1. Ruiz RR. Sports court upholds ban on Russian track and field athletes. New York Times. July 21, 2016. Accessed July 26, 2016.
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  3. What is the Olympic motto? Accessed July 26, 2016.
  4. Yesalis CE, Bahrke MS. History of doping in sport. Int Sports Studies. 2001;21:43-76.
  5. Reardon CK, Creado S. Drug abuse in athletes. Subst Abuse Rehabil. 2014;5:95-105.
  6. Moore J. A brief history of performance enhancing drugs. Vice Sports. September 10, 2014. Accessed July 26, 2016.
  7. Smith R. A different kind of performance enhancer. NPR. March 31, 2006. Accessed July 26, 2016.
  8. Kahn A. Regaining lost youth: the controversial and colorful beginnings of hormone replacement therapy in aging. J Gerontol. 205;60A:142-147.
  9. Thomas Hicks (athlete). Wikipedia. July 13, 2016. Accessed July 26, 2016.
  10. NPR staff. In the 1870s and '80s, being a pedestrian was anything but. NPR. April 3, 2014. Accessed July 26, 2016.
  11. Pedestrianism. Wikipedia. July 3, 2016. Accessed July 26, 2016.
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  14. Peters J. The man behind the juice. Slate. February 18, 2005. Accessed July 26, 2016.
  15. Doping at the Olympic Games. Wikipedia. July 26, 2016. Accessed July 26, 2016.
  16. Jamshad A. Performance enhancing drugs in the Olympic Games. Premed Magazine. April 1, 2014. Accessed July 26, 2016.
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  18. Ben Johnson (sprinter). Wikipedia. June 26, 2016. Accessed July 26, 2016.
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  35. Maese R. IOC decides not to ban full Russian team from Rio Olympics. Washington Post. July 24, 2016. Accessed July 26, 2016.

Contributor Information

Neil Chesanow
Senior Editor
Medscape Business of Medicine


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Faster, Higher, Stronger: A History of Doping in Sports

Neil Chesanow  |  July 28, 2016

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Slide 1

On July 21, 2016, the International Association of Athletics Federations (IAAF), track and field's global governing body, barred Russia's team from competing in the Olympics in Rio de Janeiro because of a massive, secret government program of giving steroids to Russian athletes at the 2014 Sochi Olympics and covering up the evidence of cheating.[1] State-sponsored drug programs to give a country's athletes an unfair competitive edge date to the Cold War.[2] But individual athletes taking performance-enhancing drugs in pursuit of the Olympic ideal—Citius, Altius, Fortius (Faster, Higher, Stronger)—is as old as recorded history.[3]

Above, Russia's gold medal winner Alexander Legkov jumps on the podium with Russia's silver medal winner Maxim Vylegzhanin, left, and Russia's bronze medal winner Ilia Chernousov, right, during the medal ceremony for the men's 50 km cross-country race at the 2014 Sochi Olympics. All of these wins are suspect.

Image from Alamy

Slide 2

Performance Enhancement in the Ancients

By the third century BC, ancient Greek Olympic athletes sought to enhance performance by using such stimulants as brandy, wine, hallucinogenic mushrooms, and sesame seeds.[2,4,5] Roman gladiators took stimulants to overcome fatigue and injury. The ancients had also observed the effects of castration on domesticated animals and sought to emulate them. The organs of animals and humans were ingested to improve strength, vitality, and bravery. While cheating was severely punished in the early Olympics (one penalty was enslavement), enhancing performance by ingesting substances was not considered cheating.

Above, ancient Greek runners with torch.

Image from Alamy

Slide 3

Doping and Modern Medicine

With the advent of modern medicine in the 19th century, taking stimulants to enhance energy use, production, and recovery in sport competition grew in popularity.[4,5] Scientific experiments with the anabolic effects of hormones also began in earnest. Charles-Édouard Brown-Sequard's "Elixir of Life" became the earliest known performance-enhancing drug in American professional sports, made famous when Jim "Pud" Galvin, a pitcher with the Pittsburgh Alleghenys, downed it before a game in 1889.[6,7] (That he won the game was taken as evidence of the elixir's power.) The concoction consisted of testosterone drained from the gonads of dogs, rabbits, sheep, guinea pigs, and other animals. Many such elixirs, said to "embody the very essence of animal energy," were available at the time.[8]

Above, a 1912 ad for a Brown-Sequard–type elixir called "Sequarine."

