Drugs work - but by how much? A look at doping and performance improvements

Performance enhancing substances - do they work? And by how much? It's a relevant question, and I thought it would be good to have a look at the answers. I was going to write an article on the Ethiopian dominance of long distance running in the last ten years, but we've been receiving such thoughtful comments and questions from people regarding our posts on drug use in cycling that I thought it might be better to continue on this theme and look at just what a scientist makes of the prevalence of doping in sport. I also said I'd look at altitude training, and I will, but I'll do that tomorrow. For now, we keep going on doping.

Yesterday LuckyLab asked how much of a difference doping actually made? And unfortunately, it's quite difficult to get hold of that information! As you can imagine, it's difficult enough to find out who is doping and with what, never mind trying to track their improvements in a controlled manner! And make no mistake - this information exists, because scientists are giving out the drugs, and as scientists, they are compelled to measure changes and improvements (it's our curse as scientists!). But this information rarely makes it out into the public eye, except once....

As far as I'm aware, the only paper published in a reputable journal is one by Franke and Berendonk. This paper was published in a journal called Clinical Chemistry in 1997, and this post is a breakdown of what it showed...

To begin with, the paper by Franke and Berendonk opens with the following sentences:

"One of the largest pharmacological experiments in history has been running for more than three decades, namely, the administration of drugs to athletes to enhance performance in many different kinds of sports"

Another quote from the article's abstract (or introduction summary):

Top-secret doctoral theses, scientific reports, progress reports of grants, proceedings from symposia of experts, and reports of physicians and scientists who served as unofficial collaborators for the Ministry for State Security (“Stasi”) reveal that from 1966 on, hundreds of physicians and scientists, including top-ranking professors, performed doping research and administered prescription drugs as well as unapproved experimental drug preparations. Several thousand athletes were treated with androgens every year, including minors of each sex. Special emphasis was placed on administering androgens to women and adolescent girls because this practice proved to be particularly effective for sports performance.

Scary stuff. I won't go into massive detail in this post on the background of the study. But very briefly, Werner Franke (the author of the research paper) is one of the world authorities on doping in sport. He has a personal interest, because his wife, Brigette Berendonk, was a German Olympic shot put and discus thrower, and was on the programmes he writes about.

And their paper is all about the hormonal doping and androgenization (which means making males out of females) of East German athletes. This is still topical, because the case of the current Tour de France champion, involves a similar product - testosterone. In this research article, they write about a number of anabolic agents, notably Dianabol and Turinabol.

But let's get stuck into it. And we'll use the example they give of a German Female shot-put athlete. This athlete had been training for 14 years before she was put onto the programme, so certainly, her improvement in results cannot be explained by a response to training, as it might be if she was still a junior athlete.

So the Figure below shows the improvement in performance in this woman shot putter during a 5 month period in 1968. The blue block on the X-axis shows when she was given the drug - Turinabol, in doses of 14 tablets per week (10 mg per day, each tablet = 5mg). You'll see how she gains muscle strength and improves her performances dramatically in only a few weeks - we're talking 9% over the course of about 10 weeks of drug use! But it gets better (or worse, depending on your point of view!)


Jump ahead to 1969, where the same woman went through very much the same procedure. The Figure below shows the performances over a similar five month period. This time, the drug was administered in slightly higher doses, and in three separate cycles. The result is the same. Her performance improved by an amazing 17% from the start to the end of the season, with a new world record of 20.10 m the culmination.

There was more to come. In 1970, the same athlete was again systematically doped, but with even higher doses. She once again broke the world record, and this time, broke the indoor world record as well. She ended with a personal best of 20.22 m, which was a fully 2m further than she had managed to achieve on 14 years of training BEFORE starting on the doping programme! This is an 11% improvement! But what is particularly important is to notice how her performances when NOT ON THE DRUG are so 'poor' - she starts each season a full 3 m off what she will reach at the end, with the aid of the steroid.

The paper by Franke further breaks down the recorded improvements in performance when using anabolic agents. The table below shows some of these improvements:

Not exactly and all-encompassing and comprehensive list, but it illustrates two points. Firstly, we don't know enough about the effects of these drugs on performance. That's pretty obvious. But secondly, what we do know tells us that they work really well - 7 seconds on a 1500 m time is enormous. So is 4 seconds on a 400 m. Even 2 seconds in 400 m is a lifetime. So if you look at the current world record in the 400 m event, it stands at 47.60 (Marita Koch). No one has managed to even threaten it since the 1980's, and it's quite conceivable, assuming the table above is correct, that this 47.60 is worth about, oh, 50.60. And suddenly then, today's runners are comparable!

So, we can pretty much see that doping with anabolics does work. If only there was similar evidence of the effect of EPO. There is some information on EPO, however, and it comes from Marco Pantani, and is reported in a book by Matt Rendell called The Death of Marco Pantani and then reported in an article by Tim Noakes published in the International Journal of Sports Science and Coaching in 2006.

In this book, Rendell exposes results of rider's hematocrit levels during the course of three years - 1993 to 1995. Remember that the hematocrit levels are an indication (albeit indirect) of the use of blood doping or EPO. A normal individual would have a hematocrit between about 40 and 43%, while a trained athlete could see this get up to about 48%, possibly even 50% if that person has done altitude training. However, it is also important to remember that when a cyclist is training hard, his hematocrit levels will fall. Therefore, in the peak of competition, it would not be unusual to see relatively lower hematocrit levels, in even the elite athlete population.

So what does the data say? The graph below is a rough summary of the information from Rendell's book. It shows the hematocrit of riders who were part of a state run programme by the University of Ferrara in Italy. I have highlighted in red the periods where cyclists would be competing in the Tour de France or Vuelta. The bars in green are the "off season" where cyclists are not racing and blue are mid-season. Remember, it would be normal to see that the hematocrit is highest during the rest period, and lowest during the racing season. Yet it is quite obvious from this graph that it is the other way around, and that is something that would presumably only be possible if the athlete was using a product such as EPO.

I have also shown on the graph the values of one Marco Pantani (yellow triangles), and you can see how in 1995, his hematocrit reached an astonishing 64%! This kind of variation just cannot be explained by anything other than pharmaceutical use, in my opinion.

In his book, Rendell concludes that "There is incontrovertible evidence that Marco’s entire career was based on r-EPO abuse, which was both effective and, until 2001, undetectable by tests used in professional cycling. Is it reasonable to suppose that the most successful period of his career, from 1998 until 5 June 1999, depended on anything else?”

THe bottom line then, is that doping seems to work VERY WELL. It's still difficult, if not impossible, to put an exact number to the benefit, though the data of Franke et al give a pretty good indication that it's at least 15% in those power based sports. It may be slightly less for endurance based sports, like cycling. But as i wrote yesterday, there's substantial evidence that hormone levels, particularly testosterone fall during the course of a race like the Tour. And so if Floyd Landis and others are using the drug, the benefit would come from defending this drop-off, which promotes recovery and hence allows them to maintain their form throughout the Tour. In theory then, the systematic use of drugs will have a large effect in cycling, not because it acutely boosts performance, but because it allows it to be maintained. Think of your own training - you always have good days and bad days. But what if I said that by using a drug, like testosterone, you could drastically reduce the number of bad days - that is what these drugs will do for cyclists.

So that's it - a heavy, quite technical post. Well done for making it this far! As usual, I welcome any feedback, it always stimulates me for future posts! That's it for now as far as doping goes, though I'm sure this is one I'll return to in the future. Next time, I'll hopefully get round to that altitude training article, and the one on the Ethiopian athletes!

See you soon!
Ross T