Biological preparation and hormonal rebalancing in France (1950-2016)

This commentary is part of Christophe Brissonneau and Jeffrey Montez de Oca’s forthcoming book, Doping, Deviance, and Sports: The voices of Athletes and their Physicians in France’s elite Sport System, 1950-2010, due out in May 2017.

Through our work studying sport medicine and former dopers in different sports in France between 1950 and 2010, it appears that sport medicine is ambivalent about the doping issue. The community opposes doping but the results of their supported efforts to eradicate doping has been simply more doping in elite sport. We will see it with the medical biological concept of “hormonal rebalancing”. For that, we must go back until the second half of the 1950s, during which doping appeared in the media as a sport problem. Most of the doping scandals were in the Tour de France on august or some weeks before. Pierre Dumas was to the origin of the outbreak of the scandal with journalists. As the chief of the medical staff, Dumas saw cyclists who used “magic potions” and who injected themselves with products in their hotel rooms. He connected those usages to impressive collapses during the races or collective food poisoning allegedly affecting cyclists and team management. In the Pyrenees, during the 1962 Tour de France, Pierre Dumas and his colleague Dr Maigre made plans for a colloquium to define and to eradicate doping. Scheduled for January 26 and 27, 1963 in Uriages les Bains, the two physicians called it “Premier colloque européen sur le dopage et la préparation biologique”, or the “First European colloquium about doping and biological preparation”. The meeting voted to define doping as “the usage of substances or all means to artificially increase the yield, to or during the competition, which can harm the sporting ethic and physical and mental integrity of the athlete.” The banned list mainly included psychoactive products. Until here, every thing is (more or less) understandable. But what is meant by the phrase “biological preparation”? This new official concept was issued of the Youth and Sport ministry, which wanted a medicine, specialized in exercise physiology, able to understand and to push further the sport fatigue, to have more performing sportspeople. The French sport ministry funded projects in exercise physiology related to altitude during the 1960s. Its medical department studied products and methods that can reduce the threshold of fatigue. This question is fundamental for elite sport and is asked to the eight commissions of the colloquium of Uriage les bains: what is a biological preparation and what is doping?

Doping will be products which are active the day of the competition and which are not prescribed by the physicians. The biological preparation will be products that are active some weeks before the competition and which are prescribed by physicians. But what are those products? Because anabolic steroids (banned in 1973) – whose effects are perceptible some weeks later – can be included in the biological preparation definition. Advocating biological preparation, the presence of the doctor covers a second justification: a (medical, physiological and biological) support of elite sportspeople. Sport physicians are also applicants to mentor athletes. For example, during the congress of the Fédération Internationale de Médecine du Sport in 1958, its president, the Belgian professor Albert Govaerts, disagreed about the cooperation of the physician with the trainer. He proposed his total disappearance. For him, to be performing, the elite athlete must work scientifically with the physician-coach! At the beginning of 1960s, the French professor Chailley-Bert (having the only one Chair in exercise physiology) will totally agree many times. Already at this time, physicians, close but also far of the sport world, wrote in sport newspapers or in medical review about the possibilities for the cyclists and sport professionals to use amphetamines. Those physicians thought that the medical profession must manage elite sport, certain to help them in the frame of a biological preparation, others to avoid the usage of more dangerous products. To better understand the relation between the fatigue process and hormones, the sport ministry asked professor Plas in 1975 to write a report about:

·         The prevalence of doping usage among top athletes

·         The analysis of biological changes during prolonged physical effort

·         The existence of a benefit on the performance of an athlete, hormonally doped compared to placebo

His report showed a decrease in hormone levels among the studied sports and the importance of doping cases. The top athlete is presented as a patient with the hormonal system having major problems, due to its intensive physical activity. The results of those studies, extended in commission titled "biology of the Champion" from 1977, induced that high level sport was a source of health disorders. The doctor's role is advocated to correct a posteriori these perverse effects. A "complementation" with micro doses of steroid hormones would respect the usual rates of the sportsman. Giving more would be a “supplementation”, it means doping.

Until the end of the 1980s (there were some important scandals in athletics in France and abroad), debates during medical conferences would be around the “biological preparation” and whether it counted as doping. This question disappeared in the media during 1990s (because no important scandals) but some doctors and medical researchers continued to promote it.

During 1980s, De Lignière continued to defend the necessity of the hormonal rebalancing in intensive training and gather some physicians (connected or not to sport world) to officially question the National Advisory Council on Ethics in 1989. He left the question of world sport to question the medical profession. The answer of the Council was an embarrassed refusal four years later, in 1993.

At the same time, in Bordeaux, doctor Bellocq practiced the hormonal rebalancing. Its method was this of a trainer then a physician. First, from physiological and biological data, he proposed a scientific training planning then prescribed steroid hormones to recover. He also wrote a book in which he explained his “realist” approach with a part of the French Peloton and the French sport elite. We met some sportspeople who had been “taking care” from Bellocq and they all considered him as a friend and a “right” sport physician.

The books, the different articles from De Lignières, Bellocq, Koralzstein and others practitioners impacted the representations and justifications of elite sportspeople.

Now, after the Festina scandal, how important is the “hormonal rebalancing” inside high level sport. In 1998 and the following years, some foreign physicians defended this medical point of view in the media: Drs Mouton in Belgium, Blanc in Switzerland, Pr De Lignières and Dr Koralzstein in France. Our work during our thesis (2003) allowed to find four more doctors who “intellectually” agreed with the hormonal rebalancing”. After the strong and moralist anti-doping policy, are there always physicians who think that a (legal) “biological preparation” is the role of the sport medicine or that a (illegal) “hormonal rebalancing” is always a necessity in elite sport?