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“No Systematic Doping in Football”: A Critical Review
Dominic Malcolm (Loughborough University, UK)
Ivan Waddington (University of Chester, University College Dublin, Norwegian
School of Sports Science, Oslo)
Abstract
This paper examines the degree to which football administrators are correct to believe
that there is relatively little use of performance-enhancing drugs in elite football. In
contrast to FIFA’s reliance on the results of drug testing as a means of gauging this
phenomenon, this paper attempts to triangulate the evidence from the broader
spectrum of sources of information about drug use in sport. Though meaningful and
accurate data on the use of such drugs in a sport are difficult to obtain, sources
indicate that whilst doping might not be as widespread in football as it is in other
sports and that its prevalence appears to vary from country to country, there is
evidence to suggest that systematic doping programmes have been implemented at a
number of leading European football clubs. FIFA’s short-sighted assessment of the
problem potentially restricts the effectiveness of, and the deterrent posed by, existing
anti-doping programmes in football.
Over the last two decades a growing amount of evidence has become available about
the extent of illicit drug use in sport. Although much of this evidence has been
anecdotal, some has come from relatively reliable sources like parliamentary or
judicial inquiries at which evidence is given under oath. Although we cannot be sure
of the precise level of drug use in modern sport, most writers agree that the
phenomenon has increased markedly since the Second World War, and in the last
three decades in particular. Mottram has recently cited drug use as “perhaps the
biggest challenge facing sport today.”
i
Although there has recently been a study of drug use by amateur footballers in
Cameroon,
ii
it remains the case that there are almost no systematic data about the
extent of drug use in football. We do know that the use of performance-enhancing
drugs in football is not new. In 2004 a BBC radio programme provided wide-ranging
evidence of the history of the use of performance-enhancing drugs in English
football.
iii
The programme reported use by the Arsenal team of “pep pills” prior to an
FA Cup match against West Ham United in the 1924-25 season,
iv
questions raised in
the House of Commons in 1939 about Wolverhampton Wanderers’ use of extracts
from monkey testicles,
v
Stanley Matthews’s description of his use of pills what were
almost certainly amphetamines prior to an FA Cup fourth round tie in 1946,
vi
and
testimony from Manchester United players Albert Scanlon and Harry Gregg of their
use of amphetamines during the 1950s. There was, indeed, considerable concern over
the use of drugs in football at this time. In response to a Council of Europe
investigation in 1963, football was identified by the British government as one of
three sports (the other two being cycling and athletics) with the most severe problem
of drug use.
Despite such historical evidence, officials of the Fédération Internationale de Football
Association (FIFA) largely assume, and publicly state, that football is relatively free
from drug use. Typically FIFA President Sepp Blatter has argued that, “from current
data, the incidence of doping in football seems to be very low and we have no
evidence of systematic doping in football.”
vii
Gordon Taylor, Chief Executive of the
Professional Footballers Association (PFA) in England, has similarly stated that, “I’m
almost certain that we have a clean sheet over performance-enhancing drugs.”
viii
Articles co-authored by FIFA’s Chief Medical Officer, members of FIFA’s Doping
Control and Medical Committees and the editor of the British Journal of Sports
Medicine, also reflect the belief that performance-enhancing drugs are rarely used by
footballers.
ix
Such a stance is not unique to football for, as Yesalis et al. note, sports administrators,
when faced with allegations of drug use in their sports, “have often tended to deny
that a major doping problem exists … or have at least played down its magnitude.”
x
Yet the case of football is rather different. FIFA officials base their claim on the
relatively low incidence of positive tests from players. Convinced of the rigour of
their drug testing programme, they have cited a number of possible explanations for
these “favourable” test results:
• “The stringent drug testing programme occurs during the entire football season
in most countries;
• Football players worldwide understand that prohibited substances in sport will
neither improve their physical performance nor their football specific skills
and hence are reluctant to use agents that are not effective and subject to
possible sanction;
• Ongoing education campaigns by FIFA for doctors, administrators, officials
and players have encouraged a drug-free culture in football.”
A fourth possible explanation, though one that is quickly dismissed as “unlikely,” is
that football’s drug testing programme is “insufficient to detect drug use.”
xi
The object of this paper is to critically evaluate these claims. This is no easy task for,
as Mottram has noted, “[m]eaningful data on the prevalence of use of performance-
enhancing drugs in sport are difficult to obtain” for, by its very nature, drug use in
sport is a covert activity.
xii
Yesalis et al. note that there are four major sources of
information about the prevalence of drug use among athletes: investigative
journalism, including the writings and testimonials of athletes and others involved in
sport; government investigations; surveys; and results from drug testing. All four
sources suffer from significant methodological problems. Yesalis et al. suggest, for
example, that those who have used drugs and who serve as informants “may project
their own behaviour onto others in an attempt to rationalize their drug use,” producing
an overestimate of the level of drug use.
xiii
However, they argue – almost certainly
correctly - that most of the methodological difficulties are more likely to lead to an
underestimate of the level of drug use. In particular, they argue that:
the responses of athletes to the questions of journalists, drug use surveys, or even
government investigations may be influenced by the athlete’s desire to respond to
questions in a socially desirable manner, memory lapse, the illegal nature of the
substances being surveyed, and a general distrust of those doing the questioning.
