drugs in sport

Drugs in sport: From EPO to gene doping: Ron Maughan on the ceaseless quest for the undetectable magic bullet and the sterling efforts of the 'good guys' to stay ahead of the game

In 1990, Ron Maughan was engaged primarily in physiological research and postgraduate training at the University of Aberdeen. A keen sportsman, he had made a conscious decision to avoid any professional involvement in sport. In 1992, however, he accepted an invitation to chair the Nutrition Steering Group of the British Olympic Association, and he subsequently became involved as a consultant to various bodies, including UK Athletics and the national Olympic committees of various countries. In 2002, he was asked to chair the IOC Medical Commission’s newly-established nutrition working group. At about the same time, he took up the chair of sports science at Loughborough University, where he is still based.

If anyone had told me in 1990 that I would find myself a decade or so later defending British athletes who had failed drugs tests, I would have laughed at the idea. However, that is just what happened. There is good evidence that some of the positives – for nandrolone and other drugs – are the result of innocent ingestion in contaminated dietary supplements.

Having been appointed chair of the recently established nutrition working group of the International Olympic Committee Medical Commission, this whole problem has greatly exercised me over the last couple of years.

One of the earliest issues of PP featured an article on the emerging threat of a new drug that promised to change the face of sport. The drug in question was erythropoietin (EPO). There were two reasons why this was seen as more of a threat than any of the other drugs then in use in sport: first, it was reported to be extremely effective in enhancing performance in endurance events; secondly, the fact that it was essentially undetectable by means of the conventional urine testing methods in use at the time suggested it could be used with impunity.

EPO is produced naturally in the body and has several physiological roles, the most important of which is to switch on the production of new red blood cells. The end result is an increase in the blood content of haemoglobin, the ironcontaining pigment that gives blood its red colour and transports oxygen from the lungs to the tissues. Boosting blood haemoglobin increases aerobic capacity and improves endurance performance, hence the appeal of blood doping procedures in the 1970s and 1980s.

The problem of athletic anaemia

Before the advent of EPO, one of the striking characteristics of endurance-trained athletes was a low blood haemoglobin level. This so-called ‘athletic anaemia’ was a consequence of the disproportionate expansion of the plasma volume, effectively diluting the red blood cells. In the years after the introduction of EPO, however, the haemoglobin level of endurance athletes – at least those competing at the elite level in sport – was generally reported to be much higher than normal.

Soon there were reports of widespread use – or abuse – of EPO across a range of endurance sports, including cross-country skiing, triathlon and distance running. The problem, of course, was that the evidence was purely circumstantial, with any athlete producing a good performance likely to have the finger of suspicion pointed in his or her direction.

Around this time, too, there were an alarming number of unexplained sudden deaths in young, apparently healthy, professional cyclists. Some ascribed this to the haematocrit – the fraction of red blood cells in the circulation – becoming so high that the blood became too viscous to flow easily around the circulatory system.

As an interim measure to prevent the worst abuses, some sports, including professional cycling, introduced a haematocrit ceiling: a value of 50% or more meant that a rider was not allowed to race that day. This was not a satisfactory solution, however, as a high haematocrit itself was not evidence of cheating, and 50%, although high, is still within the accepted normal range for young men.

The scientists responded vigorously to the challenge, however. Some possible detection methods were soon devised, and blood testing was implemented on a limited scale. Inevitably, once the possibility of detection became a reality the use of EPO declined, but this was also, in part, because it was replaced by cheaper and more effective alternatives.

Move on some 14 years or so to 2004 and what do we find? We learn that EPO is still being used by athletes competing at the highest level, but now by those in strength and power sports. The evidence for this comes from two unusual sources. The first was the US tax investigations into the affairs of the Bay Area Laboratory Co- Operative (BALCO), which had been supplying dietary supplements and various other products and services to a number of top sportsmen and women. The second source of information was the reported admission by American sprinter Kelli White that, in addition to a range of other prohibited substances, she had also been using EPO supplied by BALCO.

Clearly, either sprinters know something that scientists don’t or they are so desperate that they will try anything. I suspect the former to be true. We know EPO has a number of functions in the body; and the fact that the focus until now has been on the formation of new red blood cells and performance in endurance sports does not mean there are no other possible ergogenic effects.

The admission by Kelli White was not, of course, given freely. After the World Athletics Championships in Paris in August 2003, she tested positive for the stimulant Modafinil. Following the usual initial denials, the US Anti- Doping Agency produced enough other evidence – including doping schedules and emails detailing her drugs use – to convict her of charges relating to the use of EPO and also a new so-called ‘designer steroid’ tetrahydrogestrinone (THG).

This was one of the first cases where an athlete was convicted on the basis of a ‘non-analytical positive’. And it means that athletes can be found guilty without ever having failed a doping test, providing the other evidence of an offence is strong enough.

The Kelli White case is also part of the ongoing THG/BALCO saga, which is an intriguing story in itself. The THG story has confirmed the fears of earlier generations of athletes that their competitors may have access to drugs that are effective in improving performance but are undetectable. In fact, THG turned out to be highly detectable once the scientists knew what to look for, but clearly there are some pretty smart people out there looking for ways to help athletes beat the system.

Having been caught out once, however, it is less likely that the equally smart people who work for the anti-doping agencies will be so easily caught again. The possibility that urine samples may be stored for future analysis and detection of drugs that are not currently tested for must be giving a few athletes around the world some sleepless nights. The word is that some big names from various sports can expect a letter through their mailbox asking them some very difficult questions.

There are, of course, many other challenges that were not thought of even a decade ago. The possibility of gene doping – manipulating the very basis of life itself – was not considered a serious possibility outside the realms of science fiction. Now, though, it does not seem so far away.

It would seem foolish to speculate on what the future might hold, but we can be sure there will be some surprises. There are almost certainly things happening now that would cause alarm if revealed. Should we give up the battle against drugs and leave the field open for athletes to take anything they want to? Definitely not: I, for one, believe that the good guys will win in the end!

Ron Maughan

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