The Olympic Games.

Most, if not all, sportsmen and sportswomen recognize the Olympiad as the pinnacle of athletic endeavor. Even qualifying for the Olympic Games is an achievement in itself. Relishing the opportunity to stand on the podium and accept a winner's medal, with the sound of the national anthem reverberating around a packed and cheering arena, must indeed be a once-in-a-lifetime moment.

Cast your mind back, if you will, 3,000 years, to ancient Greece, where the precursor to our present-day Olympics was well underway. How do you picture the scene? Do you see, in your mind's eye, muscular, bronzed athletes, their skin a healthy glow with the perspiration of their efforts, engaging in competition only to demonstrate their strenuous training and athletic abilities?

If so, I suppose you can be forgiven. This seems to be our "programmed" picture of the Greek ideal. The reality, though, was surprisingly closer to today's scenario. The overriding purpose behind most athletes' presence at the Olympics - then, as now - does match that ideal, but sporting success - then, as now - was accompanied by the desire for fame and financial award.

Some things never change.

A more surprising parallel, perhaps, is the means employed by athletes to achieve their goals. Even centuries before the advent of modern medicinal chemistry, athletes were willing to ingest almost anything in order to promote their chances of winning.

Today's ever-lucrative roles of advertising and sponsorship, together with large cash prizes for the successful athletes (albeit as trust funds - the Olympics is still, after all, an amateur affair) probably has done the bulk of the damage. Where big bucks are offered, so too is the temptation to take the fastest route possible to obtain them.

Enter drugs.

Going hand in hand with the increasing prizes and fame is the rise of illicit drug use by athletes to enhance their performance. They believe the drugs will help them become stronger, faster, bigger (or smaller), heavier (or lighter). Or, indeed, whatever they want the drugs to do.

Clearly, athletes take their particular drug (or drugs) of choice because they believe there is evidence that the chemicals will afford them enhanced sporting ability. Much of this belief is propagated through carefully selected scientific citations and extrapolations. The main question, though, still remains. Do the drugs work? Is there any evidence that the drugs actually do help an athlete gain a competitive advantage?

What drugs do the pharmacological athletes take? The answer is ever changing. Essentially, as testing procedures improve, so does the inventiveness of the athletes and their suppliers. New drugs are introduced to the sporting arena far quicker than testing can catch up with them. As such, studies into the efficacy and utility of new drugs are few and far between. Better studied drugs include those that most of us know of (through media exposure, rather than use). For various reasons, athletes have taken common recreational drugs as sporting adjuncts. These include alcohol, marijuana, amphetamines, cocaine, and other narcotics. Most common among the drug cheats - and there are no prizes for guessing - anabolic steroids.

Reasons for the popular use of steroids by athletes at all levels of ability vary, but one common theme rises above the rest. The reason belies a physical attribute beneficial in most modern sports - strength. The logic behind this tenet is that anabolic steroids are related to the male sex hormone, testosterone, and it is known that muscle mass increases when testosterone levels increase in adolescent males; therefore, anabolic steroids ought to build muscle (and, subsequently, strength) in athletes.

A considerable amount of research has been performed since the height of steroid abuse (late 1960s to 1970s), and work continues in this area. Controversy still surrounds these studies, however, specifically, in relation to conflicting data and the subject choice.

For example, two recent studies [1,2] published in the Journal of the American Medical Association, show a drug exhibiting conflicting effects. Androstenedione (a natural precursor of testosterone) was given to subjects with a view to measuring the resultant effect on testosterone levels. One study showed androstenedione caused no change in blood levels of testosterone, the other study showed a marked increase. The other point of issue, also manifest in both of these studies, is the choice of subjects. The studies used "healthy male volunteers" as study subjects. In addition, one study purposely sought men who were not engaged in strength-building exercises. This method of participant selection may allow for an "even baseline" on which to draw conclusions. It does, however, miss the point that it is highly trained athletes who are taking the banned drugs. As such, are these studies valid?

More recent developments add to the mêlée. The use of what are essentially "natural" agents, such as human growth hormone and erythropoietin (a peptide that induces red blood cell production and is favored by endurance athletes), are blurring the edges of defining and proving cheating. Their use is an attempt by the drug users to stay one step ahead of the drug tests. Being "natural" substances makes them invisible in identification tests, and setting up index tests to prove unnatural levels is a very complex and time-consuming process.

Like all the other illicit drugs taken by athletes, these "natural" pharmaceuticals are taken in the belief they will enhance the athletes' sporting performances. How is the defining line drawn, though, when the legitimacy of the use of natural products is questioned? To extend the point, certain foods are known to be particularly nutritious and, as such, confer upon the athlete enhanced performance. This process may take several years or a few days to elicit a response, but, nonetheless, the response occurs. Is this the same as taking other natural products to enhance sporting ability?

It is certainly not a black and white issue - where is the line between nutrition, training aids, and cheating to be drawn? Studies - appropriate, relevant, well-funded, and carefully thought out studies - are required. Without a thorough investigation into current practices, the efficacy, safety, and ethical implications of drug use in sports cannot be determined. Without such studies, the sports authorities will keep playing catch-up with the ever evolving athletic pharmacy.