The contradictions of drugs in sport

When is it legal? Dr Xand van Tulleken investigates

112386

Tim Montgomery is charming, friendly and surprisingly slight, bearing in mind that he was, briefly, the fastest man in history. I watched him win the men’s 100m in 2002 at the IAAF grand prix final in Paris. It took him 9.78 seconds, but he was stripped of the record three years later when he was found guilty of drug-taking in a US Anti-Doping Agency investigation.

Of the eight runners in that race, three were banned for doping offences, one for supplying drugs and a fifth received a warning after a positive test. Montgomery admitted, and described in detail, the many banned substances he used, including testosterone and human growth hormone; at one point he was taking 25 to 30 pills a day. His fall from grace after his suspen- sion was catastrophic: he served prison sentences for cheque fraud and dealing heroin and now lives modestly in Gainesville, Florida.

Sport today is certainly no cleaner than it was then. The London 2012 Olympic Games were supposed to be the cleanest in history, but in the past six weeks recent retesting of urine samples from those Games has led to the banning of 23 athletes, with the prospect of more to follow. The Russian track and field team has been banned from the Rio Olympics this summer because of compelling evidence of systemic, possibly state-sponsored, doping. And there has been a steady stream of scandals involving doping across many sports, from Lance Armstrong in cycling to, recently, tennis star Maria Sharapova. And yet we continue to enjoy Wimbledon, and are looking forwards (perhaps with some trepidation) to Rio. 

When I met Tim Montgomery I didn’t feel as if I was meeting a cheat who had gained an unfair advantage. The public outrage when athletes are caught cheating – or at least the outrage expressed in the media on behalf of the public – seems to me to exist in a peculiar world of vague morality. We love watching ever greater sporting triumphs and live in denial of, rather than real ignorance about, the ubiquity of performance-enhancing drugs in high-level sport. Official and public reactions to drug cheats seem to me to ignore the most important aspect of the consequences of doping – the very real danger that it poses to public health. 

There’s a consensus that those taking performance-enhancing drugs should be banned. But I’m uneasy with that because the difficulty in deciding where the line is drawn means that many of the rules are unnecessary, distracting and hard to enforce. Perhaps the best example of the contradictions, wrong thinking and silliness of the way in which drugs in sport have been discussed and regulated is the most popular drug in the world. Caffeine.

The questions around caffeine reveal the uselessness of the World Anti-Doping Agency’s (Wada) logic in regulating drugs. Caffeine was a prohibited substance until 2004 and is still on the “monitoring program” to “detect patterns of misuse”. A substance has to meet two out of three of the following criteria for Wada to consider banning it: potential to enhance or enhances sports performance; an actual or potential health risk to the athlete; use violates the spirit of sport.

112393

False claim: Montgomery’s world record in the 2002 IAAF grand prix final was fuelled by drugs

Caffeine does seem to satisfy the first: studies show that it improves muscle contractibility; increases time to exhaustion; improves concentration; enhances alertness; and reduces fatigue. My identical twin brother Chris and I took part in an experiment for Horizon that showed caffeine caused a three per cent improvement in performance over a 1km run. The five-second margin I won by is the difference between a place on the podium and going home empty-handed.

It does not, as far as I’m concerned, satisfy the second criterion: the doses required for benefit are (depending on the person) roughly the equivalent of two shots of espresso. Performance decreases at higher doses and long before it gets dangerous to health.

The third criterion – the spirit of sport – seems at best vague and frankly, in the context of the modern Olympics with its associated corruption, an irrelevance.

But even if it does satisfy two out of three of these criteria I don’t believe anyone would think a sprinter having a cup of coffee at breakfast was a cheat. And there are other examples. High- altitude training routinely undertaken by distance runners in places such as Kenya artifi- cially distorts the chemistry of the body by producing more oxygen-carrying red blood cells. No one has suggested ending that, but Wada has considered banning the use of simulated alti- tude devices (low-oxygen tents to sleep in).

But it gets much more peculiar: into the realms of very poorly understood neurophysiology. I underwent “brain-doping” in a lab at Kent University – a practice that involves, and I’m not really oversimplifying much here, a nine-volt battery and a couple of wires plugged into sponges soaked in salt water and strapped to a precise area of your scalp. It’s called transcranial direct stimulation or tCDS, is painless and seems to work by reducing your brain’s perception of pain, allowing you to train longer and harder. I only obtained a small improvement, but the data suggests that, depending on the event, it can confer a significant advantage.

What isn’t known is the long-term effect of stimulating your brain in this way. It is currently undetectable by the doping authorities and easy enough to do that it seems to be catching on. The US ski team have trialled headphones for training with the so-called trans-cranial direct stimulation tCDS systems built in. There are many other ways to improve your performance: focusing on technique, psychology, equipment, diet and training programmes all make a significant impact, but those things are rarely exclusive enough to give an athlete an edge. Thus the proliferation of use of performance- enhancing drugs (PEDs).

My biggest concern about the use of PEDs is not directed at elite athletes such as Tim Montgomery. They are exposed to great risks, but they’re mostly adults and usually fairly well supervised and monitored. They are weighing up whether the potential benefits outweigh the obvious side-effects, which range from the unpleasant to the life-threatening. You could argue that as long as they know the risks and as long as the drugs have been tested and cleared for over-the-counter use, why shouldn’t athletes be allowed to use them? I think that’s a valid view, though some of the newest ways of doping are molecules never intended for human use and pose huge safety concerns. But the controversies around banning athletes are a huge distraction from a much bigger concern than even the health of high-level athletes.

Those who need protecting are children, adolescents and amateurs. The rewards of breaking into professional sport, or the desire to succeed at an amateur level, are coupled to the increasing availability of PEDs, and instructions on how to use them, on the internet. Some estimates now put the number of users in the UK at several hundred thousand. This, to me, is the crisis that professional sport faces: setting a potentially fatal example to the many among us who model our lives on our sporting heroes.The sanctimonious hand-wringing over the morality of cheating (The New York Times repeatedly calls for a “level playing field”) is a red herring; we should be worried about the long-term health effects of widespread unsupervised use of seductive and deeply dangerous products. It isn’t a problem simply for the image of cycling or tennis, it’s a huge, poorly understood health threat to the public.

Advertisement