HISTORICAL ASPECTS
AntiquityThe use of doping is as old as humanity. Csaky [1] mentions that doping started in paradise, when Eve gave the apple to Adam, to make him as strong as God. The first document related to the use of doping agents was a painting of the Chinese Emperor Shen-Nung, from 2737 BC, showing him with leaves of‘‘machuang’’ (Ephedra). The Emperor is considered to be the father of the Chinese medicine and is believed to have introduced the art of acupuncture. Hewas also the first to classify medicinal herbs according to their pharmacologic effects [2].In the ancient Olympic Games, at the end of the third century BC, according to Galen and other authors of the time, athletes believed that drinking herbal teas and eating mushrooms could increase their performance during competitions [3]. Another interesting form of doping of this time was to prepare a powder with the oil, dust, and sweat of an athlete after a competition.This mixture was removed in the dressing room with the ‘‘strigilo,’’ a metallic instrument in the shape of an ‘‘L’’ (Fig. 1). Athletes sold the mixture to other participants, who believed that by drinking the mixture they would have the same physical capabilities as the champion. This myth was not accepted,however, by Conrado Durantez, a Spanish historian of the ancient Olympics[4].In South America, stimulants ranging from the harmless mate tea and coffee up to strychnine and cocaine were used to increase performance. Spanish writers report that the Incas chewed coca leaves to cover the distance between Cuzco and Quito, in Ecuador [5]. In 1886, 10 years before the inauguration of the modern Olympic Games, the first fatality caused by doping was reported when a cyclist named Linton died after an overdose of stimulant in a race between Bordeaux and Paris [6].
In the Olympic Games of 1988 in Seoul, it was believed that the athleteswould learn their lesson, and only a few positive controls would be detected.The reality, however, was very different. Many cases were detected, amongthem that of Ben Johnson, one of the more important athletes of his time, bringing great impact in the media the world over.
In the Athens Olympic Games, for the first time human growth hormone was found in the blood in 380 athletes, even if the method had only a small window of detection and was not accepted by most scientists of the area. Independent observers recruited by WADA audited the quality of doping control of this Games and their report can be found at the previously mentioned Web site of the Agency.Athens showed a new form of judging of adverse analytic findings, a newterminology from the WADA Code for laboratory-positive cases. All cases were judged, not by the IOC Medical Commission, but by a Disciplinary Commission formed by three IOC members, with final approval of the Executive Committee, who notified the press. The Medical Commission only supervised randomly the operation of doping control and the medical care of the athletesin the Games (Table 8).The same system was maintained for the Turin Winter Games, in 2006. TheIOC established an Olympic period, from the opening to the closing of all Olympic villages, and during this time 616 urine samples and approximately 300 blood samples were collected from athletes. Only one female athlete from Belarus, from the biathlon team, had an adverse analytical finding for stimulant, later converted in Anti-Doping Rule Violation. The doping laboratory in Turin worked with a temporary accreditation, done by WADA to the group of Francesco Botre, which was helped by 11 other directors of accredited laboratories in the Games.
ACTUAL DEFINITION OF DOPING
The first definition when control of antidoping began was only related to an artificial increase in the performance of an athlete, using drugs or forbiddenmethods. The actual definition of doping, in accordance with the WorldAnti-Doping Code enforced in Copenhagen, is two of three things: the use of substances or methods able artificially to increment the performance of the athlete, the fact that these substances are harmful to the health of the athlete,and the fact that using doping is against the spirit of the Games [13].Doping is contrary to the principles of the Olympics, of sports, and of medical ethics, even sports medicine ethics. It is forbidden to use doping, as it is to recommend, propose, authorize, or facilitate the use of any substance or method included in this definition. The permanent progress of pharmacology,sports medicine, and science of performance led to the appearance of new forms of artificial increment, which made necessary a strong legislation, dynamic,actual, and flexible.
TYPES OF EXISTING DOPING CONTROL
Doping control can be in urine, in blood, or both. According to the World Anti-Doping Code [13], there are two types of antidoping control: controlsin-competition and controls out-of-competition. The in-competition doping controls are done immediately after a sports event. In this type of control, one considers the entire menu of substances and methods proposed by WADA inits Forbidden list of Substances and Methods when in a so-called ‘‘Olympicperiod.’’ Out-of-competition testing can be done at any moment: in training,in the house of the athlete, or even near a competition.The substances controlled in both kinds of tests are not identical. According to the Code the in-competition test includes all the banned classes of drugs andmethods, but the out-of-competition test is more selective, including only anabolic agents, b2-agonists, agents with antiestrogenic activity, diuretic and masking agents, and all the banned methods. Stimulants, narcotics, and cannabis are not analyzed in this type of control.There are other kinds of control, such as the one done during the period of time in the Olympics that comprises the controls in-competition during the entire period, from the opening to the closing of the Athletic village, and the health controls done just before some competitions, such as cycling, skiing,and skating, to control the levels of red cells in the blood of competitors. If the hematocrit is elevated, there is a ‘‘no start’’ established by the judges and the athlete is withdrawn from the competition, although the results are not considered a doping situation.The ruling of WADA in doping control is accepted by all national Olympic committees (NOC), the IOC, the international sports federations, and governments of the world. The same list is also valid for the International Paralympic Committee and its sports.
