Development of Doping in Sports: Overview and Analysis: Original Article
Development of Doping in Sports: Overview and Analysis: Original Article
Development of Doping in Sports: Overview and Analysis: Original Article
Original Article
Abstract:
Doping is a public health issue and not simply a problem inside the professional sports community It is
a complex and ancient phenomenon considering the vast variety of substances, supplied through both legal and
illegal trading routes. It occurs in elite athletes but also affects amateur athletes and was generally considered as
dangerous and unhealthy. Furthermore, it involves athletes’ friends and relatives, medical staff, managers,
chemists, biologists and pharmacists, pharmaceutical industries, clandestine laboratories and criminal
organizations. Over time, doping has shown a great ability to discover and always use new substances and
appropriated the new scientific discoveries. Unfortunately, new discoveries for the human health are been used
in distorted way by the athletes. In fact, the athletes may be able to use gene therapy to re-engineer their bodies
for better performances. Drug dependence depends on several factors: the socio-environmental context of the
subject and what effects have the substance in the body. We will agree that sport is essentially under the current
anti-doping campaign executed by a coordinated alliance between the World Anti-Doping Agency (WADA),
law enforcement authorities, sports organizers and the media. This paper explores comprehensive description of
the state of doping and its regulation in the modern Olympic Movement.
Key words: doping, drugs, sport, education, WADA, ethical
Introduction
The desire to increase their own physical performances in order to obtain better results in sports led
athletes to seek alternative methods to train hard (Mazzeo, 2016). For a long time individuals have tried to
improve in artificial way their physical performances. Man has always tried to improve his physical performance
by any method: legal or illegal, healthy or harmful to health (Mazzeo et al, 2016; Santamaria et al., 2013;
Sjöqvist et al., 2008; Calatayud et al., 2007). The reasons of these attempts are various and they are changed over
time: from to get best results in the hunting to obtain profit. In fact, best performances mean, great earnings
(Lippi et al., 2009). Furthermore, it involves athletes’ friends and relatives, medical staff, managers, chemists,
biologists and pharmacists, pharmaceutical industries, clandestine laboratories and criminal organizations
(Marclay et al., 2013; Esseiva et al., 2007).
Therefore, drug abuse is one of the biggest problems in sports. In elite athletes, it involves the repeated
and excessive use of substances to realize a certain effect (Mazzeo, 2017; Sjöqvist et al., 2008). Furthermore, the
desire to enhance their physical abilities did not even spare the disabled athletes (Mazzeo et al., 2015; Montesano
et al. 2013). Doping has ancient origins, probably it would have the same age of sport phenomenon as from the
moment in which individuals began to practice physical activity in competition with others, in fact, they have
sought to improve their own performance by taking mixtures of various types of plants. Indeed, it seems that the
term “doping” is derived from an ancient African dialect “doop” as meaning “a mixture or a potion”. Doping is
an ancient phenomenon. Probably would have the same age of sport as from the moment when the man began to
practice physical activity in competition with other men, he sought to improve own performance by taking
mixtures of various types of plant origin (Calatayud et al., 2007). In fact, it seems that the term doping is derived
from an ancient African dialect “doop” as meaning a mixture or a potion. Greek wrestlers and the Roman
gladiators attempted to improve their own performance by eating specific part of animal’s meat (Dilger et al.,
2007). Doping exists not only in professional sport, but also affects amateur athletes who are making increasing
use of performance-enhancing drugs (Mazzeo, 2017). Doping is thus increasingly a matter that concerns the
whole society (Lippi et al., 2008; Anti Doping Convention 1989). The World Anti-Doping Agency (WADA)
was established on November 10, 1999. In 2004, the World Anti-Doping Code has harmonized the rules and
regulations governing anti-doping across all sports and countries for the first time. If we consider all substances
included in the WADA Prohibited List, we conservatively estimate 253,700 users of doping products in Italy for
specific use.
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Corresponding Author: GAETANO RAIOLA, E-mail: graiola@unisa.it
FILOMENA MAZZEO, GAETANO ALTAVILLA, FRANCESCA D’ELIA, GAETANO RAIOLA
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In the beginning of the 20th century, in the search for substances able to make it stronger than others,
the athlete was matched and complicity in different professionals: coaches, managers, doctors and pharmacists,
nutritionist, equally interested in increasing their power, in a general and economic perspective. In the last
quarter of the twentieth century, the use of doping in sport activities has become massive and systematic
(Mazzeo et al. 2015). With the advent of sponsors and mass media, the success in major sports competitions
(Olympics, World Championships, and so on) has been playing an increasingly significant social and economic
goal, such as to encourage the use of all means, legal and illegal to catch up.
