House of Commons - Culture, Media and Sport

Select Committee on Culture, Media and Sport Seventh Report

3 Drugs in sport

12. The use of drugs intended to enhance, or in some cases to nobble, sporting performance is generally known as "doping".[16] The term, used in this sense, appeared first in the late nineteenth century but the use of drugs, and preparations containing more or less potent ingredients, is evident throughout the history of sport. From the outset it appears to have been the appalling health risks run by sportsmen and -women using performance-enhancing substances that have driven the effort to combat the practices. Professor David Cowan, Director of the Drug Control Centre, Kings College London, told us that one consolation he felt, in the face of frustration with the pace of progress in anti-doping, was that "the deaths are not quite as common as we used to have."[17]

13. Information made available online by the Australian Sports Drug Agency—and repeated across a wide variety of internet resources and media articles—asserts that ancient Greek athletics, and its proponents, enjoyed a status roughly equivalent to today's major sports and sporting heroes. Olympic victories brought substantial rewards (including tax exemptions and deferment from military service) and, in consequence, corruption was commonplace. Competitors of this period were reputedly willing to ingest any preparation that might enhance their performance. According to the Australian agency, the Romans were no better (motivated perhaps more by a desire for ever more spectacular events). Chariot-racers doped their horses to enhance their speed and gladiators were similarly treated to ensure their combat was "sufficiently vigorous and bloody".[18]

14. Sporting events, as we would recognise them, were relatively quiescent between ancient Greece and Rome and, virtually, the dawn of the industrial revolution. In Britain, urbanisation moved sporting events away from mass engagement at community festivals and towards mass spectatorship at more organised events.[19] The resulting increase in commercialism and professionalism (initially in the loose sense of new demarcations between players and spectators, winners and losers) has been blamed for "pressure on sports people to become not only successful, but the best".[20] This pressure is argued to have, at the very least, contributed to an escalation in drug-taking, and therefore of drug-related deaths, within the sporting community.[21] The response to these matters, however, was initially neither swift nor sure, as the table of key events set out below reveals.

15. International and national sporting organisations, assisted by growing concern amongst governments and inter-governmental bodies (the first of which to be seized of the issue was the Council of Europe[22]),continued to develop anti-doping initiatives throughout the late 1960s and 1970s and drug-testing became a more common feature of high-level sporting competition. There were, however, problems with the effectiveness of the available drug tests and much evidence of athletes learning quickly how to beat the system. This included the provision of 'clean' substitute samples; allowing the drugs in question to clear the body prior to a sample being given; new substances and methods being sought and found; and/or other drugs being taken that masked the presence of anything untoward.[23]

16. It is worth noting here the longstanding view of the British Airline Pilots Association (BALPA) that the best way to identify substance abusers, albeit in its own sector, was by way of "peer intervention" (in other words, whistle-blowing) rather than by random testing.[24] Ms Verroken told us that: "the athletes were always the best people to tell us who we should have been testing and we tried to make them very much part of the process".[25] 'Peer intervention' was of course the route by which the existence of a new synthetic anabolic steroid, tetrahydrogestinone (THG), came to light in 2003 (see below).

17. In addition to the actions and attitudes of some sportsmen and -women, Ms Verroken pointed to evidence of negligence, whether wilful or not, within sports governing bodies when it came to putting their athletes in the dock on doping charges. She told us that there were examples of where sports bodies had kept quiet about names of athletes with adverse findings despite forthcoming major events and the terms of continued public funding and/or private sponsorship.[26] She also said that the material gathered in 1987 for Sebastian (now Lord) Coe's seminal Drugs in Sport report contained evidence of "samples that did not reach the laboratories and samples were not provided by the athletes who were selected".[27] Separating mistakes from deviousness was obviously very difficult. Mr David Sparkes, Chief Executive of British Swimming, conceded that "governing bodies by their nature want to keep things to themselves, because then they can deal with them in-house" but he emphasised that he wanted more openness and transparency about these matters to give the public confidence in the process.[28]

18. It is worth emphasising that taking drugs with the aim of enhancing performance is certainly not always a successful strategy (quite apart from the health risks and the consequences of getting caught). Ms Verroken emphasised to us that the assumption that taking drugs led to success was quite wrong. She told us that, on the one hand, "one would hope that Paula Radcliffe is the prime example of how that is not the case" and, on the other, "David Jenkins will be an example of an athlete who, on his own admission, seems to have performed worse when he was actually taking drugs than he ever performed before."[29] Mr Peter Leaver QC, panel member for the Sports Dispute Resolution Panel, said that "most athletes do not take drugs".[30] However, for those who did, there seemed to be no limit to what they would try. Mr Leaver recalled a case - from the Salt Lake Winter Olympics - where he described a bob sleigh pusher's use of multiple illegal substances as the chemical equivalent of standing in the path of an express train.[31]

19. A significant impetus behind international initiatives to combat drugs in sport has come from the Olympic movement which holds a substantial sanction in its capacity to withhold, or restrict participation, in the Games and in its ability to take anti-doping considerations into account in awarding the right to host the event. In selecting athletes to compete at the Olympics, bye-law 8.1 to Rule 31 of the Olympic Charter requires national Olympic committees to take into account, not only the "sports performance of the athlete" but also his or her ability "to serve as an example to the sporting youth" of his or her country. The International Olympic Committee (IOC) and, more recently, the relatively new World Anti-Doping Agency (WADA) have been at the heart of the battle. However, virtually all international sports federations, including those for non-Olympic sports, have taken the issue very seriously and have long had relevant codes of conduct with associated testing programmes and sanctions.