LIST OF SUBSTANCES AND METHODS BANNEDBY THE WORLD ANTI-DOPING AGENCY
Every year, the prohibited list of WADA is revised by the List Committeeand, after ratification by the Committee of Health, Medical, and Science,goes to the Executive Committee for approval. The list the is posted to theInternet on the 1st of October, but comes into effect only on January 1st ofthe next year.The list is used by all stakeholders in a way that, for the first time, there is realharmonization all over the sports world and the political world. The list openswith a sentence that mentions that ‘‘the use of any drug should be limited to medicaljustified indications’’ and begins by mentioning substances prohibited at alltimes [14]. To consult the complete list with examples and explanations refer tothe Web site www.wada-ama.org and click on ‘‘Prohibited List.’’Substances prohibited at all times (in- and out-of-competition) include thefollowing:Anabolic steroidsHormones and related substancesb2-agonistsAgents with antiestrogenic activityDiuretic and other masking agent
DOPING IN ATHLETES – AN UPDATE
Methods prohibited at all times (in- and out-of-competition) include thefollowing:Enhancement of oxygen transfer Chemical and physical manipulation Gene doping The following categories list further substances prohibited in-competition:StimulantsNarcoticsCannabinoidsGlucocorticosteroidsSubstances prohibited in particular sports include alcohol and b-blockers.The Prohibited List may identify specified substances that are particularly susceptibleto unintentional antidoping rule violations because of their general availability in medicinal products or that are less likely to be successfully abused as doping agents
References
[1] Csaky TZ. Doping. J Sports Med Phys Fitness 1972;12(2):117–23.[2] Loriga V. Il doping. Roma: CONI; 1988.[3] Mottram DR. Drugs in sport. Champaign: Human Kinetics; 1988.[4] De Rose EH, Nobrega ACL. O doping na atividade esportiva. In: Lasmar N, Lasmar R,editors. Medicina do esporte. Rio de Janeiro: Editora Revinter; 2002 [in Portugese].[5] Montanaro M, et al. Il propblema del doping. In: Venerando A, editor. Medicina dello sport.Roma: Universo; 1974.[6] Gasbarrone E, Leonelli F. Il doping. In: Silvy S, editor. Manuale di medicina dello sport.Roma: Editrice Universo; 1992.[7] La Cava G. Manuale pratico di medicina sportiva. Torino: Minerva; 1973.[8] Burstin S. Cinq ans de contro´le me´dical antidopage au millieu sportif. Medicine du Sport1972;(4):204–8.[9] Muller N. Pierre de Coubertin: textes choisis (II). Zurich: Weidmann; 1986.[10] De rose EH. A medicina do esporte atrave´s dos tempos. In: Oliveira MAB, Nobrega ACL,editors. To´picos especiais em medicina do esporte. Sa˜o Paulo: Editora Atheneu; 2003.[11] Dirix A. Doping: theorie et pratique. Br J Sports Med 1972;(1,2):250–8 [in French].[12] Dirix A. Medical guide. 2nd edition. Lausanne: International Olympic Committee; 1992.[13] WADA. The World Anti-Doping Code (version 3.0). Montreal: WADA; 2003.[14] WADA. The prohibited list. Science and Medical Committee. Montreal: WADA; 2005.[15] Schanzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenicsteroids: an international study. Cologne: DSHS; 2002.[16] Feder MG, Cardoso JN, De rose EH. Informac¸o˜es sobre o uso de medicamentos no esporte,2a. Rio de Janeiro: edic¸a˜o COB; 2000 [in Portugese].[17] WADA. Report of the accredited laboratories. Montreal: WADA; 2005.[18] WADA. Athlete’s guide to the doping control program. Montreal: WADA; 2003.[19] Friedman T, Koss J. Gene transfer and athletes: an impending problem. Mol Ther 2001;3:819–20.[20] Pound R. Taking the lead. Play True 2005;2(2):1.