At Any Cost: Cheating, Integrity, and the Olympics

Researchers continue to advance the science behind doping in sports and are developing detection measures to catch the cheaters. But will it be enough to maintain the integrity of the Olympic Games?

Published August 1, 2004

By Diane Kightlinger
Academy Contributor

Crossing the finish line in Athens this August should mark the climax of the athletes’ quest to put native ability, training, perseverance, and courage to work in pursuit of their Olympic moment. And provided that’s all the athletes bring into play, they won’t mind the team waiting on the sidelines to signal the start of the next challenge – the contest between the dopers and the testers.

The result can topple victors, strip medals, and bar athletes from competing, possibly for life. For now, the competitors know only that sometime between the victory lap and awards ceremony and press conference, the doping control team will take aside the top four finishers and two other randomly selected athletes to find out if they played true.

Drug testing in the Olympic Games began in 1968, a response to illness and death caused by widespread amphetamine use in prior decades. Since then, the estimate of how many athletes use performance-enhancing drugs in sport has ranged from almost none to almost all. Look at test results and the dopers amount to less than 3% of athletes; ask coaches and trainers and the number can rise as high as 90%, according to “Winning at Any Cost: Doping in Olympic Sports,” a September 2000 report released by the National Center of Addiction and Substance Abuse (CASA) at Columbia University.

Banned Substances

Today the pharmacopoeia of substances banned at the Olympic Games includes not only stimulants, but narcotics, anabolic steroids, beta-2 agonists, peptide hormones such as EPO (erythropoietin) and hGH (human growth hormone), and a shelf-full of masking agents. Add designer drugs like the steroid THG (tetrahydrogestrinone), around which the Balco scandal churns, plus the specter of gene doping, anticipated by the Beijing Olympics in 2008, and the testers face increasing odds of losing the detection game.

But don’t count them out just yet. The researchers and administrators focused on catching dopers have won important battles in recent years by developing tests for THG and EPO and by using them to catch abusers. Testers are increasingly taking a proactive stance, anticipating their opponents’ next moves and the techniques needed to identify illegal substances and methods. And the creation of the World Anti-Doping Agency (WADA) in November 1999 should soon result in near-universal standards for doping control across sports federations and countries.

Whether in- or out-of-competition, sample collection today is a painstaking ritual overseen by the athlete, his representative, doping control agents, and independent observers who act as the public’s eyes and ears. The athlete selects a sealed collection vessel and provides a 75-ml urine sample in view of a doping control officer (DCO) of the same gender. After dividing the urine into A and B bottles, the competitor seals them securely and makes sure the DCO records the correct code on the control form. Blood tests employ a phlebotomist and similar procedures to obtain 2 tubes of at least 2-ml each.

Gaming the Tests

On site, the DCO checks the urine’s pH and specific gravity to ensure it will prove suitable for analysis, and may also screen the blood sample for reticulocytes, hemoglobin, and hematocrit. Athletes must document all prescription and nonprescription drugs, vitamins, minerals, and supplements they take; then all parties sign the doping control form and the samples are sent by courier for analysis at one of 31 laboratories accredited by WADA.

But testing during the Olympic Games accomplishes only so much: It won’t catch athletes who use steroids to bulk up during training but stop months before the Games, or those who use EPO much more than a few days before competition. “Ninety to 95% of the solution is effective, year-round, no-notice testing,” according to Casey Wade, WADA education director. “Give athletes more than 24 hours’ notice and they can provide a sample all right, but it’s going to be free from detection.”

The International Olympic Committee (IOC) requires most Olympic athletes to make themselves available for doping tests anytime and anywhere for one year prior to the opening of the Games. WADA plans some 2,400 tests this year, with a selection process based on the requirements of each sport, the substances an athlete might use, when the abuse might occur, and how long the body will take to clear the drug from the athlete’s system before the Athens Games start.

Once the Olympic village opens for the Games, the IOC will take charge of testing at sporting venues. WADA will continue to conduct out-of-competition tests inside and outside Greece, however, and at non-Olympic venues in Athens to determine which athletes will be allowed to take part in the Games.

The Key to Meaningful Doping Tests

The key to meaningful doping tests lies in the lab’s ability to detect substances and also to document the chain of custody meticulously enough to meet the burden of proof in court cases. Once the samples arrive in the lab, scientists store the B bottle for use in confirmation tests, and open the A bottle, withdraw multiple aliquots, and test for substances on the WADA Prohibited List. The U.S. Olympic Lab at the University of California at Los Angeles, a preeminent testing facility, employs an array of mass spectrometry techniques to work through the samples.

“Mass spectrometry breaks up the molecules and sorts the resulting fragments by mass,” said Don Catlin, the lab’s director. “We can identify steroids by chemical moieties with characteristic masses but, for example, THG was modified in such a way that it lacked those characteristic fragments, making it difficult to spot on conventional tests.”