Doping poses a threat to sport worldwide. It undermines the principle of open and fair competition
(Mottram, 2005). It is a factor that discourages the practice of sport in general and puts the professional under
unreasonable pressure. It seriously affects the image of the industry and represents a serious threat to individual
health (Anti Doping Convention 1989; Mazzeo et al., 2016). Unfortunately, in the past and for a long time,
doping was underestimated and public institutions considered it as a problem exclusively of sports organizations
that alone had to vanquish a phenomenon in continuous expansion (Møller e Di Meo, 2014).
In accordance to the WADA Code, doping is conceived in different ways including different specific
meanings. That is: “the presence of a prohibited substance or its metabolites or markers’ banned; the
possession, use or attempted use of prohibited substances or methods; the refusing or the failing, without
compelling justification, to submit to sample collection; the violation of applicable requirements regarding
athlete availability for out-of-competition testing; the tampering or the attempting to tamper with any part of
doping control; the trafficking or the attempted trafficking in any prohibited substance or methods; the
administration or the attempted administration to any athlete of any prohibited methods or substances, or the
assisting, encouraging, aiding, abetting, covering up or any other type of complicity involving an anti-doping
rules violation or any attempted anti-doping rule violation”( WADA ,2015).
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JPES ® www.efsupit.ro
The World Anti-Doping Agency (WADA," defines gene doping as the "nontherapeutic use of
cells, genes, genetic elements, or modulation of gene expression, having the capacity to enhance performance"
(World Anti-Doping Agency, 200; Santamaria et al. 2013; Gaffney et al., 2007).
The goals of gene doping include the injection of novel genes of the modulation of existing genes too;
however, the gene doper introduces the gene products for the enhancement of physiologic parameters expedient
to the athlete’s competitive tasks, rather than the treatment of a medical illness [Gaffney 2007; Keying 2008;
Doessing 2005].
Now, in the 2013 WADA Prohibited List, gene doping, is “the transfer of polymers or nucleic acid
analogues” and “the use of normal or genetically modified cells” (World Anti- Doping Agency 2013).
Growth hormone (GH) has a multitude of effects on the body associated with growth. It has a well-
documented stimulatory effect on carbohydrate and fatty acid metabolism, and a possible anabolic effect on
muscle proteins (Doessing et al., 2005).
Doessing and Kjaer (2005) also suggest a role for GH as an anabolic agent in connective tissue in
human skeletal muscle and tendon (Gaffney et al., 2007). Recombinant GH, is already being used as a doping
agent in sports. Insulin-like growth factor 1 is a protein that stimulates cellular proliferation, somatic growth and
differentiation (Doessing et al., 2005) (Table 2)
Table 2- Genes for sports doping and physiologic response.(Santamaria et al., 2013)
Gene/Product System/ target Gene product Physiologic response Sport
tissue properties
ACE Skeletal muscles Peptidyl dipeptidase ACE-I seems to correlate with Endurance
endurance
ACE-D involved in sprint and
powers
ACTN2,3 Muscular system Actin-binding proteins Involved in fast twitch Endurance
related to dystrophin muscles and sprint
Endorphins, Central and Widely active peptides Pain modulation. Increases Endurance
Enkephalins peripheral nervous risk of overuse of
systems musculoskeletal and
cardiovascular system.
Increase stress and pressure
on heart
EPO Hematopoietic Glycoprotein hormone Increases RBC mass and Endurance
system oxygen delivery
HGH Endocrine and 191–amino acid protein Increases muscle size, power, Entrengh
muscular system and recovery
HIF Hematologic and Multisubunit protein Regulates transcription at Endurance
immune systems hypoxia aerobic
response element
IGF-1 Endocrine/metaboli 70–amino acid protein Increases muscle size, power, Entrengh
c/skeletal muscle and recovery
Interleukin-15 Skeletal muscle cytokine with strong Myoblast proliferation and Strength
antitumor properties muscle-specific myosin heavy
chain (MCH) expression
Myostatin. Muscular system 2-subunit protein A negative muscle mass Entrengh
regulator. Demage of tendons
ligament and bone
PPAR-δ Skeletal muscle and Nuclear hormone Promotes fat metabolism and Speed and
adipose tissue receptor protein increases number of slow endurance
twitch fibers
VEGF Vascular Glycosylated disulfide- Induces development of new Endurance
endothelium and bonded blood vessels
angiogenesis homodimers
Abbrevation: ACE, angiotensin-converting enzyme; ACTN3, actinin binding protein 3; EPO, erythropoetin;
HGH, human growth factor; HIF, hypoxia inducible factor; IGF-I, insulin-like growth factor; PPAR-
delta, peroxisome proliferators-activated receptor (delta); VEGF, vascular endothelial growth factor.
