One of the most discussed topics in sport at present is the doping scandal and corruption that has taken place widespread across athletics, resulting in many athletes losing confidence in the sport and the people that govern it. As more and more information comes out of the woodwork about the possibility of athletes taking performance enhancing drugs or covering up the intake of them, we witness many well known athletes that were once seen as incredibly talented individuals become better known for their lies and deceit towards the sport as the truth is uncovered regarding their doping involvement.

Recently, it became apparent that Ethiopian born 2014 World Indoor 1500m Champion, Abeba Aregawi, failed an out-of-competition dugs test and has voluntarily pulled out of competition whilst further tests are carried out.  It has been rumoured that Aregawi has tested positive for Meldonium (also known as Mildronate). This is a performance enhancer originally meant for the treatment of Ischemia, which occurs due to a lack of blood flow to a limb causing the limb tissues to become starved of oxygen. Interestingly, Ethiopia’s 2015 Tokyo marathon winner Endeshaw Negesse has recently tested positive on a doping test for Meldonium. Other athletes to have reportedly tested positive for the drug are Ukrainian biathletes Artem Tyshchenko and Olga Abramova. Meldonium was only added to the World Anti-Doping Agency banned list on January 1st 2016, so there could yet be more and more athletes who test positive for this performance enhancer in the near future.

So, what exactly is Mildronate?

Also known as Meldonium, Mildronate was originally developed as a growth-promoting agent for animals and has since been identified as an effective anti-ischemic drug (Simkhovich et al., 1988). The clinical benefits of Mildronate stem from carnitine metabolism, which plays an important role regulating cellular energy metabolism via a fatty acid beta-oxidation pathway and glycolysis; in the mitochondria carnitine is the main molecule in fatty acid metabolism (Gorgens et al., 2015). Mildronate works to inhibit the last step of carnitine biosynthesis. During oxygen deficient conditions (anaerobic exercise), there is insufficient oxygen supply and a lower amount of free carnitine which means fatty acid metabolism is lowered and glycolysis is enhanced. This increases the effectiveness of ATP production. Rather than fatty acid oxidation producing energy, there is carbohydrate oxidation which requires less oxygen per ATP molecule compared to fatty acid oxidation (Liepinsh, Kalvinsh & Dambrova, 2011), making the body more efficient at producing energy in those tough, anaerobic states.

When it comes to showing the performance benefits of Mildronate, studies have demonstrated an increase in endurance performance in athletes, an improvement in recovery after exercise and an increase in learning and memory performance (Gorgens et al., 2015), which can be a benefit for many athletes across a wide variety of sports (Dzintare & Kalvins, 2012; Klusa et al., 2013). The use of such a drug has been shown to be worryingly vast across many elite sports and the easy access of Mildronate has allowed many athletes to use it freely and without guilt before the inevitable ban earlier this year (Gorgens et al., 2015).

Whilst it is wrong to take performance enhancing drugs and cheat your way to the top, we often forget the larger context and what it is that drives people to do this rather than just train hard like everyone else and be the best you can be naturally. The psychology of drug taking in sport is extremely interesting and opens your mind into an area that is very rarely discussed.

One of the most common reasons to use performance enhancing drugs in sport is to achieve athletic success, closely followed by financial gain (Morente-Sánchez & Zabala, 2013). This is important. Many athletes dedicate their lives to their chosen sport and sacrifice so much in order to gain huge performance accomplishments that could financially support their family and change their lives. The decision to take a drug to increase performance is a massive risk, however for some it could be an opportunity to enhance their performance to a level that would enable them to provide for their family and to make the years of gruelling training, knockbacks, giving up time with family, injury and psychological strain worth it. The mere thought of gaining recognition for sporting achievements as opposed to going unnoticed for so long is a tempting outlook, one which could push an athlete into believing that taking a performance enhancing drug is the only way forward.

On the other hand, some athletes are pressured by their coach or family members (Pitsch, Emrich & Klein, 2007). The power of manipulation stemming from a coach that craves world class results could pressure an athlete into taking a drug that they don’t even know is a banned substance. Who really knows what goes on in the world of athletics these days?