They also note that drug testing “is hamstrung by significant limitations in
technology,” and conclude that, “All these limitations would likely result in a
significant under-reporting bias.”
xiv
While each of the sources of information on drug use in sport raises particular
methodological difficulties, the fact that we are not dependent on a single source
enables us triangulate our findings, thus increasing the validity of our conclusions. As
Goode has noted in relation to the problems of estimating the extent of drug use more
generally in American society:
As a general rule, the greater the number of independent sources of information
that reach the same conclusion, the more confidence we can have in that
conclusion. That is what we mean by triangulation: getting a factual fix on reality
by using several separate and disparate sources of information. To the extent that
several independent data sources say the same thing, we can say that their
conclusions are more likely to be true.
xv
To a greater or lesser extent, data on drug use in football can be gleaned from each of
the four major sources identified by Yesalis et al. In examining these data sources, we
made three important assumptions which should be noted. Firstly, we focussed
primarily on the European game. This we did because European football has supplied
the majority of positive tests in recent years (72.7 in 2004, 74.4% in 2005),
xvi
but also
because the press coverage of European football is both greater and easier to access,
and because the prior research on drug use in football, and all legal investigations,
have been European based. Secondly, we focussed primarily on the use of
performance-enhancing rather than recreational drugs for, across sport, the former is
generally perceived to be rather more serious than the latter. Thirdly, in our selection
of data we have primarily been concerned with evidence of the systematic
administration of substances, for analysts largely agree that drug use which is
organized at an institutional level is more problematic than that which is individual
and often therefore largely ad-hoc. Moreover, our focus on systematic drug use
directly addresses one of the key claims that FIFA officials make about drug use in
football.
This paper examines each of these four data sources to assess more adequately the
prevalence of the use of illicit drugs in football, before turning to consider some of the
implications of these findings. It is our contention that there are both empirical and
theoretical grounds for believing, firstly, that a significant minority of European elite
footballers are using performance-enhancing drugs and that, secondly, some clubs
have been involved in the systematic organization and delivery of doping
programmes. We also argue that there are clear grounds to suggest that the use of
performance-enhancing drugs is not as widespread in football as in many other sports,
and that drug use is likely to be more common in some European countries than in
others. We conclude by arguing that FIFA’s limited analysis of evidence of the use of
performance-enhancing drugs in football leads to an underestimation of the scale of
the problem which the sport faces, and thus threatens the efficacy of their anti-doping
programme.
Data on Performance-enhancing Drug Use in Football
Evidence from Testing
Football was the first sport to conduct drug testing at a major event, introducing tests
for the 1966 World Cup and thus pre-empting the first testing at an Olympic Games
by two years.
xvii
FIFA has also been at the forefront of moves in international sport to
use blood tests, introducing them in 2002 to supplement urine tests at the Japan-Korea
World Cup.
xviii
These testing procedures have generated few positive test results.
Two players were ejected from major football tournaments for taking drugs during the
1970s: Ernest Jean Joseph of Haiti in 1974, and Willie Johnston of Scotland in
1978.
xix
Between 1994 and 2005, just four (0.12%) of the 3,327 tests carried out at
FIFA competitions were positive;
xx
most famously Diego Maradona, captain of
Argentina at the 1994 FIFA World Cup who tested positive for ephedrine. Of the
22,500 drug tests worldwide in 2004, just 92 were positive, and the majority of these
positive tests derived from the use of recreational drugs such as marijuana (39 cases)
and cocaine (29 cases).
xxi
Figures released by the World Anti-Doping Agency
(WADA) indicate that of 23,478 football-related tests performed by WADA
accredited laboratories in 2005, 343 produced adverse findings.
xxii
Drug testing in
international football, therefore, has revealed remarkably little evidence of the use of
drugs in general, and the use of performance-enhancing drugs in particular. FIFA’s
Chief Medical Officer, Jiri Dvorak, concludes that, “It can only be assumed that team
sports such as football are not as prone to misuse of performance enhancing
substances as are individual sports.”
xxiii
Drug testing programmes in domestic football leagues have similarly produced
relatively few positive results for performance-enhancing drugs. Data from UK
Sport, the body which administers drug tests in British football, indicate that, over the
period from 1988 to 2001-2002, there were in Britain 89 positive drug tests in football
(these data include the results of testing on behalf of the Welsh and Scottish Football
Associations, as well as the English FA). The most commonly detected drugs were
Class 1A stimulants such as pseudoephedrine and metabolites of cocaine, of which
there were 40 positive cases, and marijuana, for which there were 29 positive test
results.
xxiv
It is probably the case that the metabolites of cocaine were associated with
recreational drug use rather than with drugs which were taken for performance-
enhancing reasons. UK Sport figures indicate that the number of positive tests per
year has gradually fallen – from 14 in 2003-04, 11 in 2004-05, to just 6 in 2005-06.
Cocaine and marijuana cases remain the most common. Included within these figures
are a number of high profile footballers who have tested positive for recreational drug
use, most notably Mark Bosnich and Adrian Mutu of Chelsea in 2002 and 2004
respectively, and this has reinforced the impression that a culture of recreational,
rather than performance-enhancing, drug use exists in English football.
However, between 1998 and 2002 footballers also produced six positive tests for
anabolic agents. All these players initially escaped punishment or were given
suspended punishments after successfully arguing, for instance, that the substance had
been ingested inadvertently. However, the Rushden and Diamond’s goalkeeper Billy
Turley subsequently tested positive for a recreational drug, at which point his prior
suspended two year ban (he had tested positive for the banned steroid nandrolone)
was enforced.
xxv
Turley remains the only British player to have been punished for
using a performance-enhancing drug. The only English league player to have been
found guilty of taking performance-enhancing drugs since this time is
Middlesborough’s Portuguese international Abel Xavier, who tested positive for the
anabolic steroid dianabol during a UEFA Cup tie in Greece in 2005. His initial 18
month ban was subsequently reduced to 12 months by the Court of Arbitration for
Sport (CAS) and subsequently the club decided to re-instate his contract.
xxvi
Though the actual numbers cited suggest a definition of “positive doping samples”
which may be rather different from that used by UK Sport, Dvorak et al. demonstrate
that a greater number of positive tests for drugs have occurred in other European
domestic leagues. During 2004 and 2005 there were 30 positive tests in France, 21 in
both Italy and Portugal, and 20 in Belgium compared to (according to FIFA figures)
just one in England.
