Irrespective of which side you are on, the issue of drugs in sport is one that, it seems, will not go away. Certainly no single issue has the same collective emotional impact, and as the age-old debate of whether their use is appropriate or justified rages, they appear to be spreading through many levels of society and have become, in many quarters, an accepted way to improve athletic performance.
That most athletes in all major sports today are aware of and, in many cases, directly impacted by performance enhancing drugs, hints at the lengths to which people will go to be the very best in their chosen field. Although performance drugs in general, and anabolic-androgenic steroids in particular, are effective for boosting athleticism - and this point is indisputable - is their use really justified and is there a better alternative?
Is drug use in sport warranted based on the increasing demands placed on athletes to perform at the highest level or has sport simply become, in many cases, an arena where knowledge of how to apply certain chemicals in the right qualities is the number one criteria for success?
There will probably never be a definitive answer as with changing times there has been a complete change in the sporting dynamic and the social fabric from which athletes are developed - the conditions that athletes are subject to require a more sophisticated approach to be overcome and sporting requirements have changed as a result.
In earlier times, competition was not as fierce and athletes balanced training with everyday life. Now, with the proliferation of lucrative sporting contracts, and major money to be made, training has become everyday life for many athletes and with this has come standard six to eight hour training days, more intense competition more often, and an overriding pressure to perform at a high standard always. And the drugs are needed to achieve this end.
On the other hand, there are those from the old school who believe good old hard work and healthy eating should be all that is required. If all athletes took this approach then its merits would be obvious but, as is commonly known, the playing field has changed and, with records and new benchmarks for success having been set, the hands of time are unlikely to be changed.
A question regarding drug use in sport that has always interested me is, "Where will it end?" Under the current regimes of drug use, a new standard of sports performance has been set. To smash these benchmarks, exactly what will be needed?
An indisputable factor is the combination of drugs, nutrition, training and superior genetics needed to reach the top. There is another consideration though: the combination of gene therapy and genetic engineering. Inserting foreign DNA into a mature human being using a retrovirus, for the express purpose of improving that persons DNA to enhance their athletic performance, is a very real technology.
Stuff that was once science fiction is now being covered in prestigious scientific journals, and some speculate that by the 2008 Olympic Games we will see athletes performing under these conditions. Only you probably won't really know whether they are "Gene Doping" or not since this therapy cannot be detected in either blood or urine. And unless sporting federations begin stipulating mandatory muscle biopsies, this technology could proliferate to where it replaces steroids as the performance-enhancing drug of choice.
So as fascinating as the issue of steroids in sport is, it could prove to be a moot point if the science fiction, which has become science fact, becomes accepted sports practice among elite athletes. One man who is at the forefront of performance enhancing drug use is world-renowned anti-aging and health sciences researcher, Dr. Robert Goldman.
From 1975, Dr, Goldman spent over 10 years researching the effects drugs have on the athletic population. He put his findings in his monumental work, Death In The Locker Room, the most comprehensive book on performance drugs ever published.
Among his many appointments and achievements, Dr. Goldman co-founded and serves as Chairman of the Board of Life Science Holdings, a biomedical research company which has had over 150 medical patents under development in the areas of brain resuscitation, trauma and emergency medicine, organ transplant and blood preservation technologies.
Interestingly, he started in the health and fitness industry as, among other things, a bodybuilding magazine writer and was featured in the Guinness Book of Records for some of the 20 world strength-records he has set.
In 2005, as World chairman of the IFBB Medical Commission, he received the IFBB's highest award - the IFBB gold Order. As he is an expert on drugs in sport I felt it important to contact Dr. Goldman on the eve of what could be a turning point in sports performance history: the possible use of genetic engineering within athletics at the 2008 Olympics.
Frank in his comments on the history of drugs in sport, the motivation behind why athletes choose to use these substances, and future performance enhancement technologies, Dr. Goldman gave some valuable insights into this most contentious of issues. This interview is the result.