Some athletes genuinely believe that taking performance enhancing supplements is the only way to continue in their career or to prevent nutritional deficiencies, maintaining their ‘natural’ health (Erdman, Fung, Doyle-Baker, Verhoef & Reimer, 2007; Lentillon-Kaestner & Carstairs, 2010).

The concept of the “false consensus effect” has been studied in literature (Petroczi, Mazanov, Nepusz, Backhouse & Naughton, 2008) and it suggests that athletes who take performance enhancing drugs usually overestimate the prevalence of drug taking in sport. It seems that athletes who believe that other athletes are taking drugs to enhance their performance are more likely to take drugs themselves which could lead us into a vicious cycle that propagates a pro-doping culture (Tangen & Breivik, 2001; Uvacsek et al., 2011). This is something that can be applied to the doping culture in athletics of recent.

In relation is “the doping dilemma” which stems from the classical prisoner’s dilemma (Haugen, 2004). If there is suspicion that other athletes are doing, which there certainly is right now, other athletes feel they need to take performance enhancing drugs in order to play on a level playing field. The power of the unknown comes into play here, with athletes being sceptical as to whether the competitor on the start line next to them is clean or not. The decision to take performance enhancing drugs suddenly seems that little bit more acceptable.

When Lance Armstrong was asked whether he would dope again after being caught he replied with “If I was racing in 2015, no, I wouldn’t do it again because I don’t think you have to. If you take me back to 1995, when doping was completely pervasive, I would probably do it again.” When an athlete believes that everyone else is taking performance enhancing drugs they are more likely to take part in this same behaviour; social acceptability within a small, performance focused environment can pressure an athlete into doping whilst they strive to be the best.

Unfortunately there remains a lack of education surrounding the use of doping in sport and it is important that at an early age sport coaches should emphasis to their athletes that drug taking in sport is simply not an option; if a sport coach’s task is to educate their athletes in this way then the coach will be the primary source of sport education for that athlete (Vangrunderbeek & Tolleneer, 2010). Without such an education regarding this matter an athlete may be more likely to regard drug taking in sport as an option.

We are more likely to cheat if we see others doing so. We tend to conform to accepted norms of reasonable behaviour, rather than adhere to strict rules.” – Evan Davis.

Whilst it is easy to point the finger at athletes who have taken drugs in order to enhance their sporting capabilities, we are far too reluctant to take into consideration the wider context and the problems that still face us regarding the lack of education for doping in sport. The above points are not excuses for doping, they are reasons, and behind the reason is a person who knows that the behaviour is wrong but still feels the need to go ahead with the decision to dope, even with all the devastating consequences that could follow.

A focus is needed on the antecedents of doping behaviour and associated attitudes and behaviours that lead up to the action. With a focus here and the correct education, doping in sport could be lowered and hopefully diminished in the long term, allowing a wide open space for natural ability to blossom through and a regaining of trust and confidence in sport.

ReferencesShow all

Morente-Sánchez, J., & Zabala, M. (2013). Doping in sport: a review of elite athletes’ attitudes, beliefs, and knowledge. Sports Medicine, 43, 395-411.

Simkhovich, B. Z., Shutenko, D, V., Meirena, K. B., Khagi, R. J., Mezapuke, T. N., Molodchina, I. J., & Kalvins, E. L. (1988). 3-(2,2,2-trimethylhydrazinium) propionate (THP): A novel gammabutyrobetaine hydroxylase inhibitor with cardio-protective properties. Biochemistry Pharmacology, 37.

Liepinsh, E., Kalvinsh, I., & Dambrova, M. (2011). The regulation of energy metabolism pathways through L-carnitine homeostasis. INTECH Open Access Publisher.

Görgens, C., Guddat, S., Dib, J., Geyer, H., Schänzer, W., & Thevis, M. (2015). Mildronate (Meldonium) in professional sports–monitoring doping control urine samples using hydrophilic interaction liquid chromatography–high resolution/high accuracy mass spectrometry. Drug testing and analysis, 7(11-12), 973-979.

