Doping yesterday, today, tomorrow: A challenge for the clinical laboratory.

This work highlights the role of the clinical laboratory, in the early detection of the use of substances prohibited for doping. This is because most people who practice sports today are non-professional athletes and amateurs, in particular young kids. These persons are not subjected to anti-doping controls but are at risk for their health. Endocrinologists and laboratory tests, by detecting evidence of such usage can help protect their health. Anti-doping testing require specific instruments for qualitative and quantitative chemistry, to meet regulations of official competitions but are impossible to be used in every person because of high cost. A particular role the clinical laboratory can acquire in the future is through its molecular biology sections, when genetic doping will probably be a reality and quantitative chemistry will be unable to detect it. A brief history of doping is provided to understand the reasons of its spread. Although doping has great resonance nowadays, it is not a recent problem. It was common among ancient Greek wrestlers and Romans, who used mixtures of herbs and stimulants. Ancient Greece started the Olympic Games and winners assumed great esteem, akin to demi-god status. Therefore, any attempt to improve athletic performance was a norm, also because the damage caused by the substances used was not known at that time. The use became so widespread that soldiers also used drugs to better combat during recent wars, and doping was practiced by athletes, actors and musicians in attempts to obtain better performance results. Today, doping has been refined so as not to be discovered and there is a continuous race between those who promote new substances and those who, like the World Anti-Doping Agency (WADA), were created to defend the health of athletes and comply with regulations of competitions. The clinical laboratory plays a fundamental role in identifying the use of prohibited substances, especially in competitions not classified as official, which are the majority and involve thousands of amateurs. In this paper a series of laboratory tests are proposed in this perspective, at low cost without the need of qualitative/quantitative chemical analyses required by the sport jurisdictions. Finally, a glance into genetic doping illustrates a likely future and imminent practice.

Chronicle of an unintentional MDMA intoxication of a field hockey team to prevent its qualification for the Beijing 2008 Olympics: A case report.

Current doping trends overshadow the traditional interpretation of using prohibited performance-enhancing drugs to improve training and/or sports results. Its definition has evolved due to several recent cases of unconventional manipulation in sports. In this article, we present a case study of an intentional intoxication against the Spanish National Field Hockey team that resulted in its ineligibility for the 2008 Summer Olympics. The events occurred during the pre-qualifying Olympic tournament held in Azerbaijan. The Spanish team won the final match of the tournament against the hosting team and gained qualification for the Olympic Games. One month later, the International Hockey Federation (IHF) reported that two players of the Spanish National Hockey Team had tested positive for MDMA and would subsequently disqualify the Spanish National team from the tournament. The Spanish Hockey Federation then started an appeal process to demonstrate (1) contamination through team's hotel air ventilation and (2) tampering of a urine sample. This process ended with the IHF's final ruling that overturned the sanctions imposed on the Spanish National Team. This manuscript not only outlines a deliberate case to exclude a team from the Olympic Games, but also a federation's difficult efforts to prove an intentional intoxication that resulted in adverse findings.

Detecting - the 2004 Athens Olympic Games.

A summary of the preparations and the operation of the Athens Doping Control Laboratory for the 2004 Olympic Games is presented. The preparations involved an upgrade of the laboratory infrastructure: staff, equipment, space, new analytical methodologies. The operation of the laboratory during the Games created a major number of events in agreement with the International Olympic Committee's commitment to doping-free "clean" Games. This summary was created by the director of the Athens Doping Control Laboratory and reflected the author's outlook 15 years later.

Gene doping: Present and future.

Being an elite athlete is an extremely coveted position, which can lead an individual to use doping. As knowledge is extended, doping techniques have become increasingly sophisticated, and the newest method of doping is gene doping. This article aims to present an updated bibliographic survey that addresses gene doping between 1983 and 2018. Anti-doping agencies have not yet approved any detection technique for this type of doping. The possibility of eradicating such doping is almost zero mainly because gene therapy advances rapidly. In this scenario, the future of gene doping must be discussed and decided before irreversible limits are exceeded.

A probable case of doping in an Olympic athlete coming back from ancient Greece (V cent. B.C.).

We present here the hypothesis of doping in an athlete coming back from the ancient Greece, dating back to V century B.C. There are some bone alterations due to the sports that he probably practiced, and that are represented on the amphorae (prices of his victories) found near his sepulchre. The skeleton shows a considerable mass and bone density. The chemical analyses performed on the bone emphasized the presence of arsenic, while the X-ray and CAT scan examinations revealed a quite big sella turcica. These two aspects might have influenced the performances of this athlete, and in the same time might have provoked his death at the age of about 30 years.

Brief History of Anti-Doping.

