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June 15, 2004

Welcome To The Pharmacology Olympics

(Ed.- It is with chilling irony that this month’s guest writer—the highly regarded Dr. Gary Wadler, preeminent expert in performance-enhancing drugs, has selected “Pharmacology Olympics” as the tongue-in-cheek theme of his essay. Performance-enhancing drugs have moved to the front and center of a profoundly fundamental debate pitting “naturally” developed athletes versus “artificially” improved athletes. Thus, not only are athletes competing with one another, so are pharmacologists.)

By Gary I. Wadler. M.D.

CONSIDER TODAY’S PHARMACOLOGY PROFESSIONALS. Diligent, dedicated and largely unnoticed, they labor anonymously in research laboratories, pharmaceutical companies and in clinical settings, such as medical schools and hospitals. They are the backbone of modern pharmacology and therapeutics.

A small subset of pharmacologists gravitated to the forensic, law enforcement and anti-doping niches of the profession. Others, sadly, have drifted into the unscrupulous substrata of their profession, plying their skills for the devious purposes of developing illegal and/or undetectable performance-enhancing drugs, where money is a prime motivator for participation in these nefarious activities.

But there are other seductions as well. For some, it is the desire to bask in the celebrity of their client-athletes. For others, it is the opportunity to develop drugs—albeit illegal—unfettered by restrictive oversight of corporate, academic and government institutions.

MEANWHILE, THE INTENSITY AND COMPETITIVENESS of American sports have increased alarmingly at all levels. Excesses in youth sports have become commonplace. Much of high school and college athletics has become viciously cutthroat. The spoils of the victors—notoriety, ego satisfaction, high draft selections, Olympics glory, lucrative endorsement futures—all but guarantee a cycle of crazed competitive intemperance.

However, it is at the professional level that athletes, awash with mountains of money, dazzled with national and international recognition, have most acutely experienced the mind-boggling pressure to win-win-win at any cost, even if it means using illicit performance-enhancing drugs.

Some exceptionally gifted professional athletes, naturally blessed with the incredible speed, reflexes, size and strength become—and remain—champions in their sport, free of performance-enhancing drugs, such as Ted Williams, Gordie Howe, Tiger Woods, Muhammad Ali, Pete Sampras, Chris Evert, Wilma Rudolf, Michael Jordan, Gale Sayers, Pele and Mario Andretti.

And there have been many professionals who, perhaps somewhat less gifted, have nonetheless succeeded in navigating their path to drug-free glory by way of tried and true, scientifically and ethically sound training techniques, intense physical regimens, exhaustive analysis of the mechanics/strategy of their sport, maximum effort at all times, nutritionally sound diets, and psychological methods.

Sadly, another group of elite athletes have turned to anabolic steroids and other prohibited performance-enhancing drugs and techniques. From the appalling doping experiments by the East German Olympic teams in the fifties, we have steadily “progressed” through a succession of more potent (and, in some cases, less and less detectable) prohibited performance-enhancing drugs and methods. And there is nothing ethical, legal, safe or sporting about these drugs and methods.

Countless athletes desperate to get on top, or stay on top, have sacrificed their future health by experimenting recklessly with dangerous performance-enhancing drugs.

As our society seems to increasingly reward winning, less and less our society seems to reward hard work, fair play and “doing the right thing.” Too often it has become “It matters not how you play the game, it’s whether you win”, and not the other way around.

Against this daunting backdrop, it is no wonder that there are all manner of cheaters, schemers, short-cut artists and opportunists constantly pushing the envelope to win at all costs.

FOR THOSE OF US involved in the active pursuit of the maintenance of the purity and fairness in athletic competition, these are trying times indeed.

Despite this bleak landscape, I believe that there remains an enduring commitment by responsible world leaders in the fundamental tenets of law, order and propriety. From these tenets have been developed rules, standards and parameters for all the institutions of our society: business, medicine, politics, law, and . . . sports.

It is in this context that, at the international level, the World Anti-Doping Association (WADA) was created in 1999. The WADA was a shared initiative of sport and world governments, with a vision for a world that values and encourages a doping-free culture. The WADA is committed to promoting and coordinating the fight against doping at the international and national level through education, advocacy, research and leadership. Similarly, at the national level, the United States Anti-Doping Agency (USADA) was established in conformity with the standards of the WADA.

