|  | Emerging Scholars | No.56 May 2009 |
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Anti-Doping Education for Nepalese National and International Athletes Diwakar Lal Amatya |
Introduction Historical Overview of Doping Performance-enhancing drugs are not unique to modern athletic competition. Mushrooms, plants and mixtures of wine and herbs were used by ancient Greek Olympic athletes and Roman gladiators competing in Circus Maximus dating back to 776 BC. Various plants were used for their stimulant effects in speed and endurance events as well as to mask pain, allowing injured athletes to continue competing (1-3). In the 1904 Olympics, marathon runner Thomas Hicks used a mixture of brandy and strychnine and nearly died. Mixtures of strychnine, heroin, cocaine and caffeine were used widely by athletes and each coach or team developed its own unique secret formulae. This was common practice until heroin and cocaine became available only by prescription in the 1920s. During the 1930s, it was amphetamines that replaced strychnine as the stimulant of choice for athletes. In the 1950s, the Soviet Olympic team first used male hormones to increase strength and power. When the Berlin Wall fell, the East German government’s program of performance enhancement by meticulous administration of steroids and other drugs to young athletes was exposed. These well-documented and controlled hormonal doping experiments on adolescent athletes by the East German Sports Medical Service yielded a crop of gold medalists (mostly young females as they responded more dramatically to male hormones). Many of these athletes suffered severe medical abnormalities, including premature death (4). The world became acutely aware of the extent and benefits of doping in sport when Ben Johnson’s gold medal was stripped in the 1988 Seoul Olympics for using the steroid stanazalol. The International Olympic Committee (IOC) medical commission had established a list of prohibited substances in 1967 and introduced anti-doping testing of athletes in the 1972 Munich Games. It was clear at this point that doping did work and if undetected, would help win gold medals. East German scientists from the state-run doping programs at Kreischa and Leipzig, who were disgraced in their own country, where now in demand in Asia, former Soviet Block nations and sports organisations worldwide that wanted to promote their status. Doping became so prevalent in Olympic sport that some argued that all records should be discarded or put on hold until all forms of doping could be detected and stopped. Through the 1980s and 1990s, clandestine doping programs spread from sport to sport guided by modern, albeit unethical, pharmacists and sports medicine professionals. In 1999, the IOC organized a World Conference on Doping in Sport in response to a shocking discovery of massive amounts of performance enhancing drugs and paraphernalia by French police at the 1998 Tour de France. It was at this meeting that an independent global agency was founded, the World Anti-Doping Agency (WADA). Its mission was to work independently of the IOC, sports organisations and governments to lead the fight against doping in sport (5). It is true that doping can help athletes to build strength and muscle tissue, reduce tiredness or hide pain, but it has bad side effects too. Some drugs can lead to obvious changes in appearance. For example, steroid use can cause acne, particularly on the back. In boys it can shrink testicles, cause impotence and baldness and girls can develop a deeper voice and facial hair. There can be even more serious side effects, doping can cause heart, liver and kidney problems and has even killed some athletes. Doping in sport is also cheating, destroying fair play and sporting competition. There is much more to sport than just winning and for sport to survive as a positive, worthwhile activity, honesty, cooperation and courage are essential. ‘Doping’ refers to an athlete’s use of prohibited drugs or methods to improve training and sporting results. Steroids are the drugs that often come to mind when we talk about doping, but doping also includes an athlete’s use of other banned drugs (such as stimulants, hormones, diuretics, narcotics and marijuana), use of forbidden methods (such as blood transfusions or gene doping), and even the refusal to take a drug test or an attempt to tamper with doping controls. As you continue to participate in sport, doping is an issue that you will increasingly face: you could be tested for drugs; some of your competitors may be cheating by using drugs; you may even be tempted to do so yourself. Most athletes know that doping is cheating, however, some still take the risk. Sometimes prizes, money or fame can cause people to make bad decisions. They are told that doping might give them a boost, provide a shortcut to long years of training or help them win. They are prepared to risk their sporting careers and their health - they are prepared to win at all cost! Others feel pressure from coaches, parents or themselves to be the best. They see doping as a way to meet these expectations (6). Anabolic steroid usage has been recognized as a serious health and ethical problem in athletes for several decades. Numerous examples of steroid use violations have been highly publicised and have lead to the suspension and stripping of medals from international athletes, including many American professional athletes. Elite athletes, however, are not the only population of individuals that use steroids. Recreational athletes also use steroids to enhance performance and to improve personal appearance. Furthermore, evidence indicates that steroid usage often starts during high school (7-9). Anabolic-androgenic steroids (AAS) are synthetic derivatives of testosterone that have been used by athletes for decades to increase lean body mass, strength and overall athletic performance (10). A number of side effects have been associated with AAS use, including acne, hair loss and increased risk of heart disease, kidney, liver dysfunction, hypertension and impotence (11). Some athletes use drugs to overcome an injury. Coaches might say that drugs can make you forget about the pain or may help speed up recovery, but they often do not mention the health risks and that doping is cheating. Whatever the reason, there is no excuse for doping. Educational Background of Athletes in Nepal Sport has almost become a