[ Q ] Steroid use appears to have proliferated in recent times to where high school children are taking them to gain more size for sports. Why the increasing attraction to steroids?
It's not so much that they have proliferated in recent times. The use of substances in sports goes back probably several thousands of years. Everyone is always looking for the edge so it is not a new phenomenon and it is not something that is going away.
If you read the book that I wrote years ago, Death In The Locker Room, you will see the long history of caffeine and various stimulants that were used back in ancient Greek and Roman times. But this is something that, especially today with the very high incomes that come with being a professional athlete and the high upside with high levels of performance, has and will continue to be something that is a common activity.
But in the future, and by this I mean in the next four to eight years or so, genetic engineering and gene therapy will come along which will sort of obviate all the drug issues you are seeing because then you will be able to program right into the gene, which will make the drug sort of like a buggy whip.
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Gene Therapy: A New Gene Is Inserted Into An Adenovirus Vector, Which Is Used To Introduce The Modified DNA Into A Human Cell. If The Treatment Is Successful, The New Gene Will Make A Functional Protein.
Image From The National Institutes of Health.
[ Q ] Does your research show drug use in high schools to have become more common in recent years?
It's been common for a long time. Going back to the 80s we found about eleven percent of high school boys and about two to three percent of high school girls were engaging in this for cosmetic reasons, so this is not a new phenomenon.
Now because of what you see in magazines, on TV and in the movies, what you see is these kind of super-hero-like individuals and it is kind of difficult to achieve this type of physique under normal circumstances, so the image of what a child thinks it would be great to look like can be a bit distorted. So its very challenging to give these kids or young adults a realistic view of the way in which to approach what is a realistic form of performance or look.
When Dan Lurie, for example, was training more than 50-years-ago he didn't really have much access to or circumstance for it. This sort of behavior didn't really occur, it didn't really initially launch probably until the 50s and 60s, and into the 70s is where it began to be seen more.
It certainly proliferated in the 80s and 90s and today. Where today these medications and also being able to get your hands on these substances is dramatically different than of course it was back when Dan was doing his strength feats and when I was doing my thing back then.
[ Q ] Are steroids' apparent increase today more a case of the fact they are more easily accessible?
Actually there was less regulation in the 80s and 90s so in some ways it was probably easier to get your hands on some of the stuff back then than it is today. It may appear that it has increased but in reality, stateside at least, what you will see is that it has been pretty accessible for quite a period of time.
[ Q ] In your view what are the worst commonly reported side effects of steroid use among athletes?
Let's make sure we distinguish between appropriate hormone replacement for a patient who is hormone deficient when they get older - 40, 50, 60-years old - versus a child or a young person who is producing appropriate levels of hormones, who is now abusing these things in a misused fashion.
So with high dosages you can begin to see pre-mature hair loss, sperm count decrease, acne vulgaris which can be quite uncomfortable. You will begin to see untoward behaviour pattern changes where a person can become overly aggressive.
There's a whole array of side-effects and of course the changes of various constituents of blood so cardiovascular disease becomes more of a concern with a drop in the HDL's (High Density Lipoproteins) and an increase in the LDL's (Low Density Lipoproteins).
Some of the joints and ligaments may get damaged because they are utilizing too much weight, more so than their body is really accustomed to be able to handle under normal circumstances.
[ Q ] What typically leads to these kinds of side effects?
Well it is dose related. You have people who appropriately can be treated with various medications who are in their 40's and beyond, but the problem occurs when they are not utilizing therapeutic doses and they are utilizing abusive dosages where instead of taking a fraction of what they should take they are taking super-normal ten to one-hundred times what would be a therapeutic dose and that's when the problems occur.
[ Q ] So if we were talking controlled dosages would there be any merit at all for certain populations to be using controlled levels of steroids under a doctors supervision?
Well yeah, hormone replacement has been around for half-a-century and proper hormone replacement is something that is appropriate in certain patient populations, but again this needs to be done under doctor's supervision and not done for sport enhancement but more so for the regenerative effects of trying to deal with an actual deficiency that occurs with age.