xxvii
At times “clusters” of positive tests occur. For instance, between April and October
1997, five players, from a number of top French teams, tested positive for anabolic
steroids.
xxviii
In Italy in 2000-2001 nine leading players in Serie A, and a number of
more minor players, tested positive for nandrolone.
xxix
A number of these involved
leading Dutch international footballers (notably Jaap Stam and Edgar Davids), and
with the Dutch captain Frank de Boer also testing positive for nandrolone whilst
playing for Spanish team Barcelona, there were suggestions that a common link might
have been the Dutch national squad.
xxx
The fact that 31 first division players in
Portugal also tested positive during a five month period in 2001 suggests however that
the use of nandrolone at this time was more widespread.
xxxi
That these clusters always
involve performance-enhancing drugs suggests not only an improvement/increase in
testing, but also that the drug use has an underlying pattern rather than being ad-hoc.
Notwithstanding this evidence, the data from drug testing suggest that the use of
performance-enhancing drugs in football is relatively rare. It is important to note,
however, that there is a widespread recognition among informed observers that the
number of positive test results merely represents the tip of a much larger iceberg. The
Dubin Commission in Canada, for instance, concluded that “many, many more
athletes than those actually testing positive have taken advantage of banned
substances and practices” and that “positive test results represent only a small
proportion of actual drug users.”
xxxii
It therefore seems probable that this pattern of
positive drugs tests merely scratches the surface of a more widespread phenomenon.
Other sources of information support this claim and indicate how FIFA’s approach to
estimating the prevalence of drug taking in football can best be describe as myopic.
Testimonials of those Involved in Football
A number of allegations of doping made by players and managers suggest that the
number of positive drugs tests underestimates the extent of drug use in football. In
1999, Dr. Wilfried Schiesslir (club doctor with German Bundesliga club Nuremburg)
and Robert Louis Dreyfus (head of adidas and president of Olympique Marseilles)
called for the liberalization of anti-doping laws in football because the “current
system of doping control is flawed.”
xxxiii
In 2002, Dr. Michel D’Hooghe, chairman of
FIFA’s Medical Commission argued that players across Europe were using
erythropoietin (EPO), human growth hormone and anabolic steroids. He further
claimed that “high profile stars” had started to employ their own medical specialists
and that doctors known to have been active in administering performance-enhancing
drugs in cycling and endurance skiing were “suddenly appear(ing) around football
clubs all over Europe.”
xxxiv
Players such as Emmanuel Petit, Marc Overmars and
Gianluca Vialli have made similar allegations that leading players in the game were
using performance-enhancing drugs to cope with the physical demands of playing an
increasing number of games. In 1999, for instance, Petit said that, “If the present
number of games continues, something is going to give. We will all have to take
drugs to survive. Some footballers already do. I know that.”
xxxv
Perhaps more interesting, however, is the testimony of Arsenal manager Arsene
Wenger. Speaking in 2004 Wenger claimed that some players joining Arsenal had
displayed symptoms of EPO use. He said, “We have had some players come to us at
Arsenal from other clubs abroad and their red blood cell count has been abnormally
high. That kind of thing makes you wonder.” He went on to exonerate the players,
stating that, “There are clubs who dope players without players knowing. The club
might say that they were being injected with vitamins and the player would not know
that it was something different.”
xxxvi
Wenger’s comments are interesting in that they
are based on tangible evidence derived from Arsenal’s own blood testing programme.
The evidence upon which Wenger based his suggestion that such players had been
subject to club-administered doping regimes is, however, less clear.
That such organized and systematic doping occurs in European football is, however,
indicated by the testimony of a number of retired players. Two former Marseilles
players have publicly stated that the club provided players with performance-
enhancing drugs. In his autobiography (published in 2002) Marcel Desailly stated
that club chairman, Bernard Tapie, had instructed the squad to take pills before big
matches and that whilst some team mates refused, Desailly himself took the tablets
“several” times. Whilst Desailly was not sure what these pills were, he recalled that
the box of tablets contained the warning that: “This medicine, above a certain dose,
can be considered as a doping substance for high-level sportsmen.”
xxxvii
Four years
later midfielder Jean-Jacques Edelie confessed to having agreed to take an illicit
substance prior to the 1993 Champions League Final. Moreover, he argued that
performance-enhancing drug use occurred in all but one of the clubs for which he had
played, and that at Marseilles, “we all (except Rudi Voller) took a series of injections
and I felt different during the game, as my physique responded differently under
strain.”
xxxviii
Only one Marseilles player (Christophe Dugarry) tested positive for a
banned substance, and then some years later.
xxxix
In contrast to the Marseilles evidence, allegations of a systematic doping programme
at Spartak Moscow football club arose directly from the positive test of a player.
Yegor Titov tested positive for bromantan (a stimulant and masking agent) whilst
playing for Russia against Wales in November 2003. The Russian media
subsequently claimed that this drug had been administered as part of a systematic
doping programme at Spartak, citing the sudden withdrawal of Spartak players on the
eve of Russia’s match against Ireland in September 2003 as suspicious. Two former
Spartak players, Vladislav Vashchyuk and Maxim Demenko, subsequently provided
testimony of their participation in this doping programme. Demenko recalled that,
“Small white pills were given to first team players before each game,” and Vashchyuk
said that doctors often used a drip to administer banned drugs.
xl
Finally, in 2006 Le Monde accused Spanish clubs Real Madrid, Barcelona, Valencia
and Real Betis of having employed the services of Spanish doctor Eufemiano Fuentes.
