Drugs in sports: Who is winning the doping war?

As scientists close the gap on doping detection, athletes bent on cheating can still game the system. Stricter enforcement from league authorities is critical to redeeming sports scandalized by doping – cycling, baseball, and potentially the NFL.

Focus

January was a busy month for drugs in sport. First, cyclist Lance Armstrong admitted on national television to running what one antidoping agency called "the most sophisticated, professionalized, and successful doping program that sport has ever seen."

Two weeks later, news reports claimed that documents from a Florida clinic connected New York Yankees third baseman Alex Rodriguez to the use of performance-enhancing drugs (PEDs). Meanwhile, in New Orleans, Baltimore Ravens linebacker Ray Lewis was besieged by questions before the Super Bowl about "deer-antler spray" and whether he used illegal substances during his remarkable recovery from a serious arm injury.

Such allegations are common in the world of sports, and Rodriguez and Lewis have denied the reports. But recent weeks have pointed to how the fight against doping is evolving. Though science has made significant leaps forward in its ability to catch drug cheats, antidoping efforts are only as successful as the programs that enforce them. And if there is a lesson from the past decade, it is that from cycling to baseball, it takes a serious scandal and a threat to the very integrity of a sport to get officials to crack down.

Marion Jones and the BALCO scandal threatened the fair play that undergirds the Olympic movement, leading the International Olympic Committee to adopt an antidoping regime that remains the world's standard. Baseball's "juiced-ball" era made a sham of the record books and led baseball writers in January to elect no players to the Hall of Fame; in the wake of such embarrassments, baseball is taking halting steps toward expanding its antidoping regime.

"In sports where comprehensive, unannounced testing is done year round, the sport is pretty clean and much, much better than, say, in the 1990s," says Jim Stray-Gundersen, an anti-doping expert who served as a physician for the 1988 and 1992 Olympic teams, in an e-mail. "In sports where there is not a comprehensive program, doping is likely as common as ever."

That leaves the National Football League (NFL) as the leading pariah of the antidoping world, with many experts saying that its first big PED scandal is more a matter of when, not if.

For much of the past three decades, Don Catlin has been on the front lines of the campaign against PEDs. The lab where he used to work, the UCLA Olympic Analytical Laboratory, was the first of its kind when it was founded in 1982. In it, he and his team developed a wide range of tests for PEDs including anabolic steroids, EPO (erythropoietin), and tetrahydrogestrinone (known as THG or "the clear" – the drug at the center of the BALCO scandal).

"Things are moving forward. But they're also stepping back," he says.

In particular, Armstrong's doping program, revealed in an October report by the United States Anti-Doping Agency (USADA), gives Mr. Catlin pause. While scientists are better than ever at identifying banned substances, athletes still can game the system.

"We thought we had this whole problem nailed," he says. "We spent a lot of time trying to find the drugs and get them in pure form. But that doesn't deal with how you get the drug into the athlete, or the athlete sending in someone else's urine."

Others agree that the cat-and-mouse game of doping has changed from decades ago, when athletes were using cutting-edge PEDs that scientists couldn't detect. "I think the doping athlete today is looking to use tried-and-true doping agents in a manner to avoid detection, rather than find something currently undetectable," Dr. Stray-Gundersen says.

The financial advantage is clearly with the athletes.

"The annual budget for WADA [the World Anti-Doping Agency] is $28 million, which is the price of one good baseball player," Catlin says. "How do you expect to really catch guys with that kind of money?"

In the wake of numerous doping scandals in track and field and cross-country skiing, among other sports, the Olympics adopted WADA's World Anti-Doping Code in 2003. Its recommendations include having an independent third party (not the league itself) conduct the drug tests, a routine of rigorous and random in-season testing, and harsh punishments for athletes who are caught.

Under the code, athletes can be banned for two years for the first infraction and banned for life for the second. They also have to pick one hour a day, seven days a week, to be available for unannounced testing.

Scientists say frequency and timing are key to effective testing, and testing at the 2012 summer Olympics was more aggressive than ever. Half of all competitors were tested, as well as every medal winner.

During the Games, Olympians could be tested anytime, without any advance notice. The antidoping lab used during the London 2012 Olympics was the first ever underwritten by a major pharmaceutical company, Glaxo-SmithKline; it tested 400 samples per day.

