[Ongoing medical problems in the anti-doping fight]. / Problèmes médicaux actuels de la lutte antidopage.

ABSTRACT

Over the last 20 years systematic doping has become a major threat for elite sport. So far, there is no clear information about the daily practice of doping. Repeated scandals and recent personal statements have added to our knowledge. Several more recent doping agents like Erythropoietin (EPO) and, probably, growth hormone (GH) enhance performance in a highly effective way and, together with the well known anabolic steroids (AAS), belong to the major doping categories. The introduction of EPO has really changed the paradigm in endurance sports allowing a good middle class athlete to become a champion. It is evident that doping practices are influenced by the possibilities of the anti-doping control system. Unethical, criminal medical doctors play a decisive role in the ongoing practice of major doping. Apart from the already mentioned substances AAS, EPO and GH several novel drugs appear on the horizon. They are highly effective and there is no doubt that they will be used in attempts to improve performance. During the last years, doping control systems have also been improved EPO can now be detected in urine samples and the detection of AAS has also become much more sensitive. However GH hormone detection is not possible at the moment and this remains a major weakness of doping control. Other problems are the control procedures which are far from being optimal. In the future the quality of doping controls will be decisive and not only the quantity; controls will have to be "intelligent". The effective fight against doping in the next years will decide about the survival of elite sport.