Fuentes was then being investigated by a Spanish judicial inquiry into doping in sport
and was arrested in May 2006 on charges of crimes against public health. Though
Barcelona and Madrid denied the allegations, and insisted that Fuentes had never been
linked to their players either formally or informally, the journalist responsible,
Stephane Mandard claimed that he had seen Fuentes’ handwritten notes mentioning
the teams as having been treated by him.
xli
These allegations support D’Hooghe’s
assessment of drug use in European football cited earlier.
Evidence from testimonials therefore suggests that organized doping programmes
have existed at a number of leading clubs in several European countries. An
interesting aspect of these testimonials is that none have come from players who have
been found guilty of doping offences, but have been volunteered by those who have
been neither accused nor convicted of taking performance-enhancing drugs. Indeed,
the players have largely projected themselves as “victims” in these scenarios, either
given insufficient information or misled by doctors and football club administrators.
Clearly some have stood to benefit commercially from such revelations (e.g. through
increased sales of an autobiography), but this notwithstanding, these testimonials
point to a relatively coherent and consistent picture: that in some European countries,
leading football clubs have administered systematic doping programmes.
Government and Judicial Investigations
Across sport the most penetrating investigations of doping have come from
government inquiries and quasi-legal investigations. It is widely acknowledged, for
instance, that the Dubin Commission of Inquiry established in Canada following the
positive drug test of Ben Johnson at the 1988 Olympic Games,
xlii
and the inquiry
headed by Australian Senator Black,
xliii
have furnished us with the greatest
understanding of the use of performance-enhancing drugs in sport. Though neither
looked at drug use in football there have been two inquiries – one in Germany and one
in Italy – that are relevant here.
Post-unification inquiries into the state sponsored doping programmes operated in
Eastern Germany provide perhaps the most comprehensive and compelling evidence
of doping in sport. These inquiries have shown that elite athletes were systematically
doped by the East German state and were tested in the GDR prior to competition to
ensure that athletes representing their country could evade official drug testing. As in
other sports, the East German national football teams were “required to use drugs in
order to compete successfully against other nations”.
xliv
Research has, for instance,
revealed records of drugs tests which demonstrated widespread and systematic use of
amphetamines.
xlv
The use of performance-enhancing drugs within the national
leagues was, however, officially forbidden by the East German state, in an attempt to
promote greater playing equality between clubs. However, not all clubs complied with
state orders, and used the knowledge developed at national level within their own
club-based systematic doping programmes. Football, therefore, was no different from
any other sport in communist East Germany, characterized by systematic doping
programmes at both club and international levels prior to 1989.
The events surrounding inquiries into drug use in Italian football are rather more
complicated. In that they have revealed doping offences involving leading players at a
leading club, and in that they relate to democratic Western societies in which evidence
of systematic doping programmes has been less common, they have perhaps produced
more sensational findings.
Events were triggered by an interview with the then AS Roma manager, Zdenek
Zeman, published in L’Espresso Magazine in July 1998.
xlvi
Zeman stated that the use
of performance-enhancing drugs was rife in Serie A, and suggested that football
needed to “come out of the pharmacy.” In particular he referred to two Juventus
players, Gianluca Vialli and Alessandro Del Piero, whose muscular development had
“surprised him.” Given the implication of illegal drug use, Vialli and Del Piero
started legal proceedings against Zeman. Debate in the Italian and international press
generated pressure sufficient to lead the Public Attorney of Turin, Raffaele
Guarinielo, to start an investigation. Guarinielo interviewed firstly Zeman and then
Sandro Donati, a member of the Italian National Olympic Committee’s (CONI)
medical commission, leading to two significant findings.
On the basis of the interview with Zeman, Guarinielo ordered a raid on the Juventus
premises which revealed that the club held 281 different pharmaceutical substances.
The majority of these substances were not on the IOC’s list of banned substances,
though at least five anti-inflammatory drugs containing banned substances were
found.
xlvii
It was, however, the sheer quantity of pharmaceuticals found that raised
suspicions for, as Gianmartino Benzi, medical advisor to Guarinielo, noted, “the club
was equipped like a small hospital.”
xlviii
As a witness at the subsequent trial
suggested, “either the players were always sick or they took drugs without
justification … to improve performance.”
xlix
Donati claims that his accusations of irregular testing procedures led Guarinielo to
order that the IOC accredited Acqua Acetosa laboratory in Rome be searched.
l
Police
discovered documents hidden in the building’s air vents and the laboratory was
closed. The president of CONI resigned and the director of the laboratory was sacked
when it came to light that some of the doping controls conducted on footballers did
not include tests for the detection of anabolic steroids or other hormones. It was later
revealed that some documents relating to drug tests in football had disappeared,
li
and
that laboratory technicians had been told not to publicize positive test results.
lii
Further documents revealed that some 24 Parma players had abnormally high
haematocrit levels, indicative of the probable use of EPO. Government raids on
doping laboratories around Italy discovered “a trail of abuse involving officers who
had falsified documents and were guilty of fraud in relation to doping.”
liii
The steady accumulation of evidence led Gauriniello to bring charges against two
Juventus club officials. In January 2002 Juventus managing director Antonio Giraudo
and club doctor Riccardo Agricola were charged with supplying pharmaceutical
products to several of the club’s players between July 1994 and September 1998, a
period in which Juventus won three Italian titles and the European Cup. It was
acknowledged that the substances in question were legal, but that they were
administered in such a manner as to produce the same effects as illicit substances.