[ Q ] For athletic purposes you wouldn't agree with any dosage of steroids?
We try to keep away from that. We look at whether there is a deficiency going on and we are trying to treat the deficiency.
[ Q ] In your experience, do athletes often line up and claim to have a deficiency to warrant and justify their steroid use?
That's where the physician has to be prudent. As an example, if someone gets to be 45, 50 or 60-years-old and they are deficient and just do not have the energy or the muscle mass, and they are just not feeling good, those are the times when hormone replacement is appropriate. But again it should be therapeutic, carefully done and carefully monitored hormone replacement.
If somebody wants to get big all of a sudden because they have sport competition, that is inappropriate use and you have to be careful with that. That is not something we would recommend.
[ Q ] So any level of use among athletes is a very touchy area.
It's a very controversial, difficult, socio-economic arena and one that is very charged emotionally as well. We know that Dan (Lurie) has a certain feel about it, but Dan came from another age. He is 84 now and he came from a different time period where athletes really didn't do that sort of thing. You are going back sixty years ago.
[ Q ] It is difficult to say whether or not these guys would have used drugs had they been accessible back then.
Yeah. If you took Dan as a person and birthed him in the 60s or the 70s instead of back in the 20s, he might have had a slightly different approach to things.
[ Q ] The lifters from the 40s and 50s tend to nowadays be quite vocal in opposing drug use in bodybuilding. Why such animosity among these men towards steroids?
They came from a different age. These are guys who don't like certain things that are happening in the sport. Also they are in their 70s and 80s and your attitudes are different when you are in your 70s versus when you are 20. And I am sure if you spoke to these guys when they were 20 or 25 they may have had a different approach to these things.
It's just like when you find out that your grandparents were actually pretty wild when they were in their 20s and when they were parents they were pretty conservative and now that they are grandparents they are more liberal again.
My grandmother was extremely conservative in her younger years and in her older years she became very liberal and open to many things she would have never been open to in her younger years.
[ Q ] Is steroid use among athletes seen as being more acceptable on that basis?
Well, it depends which camp you are in. People are not too happy about it. You have to realize that today we have all kinds of drug testing programs that are done to intercede in these problems, but it is tough because it is very hard to stop something that is a global phenomenon and when you have athletes making millions of bucks over a contract, that's a real impetus to want to be the best or to be proficient at your craft.
[ Q ] A well-known pro bodybuilder recently said that steroids are constructive, not destructive. His view was that steroid use could be a good thing for athletes.
Sure they are not bad drugs inherently. Steroids as hormones are very effective medications when used in the proper fashion in the proper patient population. They are not evil drugs; these are very effective medications to be used in patients who are deficient.
They can be effective. However, when they are used in abusive dosages in improper patient populations then it is not a good thing. But even among physicians or among different sports officials there are differences of opinion.
I have been drug control officer since 1986 doing the drug testing for bodybuilding. I have disqualified many athletes all around the world yet there are patients I know in other patient categories who benefited greatly and have had their lives changed in a very positive fashion through the administration of the same drugs we disqualify athletes for.
[ Q ] Steroid use does seem to be an accepted part of athletics nowadays, more so than in the 90s even.
It is very pervasive. And we do test in certain competitions or starting more out of competition, but it is a tough thing to change. But realize that this is all going to be obviated and all old news once the new technology is used. You are not using a typewriter anymore right? You are using a computer. You are not using a simple word processor; you are using very advanced devices. The steroid controversy and discussion on anabolic steroids will become moot in the not too distant future.
[ Q ] What will happen when athletes begin using genetic engineering to improve their performance?
They are not going to waste their time with steroids.
[ Q ] And will that serve to clean up the sport as far as the negative perception drug use brings?