Selected events in the history of doping in sport

Date Event

1865 The first documented anti-doping action. The British Medical Journal cited the expulsion of a swimmer from an Amsterdam canal race for taking an unnamed performance-enhancing drug.

1896 Arthur Linton, a British cyclist from South Wales, reported to have died from typhoid fever (nine weeks after setting a record time in the then 'blue riband' Bordeaux-Paris race). His death (often given as 1886) has been linked to the use of trimethyl - one of a range of drugs in vogue within the sport at the time - but this link seems based on only circumstantial evidence.

1904 Thomas Hicks, a marathon runner, collapsed from the effects of a dose of brandy and strychnine.

Early days Most doping seems to have involved alcohol and strychnine with heroin and cocaine also in extensive use until limited to prescription only.

1928 The International Amateur Athletics Federation (IAAF) was the first international sports body formally to ban the use of doping in sport; specifically stimulants used in-competition. Other federations followed suit but there were no effective tests.

1930s Amphetamines were produced and fast became the dope of choice over strychnine. Synthetic hormones were also developed.

1950s The Soviet Olympic team suspected of using male hormones and the anabolic steroids were developed in the USA.

1952 A high profile doping case at the Oslo Winter Olympics involved several speed skaters who became ill as a result of amphetamines use.

1960 Knud Enemark Jensen, Danish cyclist, died in competition at the Rome Olympics in an accident linked to amphetamines use (one of several competitor deaths related to these Games).

1963 France passed legislation banning doping in sport. Belgium followed suit in 1965.

1966 The UCI (cycling) and FIFA (football) were among the first international sports federations to introduce drugs testing at their respective world championships.

1967 Tommy Simpson, British cyclist, collapsed and died on Mount Ventoux during the Tour de France. His death, caught on camera, was brought on by heavy amphetamines use.

IOC Medical Commission established to tackle doping in sport.

The Committee of Ministers of the Council of Europe adopts a Resolution on the Doping of Athletes (67/12) initiating Council involvement in the issue which led to the European Anti-Doping Charter for Sport in 1984, and the European Anti-Doping Convention in 1989 and numerous other resolutions, recommendations and declarations on this issue. The Council has two of the four European seats on the World Anti-Doping Agency Board.

1968 The IOC defined doping and established first list of banned substances. Drug testing began at the Grenoble Winter Olympics and the Mexico City Summer Olympics.

1970s and 1980s State-sponsored use of banned substances (and negation of effective drugs testing) suspected in some countries and, in the case of the German Democratic Republic, later largely substantiated (including the doping of minors without their consent).

1974 Reliable test for anabolic steroids introduced.

1976 IOC added anabolic steroids to the banned list.

1978 The FA introduced voluntary post-match testing of players.

1982 IOC added testosterone and caffeine to the banned list.

1983 IOC developed a reliable test for anabolic steroids and the Caracas Pan American Games endured a scandal as 19 athletes tested positive for steroids and large numbers of other athletes left the Games without competing.

1984 Eight members of the US Olympic cycling team indulged in blood doping (transfusing stored blood back into the circulation prior to competition to raise red blood cell levels and hence increase the capacity of the body to carry oxygen). The US team won nine medals overall in the Los Angeles Olympic Games.

Late 1980s Artificial EPO (a hormone that stimulates the production of red blood cells in bone marrow) introduced to help patients needing dialysis. Used by healthy athletes, it had the same effect as blood doping.

1986 IOC adds blood doping to the banned list as a prohibited method.

1987 Seminal report, Drugs in Sport, put together by Sebastian Coe, Olympic athlete, which laid the foundations for random, unannounced, out-of-competition drugs testing (to which he himself was subject only a few months later).

1988 Ben Johnson, 100 metre gold medallist at the Seoul Olympic Games, tested positive for a banned anabolic steroid and was stripped of his medal and banned from competition for two years.

The FA introduced compulsory post-match testing.

1989 UK played a lead role within the Council of Europe in the establishment of the European Anti-Doping Convention (which came into force the following year).

1990s The introduction of more effective test methods assumed to be linked to a demonstrable drop in the level of results in some sports throughout the 1990s, notably in track and field athletics.

New doping agents developed such as human growth hormones.

1992 The British Olympic Association, at the request of its Athletes' Commission, introduced a life ban on eligibility for the GB Olympic team for athletes found guilty of a serious doping offence where no mitigating circumstances were established.

1994 The FA introduced compulsory out-of-competition testing at training grounds.

1997 UK Sport was established and took on the role of the UK's "national anti-doping organisation" (as then defined by the IOC).