(Gaffney,
Parisotto, 2007)
The field of gene therapy, and by extension, gene doping, is full of unpredictable and dangerous results
like this, which is why Sweeney, Evans, and other researchers who have identified DNA targets that could
potentially be exploited for gene doping are the first to emphasize that the research is still at only an
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experimental stage. More important than the ethical implications of gene doping, some experts say,is the fact
that gene doping could be dangerous, and even fatal in the spirit of sport (Pray, 2008; Mazzeo, 20016)
Results
The athlete using drugs or nutritional supplements practice mainly sport where appearance is a
significant aspect as in body building (Mazzeo et al., 2013). These substances are more and more used by
athletes not only in competitive sports, but also in fitness and recreational sports. It is important to ask why
athletes dope. In advance, it is important to know that the prohibited substances and / or the amount of substance
prohibited constantly change: some of them have been eliminated over time while others have been added. For
example, pseudoephedrine and norephedrine were removed from the list in 2003 but in 2013, the first substance
was reintroduced with a different dosage. Local anesthetics and caffeine were eliminated in 2004 (Strano Rossi
S. and Botrè F. 2011), even if the substance has been included in the monitoring program of WADA in 2015
(Table 3) (World Anti-Doping Agency, 2015).
One thing is certain the substances that give pleasant sensations or help the subject in his activity will
bring him to repeat the consumption. But, not all people develop drug dependence. It depends on several factors:
the socio-environmental context of the subject and what effects have the substance in the body. Moreover, the
drug dependence could be connected to the indirect gratification. It consists in all situations in which the person
has a social, economical or psychological benefit thanks to use drugs. For example: we can see direct
gratification in the winning of a competition and indirect gratification in the money that the athlete receives after.
If all the gratifications are connected to use of drug, maybe he will use drug in the future.
A lots of researches focused their attention on subject’s personality. It is demonstrate that people with
an ego orientation have a low self-esteem, are aware that only with their own abilities fail in their main purpose:
to beat the others. They also hate the defeat and, therefore, looking for the victory in any way (Serpelloni et al.,
2006). Perhaps, an ego oriented person probably will use drugs because he doesn’t want to improve himself but
only give the appearance of improvement; and this result will get it only through the use of performance-
enhancing drugs (Duda et al., 1995; Duda & Nicholls 1992). Kahneman and Tversky (Tversky 1974; Kanheman
1979) give us others reasons that push people to resort to doping. Indeed, they identify four factors: the effect of
formulation, the principle of utility, the heuristic of the accessibility and the representativeness heuristic.
Data showed that in Italy in 2010, the percentage of doped athletes is higher than other years with 4.8%
(53 doped athletes on 1115 controlled - Figure 1) and from 2008 to 2012 did not fall below 3%. In 2013, the
percentage is 2.8%.
Fig. 1. Percentage of doped athletes over the years. Reference period: 2003-2013
Many of this substances taken, have various gratifications’ effects, such as stimulants, anabolic,
narcotics and cannabinoids Stimulants are used to increase the concentration, alertness and safety. They also
increase the aggressiveness and the sense of competitiveness (Stella et al., 2005). To anabolic are recognized for
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the following effects: euphoria, sense of wellbeing, glee, increased motivation and self-esteem. Moreover, the
athlete doesn’t get bored during the training (Mazzeo , 2016).
Narcotics have a calming effect on the psyche as well as beta-blockers reduce the anxiety and stress.
Corticosteroids have, instead, a stimulating effect like alcohol. Moreover, other effects include euphoria,
increased sociability and sense of wellbeing.
Cannabinoids, such as cannabis, hashish and marijuana, cause changes in mood and perception,
euphoria, happiness, relaxation and deep sleep and reducing anxiety (Mazzeo, 2017). They are considered drugs
to use social-recreational (Stella et al.,1999; Loffreda et al 2003).
Shifting the focus on the consumption of prohibited substances and considered that the control activities
of the Anti-Doping Commission began in April 2003, in that year there was a high consumption of stimulants
equal to 40%. The lower percentages were 10.3% in 2010 and 6.7% in 2013. Compared with the year 2012,
consumption fell by 13 percentage points. The average consumption from 2003 to 2013 is 20.9%.
The cannabis derivatives have a peak of consumption in 2005 and 2007, respectively, with 42.6% and
42.3%. Their use, in any case, in the other years was characterize by ups and downs: it should be noted, indeed,
that in 2012 the percentage is 31.8%, while in 2013 is 16.7%. Its lower consumption occurred in 2010 with the
7.2%. The average consumption is 26.3%.
Regarding diuretics and masking agents, they have had a trend almost constant over the years. The peak
was reached in 2011 with 24.8% and 2013 is not recorded specifically changes compared to the normal course
(10%).
