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Performance enhancing substances in sport and exercise
  1. C Jarvis

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    Edited by Michael S Bahrke, Charles E Yesalis. Published by Human Kinetics, 2002, £43.00 (hardcover), pp 384. ISBN 0736036792

    This is a worthwhile addition to the library of all who work in sport and exercise medicine whether as physician, physiotherapist, or sports scientist. It extends to over 350 pages, is straightforward to read, well arranged, and with a useful index.

    The initial chapter on the history of performance enhancing substances (PES) contains considerable information on early attempts at performance enhancement within sport, with much that was new to the reviewer. It even manages a brief reference to the current Governor of California under the subject of body building and anabolic agents!

    The first 300 pages consider ergogenic agents in specific groups—identifying the mode of action, likely performance gains, relevant clinical studies, potential problems resulting from use, and ending with a brief overall conclusion. The statements made are generally referenced, and the sources for these are listed extensively at the end of each chapter.

    The book would appear to have been initially published some three years ago—my review copy was dated 2002. As the world of PES changes very rapidly, the book inevitably predates some very significant incidents, publications, and changes in regulatory activity. There is no reference to therapeutic use exemption (TUE) certificates, nor to the 2002 IOC report on supplement contaminants. It follows that the 2004 whistle blowing on “designer drug” use by elite USA athletes is also omitted.

    I attempted to use the book to find specific information on a drug that had recently been brought before the UK TUE committee for consideration. There was good information on the group to which it belonged, but only a passing reference to the drug itself. That said, the chapter-end discussion of potential benefits and disadvantages was helpful and evidence based.

    There is an inevitable North American slant to the text, and some of the examples cited refer to American sports that are not universal in popularity. I noted reference to a local regulatory control—the US Dietary and Supplement Health and Education Act 1994; the need for regulation of non-drug supplements is clearly in harmony with current European thought on the matter.

    In the chapter on anabolics, there is what seems to be an unusual statement (p 33) “from the late 30s to the mid 80s, anabolic steroids were used successfully to treat depression, melancholia and involutional psychoses”. This certainly hasn’t been my experience of conventional UK management of any of these conditions.

    B-agonists are dealt with in some depth, Clenbuterol, which is not available in the UK or the USA but is obtainable in Europe, being the most closely scrutinised. This revisited the few unpleasant memories I have of the Barcelona Olympics, where its use by two athletes caused significant problems to GB team officials. However, I could find nothing in the chapter to justify the considerable effort many of us have made in implementing recent IOC regulations in respect of permitted B-agonist inhaler use.

    One area of discussion struck a chord with me, the difference in perception of doctors and athletes—or to be precise some athletes. Doctors and sports scientists put their faith in scientific studies. Athletes, however, often place much greater importance on testimonials and internet advertorials and treat research with suspicion if not contempt.

    Which raises the question: how valid are clinical studies of PES in athletes? The point is well made that there may be numerous confounders at play, and this is demonstrated in the often conflicting study results contained in many chapters. Athletes rarely use ergogenic aids in the framework that would be demanded of a clinical study. PES are not used in isolation, but rather within “cocktails” where the dosage consumed and the frequency of dosage may have little to do with their use in clinical indications and which would be rejected out of hand if forwarded to an ethics committee for consideration.

    The later part of the book looks to possible future developments in doping techniques and deals with some of the more difficult areas of drug testing: its problems and limitations. In the final chapter, the legal context of PES is also considered. I’ll leave the saddest quotation in the book to the end: “To be a great athlete today you need a great coach, a great chemist and a great lawyer”.

    I really do wish that didn’t ring any bells with me.

    • Presentation17/20
    • Comprehensiveness16/20
    • Readability15/20
    • Relevance13/20
    • Evidence basis16/20
    • Total77/100

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