1998 The French Festina team was expelled from the Tour de France after 400 phials of EPO were found in a support vehicle. Other teams were implicated in the scandal. Less than half the original competitors finished the race after withdrawals from the competition for a variety of reasons including protests at the nature of the investigations.

Source: ASDA, 2004, Parliamentary Office of Science and Technology (see Ev 134) and passim.

Current situation

20. Following the conclusions of a World Conference on Doping in Sport in 1999 (in the aftermath of the 1998 Tour de France debacle), the World Anti-Doping Agency (WADA) was established in Lausanne in November 1999. The aims of WADA are to:

protect athletes' rights to participate in doping-free sport and thus promote health, fairness and equality; and

ensure harmonised, coordinated and effective anti-doping programmes at international and national levels on the detection, deterrence and prevention of doping.[32]

21. A declaration on anti-doping in sport was signed by 52 governments in Copenhagen in March 2003 in order to create a foundation for international cooperation. A further 51 governments had signed up to this instrument by March 2004.[33] A convention on anti-doping, under the auspices of UNESCO, is in development and is set to replace the Copenhagen Declaration as the legal basis for inter-governmental cooperation with WADA (which formally is a private foundation constituted under Swiss law). The Minister for Sport, the Rt Hon Richard Caborn MP, told us that this process, in which the UK was taking a lead, aimed to link international "political clout" with sport's efforts on anti-doping.[34]

22. There was a meeting of representatives from the 190 member countries of UNESCO in January 2004 to discuss a preliminary draft of an anti-doping convention with a final version intended to go to the UNESCO General Assembly in October 2005.[35] Sports organisations have also been asked to accept separately the WADA Code and the Government told us that to date "the vast majority of sports international federations, the major Games organisations … the national anti-doping organisations and the Olympic committees have accepted the Code."[36]

23. The World Anti-Doping Code (WADC) came into force formally on 1 January 2004. WADA and the Code were together described by DCMS as representing "a truly global partnership between national governments and the sporting movement. Drug misuse in sport is an international problem and, as such, WADA is uniquely placed to co-ordinate and provide a lead in the international fight against drugs in sport." The Department said that the Code sought to "harmonise the principles behind testing processes, hearings, sanctions and list of prohibited substances and methods across all sports and countries."[37] The preferred date for national compliance (principally in respect of Olympic and Paralympic sports) is the first day of the Athens Olympic Games 2004. However, WADA has conceded some flexibility in this, provided signatories can demonstrate that they are actively pursuing full compliance.[38]

The WADA Code

24. The WADA programme consists of the World Anti-Doping Code; the List of Prohibited Substances and Methods (to be revisited at least once a year); a set of International Standards for technical matters (also open to revision); and a set of Models of Best Practice "tailored" to the needs of each of the major groups of signatories to the code (international federations for individual sports, international federations for team sports and national anti-doping organisations etc.). The programme includes both mandatory and advisory elements but, where flexibility is allowed (such as in the management of test results and the conduct of hearings) it is required that "the diverse approaches of the Signatories satisfy principles stated in the Code".[39]

Strict Liability

25. The key principle upon which anti-doping policy is hinged is "strict liability" and this was regarded by almost all our witnesses as a key element of an effective anti-doping regime.[40] Mr Mark Richardson, 400 metre runner and former casualty of this principle, nevertheless described strict liability as the "cornerstone" of the fight against drugs in sport which should not be diluted in any way.[41] Under this regime a sportsman or -woman is regarded as being absolutely responsible for the substances found in their samples. The doping violation, or offence, is committed when the evidence of a banned substance, or method, is identified in the athlete's urine and/or blood. Once the integrity of that sample and the result is established, the rest of the process is simply argument over whether mitigating circumstances exist that should reduce the applicable sanction.[42]

26. The reduction, or even elimination, of punishment is provided for under the Code (depending on exceptional circumstances)[43]; but the violation stands as a matter of record.[44] Mr Nick Bitel, Chief Executive of the London Marathon and sports law specialist, felt, however, that a clearer distinction should be drawn between cases of deliberate cheating and those of inadvertent violations. He quoted the Court of Arbitration in Sport in support of this argument: "It is equally important that Athletes in any sport … know clearly where they stand. It is unfair if they are found guilty of offences in circumstances where they neither knew nor reasonably could have known that what they were doing was wrong (to avoid any doubt we are not saying that doping offences should not be offences of strict liability, but rather that the nature of the offence should be known and understood.)."[45]

27. Equivalent considerations apply to other doping violations such as: attempting to use, or administer to another, a banned substance; failing to provide 'whereabouts' information; tampering with samples or other aspects of the process of doping control; possession of, or trafficking in, banned substances; and failing, or refusing, to provide a sample after notification. For example, the non-provision of a sample, after notification that one was required, constitutes the offence and subsequent argument over the circumstances may, or may not, persuade a hearing that mitigating factors should be taken into consideration. The standard of proof for all these matters set out in the Code is "greater than a mere balance of probability but less than proof beyond a reasonable doubt".[46] Some practical considerations behind the principle of "strict liability" are set out in the World Anti-Doping Code (quoting the Court of Arbitration for Sport) as follows: "it is likely that even intentional abuse would in many cases escape sanction for lack of proof of guilty intent. And it is certain that a requirement of intent would invite costly litigation that may well cripple federations—particularly those run on modest budgets—in their fight against doping".[47]

What is banned

28. The WADA Code is accompanied by the "Prohibited List", a list of banned substances and methods based on principles established by the IOC Medical Commission in 1967. Substances are assessed against three criteria:

the potential health risk for the user or the risk to the safety of other athletes;

the ability or potential to enhance sporting performance; and

the potential for a substance fundamentally to challenge the spirit of sport.