Image courtesy of Journal of Gerontology: Biological Sciences

Slide 4

Special "Doping Recipes"

In the late 19th and early 20th centuries, swimmers, distance runners, sprinters, and cyclists had begun using special "doping recipes" to gain a competitive edge against their opponents.[2,4] Boxers of the day swallowed strychnine tablets and mixtures of brandy and cocaine.[4] In the 1904 Olympic marathon, a faltering Thomas Hicks was administered two injections of sulphate of strychnine by his trainer during the race, chased down by large glasses of brandy.[4,9,10] Hicks took the gold but nearly died. Mixtures of strychnine, heroin, cocaine, and caffeine were in use until the 1920s.[2,4] No attempt was made to conceal these practices—they weren't considered cheating—but doping recipes were closely guarded secrets.

Above, Thomas Hicks running the 1904 Summer Olympics in St. Louis, Missouri.

Image courtesy of Wikimedia

Slide 5

Stimulant Use in Endurance Walkers and Cyclists

In the 19th century, "pedestrianism"—competitive walking—was all the rage. Walking races stretched to 500 or more miles and attracted 20,000 spectators a day.[2,10,11] In the 1870s and 1880s, endurance walking races were America's most popular spectator sport. Stimulants were routinely used by endurance walkers to keep awake. Long-distance cycling races soon followed.[4,6] Cyclists often took nitroglycerin, a cardiac stimulant, to improve their breathing. Some used caffeine, others alcohol, and still others sugar cubes dipped in ether to gain an edge.

Above, grass track cycle racing in Pocklington, England, in the early 1900s.

Image from Alamy

Slide 6

Doping Becomes Democratized

Stimulant drug use steadily grew from the 19th to the mid-20th century.[2,4-6] In World War II, "soldiers of both the Allies and Axis powers used amphetamines," says Charles E. Yesalis III, DSc, MPH. Dr Yesalis, professor emeritus of health and human development at Pennsylvania State University and author of Anabolic Steroids in Sport and Exercise, has been a consultant to the US Office of National Drug Control Policy, the US Olympic Committee, and the National Collegiate Athletic Association, among others. "Everybody used amphetamines," he recalls. "My dad was in the 101st Airborne. He carried amphetamines. During the war, to help morale, there were Army football teams, Navy boxing matches, and other sporting events. Participants used amphetamines and found, 'Wow, these things really work well.' After they came home, from about 1946 on, amphetamines quickly became integrated into all varieties of sport."

Above, Pervitin, an amphetamine in use during World War II. British troops alone got 72 million amphetamine tablets during the war.[2] According to one report, RAF pilots got so many it was said that "Methedrine won the Battle of Britain."[2]

Image courtesy of Wikimedia

Slide 7

Doping in Sport in the Cold War

In the 1950s, the Soviet Olympic team experimented with testosterone supplements to increase strength and power.[4] From 1974, the German Democratic Republic (GDR) sports federation had a mandatory state doping policy for athletes as young as 10, often without their knowledge.[2] By 1978, East German athletes in every sport except sailing were receiving anabolic steroids.[12] Yet in the 1976 and 1980 Summer Games, not one East German tested positive for drugs.[12] GDR athletes won 216 medals in those Olympics, 87 of them gold. An estimated 10,000 former East German athletes were scarred by drug abuse.

Above, Australian track star Raelene Boyle is beaten by East German Renate Stecher (left) in the 200-m Olympic Games final at the 1972 Munich Games.

Image courtesy of Popperfoto/Getty Images

Slide 8

Stimulant Use in Cycling

Cycling has been drug-ridden since its inception in the 19th century and played a key role in the explosion of stimulant use after World War II.[4] In the 1950s, British cyclist Jock Andrews joked, "You need never go off-course chasing the peloton [pack of riders] in a big race. Just follow the trail of empty syringes and dope wrappers."[2,4] In 1960, Danish cyclist Knud Enemark Jensen collapsed during the 100-km team time trial at the Rome Olympics and later died in the hospital; the autopsy revealed that he had taken amphetamine and the blood vessel dilator Ronicol.[2,4]

Above, Jensen is attended by a Danish official after collapsing with heat stroke and suffering a fractured skull during the 100-km team time trial at the Rome Olympics in1960. He died a few hours later in the hospital.