liv
The trial lasted almost two years, during which some of the world’s leading players,
including Zinedine Zidane, Roberto Baggio, Del Piero and Vialli, were called as
witnesses. The players stated that they had taken legal substances - for instance
Zidane revealed that he had used creatine - but the testimony of two court-appointed
independent witnesses proved crucial. Eugenio Muller, a pharmacologist, stated that
there could be “no therapeutic justification” for the club’s administration of
prescription-only drugs. Three drugs were cited in particular: Samyr, an anti-
depressant, was taken by 23 players; Neoton, a drug containing creatine used for heart
conditions, was taken by 14 players; and Voltaren, a pain killer and anti-inflammatory
drug, was used by 32 players. In the case of Voltaren in particular, the drug was not
used to treat isolated or occasional injuries; rather, according to Muller, its use was
“planned, continuous and substantial.”
lv
Juventus lawyers protested that the use of these substances was not illegal and club
president Vittorio Chiusano argued that these were “products widely used by many
other Italian footballers.”
lvi
Post-trial revelations suggest that he was probably correct
(see below), but new charges introduced during the trial relating to the use of EPO
proved more damning. Club records produced in court indicated that Juventus’ own
blood testing programme revealed particularly high haematocrit levels from a number
of players. On two occasions Didier Deschamps recorded increases of 20% in the
space of a few months.
lvii
Deschamps’ red blood cell count of 51.2% (45-47% is
considered normal), would have been sufficient for cycling’s international governing
body (the UCI) to withdraw a cyclist from racing.
lviii
Reviewing these records, a
leading haematologist, Giuseppe d’Onofrio, said that it was “very probable” that
Deschamps was among seven players who had taken small doses of EPO. D’Onofrio
however was “practically certain” that two other players - Antonio Conte and Alessio
Tacchinardi - had used EPO to overcome bouts of anaemia, and other reports have
suggested that the judge listed as many as 20 players involved in the “chronic use” of
EPO.
lix
The court found this evidence compelling and in November 2004 Agricola
was given a 22 month suspended jail sentence for supplying performance-enhancing
drugs, barred from practising medicine for 22 months and fined 2000 Euros. Giraudo
was cleared of all charges and a third defendant, Giovanni Rossano, a pharmacist
accused of supplying drugs on false prescriptions, agreed a plea bargain and was fined
5000 Euros.
Though government and judicial inquiries into drug use in football have been few in
number, where they have been undertaken, legally scrutinized evidence has been
produced which indicates that organized and systematic doping programmes have
occurred in elite European football. However, by their very nature, inquiries tend to
provide us with depth rather than breadth of understanding and can therefore only
point us towards the existence of relatively small pockets of drug taking in football.
What is interesting about the Juventus trial is not simply that it provides almost
incontrovertible evidence of a club-administered doping programme, but that the
doping which it revealed is almost identical to that described in various player and
manager testimonials. There are, therefore, good grounds for believing that such
practices are more widespread.
Evidence from Surveys
An alternative way of assessing how widespread is the use of performance-enhancing
drugs in sport is through athlete surveys. A number of such surveys have been
undertaken in different sports and different countries,
lx
but there has been, to date, just
one comprehensive survey of drug use in professional football, conducted by
ourselves and colleagues in 2003.
lxi
With the aid and support of the English
Professional Footballers Association (PFA), reply-paid postal questionnaires were
sent to the home addresses of all 2,863 members of the Association. 706
questionnaires were returned, giving a response rate of just under 25%. Such surveys
are not without their methodological problems, for it is clear that athletes have a great
deal, potentially, to lose from the truthful reporting of illegitimate activities. As
Mottram notes, elite athletes are generally reluctant to discuss drug use in their sport
and thus low response rates are to be expected.
lxii
However, we obtained responses
from players of different kinds (e.g in terms of ages, playing division and frequency
of first team appearances) suggesting that a representative sample was obtained. In an
attempt to improve response rates the survey asked not about players’ personal use of
drugs but, less threateningly, asked them to estimate the prevalence of drug use in
football and whether they personally knew players who used drugs. Whilst such
surveys cannot be expected to give a precise indication of the extent of drug use in
sport, it is important to bear in mind that the results will almost certainly
underestimate, rather than overestimate, the real level of drug use.
A half of all players (49%) felt that there was no use of illicit performance-enhancing
drugs in professional football. About a third (34%) felt that performance-enhancing
drugs were being used by some players, though the great majority felt that their use
was rare. In this regard, 23% of players felt that performance-enhancing drugs were
used by under 2% of players; 8% felt that between 3-5% of players used such drugs
and less than 1% felt that performance-enhancing drugs were being used by 10% or
more of their fellow professionals (17% of players expressed no opinion).
Almost 6% of respondents (39 players in total) indicated that they personally knew
players who used performance-enhancing drugs. Those who personally knew players
who used performance-enhancing drugs were spread across all four divisions, with
18% playing for Premier League clubs, 24% for clubs in Division One of the
Nationwide League, 36% for Second Division clubs and 21% for clubs in Division
Three. Of the players who indicated that they knew players who used performance-
enhancing drugs, most (68%) indicated that the drug using players were at a previous
club, though one in five indicated that the drug using players were at their current
club, and 12% indicated that they knew drug using players at both their current and
previous clubs. In all, four Premier League players two First Division players, four
Second Division players and four Third Division players indicated they knew players
at their current club who used performance-enhancing drugs.
The research also found that the use of recreational drugs is considerably more
widespread than is the use of performance-enhancing drugs. Only 29% of players felt
that recreational drugs were not used by professional footballers. Almost 28% of
respondents felt that recreational drugs were used by fewer than 2% of players, 13%
felt that between 3-5% of players used recreational drugs, 9% felt they were used by
6-10% of players while 4% felt that recreational drugs were used by more than 10%
of players (18% of players expressed no opinion).