The list distinguishes between in-competition, and out-of-competition, prohibitions (with most 'recreational' drugs excluded from the latter). In addition, there is provision for the identification of "specified substances" which are particularly susceptible to unintentional doping violations because of their presence in a wide range of medicinal products.[48]

29. The Parliamentary Office of Science and Technology (POST) supplied the following information on banned substances and methods as well as their potential side-effects.[49]

Effect Examples Main side-effects

Muscle building
Increases strength by encouraging muscle growth allowing athletes to build mass, strength and power and to train longer and harder

Anabolic steroids; Beta-2 agonists; hormones that stimulate natural steroid production; hormones that stimulate growth; insulin

Gene therapy (IGF-1 and similar factors applied by viral agents to nerve cells)

Jaundice, liver damage, mood swings, nausea, headache, raised heart rate;
overgrowth of hands, feet and face, heart problems; low blood sugar

Mainstream research is still some distance from clinical tests on humans

Increasing oxygen supply
Enhances performance by increasing the supply of oxygen to muscle tissue

Protein hormones (EPO); artificial oxygen carriers; blood doping
Increased risk of heart failure and strokes; damage to immune system and kidneys, iron overload; infection and further increased risk of heart failure and strokes

Masking pain
Allows athletes to train through injuries by masking pain (the warning signal for problems)

Narcotics; inflammation reducing hormones; local anaesthetics
Addiction, impaired mental abilities; stomach irritation, ulcers, long term effects on bone and muscle tissue; aggravated injury

Stimulation
Make athletes more aggressive, confident, alert and less fatigued

Caffeine, amphetamines, ephedrine and cocaine
Irregular heartbeat, high blood pressure, and convulsions, uncontrolled behaviour

Relaxation
Help athletes relax, and may be used to steady hands (in skill-based sports) and overcome inhibitions (in risk-based sports)

Alcohol, cannabinoids; beta blockers
Impaired mental functions (including judgement of risk); low blood pressure, slow heart rate, fatigue

Weight control
Helps athletes lose weight

Diuretics
Dehydration, dizziness, cramps, heart damage and liver failure

Masking
Works to reduce levels of other drugs in the urine or to mask their presence

Diuretics; epitestosterone; plasma expanders; secretion inhibitors
As above; allergic reactions; nausea, vomiting, kidney damage

30. It is significant, if depressing, that POST reported that researchers developing gene therapy (aimed at encouraging muscle development in patients suffering from serious wasting diseases) had "already been approached by athletes" interested in using gene therapy for performance-enhancement despite the fact that the techniques in question were still "some 5-10 years away from being clinically useful in humans".[50] The misapplication of legitimate clinical developments, often aimed at solving serious chronic diseases, seems to be a common feature of doping in sport including EPO (renal problems), growth hormones (poor development in children), anabolic steroids (various wasting diseases) not to mention medicines originally developed for gout and anaemia. The DCMS told us that, currently, it had no mechanisms to work jointly with the Department of Health, and/or the Medical and Healthcare Products Regulatory Agency (MHRA), on the specific issue of the misuse of new medical research, pharmaceuticals or devices for the purposes of enhancing sporting performance. Given the apparent ingenuity and foolhardiness of the minority of sportspeople who seek to cheat, we recommend that the DCMS, UK Sport, DoH and MHRA jointly determine whether to seek to pre-empt the abuse of new medical research and developments by sportsmen and -women or their coaches.

Drawing the line

31. WADA's List of Prohibited Substances and Methods, developed through worldwide consultation with experts in medicine, science and ethics, establishes for the first time an international consensus over what is allowed and what is banned. Its key achievement is that it has attracted this consensus and therefore stands as part of the rules of sport which sportsmen and -women must respect. We received evidence on two broad issues arising from the List in addition to the questions raised by the discovery of tetrahydrogestinone (THG), the so-called "designer steroid".