Image courtesy of the Hulton Archive/Getty Images

Slide 9

Commercialization of Anabolic Steroids

John Bosley Ziegler, MD, a physician for the US weightlifting team in the 1950s and '60s, was having drinks with his Soviet counterpart in Vienna, Austria, in 1954 and learned that the success of the Soviet weightlifting team was due to their being given testosterone.[4,13,14] Deciding that US athletes needed a chemical edge to remain competitive, Dr Ziegler worked with the CIBA Pharmaceutical Company to develop an anabolic steroid, methandrostenolone (Dianabol), which appeared on the market in 1960.[4,13,14] The weight- and strength-gaining results were so impressive that steroid use quickly spread from weightlifters to other athletes.

Above, one of "Doc" Ziegler's star lifters, Ike Berger, shown here at the 1964 Tokyo Olympics. At a body weight of 130 pounds, he was kilo for kilo the strongest man in the world.

Image courtesy of The Asahi Shimbun/Getty Images

Slide 10

Steroid Use Grows in Popularity

Anabolic steroid use was thought to be limited in the 1960 Olympic Games, but by the 1964 Games, the startling improvement in many strength athletes was impossible to ignore.[2,4,6] Soon steroids were being extensively used by athletes in all strength sports. By the mid-1960s, most top-ranking shot-putters and discus, javelin, and hammer throwers were taking steroids.[4,15,16] By 1968, sprinters, hurdlers, and middle-distance runners had joined them.[4,15,16] At the 1968 pre-Olympic training camp, an estimated one third of the entire US track and field team had used steroids.[4,15,16] Said a US weightlifting team doctor, "I don't think it is possible for a weight man to compete internationally without using anabolic steroids."[4]

Above, Arnold Schwarzenegger, former Mr Olympia and Mr Universe. He admitted taking steroids in a 1977 interview.[17]

Image courtesy of Hulton Archive/Getty Images

Slide 11

Steroid Use in Track and Field

Coaches and athletes in other sports quickly reached the same conclusion. "Drugs work," Dr Yesalis concedes. "If you train naturally for a hundred years, as far as your strength and physicality, you'll never get to the place that you can with some of these drugs." Indeed, between 1956 and 1972, Olympic statistics show that the weight of shot putters increased 14%; the weight of steeplechasers increased 7.6%.[2] "A medical team in the United States attempted to set up extensive research into the effects of steroids on weightlifters and throwers," recalled Olympic pentathlete gold medal winner Mary Peters, "only to discover there were so few who weren't taking them that they couldn't establish any worthwhile comparisons."[2] Some athletes were taking 10-100 mg of steroids a day.[2]

Above, the Soviet Union's Tamara Press wins the gold medal in the shot put, setting a new Olympic record for the event in the 1960 Rome Olympics.

Image from Associated Press

Slide 12

Doping in Baseball and Football

In football and baseball, drugs were often introduced by team coaches, trainers, and doctors as well as players. As one doctor with the St. Louis Cardinals baseball team told Sports Illustrated in 1969, "We occasionally use Dexamyl and Dexedrine [amphetamines]… We also used barbiturates, Seconal, Tuinal, Nembutal… We also used some antidepressants, Triavil, Tofranil, Valium."[6] But, he added, "I don't think the use of drugs is as prevalent in the Midwest as it is on the East and West Coasts." A former San Diego Charger told a California legislative committee on drug abuse in 1970, "We had to take them [steroids] at lunchtime. He [a team official] would put them on a little saucer and prescribed them for us to take them and if not he would suggest there might be a fine."[2]

Above, San Diego Chargers' defensive tackle Ernie Ladd in 1963. Ladd was the largest player of his time: 6 feet 9 inches and 315 pounds, with a 52-inch chest, 39-inch waist, 20-inch biceps, 19-inch neck, and size 18D shoes.

Image from Associated Press

Slide 13

Early Attempts at Drug Testing

In 1928, the IAAF first attempted to ban athletes for doping, but without reliable drug tests, officials had to rely on the honor system. Actual drug testing of athletes began at the 1966 European Athletics Championships.[5] In 1968, the International Olympic Committee (IOC) introduced drug testing at both the Summer and Winter Olympics.[5] Anabolic steroids were banned in 1976, after a reliable test was developed, and in the late 1970s, doping-related disqualifications, particularly in strength-related sports, markedly increased.[5] In the 1970s and 1980s, however, news of drug use in sport was relegated to the sports pages of newspapers, if it was reported at all.[6] The practice had not yet risen to the level of major public scandal. In the 1990s, that changed.

