By Phillip Huynh, UNSW

SYDNEY, 4 OCTOBER 2013: The debate surrounding sports doping is often focused on arguments about two extreme regimes – a strict prohibition on all performance-enhancing substances, or a laissez faire approach where all substances are permitted. This piece highlights a grey area for consideration – should we view prohibited substances used for athlete injury recovery in a different way?

Should there be an exception under the current anti-doping system to recognise the use of prohibited substances and medical procedures for injury recovery?

Current system

In the interests of ‘levelling the playing field’ in 2004, the World Anti-Doping Code (WADC) was implemented by more than 600 sports organisations, harmonising the rules and regulations governing anti-doping across all sports and all countries for the first time.  

Doping is defined in the WADA Code as the rule violations in Articles 2.1-2.8 of the Code. Under Article 2.1.1 of the Code ‘it is not necessary that intent, fault, negligence or knowing use on the Athlete’s part be demonstrated in order to establish an anti-doping violation’. That is, the offence is triggered when an athlete's biological sample tests positive for a prohibited substance regardless of how the substance entered the athlete's body; whether the athlete was negligent or reckless; and the purpose of or advantage gained from using the substance.

Prohibited substances used in athlete injury recovery

On the performance side, research has shown synthetic human growth hormone (HGH), when injected into a user, yielded a boost of energy in sprinting events such as running or sprinting. Users experienced a 4-5% increase in speed on a bicycle and a 0.4 second improvement over a 100 meter sprint. Contrary to the common misconception that HGH yields strength improvements, like steroids, users showed no improvement in fitness, weight lifting or jumping.

Researchers also found that while HGH led to reduced fat mass and more lean body mass, it could also trigger swelling and joint pain. High doses of HGH could also lead to a loss of stamina, fatigue and overall decline in athletic performance. More serious long term side effects include diabetes, accelerated osteoarthritis and carpal tunnel syndrome.

However the primary reason for permitting HGH use would be its ability to reduce athlete recovery time. Produced naturally by the anterior pituitary gland, at the base of the brain, growth hormone plays a major role in body growth by stimulating the liver and other tissues to produce insulin-like growth factor (IGF-1). One of the main functions of IGF-1 is to promote cartilage and bone creation. HGH success stories include Joe Root, a 50 year-old American motocross rider who shattered his hip and broke his femur in a race in 2000. His orthopaedic surgeon told him to expect 9-12 months of rehabilitation. He returned to racing in just eight weeks, using a regimen of growth hormone initiated and monitored separately by Mark Gordon, a doctor and prominent member of the American Academy of Anti-Aging Medicine (A4M).

Closer to home, the benefits of a HGH-accelerated injury recovery have been touted by former rugby league player Grant Hyde. Hyde found physiotherapy, acupuncture and massage useless in repairing or even alleviating his chronic shoulder pain. Four HGH sessions over two weeks eased Hyde’s pain to the point where it was ‘feeling better than the injury almost seven years ago’. Hyde retired from football at age 35 after dislocating his shoulder. One wonders whether he and other athletes could have had longer productive careers if HGH-accelerated recovery were a legitimate option for them.

Medical methods such as Orthokine therapy, a variation of blood spinning, are also prohibited by WADA. The Orthokine procedure involves taking 20 cc of the patient’s blood and putting it in a tube with ‘factors,’ incubating it for a time. Next, the blood is spun down and injected into the patient where the platelets and lymphocytes help the body heal itself quickly. The therapy has helped revive the careers of Kobe Bryant, Vijay Singh, Fred Couples and Alex Rodriguez. In particular, Kobe Bryant played five more minutes per game compared to the season prior to undergoing the therapy, and performed above his career averages in points and rebounds per game. Bryant and Rodriguez were able to use the therapy as the NBA and Major League Baseball have not fully adopted WADA’s full code of recommendations.

Recognising exceptions

Based on the discussion above, an anti-doping system that permits the use of prohibited substances and procedures for injury recovery purposes would enhance the spectacle of the game. Fewer players would need to retire due to chronic injuries, and star players would be able to return to action sooner. Athletes already benefit from similar medical advancements in areas such as nutrition, training regimen and higher success rates in surgical procedures.

The difficulty lies in ensuring that the use is strictly limited to injury recovery. This might be better left to doctors and physicians. Relevant prohibited substances could be made available by team doctors or individual accredited trainers under a system similar to the system currently allowed for therapeutic use. Before any prohibited substances were administered for an athlete’s recovery, their doctor or trainer could make an application to the sporting body or some other authorised body who would then appoint an anti-doping association approved doctor to conduct an independent assessment. All parties should consult to reach an agreement about a treatment plan and if the injury is significantly long-term, plans should be made for re-assessment in the future. Once this process has been approved, treatment in accordance with the plan can commence, with intermittent testing to be conducted by the sporting body to ensure the athlete is not abusing the prohibited substance. Of course this system assumes that the doctor and the sporting body are also committed to ensuring that the substances are only used in this way. Disturbingly, the history of performance enhancing drug use is littered with examples of sporting organisations and medical staff encouraging and willing to assist athletes to ‘game the system’. Introduction of this exemption would likely lead to further instances of performance enhancement.

An anti-doping system that exempts the use of prohibited substances for athlete injury recovery, provided that use is regulated and supervised, would enhance the spectacle of the sport.

As former European Football Championship winner and current manager Bernd Schuster puts it, ‘if a player can reach his full fitness level two to three weeks faster, then it makes sense. It’s not about players being brought up to 120, 150 or even 180 per cent. It’s about getting players to their usual level as soon as possible‘.

In practical terms, whether use of banned substances should be used for this specific purpose really boils down to whether it can be effectively implemented.