part of the educational system in our modern society; therefore, it is an important agent of socialisation. In Nepal, whether in primary school, college, university, community or during the religious festivals, sport has become an important element of youth sub-culture. Given the prominence of sport in the educational system, the casual observer might even assume that sport is a necessary component of the curriculum. The data for this study has been collected from the 121 athletes from 13 sports disciplines, each were preparing for the 9th South Asian Federation Games, to be held in Islamabad, Pakistan. Around 53 years ago, Nepalese people first had the opportunity to play modern sports. Before that, sport was limited by the Royal and Rana regime and the Nepalese public had far fewer opportunities to enjoy modern games. So after more than five decades, development has occured in many areas of Nepalese life, sport is certainly one of them. Out of the 13 disciplines included in the Games, the most educated are the Shooters and Badminton players with 12.50 points, which means there are 12.5 class passed or just above the intermediate-level participants (Max.-Graduate & Min.-10 Class). Other disciplines to score 12 points or more were Table Tennis and Squash, with scores of 12.44 and 12.00 respectively. Taekwondo (11.18), Volleyball (10.70), Karate (10.45), Kabaddi (10.33), and Athletics (10.00) came in the middle range from Class 10 to Intermediate category. Four other games, namely, boxing (9.63), Swimming (9.57), Wrestling (9.40) and Weightlifting (8.86) had the lowest educated athletes. If all the athletes' average is taken into account, Nepalese athlete's education is below 11 class pass. Nepalese Athletes Education Status during 9th SAF Games - Pakistan-2003
Education Level | (%)
Up to SLC (10 Class) and Below | 66.96
Up to Class 12 (Intermediate) | 17.86
Up to Class 15 (Bachelors degree ) | 13.40
Up To Class 17 (Master degree) | 1.78
The above table shows the percentage distribution of Nepalese athletes in different levels of educational standards. This displays the poor levels of Nepalese athletes' academic qualifications. Out of these 112 athletes, 66.96 % of athletes have education level of up to SLC or below (12). Materials and Methods The data for this study was collected from the Nepalese athletes from five sports namely Boxing, Karate, Weightlifting Gymnastics and Bodybuilding. A total of 102 players were interviewed on food habits, knowledge and education on doping.
Sports | Total Athletes
Boxing | 21 | 20.59 %
Karate | 19 | 18.63 %
Weightlifting | 23 | 22.55 %
Gymnastics | 22 | 21.57 %
Bodybuilding | 17 | 16.67 %
Total | 102 | 100.00 %
In the study, statistical tools such as pie-charts and bar-diagrams and percentages were used to analyse and display the data. Results and Discussion As mentioned in the introduction, more than two-thirds of Nepalese athletes have an educational standard equal to or less than ten. So to allow for fairness in the study, only simple, non-technical questions were asked to them. Fig-1: Almost 65% of Nepalese eat two hours before training and competitions. It remains a fact that in majority of participants, most of the popular sports played in Nepal are dominated by Army, Police and Armed Police Force personnel. Their main job is to play for their concerned departments and is the main reason that almost 73 percentages of Nepalese athletes expressed sport as their profession (Fig-2). Drinking coffee and cola is normal among Nepalese athletes. Most of the Nepalese Athletes in this study did not know (65%) that they may be tested for doping. Besides this cough syrups are easily available in medicine store in Nepal. 61% of athletes did confirm their ignorance of doping these medicines. Diuretics are used to reduce their body weight in a short time, so in many of the sports with weight categories, sportsmen do use these medicines. However, it is perhaps surprising to note that 26 percent Nepalese athletes do admit use of diuretics for the reduction of their body weight before competitions. Anabolic steroids Anabolic steroids are drugs that resemble testosterone, a hormone which is produced in the testes of males and to a much lesser extent, in the ovaries of females. Testosterone is partially responsible for the developmental changes that occur during puberty and adolescence. It is also involved in controlling the rates of buildup and breakdown of the main biochemical components of all tissues, including muscle. Because testosterone and related drugs affect muscle growth, raising their levels in the blood could help athletes increase muscle size and strength. Athletes who use anabolic steroids also claim that they reduce body fat and recovery time after injury. But the androgenic (masculinising) side-effects, such as increased body hair and a deepening of the voice, are not always desirable, particularly in women. To counteract these side-effects, scientists have manufactured steroids that retain their anabolic effects but have a lower androgenic effect (eg, androstenedione and nandrolone). Androstenedione was used by East German Olympic swimmers and other athletes in the 1970s and 1980s to improve their performances. It was banned by the International Olympic Committee in 1997, but is currently permitted by some other sporting bodies. Mark McGuire, who set a baseball home-run record in 1999, has admitted to using androstenedione (as well as the controversial food supplement creatine). Nandrolone was allegedly detected in a urine sample provided by British sprinter and Olympic gold medalist Linford Christie in 1999. Health risks of anabolic steroids Medical experts see significant dangers in the use – and particularly the gross over-use – of anabolic steroids. Some of the effects are minor or only last while the drug is being taken; others are more serious and long-term. For example, anabolic steroids can cause high blood pressure, acne, abnormalities in liver function, alterations in the menstrual cycle in women, decline in sperm production and impotence in men, kidney failure and heart disease. They can also make both men and women more aggressive (13). Nepalese Athletes Responses for different Questions (Table-1)
Do you know where Anabolic Androgenic Steroids are available?
| No of Athletes | % |
Yes | 15 | 14.71 |
I don't know | 87 | 85.29 |
Do you ask your doctor about whether these medicines are banned by WADA?