Means or ends

32. The first issue is best illustrated by the banning of the artificial peptide hormone, erythropoietin (EPO), which enables users artificially to increase their capacity to supply oxygen to muscle tissue, thereby increasing endurance levels (usually in competition). EPO has the same effect as blood doping (the reintroduction to the body of stored blood just before competing). Although the Sydney Olympics in 2000 saw the introduction of a blood test for EPO it is said to be of limited value without regular blood screening to assess 'normal' red blood cell levels on an individual basis.[51]

33. A significant point is that sophisticated, and more expensive, training methods, such as time spent in a hypoxy tent to reproduce high altitude conditions, also 'artificially' boost the body's capacity to carry oxygen. In his submission Mr Nick Bitel raised the question of why EPO and blood doping are banned, while hypoxy facilities are not, in the context of a consistent and levelled playing field.[52] Whilst not concluding against this apparent inconsistency, he did emphasise the importance of continually reviewing why certain drugs or techniques are, or are not, banned in sport: a point of view with which we agree.[53]

34. We believe that the "level playing field" argument should be seen as a development of the right of sportsmen and -women not to feel the need to take banned drugs in order to prevail. To protect athletes from themselves, the pressure to put potential glory ahead of possible death or injury must be reduced by ensuring that as far as possible drug cheats do not—and are not perceived to—win all the medals. The idea that the 'playing field' is being levelled for reasons of equity between nations with different access to sophisticated banned substances cannot be correct in the light of the vast differences between countries in terms of their investment in legitimate training methods, medical and dietary support and sporting facilities.[54]

35. In the view of virtually all our witnesses, the ultimate value of WADA's work on the Code and the banned list is that, whether right or wrong in every last detail, there does now exist a single standard, and set of principles, that all of sport can look to; and a process by which further refinements can be made in a way that will command consensus. The task now was said to be to educate everyone involved in sport in the implications and practicalities of these standards. The challenge of this task should not be underestimated and, as stated by virtually all our witnesses, its importance could hardly be overstated.[55]

Recreational drugs

36. A second controversial issue is the treatment of illegal narcotics when taken out-of-competition for 'recreational' reasons rather than for performance-enhancement. Ms Verroken told us that UK Sport had originally put forward "strong arguments" to WADA that, for instance, cannabis should not be on the banned list but should be a "monitored" substance (the way that alcohol is treated within football).[56] UK Sport and the Government drew attention to the current distinction between out-of-competition, and in-competition, rules. The Government's memorandum stated that: "The majority of substances that are usually considered to be social are not tested for during out-of-competition testing programmes, as these substances are not considered prohibited in sport in…[this]…context."[57]

37. The Government believed that it was important that such substances be banned in-competition and that the same sanctions should apply for adverse findings for social drugs, as for performance-enhancers, in view of the message that would otherwise be sent out regarding what is, and what is not, acceptable behaviour.[58] UK Sport also pointed out that certain "recreational" substances had effects that were either performance-enhancing, posed risks to the athlete and those around them or could mask other substances. UK Sport stressed that the anti-doping rules were clear and that a violation was caused by the presence of a banned substance in an athlete's specimen; the violation itself (as opposed to the eventual sanction) did not depend on whether the motivation was to gain an advantage or just for 'fun'.[59]

38. The issue of social or recreational drug use was of key concern to the Football Association. The FA told us that out of thousands of tests of players in English football over the years "there had only been one positive find for a performance-enhancing substance"[60] but, in common with society as a whole, "professional football has to deal with social or recreational drug use".[61] The FA said that those "who use, and particularly those with addictions to, social drugs may be causing themselves harm, and possibly risking harm to fellow professionals … if they go on to the field of play in an intoxicated state."[62] In accordance with this view, and the nature of the football season, Mr Nic Coward, Director of Corporate and Legal Affairs, told us that the FA did not distinguish between in- and out-of-competition regimes but tested throughout the season for the full range of substances, including social drugs. Mr Coward said that 'football', by way of joint action between the governing body, the employers the leagues and the players, had decided to take this comprehensive approach "of itself, for itself".[63] This has implications for The FA's approach to disciplinary proceedings to which we refer later in the Report.

New substances

39. The original List banned substances, classes of substances and their "analogues" and "mimetics" in an effort to provide for just the sort of illicit new development of which THG is a prime example. The List defined an "analogue" as a substance with a similar chemical structure and similar pharmacological effects. In the case of "THG", a banned anabolic steroid was re-engineered to mimic the effects of a banned substance without triggering existing tests. In the light of these circumstances, WADA has concluded that new performance-enhancing substances—unsurprisingly but contrary to good and safe medical practice—will be administered to, or taken by, sportspeople without any studies having been conducted on their pharmacological effects. In consequence, the List has been amended and now bans specified substances and others with "similar chemical structure or similar pharmacological effect(s)".[64]

UK compliance

40. The UK has had a "national anti-doping policy" in place since 2000 to which the relevant bodies (the home country sports councils, the British Olympic Association, the British Paralympic Association, UK sports governing bodies) and athletes have signed up. This policy is in the process of being updated to reflect the final WADA Code.[65] UK Sport described the outstanding issues as twofold:

the need for WADA-related revisions of the rules of international sports federations, and national sports governing bodies, and of the UK national policy, to be dovetailed and consistent; and
resolution of some complex legal and other issues around interpretation of the Code and the need for related consultation of all parties.[66]