The fight against doping in sport as we know it today commenced by the creation of the International Olympic Committee (IOC) Medical Commission in 1961 following the death of a Danish cyclist during the Rome Olympic Games the year before. After a slow start, the fight got under way as from the early 1970s under the leadership of the IOC and of the International Association of Athletics Federations. Despite a lack of understanding and weak support even from the sports community, a series of measures were taken during the 1970s and 1980s which still form cornerstones of today's anti-doping strategy. In addition to information and education campaigns, the most important examples are the introduction of procedural rules for doping controls, the establishment and follow-up of a list of prohibited substances and methods, the accreditation of doping control laboratories, the introduction of in- and out-of-competition testing, rules for therapeutic use exemption, and the introduction of blood sampling. During the 1990s, the anti-doping fight gained increasing support both inside and outside the sport community. In order to harmonize the wide variety of rules that had developed both in sport organizations and at the domestic level and to promote anti-doping activities, the World Anti-Doping Agency (WADA) was jointly created by the Olympic movement and the public authorities in 1999. WADA is today carrying on the fight supported by the universally accepted WADA Code and an International Anti-Doping Convention under UNESCO.

Blood doping at the Olympic Games.

INTRODUCTION: The objective of this paper was to review our knowledge of athletes who have, are believed to have or have attempted to engage in blood doping to enhance their performance at an Olympic Games. EVIDENCE ACQUISITION: The paper focused on the Games from Munich 1972 to London 2012 and the author had a medical role at each of the Olympics that is discussed. EVIDENCE SYNTHESIS: The study revealed that Olympic athletes have benefitted from manipulating their blood by re-infusion of autologous or infusion of homologous blood and by administering erythropoiesis stimulating agents, notably the three generations of erythropoietins. Fifty seven athletes have been sanctioned with 12 athletes forfeiting 17 Olympic medals including 12 gold medals because of blood doping. Until 1986, the infusion of blood was not prohibited in sport but considered unethical. Erythropoietin was prohibited by the International Olympic Committee's Medical Commission in 1990. CONCLUSIONS: There has been a change as to how Olympic athletes have enhanced performance by blood doping, commencing with blood infusion and later administering erythropoiesis stimulating agents and significant advances have occurred in detecting such misuse. Currently, the hematological component of World Anti-Doping Agency's athlete biological passport is an important but not infallible mechanism to identify athletes who cheat by blood doping.

Performance-Enhancing Drugs I: Understanding the Basics of Testing for Banned Substances.

Whenever athletes willfully or accidentally ingest performance-enhancing drugs or other banned substances (such as drugs of abuse), markers of those drugs can be detected in biological samples (e.g., biofluids: urine, saliva, blood); in the case of some drugs, that evidence can be apparent for many weeks following the last exposure to the drug. In addition to the willful use of prohibited drugs, athletes can accidentally ingest banned substances in contaminated dietary supplements or foods and inadvertently fail a drug test that could mean the end of an athletic career and the loss of a good reputation. The proliferation of performance-enhancing drugs and methods has required a corresponding increase in the analytical tools and methods required to identify the presence of banned substances in biofluids. Even though extraordinary steps have been taken by organizations such as the World Anti-Doping Agency to limit the use of prohibited substances and methods by athletes willing to cheat, it is apparent that some athletes continue to avoid detection by using alternative doping regimens or taking advantage of the limitations in testing methodologies. This article reviews the testing standards and analytical techniques underlying the procedures used to identify banned substances in biological samples, setting the stage for future summaries of the testing required to establish the use of steroids, stimulants, diuretics, and other prohibited substances.

Drug misuse in sport: a historical perspective.

This editorial draws comparisons between the recent revelations of drug misuse in Russian sport, and the State-sponsored programme of the former German Democratic Republic. While 50 years separates these two regimes, there are commonalities. The history of major incidents involving drug abuse by serious national players in sport suggests a 20-year cycle, with the GDR, China and now Russia employing similar strategies. These events underscore the value placed upon international sporting success by politicians.

[Anti-doping policy development process in the sports world (1968~1999): focusing on IOC activities and passive response from Korea].

This study investigated the anti-doping policy promoted by the IOC historical sociologically focusing on the period from 1968 to 1999. Public opinion surrounding doping control has emerged as a large amount of drug possession by athletes who had participated in the 1952 Olympics was caught, as well as following the accident where an athlete had died during the competition as a result of doping. From 1960, as many doping cases in sports games were exposed, several international organizations proclaimed fight against doping in order to seek a preventive measure. In 1961, the IOC newly established a medical commission within the organization. It was decided to implement doping control and female sex testing at the same time for all athletes who participated in the 1967 Olympics, and they were implemented from 1968 winter and summer Olympic Games. In 1971, the provisions for the tests were prescribed as mandatory on the IOC charter. From 1989, the OCT system was introduced as a measure to overcome limitations of the detection during competition period. As political problems and limitations emerged, WADA (World Anti-Doping Agency) was established in 1999 to professionally manage and push for doping control. Female sex testing policy contributed to preventing males from participating in female competition by deceiving their gender to some extent. However, it was abolished due to strong public condemnation such as women's rights issues, social stigma and pain, and gender discrimination debate. In 1984, a doping control center was established in Korea, which enabled drug use or doping in the sports world to emerge to the surface in our society. Korea Sports Council and KOC articles of association that supervise doping related matters of Korean athletes were revised in 1990. The action of inserting doping related issue in the articles of association was taken 20 years after the start of IOC doping policy. Beginning with two international competitions in the 1980s, Korean athletes experienced doping test directly, yet education about doping was limited. However, some national team level athletes tested positive on the doping test and underwent disciplinary action. In addition, athletic federation or leaders acquiesced athletes doping made secretly; this indicated that South Korea was also not free from doping. It was found that Korea world of sports showed very passive countermeasures and development process.