Above, the 110-m hurdles at the 1976 Montreal Olympiad, the first in which full-scale drug testing took place, says Dr Yesalis.

Image from Getty Images

Slide 14

"The Biggest Sports Scandal Ever"

At the 1988 Summer Olympics, Canadian sprinter Ben Johnson won the 100-m dash.[2,18] But when a subsequent drug test found the steroid stanozolol in his urine, he was stripped of his gold medal; the world-record title went to American sprinter Carl Lewis, the runner-up.[2,18,19] In 2003, however, it was revealed that Lewis was among those who had failed drug tests at the 1988 Olympic trials—he had tested positive for banned stimulants and bronchodilators—and should have been disqualified.[2,18,19] But by 2003, the tests had been revised, and the amount of drugs found in Lewis in 1988 would not have triggered a positive test in 2003. As such, he was allowed to keep his title. "Ben Johnson was the biggest sports scandal ever," says Dr Yesalis. "It was on the front page of virtually every newspaper. It was the first time people said, 'Wait a minute, I thought you tested these people.'"

Above, Ben Johnson in action during the 1988 Summer Olympics, winning the 100-m race before being stripped of his medal and record for illegal drug use.

Image from Gary Kemper/AP

Slide 15

The BALCO Affair

By the 2000s, the true extent of drug use in elite athletes was coming out. In 2003 (the year Major League Baseball introduced its first steroid policy), the BALCO Affair exploded.[20-22] The Bay Area Laboratory Co-operative in Burlingame, California, marketed a then-undetectable designer steroid, terahydrogestrinone (THG, known as "The Clear"). Shortly after, a test for THG was developed, and 550 existing urine samples from athletes were tested; 20 tested positive. THG, it emerged, had been used by a number of high-profile sports stars. They included Major League Baseball players (Barry Bonds, Bobby Estalella, Jeremy Giambi, Amando Rios, and Benito Santiago); National Football League players (Chris Cooper, Bill Romanowski, Barrett Robbins, Dana Stubblefield, and Tyrone Wheatley, all of the Oakland Raiders); track and field athletes (hammer thrower John McEwen; shot putters CJ Hunter and Kevin Toth; and sprinters Zhanna Block, Dwain Chambers, Marion Jones, Tim Montgomery, Raymond J. Smith, and Kelli White; and middle-distance runner Regina Jacobs); boxer Shane Mosely; and cyclist Tammy Thomas. "Literally hundreds of athletes were tested hundreds if not thousands of times in a variety of sports and never got caught," says Dr Yesalis. "BALCO showed that drug testing was a farce."

Above, former track star Marion Jones pauses while speaking to the waiting media at Federal Court after pleading guilty to lying to a federal agent about her drug use. She tested positive for THG and was stripped of five medals won at the 2000 Summer Olympics.

Image from Craig Ruttle/AP

Slide 16

Scandals in Cycling

The Tour de France, the oldest and most prestigious race in cycling, has been riven by scandal since drug testing was introduced. In 1998, for example, a car full of performance-enhancing drugs belonging to the French Festina cycling team was found before the race.[2] All nine Festina riders confessed to using erythropoietin (EPO, a hormone that stimulates red blood cell production and is taken to increase stamina). A resulting investigation cast suspicion of systemic doping on many teams of the Tour de France; several withdrew from the race. American Floyd Landis initially won the 2006 Tour de France, but after his Stage 17 victory, his urine twice tested positive for banned synthetic testosterone and he was stripped of the win.[22,23] Another American, Lance Armstrong, was number one in the world in 1996, the same year he recovered from testicular cancer.[24,25] In 2005, after winning his seventh Tour de France, he was accused of doping; that his teammates had been caught taking EPO gave weight to the accusations. In 2012, he was stripped of his Tour de France titles since 1998. The next year, Armstrong admitted to doping in a televised interview with Oprah Winfrey.

Above, Floyd Landis, winner of the 2006 Tour de France, listens during the hearing at Pepperdine University in 2007 at which he was accused of doping.