I think with the utilization of anything there is going to be challenges, and I don't know what the side effects are gong to be. They could be good or they could be very bad depending on what the athlete does. If someone shoots in the wrong kinds of genes where the muscles get so strong that they start ripping the tendons off the bone or muscles develop such high levels of mass that the athlete ends up having cardiac arrest. I don't know. We will have to see.
[ Q ] How far off is this technology?
Well it is already in play. I think by the Beijing Olympics we will see some of it but certainly by the Olympics following it you will see a fair amount of it. You can't test for it either as it doesn't show up in urine or blood. It only shows up in muscle biopsies. And you're going to have a hell of a time getting a muscle biopsy out of an athlete.
[ Q ] What kind of technology will be seeing used specifically?
It involved genes being manipulated and inserted into the muscle, which changes the muscles capacity. This is still a scientific work in process, but it's going to provide significant challenges.
[ Q ] What will be some of the obvious effects of gene therapy from a bodybuilding standpoint?
Oh yeah, I think in the future you will see athletes in general, not just bodybuilders, being seven foot, 400 pounds and heavily muscled - or bigger. Your body frame is really not made to hold that so you are going to have some problems with a structure that large.
[ Q ] And steroids will become old school, like using those old liver tablets.
I think it will be like using the old cell phones that were like the size of a brick that you could program ten numbers into.
[ Q ] What have been some of the worst steroid-related side effects you have seen over the course of your career?
Well the worst one of course is death. In terms of anabolic steroids in high dosages you are disrupting a number of body systems. And so you always have the risk of heat disease, cancer and stroke. A lot of these drugs, especially orals, which are conjugated through the liver, cause a disruption of enzymes or potentially some type of liver issue, which can be a problem.
[ Q ] How big of possibility is cancer as a result of steroid use?
It is still a debatable issue. There have been cases where they were saying that patients on high doses of steroids, that had some other disorders who developed certain liver diseases. But I think that just by virtue of the liver having to conjugate things, I think if you take high dosages you could have a problem. But again if people stay within therapeutic dosages you don't see too much of that. If you did you would have a lot more of these people dropping dead of these disorders, and you see very few.
[ Q ] Would you advocate therapeutic dosages for bodybuilders at the pro level?
No, not for competitive athletes - I think we should stay away from that. Again, I am talking about therapeutic procedures for patients who are deficient, for enhancing their life, not so they can go and compete in a master's bodybuilding show.
[ Q ] Given men typically experience declining testosterone levels beginning in their 30s and beyond, would you recommend therapeutic steroid dosages beginning at this age in selected cases?
No, I think that is a little young. I would tend to stay away from patients who are in their 30s, who want to take anabolics. Testosterone does start to drop at this age but typically replacement is not really necessary until the 40s and 50s and beyond.
[ Q ] So beyond age 40 one could get tested to see if it was an option for them?
If it is significant enough where it is something that can be reviewed, not necessarily done right away, it is something you could look at.
[ Q ] Stopping short of taking steroids, are there certain things men past age 40 can do to naturally replenish the testosterone stores? What are the best natural ways to achieve steroid-like results?
Of course weight training and proper nutrition is the key. There are certain nutritional supplements and various amino acids have been shown to be popular. However, note that beyond the age of 60 those types of amino acids are not terribly effective because the pituitary function is down pretty low. So it is not as effective as when someone was a young man.
[ Q ] Does anything come close to providing the effects steroids do?
Well you won't get drug like results, but you get some results. If you are feeding the machine better fuel it will function better and get stronger. Nutrition is a good way to get an enhanced physique. Drugs are still drugs though and they do have a profound effect.
[ Q ] Is there a particular supplement that comes close to mimicking the effects of steroids?
[ Q ] What are your thoughts on tribulus as a testosterone booster?
They are interesting for testosterone production and they are quite popular.
[ Q ] Many bodybuilders from the 40s and 50s are strongly anti-steroid. Yet many today will say that the increasing use of steroids is a sign of progress? What are your views on this divergence of opinion?