THG posed only one of many challenges the lab has faced and overcome. Catlin said that the detection of EPO and hGH abuse is particularly vexing. EPO increases oxygen delivery to the muscles, and hGH enhances muscle growth. As potent substances, both appear only in minute quantities in body fluids.

“With methyltestosterone, you might have 500 nanograms per ml of urine; with EPO, you might have less than a nanogram,” explained Catlin. “You have to extract the EPO from the urine, and the less there is, the more difficult it is to extract with good recovery. Then you’re faced with the final jolt: EPO has a molecular weight of 30,000 to 35,000, whereas most of the drugs we’re working with have molecular weights of 300. EPO molecules are too large for our mass spectrometers, which means we have to use different approaches based on molecular biology. It’s really tough work.”

Blood and Gene Doping

A long-acting form of EPO, darbepoetin, became available shortly before the Winter Games in 2002. The existing test for EPO could detect darbepoetin, but Catlin chose not to announce it – catching two gold medalists. Both were stripped of medals for events in which they tested positive in Salt Lake City and, later, of all medals they won at the Games.

For hGH, scientists, lab directors, physicians, and administrators have not yet agreed on a test, but that doesn’t mean athletes can freely abuse the substance. WADA has placed hGH on the Prohibited List, and DCOs will draw, freeze and store blood samples during the Athens Games for later analysis.

In addition to banning dozens of substances, the Prohibited List also bans methods such as blood and gene doping. The proliferation of gene therapy trials, which now number in the hundreds, and the promise of gene transfer methods to build skeletal muscle and increase red blood cell production, make genetic approaches to enhancing performance an encroaching reality.

“All the technology is in the medical literature,” said Theodore Friedmann, director of the Program in Human Gene Therapy at the University of California at San Diego. “The genes are all available or you can make them. The vectors, the viral tools, are all published and available. All it takes is three or four reasonably well-trained post-docs and a million or two dollars.”

On and Off: Inducible Genes

With that in mind, researchers are already focusing on several approaches for gene doping tests. Geoffrey Goldspink, professor, University College Medical School, London, England, described some of the possibilities being pursued. If an adenovirus or lentovirus is used as the vector to transmit a gene such as hGH, Goldspink said, the virus might also move into cells in the blood or mucus. A scrape of the inside of the cheek, followed by real-time RT-PCR (Polymerase Chain Reaction), could produce sufficient sample for scientists to distinguish the wild-type virus from the engineered version.

In addition, some gene transfer techniques may involve inducible genes, which can be switched on and off. Without a mechanism to stop production, EPO could swamp the body with red blood cells, for instance. But introducing a gene that can handle the switching function might give testers a detectable bit of DNA on the vector. Friedmann cautioned that although these approaches represent reasonable first steps, new technology will be required to characterize the system and enable researchers to predict when vectors or genes or gene products will appear and then detect them.

Whatever techniques ultimately prove viable, they are likely to drive one change already taking place: the shift from urine to blood tests for detection. “Some of the new tests that we are developing are based on the blood matrix,” said Olivier Rabin, WADA science director. “This is clearly going to be used to detect new substances, to better detect blood transfusions, and also in the future to detect gene doping.”

The Magnitude of the Doping Problem

For decades, the magnitude of the doping problem among Olympic sports and the rewards made possible by ignoring the issue tarnished every medal awarded, even if the athlete tested clean. Tom Murray, bioethicist and president of the Hastings Center in Garrison, New York, and a longtime member of the committee entrusted with drug control for the U.S. Olympic team, said “I think for most of the time, drug control was just seen as a nuisance that they’d rather have go away. Their concerns were marketing and bringing home medals. Drug control was just a pain.”

Since the inception of quasi-independent organizations such as WADA and the national anti-doping agencies, which are funded only partly by their respective Olympic committees, many of the problems cited in the CASA report of 2000 have been alleviated. WADA employs a standard protocol for establishing the Prohibited List; accredits testing labs around the world; sends independent observers to oversee major events; and provides timely notice of banned substances and methods for athletes, coaches, and administrators. In addition, a detailed approach to reporting and managing results insures legal recourse and standard sanctions for athletes who test positive.

Making Strides

On the other hand, the $3 million in research grants doled out by WADA each year, combined with $2 million from the U.S. Anti-Doping Agency, still runs far shy of the $50 million to $100 million collaborative effort over five years that the CASA report called for. But scientists are making strides by developing effective tests, streamlining existing procedures, and lowering costs.

And they seem almost eager to face sophisticated new substances and delivery systems, no matter how difficult detection may be. Catlin summed up his view by saying, “We’re still here, we’re still able to hold our heads up. When I toss in the towel, because there’s so much doping by so many means that we can’t detect it, then it’s an issue. But I don’t think we’re there yet.”

Also read: The Science Behind Doping in Sports