The clinical pharmacology of performance enhancement and doping detection in sports

Some athletes use prohibited substances, a relevant problem given the coverage on doping in the media. In addition not all these athletes are being caught and clean athletes are sometimes falsely accused. In short, doping is a problem in sports and society. The goal of this thesis is to contribute to a solution to this problem by applying knowledge of (clinical) pharmacology to handling the use and detection of doping. First, our research shows that there is no convincing evidence for performance enhancement for 18 out of 23 substance classes on the Prohibit List. This is problematic and is mainly due to a lack of knowledge. For this reason we evaluated one of the substances, erythropoietin (EPO), in a study that could serve as a model study for evaluating potential doping substances. This study showed that although EPO did have effects, EPO-treated cyclists did not perform any better than placebo-treated cyclists in a time trial or an uphill road race. Additionally, the doping detection methods we evaluated, for EPO and salbutamol, proved to have shortcomings in detecting cheating and protecting innocent athletes. Concluding, anti-doping efforts will need to become more evidence-based to effectively tackle the doping problem.The clinical study testing rHuEPO in cyclists was funded by the Foundation Centre for Human Drug Research (CHDR) Leiden.LUMC / Geneeskund