41. Detailed issues, on both mandatory and discretionary parts of the WADA Code, highlighted by UK Sport were:

complexities arising, uniquely for the UK, out of having five possible national teams - Great Britain, England, Northern Ireland, Scotland and Wales - which were mostly concerned with avoiding potentially undue and distracting administrative burdens on UK athletes;
mandatory compliance with four detailed International Standards (relating to sample collection, laboratories, the banned list and the system of exemptions for documented medical conditions) published relatively recently in January 2004;
the need for new arrangements related to pre-hearing reviews of potential anti-doping rule violations and the reporting of results;
provision for an independent and impartial appeals process; and
complexities over the arrangements for Paralympic sports and athletes and coordination between WADA and the International Paralympic Committee's own revised anti-doping code.[67]

UK Sport said that, to some extent, its own reforms were subject to the pace of progress made by international federations on their rules and regulations.[68]

42. UK Sport argued, however, that the UK was "at a more advanced stage of compliance than many countries".[69] We commend the efforts of UK Sport, and all the relevant sports authorities and governing bodies within the UK, for the steps already taken. We regard the position of WADA—accepting demonstrable progress and determination to succeed—to be a much healthier approach than legalistic nit-picking. The international push for drug-free sport depends heavily on negotiated consensus and the winning over of hearts and minds across a complex sporting landscape of markedly different disciplines, countries and cultures. This process takes time and we believe that it is vital to keep the fundamental objectives, principles and values embodied in the World Anti-Doping Code to the fore.

The extent of the problem

43. Cases of doping in elite sport attract a huge amount of media attention and our own summary of the history of sport doping is itself alarming when taken in isolation. However, it is important to take an objective look at the available evidence. The international average for adverse findings from drug tests is 2%. The equivalent overall figure for tests carried out in the UK was 1.5% and UK Sport suggested that this indicated that "the vast majority of athletes are not attempting to cheat using prohibited substances" with those in the UK behaving better than the global population of elite sportspeople.[70] Individual comparisons with other countries are difficult to make due to variations in reporting but, for example, the respective figures for 2002-03 in the UK and Australia were 1.39% and 0.59%. The results of UK Sport's testing of sportsmen and -women, in this country over the past 5 years, are summarised in an annex to this Report.

44. UK Sport says that the data indicate that the existing testing programme, of about 6,000 tests per year, is acting as an effective deterrent.[71] However, UK Sport conceded that there is no room for complacency as indicated by the deliberate development of a new steroid, THG (for which no test existed), as a way for the cheats to move a step ahead once again.[72] Mr Bitel wrote that he did not believe that the majority of sports men and -women deliberately took performance-enhancing drugs but perceptions to the contrary had been created by three factors:

the treatment of inadvertent drug users in the same way as those intending to cheat;
the profile of drug stories in the media compared to coverage of any other aspects of sport (except football); and
the presence of illegal 'recreational' drugs on the banned list, use of which was prevalent amongst young people across the population.[73]

THG

45. During this inquiry various investigations and proceedings were taking place in the US with regard to revelations over a new performance-enhancing anabolic steroid called tetrahydrogestinone (THG).[74] An adverse finding for THG in August 2003 has already led to a British 100 metre sprinter, and Athens medal prospect, Mr Dwain Chambers, being banned from competition for two years.[75] We have not sought specific evidence on these matters, not least because the situation is developing and involves criminal, as well as anti-doping, proceedings (albeit in another country).[76] However, the material already in the public domain suggests a worrying level of sophistication on the part of those offering a competitive advantage to sports people in the form of banned substances or newly developed analogues. THG was unlikely to have been developed in someone's garden shed. UK Sport confirmed that some means were needed to tackle proactively the developers and traffickers in performance-enhancing drugs but that this would require "a commitment from all organisations working in sport, including UK Sport, Government, sports governing bodies, etc".[77]

46. On the other hand, Mr Richard Pound, Chairman of WADA, has said that the evolving THG saga demonstrated significant progress, and changing attitudes, in anti-doping; in particular, increased cooperation between sporting and government bodies. Mr Pound highlighted a number of positive factors, including:

a whistleblower supplied the US Anti-Doping Agency with a sample of the previously unknown, and untested for, anabolic steroid;
the UCLA laboratory found a test for it after intensive work (now passed round all WADA accredited drug control facilities enabling the retesting of stored samples[78]);
a US grand jury has handed down four indictments, announced personally by the US Attorney General, against those believed to have broken US law in distributing controlled substances to sportspeople;
the President of the United States referred to doping in sport in his 2004 State of the Union address; and
first in line for indictment were the alleged distributors rather than simply the sportsmen and -women themselves.[79]

47. We believe that the prevalence of performance-enhancing drugs in sport should not be over-stated. There is no doubt that a small number of sportsmen and -women will deliberately or recklessly take, or do, anything to gain a competitive advantage. There also seem to be those who seek to profit from the development of new ways to help cheats to do so. However, it seems equally clear that a significant number of sportspeople commit violations as a result of carelessness, ignorance and/or sheer bad luck. In assessing the situation, and presenting data, these categories should not be conflated, nor should it be forgotten that, even when taken together, these sportsmen and -women represent a tiny minority.

