By Sean Henahan, Access Excellence

ATLANTA (7/20/96) As the world's athletes gather in Atlanta for tests of strength and speed, toxicologists are using more accurate screening methods than ever to find banned substances, but new substances and new strategies continue to create challenges for those charged with keeping the Games fair.

"Drug testing in Olympic sport is an effort to preserve what is beautiful and admirable in sports and an effort to ensure that all athletes compete on a level playing field," notes Thomas H. Murray, Ph.D., Dir., Center of Biomedical Ethics, Case Western Reserve University School of Medicine, Cleveland, Ohio, adding: "The need for this elaborate administrative and technical apparatus stems from an intriguing combination of medical and ethical developments. Increasingly sophisticated pharmacological methods have been created to enhance athletic performance in ways that threaten the integrity and meaning of Olympic competition."

The current high level of surveillance for performance-enhancing substances originated with the death of a British cyclist under the influence of amphetamine during the 1967 Tour de France. Athletes are now tested before, during and after the Olympics for numerous substances including stimulants from amphetamine to ephedrine, anabolic steroids, diuretics, beta-blockers as well as alcohol and marijuana. Testing will also be conducted for certain peptides and glycoprotein hormones.

In this Olympiad, high-resolution mass spectrometry will be used for the first time to screen urine samples from all athletes for anabolic agents, including steroids. Using methods largely developed at the Institute of Biochemistry, German Sports University, Cologne, Germany, the high- resolution mass spectrometer will measure specific masses. Lower-resolution mass spectrometers will continue to be used to test for some steroids and other classes of prohibited substances. These methods will provide unambiguous identification of drugs and metabolites in the urine, says Dr. Murray.

"This new technology significantly lengthens the time to detect drugs in the athlete's system. With conventional technology, athletes know when to stop to avoid disqualification. This breakthrough is more sensitive and can actually detect a substance at one-third of the original concentration level," said Gary Wadler, M.D., a fellow and trustee of American College of Sports Medicine.

Wadler believes that this new technology will generate more positive drug tests in Atlanta. However, he said this does not mean more athletes are using illegal substances, but simply that there is better equipment to detect them.

Such broad-based testing always raises various scientific and ethical issues. Some question whether such testing only encourages some athletes to devise ways of defeating the tests. For example, it would be possible to take body-building hormones during training, and then discontinue use well in advance of testing. There have also been several cases where athletes questioned results, claiming that they had inadvertently consumed certain substances in over-the-counter cold medications (such as ephedrine). Other athletic groups, particularly the Chinese, charge that the disqualifications for substance use has been arbitrary.

Those doing the testing have to be especially methodical, since once false test can ruin an aspiring athlete. Methods and procedures are in place to help guarantee proper procedures, from specimen gathering to testing and confirmatory follow-up testing.

However, it seems there are no tests available for the latest types of performing enhancing substances used by some athletes. In the 1980's it was discovered that some athletes were "doping" their own blood by the addition of red blood cells, thus enhancing performance by increasing red blood cell mass. While this was banned in 1985, and can be measured by testing, a recombinant human protein, erythropoietin (EPO) can do much the same thing, and cannot be detected by any current tests.

Similarly, recombinant growth hormone is available to athletes and cannot be differentiated from the native form. Testosterone injections, recombinant chorionic gonadotropin and other hormones provide similar quandries. Researchers are currently attempting to develop assays for metabolites of most of these.

In 1994, the IOC-accredited laboratories provided data on 93,680 drug tests--up from 32,982 in 1986. The percentage of samples testing positive for all prohibited substances was 1.5 in 1994, compared to 2.1 in 1986.

Dr. Murray's comments appear in a special Olympic issue of JAMA, July 17, 1996.