Drugs, Doping and Disqualification: The Dark Side of Victory
Written By Maria-Amalia Deicu
What is doping?
Doping is the use of drugs or other substances in the scope of performance enhancement. The practice of using performance-enhancing drugs (PEDs) to improve athletic performance can be traced back to the original Olympic Games in ancient Greece, which began in 776 BC. Athletes of that era used various alcoholic mixtures and ate hallucinogenic mushrooms to enhance their performance. They also used various plants to improve speed and endurance, while others were taken to reduce pain, allowing athletes to continue competing despite their injuries. It is notable that even in ancient Greece, doping was considered unjust and immoral, with those caught doping being banned from competing. Their names were often engraved on stone pedestals placed along the pathway to the stadium, publicly shaming them.
There have been as many as 442 positive doping tests at the Olympic Games between 1968 to October 2023. The market for doping substances has greatly increased, with these substances no longer being monopolised by elite athletes, but also infiltrating schools and universities. This has created significant challenges in maintaining the integrity of athletic competition at all levels. While advancements in science and medicine have greatly benefited sports - optimising training methods, recovery processes, and overall athlete health - it is crucial that these tools are not exploited as a means to gain an unfair advantage.
The banned substances and methods
The World Anti-Doping Agency (WADA), established in 1999, works to combat doping in sports by annually updating its Prohibited List. This serves as the global standard for identifying banned PEDs and methods in competitive sports. For a substance to be placed on the Prohibited List, it must meet at least two of the following criteria: enhance performance, pose a risk to the athlete, or violate the spirit of sport. The Prohibited List is categorised into substances and methods banned at all times (e.g. anabolic steroids, beta-2 agonists, diuretics and masking agents), only in competitions (e.g. stimulants, narcotics, cannabinoids, and glucocorticoids), or in certain sports.
Anabolic steroids like testosterone (and its synthetic derivatives) are the most used PEDs at elite level sports. They increase muscle mass and strength (by increasing the rate of protein synthesis) and speed up recovery times, allowing athletes to undergo more intense training than they would otherwise be able to. These were commonly used in the 1970s in strength related sports such as weightlifting, resulting in numerous disqualifications.
Diuretics were banned due to concerns that they could dilute urine, allowing athletes using prohibited substances (especially anabolic steroids) to evade detection. Since 1988, 11 athletes have been disqualified from the Olympics for testing positive for furosemide, mainly in weightlifting and other weight-classified sports.
Stimulants have been shown to improve endurance, anaerobic performance and reaction times whilst decreasing feelings of fatigue and also cause weight loss. At the 1972 Munich Olympics, all seven cyclists (four of whom won medals) tested positive for a stimulant. Notably, while WADA has banned stimulants, it permits the use of caffeine.
WADA has also outlined a range of prohibited methods including blood manipulation, chemical and physical manipulation, and gene/cell doping. Blood manipulation involves the administration/reintroduction of autologous, allogenic (homologous), or heterologous blood into the circulatory system. It also bans methods used to artificially enhance the uptake, transport or delivery of oxygen (excluding supplemental oxygen by inhalation) in the aim to increase oxygen-carrying capacity and endurance. At the 2002 Salt Lake City Winter Games, three cross-country skiers who collectively won eight medals (including six golds) faced sanctions after darbepoetin, a form of EPO, was detected in their urine. Chemical and physical manipulation includes tampering (or attempting to tamper) with the integrity and validity of samples collected during doping control. This is usually done in the aim to mask the presence of PEDs or avoid detection. Gene/cell doping involves using nucleic acids, gene editing agents, or transferring normal or genetically modified cells to enhance an athlete’s performance. Gene/cell doping poses a notable challenge for detection and is associated with a range of potential health risks including cancer.
In 2009, FINA (now World Aquatics) banned swimsuits with polyurethane. The “super-suits” developed with NASA’s help were made of a thin layer of foam-like material with microscopic gas pockets, dramatically increasing buoyancy. Consequently, swimmers floated higher in the water, reducing drag and increasing speed. The Olympic committee referred to the 2008 Beijing Games as a time when “technology went too far”, emphasising a need to refocus on athletic ability as opposed to technological advancements.
Testing for doping
Doping tests were first introduced at the 1966 European Championships, with Olympic testing beginning at the 1968 Winter Games in Grenoble. The establishment of WADA in 1999 allowed international standards for anti-doping to be set.
The development of the Athlete Biological Passport (ABP) in 2009 marked a significant advancement in doping detection. This electronic record that monitors specific biological variables of an athlete over time, creating a unique profile. Substantial variation from an athlete’s established baseline can indicate doping (as opposed to directly detecting the use of a banned substance). The ABP has three main modules: haematological, steroidal, and endocrine. The haematological module tracks blood parameters like haematocrit and haemoglobin to detect blood doping. The steroidal module analyses urine and serum for steroid markers to differentiate between endogenous (natural) and exogenous (synthetic) steroids and can identify tampering with urine samples. The endocrine module detects recombinant human growth hormone (hGH) and its analogues, with abnormalities indicating potential doping.
