Drugs and Athletes: It's All About the Gold

From the WebMD Archives

Based on interviews and research done by WebMD, the question should probably be the other way around: How many Olympians -- indeed, how many elite athletes in any high-level competition -- aren't using drugs? Despite the self-righteous pronouncements of many official bodies and the International Olympic Committee (IOC), those in the know, including coaches, trainers, doctors, researchers, and the competitors themselves, insist that drug use is widespread among elite athletes. The situation has become an "obscene hypocrisy," says Charles Yesalis, PhD, professor of health and human development at Penn State University and the author of a book on athletics and anabolic steroids.

A news feature in the Sept. 14 issue of Nature also questions the level of commitment of the IOC and other governing bodies to research and testing. It points out that, given the level of funding to develop new tests and randomly use them on athletes, the sports federations' pronouncements will likely remain tough words and nothing more. It concludes that, despite the "fanfare" with which new tests have been announced, "few athletes are likely to be caught out at the games."

Today's athlete has an array of substances at his or her disposal. The most popular include:

  • Erythropoietin: Known as EPO, this drug boosts the production of red blood cells, which carry oxygen to the muscles and delay fatigue. Used legitimately to treat certain kinds of anemia, it is a favorite of endurance athletes such as long-distance cyclists and marathon runners.
  • Human growth hormone (hGH): Traditionally prescribed for the treatment of dwarfism, many athletes believe hGH has fat-burning and muscle-building properties that enhance endurance and strength.
  • Anabolic steroids: Bodybuilders and competitors in various sports have long used these compounds to build muscle and strength. A few former and current Olympic athletes have tested positive for a steroid called nandrolone, although they have disputed these findings.
  • Narcotics, diuretics, amphetamines, and beta-blockers have all been used by athletes in an effort to boost strength and endurance, improve speed and appearance (important in a competition viewed by a billion or more people), and mask pain.

Actually, chemical enhancement of athletic performance is nothing new. Their use in modern-day Olympics was documented as early as 1904, when marathon runner Thomas Hicks nearly killed himself with a mixture of brandy and strychnine. Indeed, strychnine was one of athletes' drugs of choice well into the 20th century, until the creation of amphetamines in the 1930s. The dangers of doping became apparent in the 1952 winter Olympics, when several speed skaters took speed -- and got sick.

Eight years later, a Danish cyclist died from an amphetamine overdose during the summer games, and in 1967, cyclist Tommy Simpson overdosed during the Tour de France. That finally prompted the IOC to develop an official definition of doping, draw up a list of banned substances, and implement a testing policy for the 1968 Olympics. Twenty years later, runner Ben Johnson was stripped of his gold medal after testing positive for anabolic steroids.

But for many, one name dominated the '88 summer games: FloJo. In those Olympics, held in Seoul, South Korea, track and field star Florence Griffith Joyner won three gold medals and a silver, setting two world records for the 100- and 200-meter events that may never be beaten. She has been called the fastest woman who ever lived.

Her victories, however, were tainted by rumors that she used drugs, most notably hGH, to achieve them. Joyner hotly denied the allegations, but she retired from competition the following February, shortly before the institution of mandatory out-of-competition drug testing. She died in 1998, of suffocation due to an epileptic seizure that occurred while she was sleeping. The rumors continue to cloud her name.

This year, the IOC has presented with great fanfare two new tests developed to detect EPO, which first entered the scene in 1987. Skeptics claim, however, that athletes can stop using the drug far enough in advance to avoid a positive test while still obtaining its benefits. Therein lies the crux of the problem: "I can take any ... team, drug 'em to the eyeballs, and not have anybody flunk a test," says Yesalis.

"The athletes are always one to two jumps ahead of the testers," says David Apple, MD, an Atlanta-based orthopaedic surgeon and co-chair of the Doping Control Committee for the 1996 Olympic Games. A former team physician for the NBA, Apple recalls that basketball players in the '70s would pack some borax under their fingernails just before a urine test, then flick it into the specimen to neutralize any questionable compounds.

Today, athletes take diuretics and drink copious amounts of water to flush drugs from their system. Instead of steroid shots they use creams, which leave the body within 24 to 48 hours. They engage in blood doping -- providing someone else's blood for a test or using a stored sample of their own blood, drawn before they took the latest round of enhancers. They can simply stop using EPO for a few days, since even the best test can't detect it more than about 10 days out. And there is, as yet, no good test for hGH, so athletes know they can use it with impunity in their quest for the gold.

It is gold of a coarser sort that has largely stymied the establishment of an effective testing program. The tests are expensive. Most experts believe they are best conducted out of season, with officials showing up at random at a potential competitor's home at various times throughout the year prior to the event -- which is prohibitively expensive, and a logistical nightmare to boot.

Money rears its head in other ways as well. For example, athletes have taken to filing lawsuits. When runner Diane Modahl tested positive for testosterone use in 1997, she successfully sued the British Athletics Foundation with claims that failure to refrigerate her urine sample properly could have led to a false-positive result. The foundation declared bankruptcy soon thereafter. What's more, national Olympic committees are reluctant to cope with the scandal, investigations, and loss of income that would inevitably occur should one of their star competitors be found to be cheating. For these and many other reasons, athletes are rarely penalized even when they do test positive for drugs.

But there is another factor as well. World-class athletes get where they are because they want to win. They already have the skill, the mentality, and the genetic endowment to excel. No drug in the world will turn a couch potato into a FloJo or a Lance Armstrong. They are constantly in search of that edge, that something to provide the extra tenth of a centimeter or fraction of a second. As one young athlete put it, "On the day, in the heat of the moment, you don't really care about risks. You gotta win, so you take it."

It remains for the rest of us to ask when the price of winning becomes too high.