Health Viewpoint: Drugs in sport: confusion rules

ONE IN 50 male high-school students in the United States take anabolic steroids - not to make them better at sport, but to improve their appearance. Musicians take beta-blockers to enhance their performances; medical students take them before their exams. Both drugs are banned by the International Olympic Committee's Medical Commission (IOCMC).

Why is there so little fuss about using drugs to improve the chances of getting a date or perform better in a concert or professional examination, but so much about using them in sport? Almost invariably the answer is that the use of drugs in sport is cheating and unfair to other competitors. Usually there are subsidiary comments about the dangers of taking them.

What is never explained is how the IOCMC imagines it is increasing competitive fairness by imposing drug abuse regulations which are themselves arbitrary and unfair. One might assume that the IOCMC, and the Sports Council's Drug Abuse Advisory Group, would have clinical pharmacologists - specialists in the effects of drugs - as expert members, but neither group has ever included one.

One might also assume that an august Olympic body would compile its list of banned substances on the basis of solid facts. But there is an almost total absence of hard evidence that any drug enhances sporting performance. The best controlled trial of steroid use among weightlifters showed that steroids produced no real improvement. The only scientifically reliable evidence is that oxprenolol, a beta-blocker, improves the performance of middle-grade pistol shooters (it either makes no difference to top-grade pistol shooters or actually reduces their scores). No other banned drug has been shown unequivocally to improve performance.

There are many examples of the absence of expert input to the lists. Six classes of drugs are banned: consider the group that covers 'stimulants'. Five are drugs for severe respiratory failure and can only be given continuously, intravenously. But they stimulate more of the brain than its respiratory centre. Dizziness, confusion, a variety of breathing problems, spasticity and convulsions are such frequent side-effects that the drugs are rarely used, even on extremely ill patients.

The stimulant list also includes amineptine, an antidepressant available only in France. Elsewhere it has been withdrawn because it can often cause liver damage. Far from being a stimulant, it leads to drowsiness. None of the other dozen or so tricyclic antidepressants is banned.

Morazone is listed as a stimulant, but is a mild pain-reliever. Strychnine is listed because it stimulates respiration before it kills you - and 10 milligrams are likely to be fatal.

The fact is that oxprenolol is the only substance on a list of more than 100 named drugs and 'related compounds' that has a firm scientific basis for inclusion. Some drugs are on the list simply because sportsmen and women experimented with them and the authorities found out. The ban itself then encouraged others to try them. Some are on the list because there are theoretical reasons to suggest that they might enhance performance. Some, such as the 'stimulants', are there for no proven reason at all.

To have produced a list like this is not without danger. Because of the way in which the list is presented, some athletes may assume that all the drugs on it boost performance, and be tempted to try them. In the Sports Council leaflet Dying to Win, the risks of some banned drugs are greatly exaggerated.

The list may also endanger those who have a real medical need for the drugs. It is not unusual to have older competitors in sports such as yachting, riding or shooting who may need treatment for high blood pressure. Both of the first-line treatments - beta-blockers and diuretics - are banned, so that such competitors would have to take more powerful drugs, with the attendant risks of greater side-effects. Similar problems arise from the ban on oral or intramuscular corticosteroids, used to treat several chronic diseases and by some transplant patients.

Nor is any attempt made to distinguish drugs used to restore an unwell competitor's performance to normal from those believed to enhance performance. Half the positive drug tests in the UK revealed substances available over the counter as cold remedies or moderate pain-relievers. In nearly every case these will have been used to treat a mild problem in the same way that I am permitted to treat my hay fever.

It is obviously unfair to permit the use of some 'restorative' drugs such as aspirin or paracetamol to treat minor conditions but not others; yet codeine is banned. If the IOCMC decided to remove from its list some of the drugs put there for the most illogical reasons, it should at the same time permit athletes to take drugs that can only be restorative.

Such a radical change would not, however, go even half-way towards knocking some sense into the IOCMC rules. The experience of trying to combat drugs of addiction has shown that criminalising their use does not help. Somehow one must reduce the incentives to use them.

Drug abuse tends not to occur in less physically demanding sports, in which men and women can compete for decades. It is much more common in sports where a lot of money is available to those who will be at the top for only a few years. Those sports also seem to have administrators who make fortunes out of them, adding to the incentive for participants to do whatever they can in order to make big money, too.

If the Olympic movement, and sport in general, wants to reduce the use of drugs, three things are needed: administrators whose primary interest is in the sports, not in making millions; a rational, scientifically-based list of drugs banned because they have been shown to boost performance, not merely restore a competitor to normal; and a much greater amount of money spent on education - the Sports Council spends only 5 per cent of its drug abuse budget on information and education. If these things happened there would be a reasonable expectation that sportsmen and women would, from their schooldays, be given reliable information about drugs.

Dr Richard Nicholson is editor of 'Bulletin of Medical Ethics' and an international target shooter.