Pubdate: Sat, 08 Aug 1998 Source: Lancet, The (UK) Section: Volume 352, Number 9126 Contact: Website: http://www.thelancet.com/ PEDDLING DRUGS TO THE PEDAL PUSHERS "The Tour de France: a broken legend" shrilled Le Monde's headline. "Tour de Farce" is how others put it. The field in this year's gruelling 21-day cycling race was decimated by drug raids, inquiries, and arrests by the French police, and walkouts by some of the teams. The race itself saw sit-down strikes and go-slows by the cyclists, voting with their pedals. The first raid was 3 days before the tour began, a team masseur being stopped at the France-Belgium border with a car-load of doping products, including epoetin (recombinant erythropoietin). The doping raids and inquiries then accelerated like a racing team itself, with hotel rooms searched and riders forced to give samples of urine, blood, and hair. Cyclists and team officials, including doctors, are waiting to be charged or questioned further by the French authorities. This year's preferred booster for the Tour de France was epoetin. Such pharmacologically enhanced endurance athletes may have the edge over their physiologically normal competitors. The use of epoetin is well recognised by the sport's international controlling authority, which has set a cutoff for packed-cell volume of 0B750 as the limit of normality. Above this, epoetin use is assumed and the rider is banned, there being no generally accepted assay for this hormone. But defining "normal" is always going to cause problems, as research published on page 451 shows . Two of 46 elite athletes (thought to be free of epoetin use) and four of 278 controls had a packed-cell volume over 0B750. In addition, setting a limit of 0B750 simply stimulates self-titration to 0B749. It is almost human nature to find ways of bending rules without being caught, especially in competitive international sport. In this journal on July 4, we featured the drug cocktails favoured by athletes , and the catalogue of side-effects that each class of ergogenic agent can carry. Clearly, competitors at all levels are under pressure from many directions to win, but too many are succumbing to the use of drugs to meet that end. A meta-analysis from France last year showed that 3-5% of youngsters and 5-15% of adults taking part in sport reported using drugs. The President of the International Olympic Committee, Juan Antonio Samaranch, told the Spanish newspaper El Mundo during the height of the Tour de France revelations that he sees two types of drug abuse. One harms health and should be banned while the other merely augments performance. This looked like a U-turn compared with his previous strong line about the use of drugs in sports--he later said that he had been misinterpreted. The IOC was quick to limit the damage to its reputation by announcing last week an international conference to be held next January on doping in sport. Many sports writers, often former participants, have pointed out that the Tour de France is so physically draining that it is impossible to take part without the use of drugs. Did the pedallers of old take drugs--or were the mountains lower then? There may be something extra-demanding about endurance cycling, but that is no reason to treat it differently from other sports. Drug taking in sport has become so widespread, and its detection so open to unfairness (the Diane Modahl case, for instance) and loss of dignity (witnessed urination, venepuncture, hair sampling), that some are beginning to think the unthinkable. Samaranch did receive some support, and separate drugged and drug-free sports were mooted. If science influences how athletes eat and train, and how bicycles are designed for weight and aerodynamic advantage, then why not drugs to build muscle, enhance oxygen carriage, calm nerves, and so on? Today's elite competitors are, in reality, highly paid or sponsored professional entertainers, some of them in commercial markets in which fair play is becoming an old-fashioned idea. While we might like to oppose unconditionally all use of drugs in sport, the real world cannot be so certain. For instance, what makes an aid to an athlete artificial enough that it should be banned? Where is the line between a nutritional supplement and a drug (ginseng versus ephedra, say)? How can the dignity of athletes be preserved during testing? Why should an adult competitor not be allowed to make an informed choice about a substance, provided it is legally acquired? The January IOC meeting has difficult choices to consider. - --- Checked-by: Melodi Cornett