Inhaled β2 agonists, which are among the drugs of choice for treatment of asthma, are prohibited for
non‐asthmatic athletes according to the most recent list of prohibited substances released by WADA (Mazzeo,
2016). This means that an athlete with asthma or EIA has to prove the presence of the disease to a medical
committee of their national or an international ruling body and wait for grant of a therapeutic use exemption
(TUE) before they can start β2 agonist treatment. The main reason for prohibition of the use of inhaled
β2 agonists in non‐asthmatic athletes is its claimed ergogenic potential (Perrotta et al.,2017). From 2003, the
Commission carried out doping tests. The tests collected only urine samples.
15.396 athletes have been checked in these 10 years – 2003 to 2013 -: 10.347 (67.2%) men and 5.049
(32.8%) women
The current system of the fight against doping makes the assessment carried out by analytical
laboratories accredited by WADA as a test not able to analyze the state of health of the athlete but as a real anti-
fraud control: the goals are diametrically opposed (Mazzeo et al, 2016; Colucci A. P. and Gagliano-Candela R.
2004).
Moreover, the highest average age of those athletes is 36 in 2010, followed by 35 in 2010. In 2013, the
average age is 33 years old and analysing that average during the last ten years, it is 31 years old. Furthermore,
as you can see in the figure 2, the phenomenon mainly touches people over 45 years old and saves younger.
Fig. 2. Average age of doped athletes. Breakdown per years. Reference period: 2003-2013
Conclusions
The first step to do to prevent the recourse to the doping is to extend the knowledge on it and in
particular on its dangerous effects on health (Thomas , 2011). The arrival of new sponsors leaded to the arrival of
new professionals who brought a new performance approach ( Brissoneu, 2010). Indeed, most athletes will not
have enough knowledge to fully understand the potential health hazards caused by it. It is necessary, therefore,
that public and sports institutions implement information and awareness campaigns aimed particularly at young
people. This can be easily achieved only with strict collaboration between the two above-mentioned institutions.
It’s necessary to enhance the role of local institutions and the National Olympic Committee to give tools,
especially economic, to carry out the work of education, training and control (de Mérode and Schamasch 1999).
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It is important that campaigns be launched to a broad audience too. These awareness-promoting actions
must involve mass media . In terms of training, about the doctors, they are at the forefront and, unfortunately,
they often have a very sketchy understanding of the relationship between therapy and doping, particularly in
terms of knowing which treatments are permitted and which are not ( de Mérode and Schamasch 1999).
From a scientific point of view, one of the most effective preventive measures can be considered the
inclusion, by the Ministry of Health, in the class S0 - substances not approved - of doping substances of Law
376/2000, also drug for veterinary purposes in view of the spread of this type of medication for the purpose of
doping (Ministero della Salute 2013).
The laboratories have an important role in the discovery of new substances; most of them are included
in the WADA List. They also determine the quantitative of those substances, carry out anti-doping tests, and
determine cases, criteria and methodologies of anti-doping tests too. Currently, there are 34 laboratories in the
World (Table 4) (Valkenburg et al., 2014, Mazzeo, 2016).
The Biological Passport is a tool for indirect detection of the presence of a doping substance in
biological samples of an athlete. With it, in fact, the changes of certain bio-markers of doping are recorded and
monitored. If the data, combined with the personal data localization in a given period, exceeded a certain range,
the athlete would assume the banned substances (WADA, 2015). The Anti-Doping Administration and
Management System (ADAMS) is an on-line database system where are recorded all data: laboratory results,
therapeutic use exemptions (TUEs) and information on anti-doping rule violations. It allows the sharing of
information amongst the organizations and promotes efficiency, transparency and effectiveness in all anti-
doping activities (Møller et al., 2014). Unfortunately, today, despite the technological advancement that
characterizes the field of scientific research, the analytical methods are not sufficiently reliable for the search of
the entire group of substances included in the antidoping lists. Professional athletes must serve as role
models and spokesmen for drug-free sport and lifestyle (Baron et al., 2007; Gomez J 2005 ). In addiction,
professional athletes are frequently the role models of adolescent and young adult populations, who often mimic
their behaviours, including the abuse of drugs. Continuing, updates educational programs developed for these
at-risk populations by national Olympic organizations and athletic federations are important first steps to curb
and to control these dangerous behaviours (Baron et al., 2007). Raising consciousness on the reality and
involvement of the situation would help to legitimate the establishment of legal grounds necessary to the
implementation of Anti-Doping Intelligence and this might prove efficient at a more proactive response
to any potential or emerging doping phenomenon or to address existing problems with innovative actions
or/and policies (Mazzeo et al., 2018).
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