Image from Reed Saxon/AP

Slide 17

Lance Armstrong's Secrets

How did Lance Armstrong elude drug testing for much of his career? One strategy was simply running away and hiding when drug testers came calling.[26] Professional cyclists must let their national antidoping agencies know of their whereabouts at all times, but as long as they accurately reported the cities they were in, they were not reprimanded for being unavailable. Armstrong often received advanced warning that he was to be tested and changed his travel plans or stayed in remote locales, which made tracking him down a challenge. He also used sophisticated techniques to thwart testers.[26-28] In one, drug masking, an infusion of saline was used to return his blood values to normal levels. And he used drugs that were untraceable, such as EPO, for which there was no test in the 1990s, when he began to take it. When a test was developed, Armstrong found that injecting small doses into a vein rather than subcutaneously produced a negative result. "You'd need to be a researcher at the National Institutes of Health to understand how he did it," says Dr Yesalis. "It was that sophisticated."

Above, on January 14, 2013, Lance Armstrong speaks to Oprah Winfrey regarding the controversy surrounding his cycling career.

Image from George Burns/Harpo Studios/CNP/Alamy

Slide 18

The Biogenesis Scandal

Biogenesis of America, a health clinic specializing in weight loss and hormone replacement therapy, operated briefly in Coral Gables, Florida. In 2013, the same year that Lance Armstrong confessed all to Oprah, a scandal erupted when several Major League Baseball players were accused of obtaining human growth hormone from Biogenesis.[29] Thirteen players received suspensions of 50 games or more, including Alex Rodriguez, Antonio Bastardo, Everth Cabrera, Francisco Cervelli, Nelson Cruz, Fautino de los Santos, Sergio Escalona, Fernando Martínez, Jesús Montero, Jordan Norberto, Jhonny Peralta, César Puello, and Jordany Valdespin—the most simultaneous suspensions in baseball history.

Above, New York Yankees third baseman Alex Rodriguez addresses the media in 2013 while facing suspension by Major League Baseball for his alleged use of steroids made by the Biogenesis clinic in Florida.

Image from Gene J. Puskar/AP

Slide 19

How Common Is Doping Today?

By many accounts, drug use in elite athletes is not just common, it's pervasive. In a 2015 Cycling Independent Reform Commission report, one expert estimated that 90% of professional cyclists take performance-enhancing drugs.[30] That same year, Kenya's Rita Jeptoo, a three-time Boston Marathon champion, was banned from competition for 2 years after testing positive for EPO.[31] Also in 2015, a report commissioned by World Anti-Doping Agency indicated a "deeply rooted culture of cheating at all levels" in Russian sport.[32] In March 2016, Russian tennis star Maria Sharapova admitted to failing a drug test.[33] She had been taking meldonium, which is used to treat ischemia but can also improve endurance.[31,33] She was suspended from competition for 2 years. On July 21, 2016, Russia's entire track and field team was banned by the IAAF from competing in the Rio Olympics for taking state-endorsed steroids.[1] Other countries are also believed to sponsor such programs.[15]

Above, New York Yankees pitchers Roger Clemens and Andy Pettitte, accused in the 2007 Mitchell Report of taking amphetamines, anabolic steroids, and human growth hormone (HGH). Pettitte later admitted to taking HGH. Clemens denied ever taking drugs.

Image from Chris O'Meara/AP

Slide 20

The Russians Are Coming After All

On July 24, less than 2 weeks before the start of the Rio Games, the IOC ruled against barring Russia across the board from the Rio Olympics, even though, as the New York Times noted, "the World Anti-Doping Agency confirmed beyond a reasonable doubt that the Russian government ran the biggest criminal doping program in the history of international sport, demeaning every notion of what athletic competition stands for."[34] Instead, the IOC will defer to 28 individual federations that govern each sport regarding whether to let Russian athletes compete in their disciplines.[34,35] While the IAAF has ruled that Russia's track and field team will be banned from Rio, many sports federations, among them gymnastics and tennis, have declared that Russian athletes should be allowed to compete.

Above, the Russian flag.

Image from Dreamstime

Slide 21

A Pessimistic Prognosis

Dr Yesalis has testified before Congress multiple times on legislation related to the control of anabolic steroid and growth hormone abuse by athletes. "What can we do about this? Not a damn thing," he concludes. "Drug tests are fraught with loopholes. The money at stake is enormous. The fans don't care. It's not enough for them to watch the Olympics or any elite sporting event to see the very best. They want bigger-than-life people doing bigger-than-life things. They don't want to see an average-looking guy or gal who's a gifted athlete. They want people who don't look normal. They want characters out of Marvel Comics. Drugs allow that."

Above, New York Jets safety LaRon Landry, who weighs 226 pounds and can reportedly bench 503 pounds, is one of the "smaller" guys in the National Football League.

Image courtesy of Nick Wass/AP

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