An unanswered question

48. One issue of concern to us was the extent of doping, most likely to be over-use of anabolic steroids, outside elite sport. As Professor Cowan made clear, anabolic steroids are regulated by the Misuse of Drugs Act and the Medicines Act. Possession without a prescription is an offence but, in practice, a conviction for a limited amount of formulated product would be very unlikely with prosecution usually reserved for trafficking offences.[80] UK Sport told us that very little research in the UK had been undertaken into this topic but that it would welcome the allocation of resources to such work.[81] The DCMS told us that the Government had not commissioned any specific research into the use of performance-enhancing drugs outside elite sport.[82] The Department cited Canadian and US studies which suggested links between steroid use at school, to improve physique, with the use of performance-enhancing substances in later life as an elite athlete. Estimated rates of steroid use amongst US adolescents ranged between 4 to 12% for males and between 0.5 to 2% for females.[83] Professor Cowan told us that US research revealed that "quite a high percentage" of young American males used steroids so they could "impress their girlfriends".[84]

49. Some Government information is available despite the lack of specific research. According to the Department of Health's biennial survey of trends in drinking, smoking and drug-taking amongst young people in England, only 1 per cent of 11 to 15-year old boys had taken steroids in 2001 (and no girls).[85] The Home Office reportedly estimates that 42,000 people per year in the UK use anabolic steroids without prescription. DCMS did give figures for HM Customs and Excise seizure of illicit imports of steroids over the last three years: 100,000 tablets in 2001; 800,000 in 2002; and 300,000 in 2003.[86] Given expected interception rates for illegal drug imports, a significant illicit market for these drugs in the UK is indicated. Key findings from the 2002/2003 British Crime Survey indicated that, in 2002, the use of steroids among 16 to 59-year olds had decreased since 1996 (with the drugs being more popular among 34 to 59-year olds than among 16- to 24-year olds).[87]

50. The DCMS said that the health risks of the use of anabolic-androgenic steroids included: mental illness, respiratory, heart and kidney disease and, in circumstances of prolonged use, combination with other substances and/or overdose.[88] Evidence from media reports has also illustrated the both physical and psychological damage that over-use of steroids can inflict including liver ruptures and heart failures arising particularly from 'unmonitored' use by body-builders and amateur weightlifters. Instances of both violent crime and violent sex crime have been linked to the increased aggression caused by excessive steroid use. A key, if indirect, health risk is that steroid users may inject the drug and, in doing so, share needles running the risk of infection with HIV or hepatitis.

51. POST reported to us that a survey in 1993 suggested that about 5% of gym-users were using anabolic steroids for performance-enhancing or cosmetic reasons. More recent surveys have indicated that steroid use is higher (in the region of 25-50%) among those attending gyms equipped for competitive bodybuilding. For example, a long-term survey of users of three bodybuilding gyms in the Mid-Glamorgan area suggested that 58% of the clientele were using anabolic steroids. One in five of those using steroids have reported that they shared needles when injecting the drugs. A follow-up study of people in the survey who had used steroids for 20 or more years found evidence of increased risks of cardiovascular disease. Indeed, further follow-up work in 2002 showed that three of the 20 subjects had died since the tests were conducted, two from cardiovascular problems.[89]

52. With regard to efforts to combat steroids in 'grassroots' sport, Ms Verroken told us of an ultimately unsuccessful pilot project that UK Sport had run in Darlington for the promotion of a self-regulatory system amongst private gyms aiming at ensuring a drug-free, steroid-free, status.[90] UK Sport's evidence included a description of Start Clean; an initiative aimed at educating 13 to 17 year-old aspiring athletes in the importance of drug-free sport as well as improving personal development, self-confidence and respect for health and well-being.[91]

53. We believe that there are sufficiently worrying indications of dangerous levels of steroid use, outside elite sport, to warrant specific research by the Government into the extent of the illicit trade and use of steroids amongst gym-users in the UK. We recommend that the Government commission comprehensive research into the prevalence of steroid use. The status of anabolic steroids under the law, and the regulation—or rather the non-regulation—of gyms and fitness clubs in this respect, should be reviewed in the light of the results.

Available data

54. Overall, we found the information available related to current levels of drug use in sport to be unsatisfactory. We asked UK Sport to set out its drug test results data in the context of: the various numbers of sportspeople eligible for testing in each sport; the estimated annual number of competitions in each category; and the split between 'public interest' tests provided by UK Sport as opposed to those purchased by sports governing bodies. UK Sport responded that: "No data collection system currently exists for the specifics of these questions. Providing such information would entail a considerable amount of time and human resource beyond current UK Sport capacity." The organisation pointed to "the difficulties of quantifying the potential numbers involved in team sports" and said that providing such figures would require too much guesswork for them to be at all meaningful.[92] We find it hard to believe that truly effective policies for anti-doping can be developed in such a data-vacuum.