Approaching a half of all players (45%) indicated that they personally knew players
who used recreational drugs. Among Premier League players, 31% personally knew
players who used such drugs, compared with 45% of players in the First Division of
the Nationwide League, 44% of Second Division players and 52% of Third Division
players. Of those who knew players who used recreational drugs, 15% indicated that
the players who used such drugs were at their present club, 63% indicated the drug-
using players were at a previous club while 23% knew players at both their current
and previous clubs who used recreational drugs. In all, 16 Premier League players, 23
First Division players, 21 Second Division players and 39 Third Division players
indicated they knew players at their current club who used recreational drugs.
These data provide clear evidence that performance-enhancing drugs are used in
English professional football, though their use appears to be quite rare; by contrast,
the use of recreational drugs is much more common. That player estimates of the
proportion of footballers using performance-enhancing drugs are relatively low, and
that players with personal knowledge of performance-enhancing drug users are spread
across the divisions, suggest that in English football the doping of players as part of
systematic, club-run, programmes does not occur, but rather those using performance-
enhancing drugs normally act independently of their employers.
Discussion
Three main questions arise from our examination of the data relating to the use of
performance-enhancing drugs in European football. First, how does doping in football
compare with that in other sports? Second, are there grounds for believing that
performance-enhancing drug use in football varies from country to country? And
third, why is it that the scale of drug use in football as indicated by the testing
programmes is much lower than that indicated by other sources?
The Prevalence of Doping in Football Relative to Other Elite Sports
According to WADA, just 1.46% of drug tests in football proved positive in 2005,
compared to an average of 2.12% for international sports in general, suggesting that
drug use is less prevalent in football than in many other sports.
lxiii
Moreover, a survey
of 1,300 elite British athletes across nine sports (including football) conducted by the
Independent in 1998, found that 54% of all athletes believed that up to 30% of
competitors in their sport were using performance-enhancing drugs; 5% believed that
between 30 and 60% were using drugs; and that 4% believed that over 60% of
competitors were using drugs. In this survey, 20% of those from the sports of
weightlifting and powerlifting admitted using anabolic agents, and 15% of those from
rugby league admitted using testosterone.
lxiv
Whilst almost a half of all PFA
members felt that there was no use of illicit performance-enhancing drugs in
professional football, no weightlifters or rugby league players, and just 3% of track
and field athletes responding to the Independent survey made a comparable claim.
Indeed in a more recent Independent survey, 84% of footballers in England expressed
the view that the sport had no problem at all with the use of performance-enhancing
rugs.
lxv
d
Cross-sport comparison therefore suggests that the use of performance-enhancing
drugs in football, or at least English football, is rather more limited than it is in other
sports. One explanation for this disparity is the structure of football relative to other
sports. All sports require a combination of physical ability and technical skill, and
those sports which place a premium on the former rather than the latter are the sports
in which the performance gains from the use of drugs are likely to be greatest.
lxvi
Thus participants in those sports which are based largely on physical strength and
power – e.g. weightlifting, cycling, athletics – are most likely to use performance-
enhancing drugs, whilst those sports which are primarily skill-based, such as golf or
football, are likely to have lower rates of performance-enhancing drug use. Sepp
Blatter has similarly argued that, “footballers have absolutely nothing to gain from
taking drugs because – in contrast to other sports – they need a vast array of qualities
and skills to succeed in the game, such as strength, endurance, speed, intelligence,
ctical understanding and ball control.”
lxvii
that he has been struck by “how much medication is
sed at FIFA tournaments.”
lxix
ta
Whilst such structural properties of different sports are clearly important factors
influencing not just whether or not participants are likely to use performance-
enhancing substances, but also the types of substances they use, the relative strength
and skill requirements in a sport are not static, but vary over time. In this regard it is
not the case, as Blatter claims, that “footballers have absolutely nothing to gain” from
taking drugs for, in addition to the data on the use of performance-enhancing drugs
discussed above, there is growing evidence to suggest that footballers use significant
quantities and varieties of legal pharmaceutical products in search of improved
performance. For instance, the survey of members of the English PFA found that
58% of players used vitamin pills, 37% used creatine and 24% used protein
powders.
lxviii
Dvorak has stated that creatine is “widely used” by footballers in Italy,
France, Portugal and Spain (interestingly the English league was not mentioned in this
list) and has further commented
u
In the wake of the Italian judicial inquiry, two further “scandals” provided supporting
evidence for this point. In April 2005, film footage was broadcast which showed
Parma footballer Fabio Cannavaro using a drip on the eve of the 1999 UEFA Cup
final. It was later claimed that the drip contained Neoton,
lxx
a drug cited in the
Juventus trial. Juan Sebastion Veron indicated that the club made the substance
available to all the players and he further suggested that “All the teams (in Italy) use
it.”
lxxi
Secondly, in 2005 Florentine public prosecutor Luigi Bocciolini opened an
investigation into the deaths of three former Fiorentina players whose deaths were
suspected of being linked to their use of drugs. Suspicion stemmed from
Guariniello’s investigation which revealed an apparently high incidence of cancer,
leukaemia and disease of the nervous system amongst players who had appeared for
top Italian clubs. In addition, former Fiorentina player Nello Saltutti, told Guariniello
that before every match “they gave us medicines, telling us they were vitamins.”
lxxii
One such drug was Micoren, banned by the IOC in 2000. Despite warnings that
prolonged use of micoren could have adverse effects on the arteries, Saltutti claimed
to have used it approximately 300 times during a 500 match career. In 2003, at the age
f 56, he died of a heart attack. o
Whilst on the one hand a clear distinction should be drawn between these events and
the illegal use of drugs to enhance sporting performance, their use demonstrates a
perceived need amongst footballers to enhance physical performance, and a
willingness on their part to use medical substances to obtain that goal. Moreover, the
evidence quite consistently points towards the use of products which build stamina
and improve cardiovascular fitness. It might be concluded, therefore, that whilst the
physical requirements of football mean that drug taking to enhance performance may
not be as widespread as it is in sports such as cycling and weightlifting, this is not to
say that footballers have no use for such substances. Moreover, recent developments
in the way that the game is played – in particular, the increasing pace of the game and
the increased number of games players at top clubs are expected to play in a season -
suggest that the demands for these substances might well be increasing and thus that
patterns of drug use in football may converge with those in other, more strength- and
ower-based, sports in future.
