In 1889, Dr Charles-Édouard Brown-Séquard, a world-renowned physiologist and neurologist, whom first described a syndrome which bears his name, published in The Lancet, a paper based on a series of lectures. He described a number of experiments done on animals and humans (including himself) which involved injecting an ELIXER derived from blood from the testicular artery, semen and fluid extracted from freshly crushed animal testicles. He concluded “…great dynamogenic power is possessed by some substance or substances which our blood owes to the testicles.” and “I can assert that the … given liquid is endowed with very great power.”¹ The inherent belief that human performance can be improved by the addition of an ELIXER can be traced to ancient Greece.  Athletes and warriors ingested berries and herbal infusions to improve strength and skill.² The intrinsic risk attached to these substances has always been appreciated. Scandinavian mythology mentions Berserkers (ancient Norse warriors) would drink a mixture called "butotens", to greatly increase their physical power at the risk of insanity. They would literally go berserk (where the modern meaning of the word arises) by biting into their shields and gnawing at their skin before launching into battle, indiscriminately injuring, maiming and killing anything in their path.³ This unrelenting desire to out-compete rivals at any cost seems to be branded into the human psyche. The willingness to partake of substances that may inevitably be detrimental even to the point of death has been repeatedly demonstrated. Thomas Hicks, an American born athlete won the 1904 Olympic marathon having received multiple injections of strychnine by his trainer. Hicks survived his ordeal but never raced again.⁴ An attempt at understanding the extent of this risk-taking behaviour was undertaken by physician Dr Bob Goldman. In his research involving elite athletes he presented a scenario where success in sport would be guaranteed by the ingestion of an undetectable substance, however with the inevitable outcome of death after five years. He concluded that approximately half the athletes would take the drug. This scenario has been dubbed the “Goldman's dilemma”.⁵ A more recent repeat of this study yielded a lower correlation.^6,7 During the Second World War soldiers on both sides were given amphetamines to counteract fatigue, elevate mood, and heighten endurance.^8,9 Following the war these drugs – nicknamed “La bomba” and “Atoom” by Italian and Dutch cyclists -  started to enter the sporting arena with the intention of minimising the uncomfortable sensations of fatigue during exercise.¹⁰ In the 1950s, there was the perception in the USA that the great success of the Russian weightlifting team was solely due to the use of performance enhancing drugs. Dr John Ziegler in collaboration with CIBA Pharmaceuticals and under FDA approval developed the first oral anabolic steroid, methandrostenolone. U.S. Athletics, which believed they needed chemical assistance to remain competitive, gave their entire Olympic weightlifting team methandrostenolone.¹¹ Zeigler was later quoted when finding out that athletes were taking 20 times the recommended dose - "I lost interest in fooling with IQ's of that calibre. Now it's about as widespread among these idiots as marijuana."¹² This belief came to a head in the 1960 Olympic Games where Danish cyclist, Knud Enemark Jensen collapsed and died while competing in the 100 km race. An autopsy later revealed the presence of amphetamines and nicotinyl tartrate in his system.¹³ In the 1967 Tour de France, British cyclist Tommy Simpson, who had previously been named Sports Personality of the Year by the BBC, died during the 13th stage after consuming excessive amounts of amphetamines and brandy. Simpson’s motto was allegedly "If it takes ten to kill you, take nine and win!"¹⁴ Simpson's death created pressure for sporting agencies to take action against doping. This ultimately led to the formation of The World Anti-Doping Agency (WADA) in 1999 as an international independent agency composed and funded equally by sport movements and governments of the world. Every year they publish an updated list of banned drugs. In general terms these fall into three groups:¹⁵ M1. Manipulation of Blood and Blood Components M2. Chemical and Physical Manipulation M3. Gene Doping Gene doping is the use of gene therapy in order to improve athletic performance in competitive sporting events. It would involve the use of gene transfer to increase or decrease gene expression and protein biosynthesis of a specific human protein. This could be done by injecting the gene carrier into the athlete using a viral vector or by transfecting the cells outside the body and then reintroducing them. WADA has placed significant resources in order to detect this process.  Currently there is no evidence that this is common practice.^16,17 In addition to the traditional incentives such as fame, honour and power, the past 60 years has brought with it the most potent of drivers - money, which in western culture embodies all three.  The financial incentives to both the sporting institutions and athletes have been profound. With some authorities claiming almost a 250% increase in revenue with the introduction of industrial scale performance-enhancing drugs.¹⁸ The supplements industry has already exceeded $60 billion per year. ¹⁹ The combination of primal ambition and ever improving designer performance- enhancing modalities makes the future of professional sport, I believe, the realm of the highest bidder. References:

1. Dr Charles-Édouard Brown-Séquard, The Effects Produced On Man By Subcutaneous Injections Of A Liquid Obtained From The Testicles Of Animals. The Lancet, 20 April 1889.
2. Kumar, Rajesh. "Competing against doping". Br J Sports 1 September 2010
3. The Saga of King Hrolf Kraki
4. Pariente, R., & Lagorce, G. La Fabuleuse Histoire Des Jeux Olympiques. Livres Bronx Books, Lasalle, QC, Canada. ODIL France 1973
5. Goldman, Robert; Ronald Klatz (1992). Death in the locker room: drugs & sports (2nd ed.). Elite Sports Medicine Publications. p. 24. ISBN 9780963145109.
6. Connor, James; Woolf, Jules; Mazanov, Jason (January 2013). "Would they dope? Revisiting the Goldman dilemma" (PDF). British Journal of Sports Medicine. 47 (11): 697–700.
7. Connor, James; Jason Mazanov (2009). "Would you dope? A general population test of the Goldman dilemma.". British Journal of Sports Medicine. 43 (11): 871–872.
8. Doping of athletes, a European survey, Council of Europe, France, 1964
9. Grant, D.N.W, Air Force, UK, 1944
10. Timothy D. Noakes, Tainted Glory — Doping and Athletic Performance, NEJM 2004; 351:847-849August 26, 2004
11. John D. Fair, "Isometrics or Steroids? Exploring New Frontiers Of Strength in the Early 1960s, Journal of Sport History, Vol. 20. No. 1 (Spring 1993)
12. Wade N, Anabolic steroids: doctors denounce them, but athletes aren’t listening. Science (1972).176, 1399–1403.
13. Maraniss, David (2008). Rome 1960: The Olympics That Changed the World. New York: Simon & Schuster. p. 111.
14. Graham M. R., Exercise, Science and Designer Doping: Traditional and Emerging Trends, Journal of Steroids & Hormonal Science, October 28, 2011
15. https://www.wada-ama.org/en/who-we-are
16. WADA, The Gene and Cell Doping Expert Group
17. Pray, L. (2008) Sports, gene doping, and WADA. Nature Education 1(1):77
18. Mitchell Grossman, et al, Steroids and Major League Baseball, Berkeley College
19. Nutrition Business Journal

  This article was first published in Medical Forum October, 2016

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General Practice Pathology is a new regular column each authored by an Australian expert pathologist on a topic of particular relevance and interest to practising GPs. The authors provide this editorial, free of charge as part of an educational initiative developed and coordinated by Sonic Pathology.