to this form of enhancement would be injected with a particular gene intended to improve the function of a normal cell and boost their performance. According to the World Anti-Doping Agency (Wada), scientists have experimented with genes that produce a substance - insulin-growth factor 1 - which helps muscles grow and repair themselves. The idea is that the genes, carried into the body by a harmless virus, would produce more of the substance than the body would normally make, stimulating muscle growth. In a similar vein, EPO users might be able to inject the gene that produces the hormone as an alternative to straight EPO injections.
Wada does not yet believe that athletes are resorting to genetic doping, though it is impossible to be sure and it may not be long before they do. Indeed it was reported last week that the trial of a German track coach had uncovered evidence indicating that it might already be a reality in sport. In the meantime, it is spending up to $3m a year on research to try to ensure that testers will be able to detect cases of genetic doping should they start to materialise.
The agency recently organised its second symposium on the subject in Stockholm. It is already clear that it intends to combat the phenomenon as uncompromisingly as it does traditional doping. Richard Pound, the body’s chairman, wrote last year that it was “hard to conceive what the consequences could be of altering a person’s genetic make-up just to make them better in sports”. He added: “This is a slippery slope we do not ever want to go down.”
There are a couple of reasons why I find it easier to sympathise with the agency’s stance on this issue than on conventional doping. First, while chemicals, however harmful, are quickly flushed out of the system, I presume that the consequences of genetic manipulation are likely to prove longer lasting, if not permanent. Second, the difference between a champion and an also-ran is often in the head. The notion of an athlete using gene therapy to reduce nervousness or increase aggression makes me profoundly uneasy, much more so than the idea of using it to grow bigger muscles.
Savulescu, it turns out, shares few of these scruples. “If you have very good evidence that it is safe, I am inclined to say you should allow it,” he says. Such evidence does not appear to exist at present, although even Pound says he is “confident science will get us to the point where gene transfer technology can be applied safely and effectively”. A Wada publication describes a French attempt to use gene therapy to treat a rare inherited disorder suffered by 11 boys. The bottom-line is that, though the treatment worked, three of the boys were reported subsequently to have developed leukemia.
Savulescu argues that sporting rules could be used to prevent sports becoming more of a freak show than they are at present, should authorities so want. “People feel that if we take one step, there is a slippery slope here... that if we allow performance enhancement, there will be people with 6ft legs doing the high jump,” he says. “It is false. We can draw a line wherever we want.”
He appears positively excited by the possibility that so worries me: of using gene therapy to improve an individual’s mental, rather than physical faculties. “The case is going to be even stronger for enhancing things like intelligence/memory that are helpful in non-competitive situations as well as competitive ones,” he says. “I don’t see any reason why [athletes] shouldn’t take more psychological enhancers to improve physical performance or vice versa. We are looking at the radical modernisation of human beings.”
Like me, he has few illusions about the profundity of the questions - and opposition - that significant steps along this path are likely to throw up. “I think what you are seeing is resistance to the internalisation of technology,” he says. “People are in favour of computers, but less so computer chips in the human brain. What they are worried about is the use of technology to change ourselves.”
These are deep waters, lapping at big subjects such as the nature of human identity. In time, the issues raised will make the debate over plastic surgery seem trite in the extreme. And yet they are issues that sport - an area of human endeavour rarely noted for the depth or quality of its thinking - may soon have to grapple with.
What am I left concluding? That sport should stop regarding performance enhancing drugs and procedures as a child regards the bogeyman: as a monster from which it needs unstinting protection. Yes, it makes a lot of sense to replace the present rickety dam-wall with a regime focused on health protection - though I acknowledge that this itself would raise many questions and that the nastiest drugs would still need to be banned. Child protection would need to be thought through with particular care.
But please let’s not pretend that the present situation is satisfactory, or anything like it. Not so long ago, in the unlikely surroundings of the University of Buckingham, I went to hear a lecture by a lawyer named Gregory Ioannidis who has been defending the Greek sprinter Kostas Kenteris against charges that he tried to avoid doping controls. “These days,” said Ioannidis, “the athlete who wins is the athlete who has the best chemist and the best lawyer.” All too often, I am afraid he is probably right.
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