The training techniques were different and they lived in a different age. What separates the footballer today from the footballer of the 40s? Today they are bigger, stronger, faster and are better trained. They weight train and do sports-specific training and their skill-sets are much higher. There is a whole array of differences.
[ Q ] How has the mental approach changed? Bodybuilders back in the 40s and 50s often say that they had to work much harder because they did not have access to the drugs of today.
Well I really don't agree with that because if you look at the way some of the people train today it is a hell of a lot harder. I mean the guys in the old days trained hard but these guys are training like professionals.
They are really scientific and very hardcore in their approach - not to say that some of the athletes of the past didn't train hard. But you have to remember these guys had to make a living, they had families to support and they didn't have any sponsors, didn't have access to the same facilities, they couldn't train as regularly.
Today you get the pro athletes and the upper level athletes who get sponsors and spend their whole day focused on their training and diet. Guys like Dan Lurie back in the old days had a lot to distract them from their training. Dan had several businesses along with a wife and family to support.
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Receiving The Keys To The City From The Mayor Of Catania, Italy (Dr Umberto Scapagnini) In Sicily With EU Government Officials Looking On.
[ Q ] Were athletes more ethical back in the early days as far as their approach to training was concerned?
The athletes of today have a strong training ethic but I am not saying they are necessarily more ethical. The athletes today are looking for a quick fix and a quick win but a lot of these kids work very hard in training. But I think there was a better ethic in the old days among the athletes.
There was more respect and mutual respect among their peers, whereas today I don't think athletes have the same respect for their peers or for those that came before them.
There is a small group of us who do have great respect for Dan and his contemporaries - the old strongmen. We have a lot of respect for them but the new kids are very self motivated so they don't have the same level of respect that they should.
[ Q ] Ethically is any degree of anabolic drug use justified among athletes?
Ethically today athletes are into the quick win and they will do whatever it takes. Ethics are pretty sparse and pretty blurred. I think back in the old days people had a much more ethical and straightforward, honest approach to things.
[ Q ] Is that because they had no choice but to do so because they did not have access to what there is today in terms of drugs?
It was different time period. How old are you now?
[ Q ] 33
Well I am 52 and if you look at a lot of the parents today, divorce was petty rare back then and the family unit was a lot more important than it is today. Today, two thirds of people get divorced or don't get engaged in that fashion at all. There are a lot of side activities, a different set of ethics. It is a different game today.
[ Q ] There is also an argument that there are such a large number of athletes taking drugs that all the athletes need to take them to stay in the race, so to speak.
It is like everybody is in the game and if you don't get with the program you are going to get left behind. That is correct.
[ Q ] On that basis a lot of people justify steroid use.
Well anyone can justify anything they want. It is not too hard to figure out an excuse as to why you want to do this or that.
[ Q ] It is thought that there have been very few deaths directly linked to steroid use.
It is very hard to do a direct link as far as what somebody has died of. But also the human body is pretty tough and it can handle a lot of abuse and it is amazing with the quantity and quality of different substances that people are ingesting these days, but after awhile critical mass takes over you have serious issues and sometimes fatalities. But that is more a rare event than a very common one.
[ Q ] A large number of bodybuilders at the top level look healthy and have no apparent problems.
Yes, the body is pretty resilient.
[ Q ] Experiencing steroid-related problems into their 40s and 50s is not at all uncommon among these guys who started using them in their 20s?
No it is not uncommon.
[ Q ] Say a pro bodybuilder is in their early 30s right now. What might be some of the problems they experience into their 40s and 50s?
I think you are going to have a lot of these guys popping off early. I think they are going to have heart attacks, cancer-related situations and a whole array of metabolic syndromes that are going to occur that are not going to be too pretty.
Where you have your bodybuilders of the past: you go to a lot of these strongman meetings and you see these guys in their 70s and 80s - take Dan who is 84 - who are very energetic and still spunky. There is a whole array of guys like that. The Weider's as well.
There are a lot of athletes today in their 70s, 80s and 90s who will far outlive in health and spirit the athletes of today. There have been a lot of problems where people just become very unhealthy once they hit their 50s. In their late 40s early 50s some of them become very unhealthy.
