Sport Medicine Journal Takes on Performance-Enhancing Drugs in Sports

At a time of intensive worldwide efforts to combat the use of performance-enhancing drugs, the July/August special issue of the Clinical Journal of Sport Medicine provides a detailed update for the medical specialists who bear the greatest responsibility for the health and performance of athletes--sports physicians.

The special thematic issue on Drugs and Performance-Enhancing Agents in Sport provides sports medicine physicians with up-to-date information on key issues in "doping" in elite athletes.

In the lead article, John Hoberman, Ph.D., discusses the long history of physicians' involvement in providing athletes with performance-enhancing drugs. While organized medicine has opposed doping as a matter of policy at least since the 1950s, sports physicians have never adequately confronted the conflicts of interest between elite athletic performance and healing in the traditional sense.

As the techniques used by athletes to gain a competitive advantage become more sophisticated, the temptation for physicians to participate in doping intensifies. Some athletes have used blood transfusions or the red blood cell-promoting hormone erythropoietin (EPO) to increase the oxygen-carrying capacity of their blood. One article in the special issue outlines strategies to detect EPO, which can be problematic because EPO is a natural hormone, not a drug or banned substance that can simply be tested as present or absent.

Another article--titled "Beyond EPO"--provides an update on even more sophisticated attempts to improve the oxygen-carrying capacity of athletes' blood, such as hemoglobin oxygen carriers. It has even been suggested that athletes may one day try genetic engineering techniques in an attempt to gain a competitive edge.

Other topics covered in the special theme issue include:*Use of stimulants in sports: focusing on an "informed decision-making" approach to evaluating the use of stimulants--from caffeine to over-the-counter stimulants to amphetamines--by athletes.

*Use of inhaled medications by athletes with asthma: the number of Olympic athletes with asthma has risen sharply in recent years, and athletes are now required to provide medical proof that they need to use inhaled drugs.

*Use of nutritional supplements: athletes are using a wide range of supplements to enhance their performance, in the absence of any regulation or quality standards.

*Misuse of the testosterone-producing steroid DHEA.

*Use of growth hormone. (Bad news for athletes trying this "performance-enhancing" substance --it doesn't work.)

In response to repeated doping scandals, extensive prevention and detection efforts are being implemented worldwide. For example, the World Anti-Doping Agency was created to work toward consistency and quality of doping control. "Sport physicians have unique responsibilities in this area. It is no small privilege to be asked to provide care and counsel for athletes," write Drs. Andrew Pipe and Thomas Best in an editorial. They express the hope that the special issue of Clinical Journal of Sport Medicine will compel all sports physicians to "take note of the responsibility each of us has to our profession, to sport, and to the athletes entrusted to our care."