In addition to the ABP, mass spectrometry techniques remain the gold standard for detecting the use of PEDs. This method can identify traces of prohibited substances in urine or blood, using isotope ratio mass spectrometry to distinguish between endogenous and exogenous anabolic steroids.
Despite WADA’s rigorous testing methods, many cases can, and do, go undetected. An anonymous survey in 2011 revealed that 57% of athletes admitted to doping in the last year, a stark contrast to WADA’s 1-2% detection rate and the 14% incidence estimated by the ABP. By consuming prohibited PEDs well in advance of competitions, athletes can benefit from their effects whilst avoiding detection during testing periods. Consequently, athletes can gain an unfair competitive edge over others whilst bypassing the anti-doping measures, unveiling a significant challenge in maintaining fairness in sports.
Why do athletes dope?
Athletes resort to doping due to various reasons, including performance enhancement, psychological factors, and external pressures. One of the primary motivations for doping is the desire to improve athletic performance. Athletes often seek to increase their strength, endurance and recovery speed whilst also masking pain during intense training or competitions. Whilst many athletes accept that doping is unethical and poses many risks to their health, they also acknowledge its effectiveness. This leads them to make decisions that compromise both their health and integrity.
Issues related to body image, anxiety and depression may drive athletes to seek substances that promise improved physical appearance or competitive advantages. Additionally, the intense pressure to perform at elite levels can create an overwhelming sense of urgency to dope in order to meet the high expectations set by themselves, coaches and supporters.
Financial incentives further complicate the issue. Exceptional performances can lead to sponsorships and support, motivating athletes to enhance their abilities through any means necessary. The false consensus effect - a psychological bias where individuals overestimate how many others share their behaviours – exacerbates this pressure. Faced with immense expectations to perform at the highest levels, athletes may perceive doping as not only common but essential to meet those demands. Athletes may come to believe that most of their competitors are also doping, creating a false sense of widespread acceptance, often fuelled by the visible success of those achieving extraordinary results. This belief justifies their own use of PEDs, making doping seem necessary to remain competitive. In turn, it reinforces the notion that it’s only fair to dope if others are doing so, further diminishing moral conflict and normalising unethical behaviour within sport.
Interestingly, research indicates that doping is less prevalent in team sports (such as football) compared to individual sports (such as cycling and swimming). This discrepancy may be due to the positive influence athletes have on each other within a team environment, encouraging healthier decision-making against doping. Alternatively, it could stem from less rigorous testing protocols in team sports, leading to fewer detected cases of doping. However, virtually all sports have been affected by doping to some degree, with cycling standing out as the sport with the most high-profile allegations over the past 150 years. Its history is marked by numerous scandals, including the infamous 1988 Tour de France, where many finishers either tested positive or admitted to using PEDs. In 2013, Lance Armstrong admitted to doping in an interview with Oprah Winfrey, resulting in the loss of his seven Tour de France titles and a lifetime ban from competitive sports. This marked a pivotal moment in the fight against doping, sparking calls for stronger regulations, improved testing, and greater transparency, while also sending a clear message about the severe consequences of doping and the critical need to preserve the integrity of sport.
Impact and consequences of doping
Doping poses a variety of serious consequences that not only undermine the core values of sports, but also negatively impact athletes in many ways. One of the major issues is the health risks associated with PEDs. These substances can lead to severe physical health problems such as kidney damage, cardiovascular diseases and even cancer. Beyond physical health, doping can adversely affect an athlete’s mental well-being, leading to anxiety, depression, and many more.
Athletes caught doping often suffer substantial damage to their reputation and a loss of status. Their personal and professional lives may also be affected, leading to social isolation. Additionally, they may face disqualification, loss of medals and titles and bans from competition that can last from a few months to a lifetime. Athletes who use PEDs gain an unfair advantage over their “clean” competitors, violating the fundamental spirit of sports. This not only disadvantages those who follow the rules, but also influences younger aspiring athletes to follow suit.
When evaluating the role of science and medicine in enhancing athletic performance, we have to ask ourselves: what ethical boundaries should we establish, and where do we draw the line? Despite clear legal and ethical frameworks to combat doping, the persistence of the false consensus effect keeps doping widespread in many sports. Even with clear regulations, athletes continue to break the rules, believing that doping is not only common but essential for success. This raises a key challenge: How can doping be stopped when athletes view it as an accepted, even necessary, practice?
To break this cycle, science and medicine must play a more proactive role in reshaping attitudes toward doping. While advances in detection are vital, they’re not enough. Education on the long-term health risks and ethical consequences of doping is crucial, as is fostering a culture that values fair competitions. Sports organisations and sponsors must also lead by example, supporting clean athletes and emphasising that success should come through integrity, not doping. Only by addressing the underlying psychological and cultural factors, like the false consensus effect, can we hope to reduce doping and restore fairness in sport.
Read the rest of the edition here