At present, professional sports in the United States remain apart from both the WADA and USADA. The professional leagues, as a group, are a panoply of separate jurisdictions with a lack of coordinated effort to standardize performance-enhancing drug proscriptions, with each pro league having different rules and penalties regarding drug use. Some conduct random testing, some don’t. Some have lenient warning mechanisms; some impose immediate suspensions. Some have strong players’ unions that resist testing; some don’t.

Nonetheless, all four major pro leagues in the United States prohibit the use of performance-enhancing drugs, although with great disparity among them as to which drugs are banned. By far the most comprehensive anti-doping program in professional sports is that of the NFL, with the least comprehensive being the NHL.

GAMBLING HAS LONG BEEN considered the bane of legitimate sports competition. It is thought—and rightly so—that sports wagering results in a severe erosion of the integrity and authenticity of competition. If fans realize that outcomes are pre-ordained (due to gambling pay-offs), they likely will stay away.

Performance-enhancing drugs present a similar threat to the integrity of sports. Athletes willing to break the rules and take risks with their health and safety amount to a de facto separate class of competitors. And it is patently unfair to have drug-abusing athletes compete on the same field of play with clean athletes.

And why this headlong rush into risky doping experimentation?

The causes are numerous and complex and are beyond the scope of this article. To be sure, this is not a new phenomenon. Evidence of such abuse dates back to the earliest recorded history of sports. While some reasons relate to the individual and others are more societal, to be sure, the adoration that our society places on sports heroes is a significant factor.

Such hero worship has caused many sports fans to develop an indifference to, or a tolerance of, athletes’ use of performance enhancement drugs, no matter whether their use is illegal, dangerous or unethical. So long as their sports heroes set records and win championships, these star struck fans are satiated.

SO WHERE’S THE GOOD NEWS? Recent unprecedented actions by the USADA are helping to tilt the balance toward the forces of fair and ethical play. In conformity with both the International Amateur Athletics Foundation (IAAF), the international federation that governs track and field, and in conformity with the World Anti-Doping Code of WADA, the USADA has recently implemented a policy of sanctioning athletes on the basis of a so-called “non-analytic positive”. This policy provides for a process in which documented evidence, using defined legal standards of proof, can be used in lieu of positive urine or blood tests. This policy could remedy some of the shortcomings of standard drug testing, which has too often been one step behind in the detection of new designer drugs.

Just last month we saw the first athlete—Kelli White—barred from the Olympics based on documentary evidence only. As part of the sordid Balco investigation, USADA used no positive urine samples or blood tests whatsoever in handing down a two year suspension. A champion sprinter, White had been expected to win several medals at the Athens Olympics.

THE FUTURE REMAINS UNCERTAIN. I see two possible scenarios for the future of performance-enhancing drugs and methods. Clearly, as legitimate advances continue in the fields of pharmacology and therapeutics, new drugs and methods such as gene therapy, will present new opportunities for abuse.

In the first scenario, we could develop into an “anything goes” society, in which ends justify means, morality is relative, ethics are ignored, and playing God is not considered to be an issue. In this scenario, the inevitable pharmacological and therapeutic miracles that we all await will paradoxically provide a frightening array of options for those determined to win at any cost. In this scenario the line between natural and artificial would become increasingly blurred.

In the second scenario, law, order, rules and regulation would prevail. Pharmacological and therapeutic advances will remain tightly regulated and permitted for bona fide medical reasons only—not for performance enhancement. In this scenario, governments, plus international and national sports governing bodies, including the academic community, will play key leadership roles in maintaining and assuring that the ethical foundations and integrity of sports are rigorously adhered to.

The challenges before us are greater than ever before. However, I remain optimistic that institutional foundations are now in place to assure that competitive athletics are governed by the principles of safe and ethical play. In this regard, our policy makers must stay firm in their resolve. Nothing less than the integrity of athletic competition hangs in the balance.

As George Will, the renowned columnist noted: “A society’s recreation is charged with moral significance. Sport and a society that takes it seriously would be debased if it did not strictly forbid things that blur the distinction between the triumph of character and the triumph of chemistry.”

Dr. Gary Wadler is the preeminent authority on performance-enhancing drugs. He is an internist and sports medicine physician, an Associate Professor of Clinical Medicine at the New York University School of Medicine, and a Fellow of the American College of Sports Medicine. Dr. Wadler is a member of the List Committee of the World Anti-Doping Agency, and is the lead author of the book Drugs and the Athlete. In 1993, he was the recipient of the International Olympic Committee’s President’s Prize for groundbreaking work in combating doping. Dr. Wadler is also an avid recreational tennis player.