[ Q ] Are their particular types of steroids what contribute to the major side effects seen, or is it a combination of several different types?
I think it is a combination. These guys are taking a lot of stuff and when you mix other drugs of abuse on top of this you have a problem.
[ Q ] What would be the most toxic steroid available?
The worst ones are the animal steroids that are liver conjugated so they are pretty rough on your liver. Those are probably your worst.
[ Q ] As far as you have seen, are animal steroids used frequently among athletes?
Well they will use whatever they can get their hands on and sometimes veterinary steroids are easier to get.
[ Q ] So it is a case they are easier to get, not necessarily more efficient.
Right, not necessarily more efficient.
[ Q ] As far as toxicity is concerned, the oral steroids are worse than the injectables, right?
Yes the ones that bypass the liver are probably less problematic than the orals.
[ Q ] Many athletes of today stack steroids. What are the problems inherent in this approach?
Well it is quantity and the number of different medications they are doing simultaneously, then you throw in a little cocaine and speed and ecstasy and all this other stuff that they are partaking in and you have a real explosive situation.
[ Q ] How common is recreational drug use among athletes?
It is very, very common.
[ Q ] In your view, why is this?
Well once you get used to taking drugs you get used to taking whatever and they no longer distinguish one from the other. It is just more stuff to take.
[ Q ] There are also a lot of other anabolic compounds used in conjunction with steroids. How concerning is this?
My real concern is using insulin. Used with steroids it is a very dangerous combination, very scary stuff. Or they abuse the diuretics to lose body water and go into an electrolyte imbalance and end up with a heart attack. That's real dangerous stuff. Especially the way these guys are wired.
[ Q ] Might diuretics potentially be more dangerous than steroids themselves?
Yes, you can kill someone with diuretics pretty quick.
[ Q ] So pre-contest would be the most dangerous time for a bodybuilder.
Yes when they are all cutting up. They are all dehydrated and they have an electrolyte imbalance and are taking diuretics. Then they will take some speed-like things to get up for the show. Those are real bad combos.
[ Q ] Why is insulin used among bodybuilders?
Well it pulls more nutrients into the muscle but it still very dangerous. You could also kill someone if you gave them enough insulin.
[ Q ] Have you directly known of a bodybuilder to suffer major consequences as a result of steroid use?
It is all commonplace in the media, with Benaziza and so on.
[ Q ] Have you had a direct association with anything of this nature?
Only that I have seen these kids as amateurs and hear about these incidents after the fact, but I haven't been there when they have expired.
[ Q ] How common is drug use in American schools today?
I imagine it does happen, but as to how common it is I really cannot say.
[ Q ] And athletics is more competitive nowadays.
Yes, everything is more competitive. That is why when a kid is born they are already trying to pick which college they are going to go to.
[ Q ] Can you give my some insight into the progression of steroids in sport?
John Zeigler was involved in the distribution of steroids back in the 50s and it progressed from there. Dianabol was the first kind of gold standard steroid that the athletes were using back then.
[ Q ] Since Dianabol was invented have steroids become more effective to where athletes need less of a dosage to get the same effect?
No, what they do is they find some new stuff and just take more of it.
[ Q ] So there is still a, "More is better mentality" among steroids users.
[ Q ] The problems can be traced to too much not necessarily a certain dose per se.
It is too much and too many combos together.
[ Q ] Okay, thank you for your time Dr. Goldman. It was a pleasure talking to you.
Thank you David.
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Dr. Robert Goldman (USA) , World Chairman IFBB Medical Commission, Receives The IFBB's Highest Award - The IFBB Gold Order, At The World Championships In Shanghai, China.
2005 Shown here with Dr Rafael Santonja (Spain) past President of the Olympic Weight Lifting Federation of Spain, and Prof. Dr. Eduardo H. De Rose (Brazil), of the International Olympic Medical Commission.