The athlete biological passport: ticket to a fair Commonwealth Games.

In summer 2014, the world watched as Glasgow hosted the 2014 Commonwealth Games and athletes pushed the boundaries of human performance. Sport has developed into a multi-billion pound industry leading to the development of a 'win at any cost' mentality in some individuals. The abuse of performance-enhancing drugs has developed into a sophisticated arms race between those unfairly enhancing performance and those wishing to preserve the dignity of sport and the health of the competitors. The challenge for the Commonwealth games organising committee was to ensure that competition remained fair and that athletes were kept safe. The athlete biological passport is a system implemented by the World Anti-Doping Agency directed towards enhancing the identification of those athletes accountable for the misuse of performance-enhancing substances. This article exemplifies which drugs are currently being exploited and how the athlete biological passport has evolved to improve their detection.

Antidoping control in Brazil: history, current situation, and prospects for the 2014 World Cup and the 2016 Olympic Games.

Brazil will soon host two major sporting events: the 2014 World Cup and the 2016 Summer Olympic Games. Given the importance of antidoping control during these competitions, it is important that the scientific community receive a status update on antidoping control in Brazil. In this brief communication, the authors present the status of antidoping control in Brazil from an historical perspective, both the benefits and difficulties to be faced by antidoping control during these events, and the legacy resulting from the efficacy of the drug testing performed during these competitions.

Challenges and threats to implementing the fight against doping in sport.

Prominent doping cases in certain sports have recently raised public awareness of doping and reinforced the perception that doping is widespread. Efforts to deal with doping in sport have intensified in recent years, yet the general public believes that the 'cheaters' are ahead of the testers. Therefore, there is an urgent need to change the antidoping strategy. For example, the increase in the number of individual drug tests conducted between 2005 and 2012 was approximately 90 000 and equivalent to an increase of about 50%, yet the number of adverse analytical findings remained broadly the same. There is also a strikingly different prevalence of doping substances and methods in sports such as a 0.03% prevalence of anabolic steroids in football compared to 0.4% in the overall WADA statistics. Future efforts in the fight against doping should therefore be more heavily based on preventative strategies such as education and on the analysis of data and forensic intelligence and also on the experiences of relevant stakeholders such as the national antidoping organisations, the laboratories, athletes or team physicians and related biomedical support staff. This strategy is essential to instigate the change needed to more effectively fight doping in sport.

Anti-doping Policy Development Process in the Sports World (1968~1999): Focusing on IOC Activities and Passive Response from Korea / 의사학

This study investigated the anti-doping policy promoted by the IOC historical sociologically focusing on the period from 1968 to 1999. Public opinion surrounding doping control has emerged as a large amount of drug possession by athletes who had participated in the 1952 Olympics was caught, as well as following the acident where an athlete had died during the competition as a result of doping. From 1960, as many doping cases in sports games were exposed, several international organizations proclaimed fight against doping in order to seek a preventive measure. In 1961, the IOC newly established a medical commission within the organization. It was decided to implement doping control and female sex testing at the same time for all athletes who participated in the 1967 Olympics, and they were implemented from 1968 winter and summer Olympic Games. In 1971, the provisions for the tests were prescribed as mandatory on the IOC charter. From 1989, the OCT system was introduced as a measure to overcome limitations of the detection during competition period. As political problems and limitations emerged, WADA (World Anti-Doping Agency) was established in 1999 to professionally manage and push for doping control. Female sex testing policy contributed to preventing males from participating in female competition by deceiving their gender to some extent. However, it was abolished due to strong public condemnation such as women's rights issues, social stigma and pain, and gender discrimination debate. In 1984, a doping control center was established in Korea, which enabled drug use or doping in the sports world to emerge to the surface in our society. Korea Sports Council and KOC articles of association that supervise doping related matters of Korean athletes were revised in 1990. The action of inserting doping related issue in the articles of association was taken 20 years after the start of IOC doping policy. Beginning with two international competitions in the 1980s, Korean athletes experienced doping test directly, yet education about doping was limited. However, some national team level athletes tested positive on the doping test and underwent disciplinary action. In addition, athletic federation or leaders acquiesced athletes doping made secretly; this indicated that South Korea was also not free from doping. It was found that Korea world of sports showed very passive countermeasures and development process.