Performance-enhancing Drugs in Football in Different European
ope, but are
articularly uncommon in England. Can such a contention be justified?
p
The Use of
Countries
The evidence reviewed here suggests that the use of performance-enhancing drugs
and the administration of systematic doping programmes vary across Eur
p
Waddington argues that the increased use of performance-enhancing drugs in sport is
the product of the conjuncture of two social processes: the medicalization of social
life in general and of sport in particular, and the “increasing competitiveness” (i.e. de-
amateurization, politicization and commercialization) of sport.
lxxiii
However, the
degree to which these two processes have converged appears to vary from sport to
sport and from nation to nation. One notable aspect of the development of sports
medicine has been the relative slowness with which it became established in
England.
lxxiv
Moreover, research conducted into the contemporary provision of sports
medicine in English professional football has indicated that football club doctors are
most usually family doctors, recruited on the basis of family or personal connections
with the club. This research similarly pointed towards an “old boy’s network” of
recruitment amongst physiotherapists at football clubs. Significantly, few of the
medical staff working in professional football clubs have specialist qualifications in
sports medicine or much experience of practising medicine in other sports
contexts.
lxxv
In sum, this research indicates that the medical care of players has
generally been viewed as a relatively low priority in English football. In this sense, it
might be argued that, by comparison with the situation in some other European
countries, English football has been relatively untouched by the broader
medicalization process and, we suggest, this has had the unintended consequence of
also limiting the extent of the application of sports medicine in general, and the use of
rugs in particular, as part of the search for improved performance.
practice, but also to the
creased use of illegal performance-enhancing practices.
d
An important caveat to this argument, however, is to note the international nature of
football, and the increasing heterogeneity of English football in particular. The
English football league is the most cosmopolitan in the world,
lxxvi
and particularly
notable has been the influence not just of overseas players, but also overseas
managers in recent times. If doping is more prevalent and more organized in some
continental countries, then it follows that the recruitment by English clubs of players
and managers from clubs in those countries in which drug use is more common and
more organized may have some unintended consequences; in particular, it may lead to
the increased use not only of legitimate sports medicine
in
Doping Control in Football
Finally we might ask why it is that the scale of drug use in football as indicated by
testing programmes is much lower than that indicated by other sources. Firstly it
should be re-emphasized that drugs tests clearly do not reveal the true extent of
doping in any sport. For instance, though we now know that illegal drug use was
widespread during the 1998 Tour de France, not one rider tested positive for
performance-enhancing drugs during the event.
lxxvii
However, whilst general
criticisms can be made of the ability of doping control programmes to reveal the
prevalence of drug use, particular criticisms can be made of the doping control
programmes in football. These criticisms can be combined under the following
eadings: failures in testing procedure; attempts by clubs to circumvent drugs testing;
ible for the national side, Lazio midfielder Rino Gattuso was
lected to play for Italy in March 2005, just one week after declining to take a urine
h
and the inability of football administrators properly to enforce doping controls.
As revealed in the Juventus inquiry, during the 1990s there appear to have been
specific instances of malpractice by testers which served to obscure the extent of drug
use, or to cover up those positive tests which did occur. It is interesting to note that
the re-opening of the Rome laboratory in 2000 coincided with an unparalleled number
of positive tests in Italian football in the following season. Italian football now
conducts an extensive doping control programme entailing three times as many tests
as in English football,
lxxviii
including the testing of two players from each side after
every Serie A match.
lxxix
As stringent as this testing programme appears, it is not
mandatory for players to take these tests. Though regulators state that a test refusal
will make a player inelig
se
test.
lxxx
Testing procedures in English football are similarly problematic. Though the Football
Association rightly argues that football is the most tested sport (there were 1516 tests
carried out between April 2004 and March 2005),
lxxxi
such is the scale of the
professional game in England, and such is the distribution of tests throughout
different levels of the game, that the testing programme appears to have only a limited
deterrent effect. For instance, tests are rarely conducted after professional football
matches, with only eight of the 380 Premiership matches in 2000-01 subject to doping
controls.
lxxxii
The survey of PFA members indicated that only about a third of
professional footballers are likely to be tested during the course of a season, and that a
substantial majority (60%) not unreasonably felt that they were unlikely to be tested
in the next 12 months. This compares very badly with other sports in the UK. For
instance, a Sports Council survey (1996) found that 77% of elite track and field
athletes had been tested by in the UK and 37% had been tested by other agencies in
the previous year.
lxxxiii
In line with these findings, former Liverpool manager Gerard
oullier noted that clubs are likely to be visited only two or three times a year, and he H
called for more frequent testing.
lxxxiv
Concerns have also been expressed about the rigour of the testing procedures in
English football. In October 2003, England and Manchester United defender Rio
Ferdinand failed to present himself to doping control officers at the club’s training
ground. Ferdinand claimed that, due to the stress of moving house, he had forgotten
that he had been required to provide a sample. Ferdinand was subsequently
suspended from football for eight months for his failure to undergo the drugs test
(failure to comply with testing is deemed an offence equivalent to testing positive for
a performance-enhancing drug) but, more interestingly for present purposes, the
inquiry into this incident revealed how lax procedures had been. The Ferdinand case
revealed that at this time there was no requirement upon testers to accompany
footballers until they provided a sample. Rather, testers were forced to act through
club medical officers who then presented players for testing.
lxxxv
Such an
arrangement is unusual in sport, for it presents the opportunity for players, in
collaboration with the club’s medical staff, to avoid testing positive (e.g. through the
administration of a masking drug). Thus, whilst doping control in English football
ay appear relatively comprehensive, the sampling and testing procedures have been
s the East German state did prior to
989), and indeed, two English clubs, Arsenal and Chelsea, have been sanctioned by
m
such that users of performance-enhancing drugs could have evaded testing positive.