Yes | 41 | 40.20 |
No | 61 | 59.80 |
Do you think doping education is required for Nepalese athletes?
Yes | 95 | 93.14 |
No | 7 | 6.86 |
From the above table, we see that more than 85% of Nepalese athletes do not know where Anabolic Androgenic Steroids can be purchased. Only 41% of athletes ask whether their prescribed medicines are banned by WADA. Whilst more than 93% of athletes questioned feel they need doping education from their sport’s governing authority. Doctors too, do not appear to have much knowledge on the subject of doping, as underlined by a study of the Nederlands Centrum voor Doping vraagstukken on 1000 general practitioners (GPs), according to which 85% of the respondents admitted that they were not familiar with banned drugs or their side effects. In another study involving 400 GPs in Sussex, UK, 12% of the respondents stated that a doctor has the right to prescribe anabolic steroids for non-medical reasons, which is medically and ethically wrong and only 35% knew that the International Olympic Committee’s (IOC) list of prohibited substances (Table 1) appears in the British National Formulary (14). Nevertheless, doctors seem to be regularly confronted with doping in their everyday practice. In one of our previous studies of French GPs, 30% of the respondents stated that they had been asked to prescribe banned drugs to athletes, or to explain how to use them. The same was reported by 18% of the British GPs cited above concerning anabolic steroids. Moreover, 87% of the French GPs considered that doping is a public health problem and 92% thought that they had a leading role to play in doping prevention, even if most (83%) considered themselves poorly trained in this topic (15). Conclusion This study suggests that Nepalese athletes consider that doping in sports is a real public health problem and that thee athletes want to participate in its prevention. However, despite the fact this observation does seem encouraging, their limited knowledge of the realities of doping should prompt the rapid introduction of adequate educational and training for athletes, coaches and sports administrators in Nepal. As the results of this study cannot represent the entire body of Nepalese athletes, we recommend that a study should be carried out on whole country. References Wadler GI, Hainline B.: Drugs and the athlete. Philadelphia: David, 1989. Yesalis CE.: History of doping in sport. In: Bahrke MS, Yesalis CE (eds). Performance enhancing substances in sport and exercise. Champaign: Human Kinetics, 2002:1-20. Landry GL, Kokotaio PK.: Drug screening in athletic settings. Curr Probl Pediatr 1994; 24:344-59. Franke WW, Berendonk B.: Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic. Clin Chem 1997;43:1262-79. World Anti-Doping Agency.: 2006 prohibited substances list. www.wada-ama.org. World Anti-Doping Agency.: 2008 prohibited substances list. www.unesco.org/en/antidoping Buckley WE, Yesalis CE III, Friedl KE, Anderson WA, Streit AL, Wright JE.: Estimated prevalence of anabolic steroid use among high school seniors. JAMA. 1988; 260:3441-3445 Yesalis CE, Kennedy NJ, Kopstein AN, Bahrke MS.Anabolic-androgenic steroid use in the United States. JAMA.1993;270:1217-1221 Windsor R, Dumitru D. Prevalence of anabolic steroid use by male and female adolescents. Med Sci Sports Exerc. 1989;270:494-497 Yesalis CE.: Anabolic steroids in sports and exercise. 2nd ed. Champaign.IL: Human Kinetics:2000 Powers ME.The safety and efficacy of anabolic steroid precursors: What is the scientific evidence: Journal of athletic training, Vol-37.Number 3. September 2002 Amatya DL.:Study on Nepalese International Athletes’ and Coaches’ Academic and Professional Qualifications. Sports Science and Physical Education Bulletin No. 39 September 2003 www.icsspe.org Australian Academy of Science.:Who will win the race? NOVA Science in News, 2004. Greenway P, Greenway M.: General practitioner knowledge of prohibited substances in sport. Br J Sports Med 1997;31:129–31 Laure P.:Médecins généralistes et dopage sportif: connaissances et attitudes. Santé Publique 1997; 9:145–56. In P Laure, C Binsinger, T Lecerf.: General practitioners and doping in sport: attitudes and experience. Br J Sports Med 2003; 37:335–338 Contact Dr. Diwakar Lal Amatya Sports Academy of Nepal National Association for Sports Health and Fitness Lalitpur, Patan, Nepal Email: amatyadiwakar@yahoo.com icsspe.org/index.php?m=15 Anti-Doping Education for Nepalese National and International Athletes Diwakar Lal Amatya