55. The picture is also confused by the testing of foreign sportspeople competing in this country and the testing of British sportspeople while abroad. UK Sport said that its figures "include tests conducted by UK Sport in the UK on UK and overseas competitors. Tests conducted on UK athletes in other countries will be included in the results reports published by those countries. Again, no data collection system currently exists for such results."[93] We note evidence from Ms Verroken relating to severe time lags in UK Sport finding out about British sportspeople with adverse findings from tests in other countries; in some instances the UK's national anti-doping agency was left to read about such cases in the newspapers.[94]

56. The information collection and analysis relating to drugs in elite sport is currently unsatisfactory in view of the seriousness with which the Government claims to be taking the matter and the importance of robust data in establishing an effective level of deterrent and preventative action through the testing regime. We expect that the development of international cooperation under the auspices of WADA and efforts of national agencies to achieve WADA compliance will help. We recommend that further resources be allocated to UK Sport to remedy this deficit with respect to British sportsmen and -women whether they are tested here or abroad.

Variations between sports

57. The available data on adverse findings from drug-free sport testing indicates marked differences across sports (and between performance-enhancing and other drugs). Anti-doping policies recognise that sports vary in character and present different levels of risk in terms of the likely prevalence of performance-enhancing drug use. UK Sport uses a number of criteria to determine the priorities for the allocation of resources within its testing regime:

the international status of the UK in the sport;

the negative public impact of a doping offence and the positive impact of clean sport;

the financial rewards available to participants (including sports council funding);

previous history of doping offences; and

the potential for drug misuse.[95]

58. These and other differences between sports, and the environment in which competition takes place, have implications at other stages of the anti-doping process. One key factor, for example, is the structure, and crucially the available resources, of national sports governing bodies and the relationships they have with their international federations. We illustrate, with a broad brush, some significant factors with reference to athletics and football (two vocal participants in this debate) in the figure below.

Athletics

Athletics is a collection of largely individual sporting activities based, in large measure on power, speed, endurance and, of course, technique and strategy. There can be quite narrow performance margins in separating gold from bronze medals (the narrowest being 0.17 of a second, for instance, in the Sydney men's 100 metres).

Athletics, in relation to many other sports, has a significant record of adverse findings in relation to performance-enhancing substances. Between Olympiads, athletics appears prominently in the media perhaps more often in relation to alleged doping infractions than for other reasons.

Between competitions athletes train in a number of locations, including travel abroad for warm-weather and/or high-altitude training.

Athletics relies on UK Sport-provided "public interest" drugs tests each year and, in general, the governing body and many athletes rely on awards of public resources. UK Athletics would prefer not to have to undertake both the supportive, and the prosecutorial, functions with respect to athletes who suffer adverse findings in drug tests. Some individual athletes enjoy effective support networks but this is perhaps not the norm. There was also concern over the risk of significant liabilities arising out of doping cases.

The IAAF has been at the forefront of initiatives to combat drugs in sport. As a lynchpin of the Olympic movement it is no surprise that the IOC's approach, now taken up by WADA, reflects the dynamics of athletics, perhaps, rather better than those of team sports.
The nature of many athletics events are potentially susceptible to participants seeking "an edge" that might be thought to be in the gift of banned substances and methods

The empirical evidence supports the contention set out above. There is a need to handle disclosure of allegations of doping offences carefully to avoid false perceptions and witch-hunts.

The need for out-of-competition testing to include effective arrangements for 'whereabouts' information is important in athletics.

The resources available to athletics and to athletes are likely to be stretched by proceedings over alleged doping offences. There is understandably a desire for an independent, publicly funded, sport tribunal system and some action to pre-empt potential liabilities.

UK Athletics, alongside British Swimming, is a strong supporter of harmony in approach across all sports on doping control issues.

Football

Football, on the other hand, is a protracted, and interactive, team game requiring multiple skills and plenty of contact. In England, The FA reports one proven case of use of a performance-enhancing substance over the last 10 years.

Professional players are effectively "in competition" for the whole season on club or national duty. Players are 'in the hands' of their clubs - i.e. required at identifiable training grounds - for most of the time. Professional football players, to varying degrees, are under a media spotlight.

Football has to have rules governing the interaction of competing players (who must contest physically for possession of the ball). This gives rise to authoritative compliance and disciplinary arrangements which The FA, a relatively large and well-resourced sports governing body, runs. The FA believes that anti-doping rules, and associated proceedings, fit comfortably into these longstanding arrangements and culture. The players have their clubs, own resources and an active and well-resourced professional association to provide support in the event of disciplinary proceedings.

FIFA was an early adopter of doping control at its world championships and was involved in the drafting of the Code from the outset. The FA looks to FIFA to provide the rules and regards itself as the national anti-doping agency for football in England.
Footballing performance, being a mix of very many factors, is not conventionally seen as being open to improvement through the use of banned substances and methods.

Professional football players are generally available to Drug Control Officers through their clubs, as a matter of practicality and contract, throughout the season (barring exceptional circumstances or deliberate action). The intense media interest in footballers' lives informs The FA's approach to disclosure.

The FA has to have a substantial and effective apparatus for disciplinary proceedings, quite apart from doping control, due to the nature of the game. Players have other sources of support due to the structure of the game and the resources within it.

The FA stresses the importance of implementing whatever is agreed between FIFA and WADA and that sports should 'own' their procedures.