A further point of concern is the extent to which clubs perform their own testing
programmes. Evidence presented in the Juventus inquiry demonstrated that Juventus
had an internal drug testing programme and Lazio has similarly stated that it regularly
drug tested its entire squad.
lxxxvi
However, internally administered testing
programmes appear to be even more widespread amongst English clubs. It has been
claimed that “almost all of England’s top clubs require players to give samples several
times a season” and that “all test results are kept secret.”
lxxxvii
The objection to clubs
performing their own drug tests is that this information may enable them to shelter
some players from official doping controls (a
1
the FA for their illegal testing of players.
lxxxviii
Finally, it should be noted that various governing bodies of football have been
criticized for their limited commitment to, and enforcement of, anti-doping policies.
In particular, FIFA have clashed with WADA, the role of which is “to promote,
coordinate, and monitor at the international level the fight against doping in sport in
all its forms.” Most analysts have seen WADA as a very significant development in
anti-doping policy. Houlihan for instance sees it as, “play(ing) an important part in
raising the level of confidence in drug testing procedures,”
lxxxix
but throughout its
history FIFA, alongside cycling’s UCI, has been WADA’s “sternest critic.”
xc
FIFA
has continually resisted WADA’s attempts to standardize doping procedures and
penalties across sports and across national boundaries. FIFA argues that the
imposition of mandatory suspensions is legally problematic as it fails to take into
account the extent of the offender’s guilt, and thus contravenes the principles of Swiss
sanction law.
xci
The objection that bodies like the International Olympic Committee
(IOC) have to this position is that such clauses mean that standardized minimum
penalties cannot be enforced and indeed bans in football (12 months for Abel Xavier)
seem to be shorter than in some other sports, e.g. athletics (24 months for Dwain
chambers). IOC president Jacques Rogge has been critical of the lenient penalties in
football, and when FIFA continued to refuse to sign up to the WADA code it came
perilously close to being dropped from the 2004 Athens Olympic Games. Eventually,
in May 2004, FIFA and WADA signed a “cooperative agreement” in which WADA
agreed to fully respect FIFA’s stipulations of individual case management and
flexibility when imposing sanctions, whilst FIFA accepted WADA’s right to refer
football related cases to CAS. Whilst the differences between WADA and FIFA have
largely now been settled, in 2006 WADA President Dick Pound was still citing
ycling and “some elements within FIFA’ as the only problematic governing bodies in c
international sport.
xcii
Inconsistencies between FIFA and other international governing bodies of sport are
further compounded by FIFA’s inability to gain compliance from national football
federations. Sepp Blatter rebuked English FA chairman Geoff Thompson over his
handling of the aforementioned Rio Ferdinand case,
xciii
and since this time FIFA has
taken harder action against the national associations of France, Italy and the
Netherlands who have been fined between £4500 and £6000 for failing to adhere to
FIFA’s minimum punishment for doping infringements.
xciv
Not only is FIFA out of
step with the majority of the world sporting community over punishments for the
legal use of performance-enhancing drugs, but the considerable autonomy wielded
overning bodies of football provides significant inconsistencies within
n the accuracy of
ur depiction of this phenomenon. Moreover, it should be re-iterated that as Yesalis
il
by national g
football itself.
Conclusion
The use of performance-enhancing drugs in football is a problem the significance of
which has not previously been fully recognized by the game’s administrators. Whilst
Dvorak et al. argue that “any estimation of the problem can be considered as merely
an unscientific hypothesis or speculation,”
xcv
it is not the case that all estimations are
equally speculative. Whilst FIFA medical officials base their estimation of the scale
of drug use in football solely on the basis of drug testing results, our triangulation of
sources is likely to provide a more accurate assessment. Whilst we recognise that
there are considerable methodological difficulties with each of the data sources drawn
upon here, the fact that they provide relatively consistent and coherent evidence leads
us to believe that we can have a relatively high level of confidence i
o
et al. note, it is almost certainly the case that the sources used are likely to lead to an
underestimate, rather than an overestimate, of drug use in the sport.
We should, however, be circumspect in our claims for we think that there are both
empirical and theoretical grounds to think that the use of performance-enhancing
drugs in football is not as widespread as it is in other sports. However, it is worth
reflecting on the factors which FIFA’s Chief Medical Officer, Jiri Dvorak, and others
have forwarded as possible explanations for the relatively low use of performance-
enhancing drugs in football.
xcvi
It will be recalled that Dvorak et al. suggest that the
stringent nature of the drug testing programme, the perception amongst footballers
that such drugs are ineffective ways of improving performance, and the success of
educational campaigns which have fostered a drug-free culture in football may all
contribute to the occurrence of relatively few positive tests in the game. However,
our analysis indicates that footballers do not see the drug testing programme as
particularly stringent, and that footballers actively seek out substances which they
think will increase their physical capabilities. The prevalence of recreational drug use
in the game would also suggest that football does not have a “drug-free culture.”
deed the most likely explanation for the apparent lack of drug use in football is the
tion that Dvorak et al. dismiss out of hand; that is to say, the existing
4, no. 4 (199 ): 283-307.
In
very explana
testing programme is simply not very effective at detecting drug use.
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xv
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xvi
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xvii
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xviii
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xlviii
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xlix
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Houlihan, Dying to Win, 172.
xc
T
xci
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