Dzintare, I., & Kalvins, I. (2012). Mildronate increases aerobic capabilities of athletes through carnitine lowering effect. Current issues and New Ideas in Sport Science, 5, 29.

Klusa, U., Beitnere, J., Pupure, S., Isajevs, J., Rumaks, S., Svirskis, Z., Dzikale, L., & Kalvinsh, I. (2013). Mildronate and its neuroregulatory mechanisms: Targeting the mitochondria, neuroinflammation, and protein expression. Medicina, 49, 301.

Vangrunderbeek, H., & Tolleneer, J. (2010). Student attitudes towards doping in sport: Shifting from repression to tolerance?. International review for the sociology of sport, 1012690210380579.

Pitsch, W., Emrich, E., & Klein, M. (2007). Doping in elite sports in Germany: results of a www survey. European Journal for Sport and Society, 4, 89-102.

Erdman, K. A., Fung, T. S., Doyle-Baker, P. K., Verhoef, M. J., & Reimer, R. A. (2007). Dietary supplementation of high-performance Canadian athletes by age and gender. Clinical Journal of Sport Medicine, 17, 458-464.

Lentillon‐Kaestner, V., & Carstairs, C. (2010). Doping use among young elite cyclists: a qualitative psychosociological approach. Scandinavian journal of medicine & science in sports, 20, 336-345.

Petróczi, A., Mazanov, J., Nepusz, T., Backhouse, S. H., & Naughton, D. P. (2008). Comfort in big numbers: does over-estimation of doping prevalence in others indicate self-involvement. J Occup Med Toxicol, 3, 1745-6673.

Uvacsek, M., Nepusz, T., Naughton, D. P., Mazanov, J., Ránky, M. Z., & Petróczi, A. (2011). Self‐admitted behavior and perceived use of performance‐enhancing vs psychoactive drugs among competitive athletes. Scandinavian journal of medicine & science in sports, 21, 224-234.

Tangen, J. O., & Breivik, G. (2001). Doping games and drug abuse. A study of the relation between preferences, strategies and behavior in connection to doping in Norwegian sports. Sportwissenschaft, 31, 188-198.

Haugen, K. K. (2004). The performance-enhancing drug game. Journal of sports economics, 5, 67-86.
  • Andrew Heyes

    Hi Sarah,

    Nice article and glad to see this topic is getting some coverage from a different angle!

    Just wanted to gauge your thoughts on a few things.

    Regarding Meldonium. The drug was on the watch list throughout 2015 before being placed on the banned list in 2016. During that time, WADA carried out prevalence estimate research finding 2.2% of elite athlete samples contained meldoinum and 17% of Russian athletes having the drug in their system. I think its clear that most of these athletes were not taking the drug for diagnosed heart conditions and ischemia. Obviously it was not banned in 2015 yet there seems something morally suspect about taking a prescription drug, one that is not FDA approved at that, for its performance enhancing capabilities, whether it is legal or not. I wondered, as you mentioned in the article about guilt, whether you feel those taking performance enhancing prescription drugs that aren’t yet on the banned list are morally wrong to do so?

    I suppose a question that continues on from the above, you mentioned athletes taking ‘performance enhancing supplements” as a way to continue on a career. Where would you draw the line between what is considered an acceptable form of performance enhancement (i.e. protein supplements, multi-vitamiens etc.) and what should be classed cheating? Or does it only becoming cheating once you are breaking the rules and taking something on the banned list?

    Finally, you mentioned the lack of education in doping in sport and focused on the role the coach should play in guiding the athletes away from doping as an option. Currently the UKAD based education system focuses more on educating the athletes themselves rather than the coaches, and encouraging adherence to strict liability (100% me etc.). Do you feel more of a role should be passed to the coaches? Many of whom might rather focus their time and effort into coaching itself. I completely agree on this by the way! Coaches should be given more role in encouraging clean sport, but I’m intrigued to know how you would go about this.

    Thanks,
    Andy