WADA also advocates the use of a "biological passport" – a compilation of data that shows each athlete's natural level for certain biological markers and hormones. That way, scientists can monitor those levels for unusual activity. Biological passports played a key role in cycling's doping crackdown.

Other professional sports leagues that follow WADA guidelines include the International Tennis Federation, all arms of the Professional Golfers' Association, the National Hockey League, Major League Soccer, and the English Premier League. The National Basketball Association, Major League Baseball (MLB), the National Collegiate Athletic Association, and the NFL don't follow the WADA code: They conduct their drug testing in-house and hand out much lighter penalties. That opens them up to criticism.

For now, the NFL's drug scandal is limited to whispered conjecture and incidents bordering on farce. Most recently, a report surfaced linking Lewis to deer-antler spray, which contains a growth hormone called IGF-1. The substance is banned by the NFL.

The league has plenty on its plate already as it faces growing questions about the game's long-term effects on player health. (Recently, President Obama told The New Republic that, if he had a son, he would have to think long and hard about letting him play football.)

The question of PEDs is a comparative blip, but it threatens to grow. Currently, the NFL Players Association (NFLPA) is in charge of the antidoping program. But in-season testing is virtually nonexistent.

That was set to change with the 2011 collective-bargaining agreement, which stipulated that the players union would institute an in-season drug testing regimen that included regular blood testing for human growth hormone (HGH). But that was two seasons ago, and some, including members of Congress, are growing impatient.

The House Oversight Committee sent a letter to the NFLPA Jan. 28 warning that NFL players and NFLPA executive director DeMaurice Smith may soon be called to testify about why an in-season testing program has yet to be implemented.

The NFLPA has cited concern about the lack of a suitable appeals process. It won't agree to a third-party arbitration system – as MLB has – and it is wary of commissioner Roger Goodell's authority to discipline players. The NFLPA also worries about the potential for false positives.

HGH is one of the trickier drugs to catch, particularly with a urine test alone, because it has a very small window of detection. Used to build muscle and reduce fat, the drug can be taken in very small doses during competition and is hard to accurately spot because it exists in the body already (especially in young males, who have a lot of it).

USADA Chief Science Officer Larry Bowers testified before Congress in December that "no test is perfect, but there hasn't been a single false positive."

The House Oversight Committee's top Democrat, Elijah Cummings of Maryland, says PED use could be exacerbating other health concerns facing the league. If players are artificially stronger and faster, that makes the hits harder and more damaging, he said.

"I know Roger Goodell, and he's trying to improve not just the health and safety of the players, but the image of the league. The NFL would get a black eye," he says.

"Football is certainly as good a candidate as any for some embarrassing revelations," says Tom Murray, president emeritus of The Hastings Center, a bioethics research institute based in Garrison, N.Y.

"The HGH test resistance by the NFLPA [is] unfathomable. If you make it easier to cheat, you're making it harder for the players that aren't cheating.... I worry about the NFLPA's leadership there, what they think they are accomplishing."

If the NFL players need an incentive to tighten the league's doping regime, they need look no further than Major League Baseball.

MLB has been at the center of the steroid question in US professional sports for more than a decade. It started as whispers during the Mark McGwire-Sammy Sosa home run race in 1998 and exploded with the BALCO scandal of 2003, which ensnared Barry Bonds. During the "steroid era" of the late 1990s and early 2000s, baseball had a ban on illegal or controlled substances, but there was no testing program until 2002.

Since then, MLB has taken steps to address doping – albeit slowly. Last month, it announced that it would begin in-season blood testing for HGH.

"This is a strong statement by the players and the league not only confirming the scientific validity of the HGH blood test and the benefit of longitudinal testing, but also the importance of clean athletes' rights and the integrity of the game," the USADA said in a press release.

But last month's Miami New Times report shed a harsh light on the regulatory holes that still exist in the doping world. It linked several high-profile players, including Rodriguez and Melky Cabrera, to Biogenesis, an anti-aging clinic in Miami with sales records for PEDs including HGH, testosterone, and anabolic steroids.

Antiaging clinics prescribe testosterone and other drugs for older people, but they've so far mostly escaped heavy scrutiny from antidoping agencies.

In the end, some observers say players receive too much of the blame for simply trying to compete in sports in which doping has spiraled out of control.

"It's not fair that only the athletes suffer when their behavior is the consequence of many different forces," Dr. Murray says.