the why of performance enhancing drugs

Monday, December 12, 2016

Every week seems to bring another player suspension by the NFL for the use of performance enhancing drugs. The frequency numbs us to the issue and unfairly, we may even suspect players who are clean and free of abuse. For that reason, the depth and breadth of the Russian doping allegations, should make us stand up and wonder what’s wrong with the state of sport. The report from the World Anti-Doping Agency provided evidence of more than a thousand international athletes who benefitted from illegal drugs or tainted testing processes as part of a governmentally run and approved program to have athletes cheat to reach the podium.

Depending upon the sport and the goal, there are a couple basic goals for doping. Anabolic steroids and human growth hormone (HGH) may allow the athlete to train harder recover more quickly, leading to muscle cell hypertrophy and increased strength. Blood doping, either by using erythropoietin (EPO) or by blood transfusion, allows increased oxygen deliver to the body prolonging the ability for muscles to work aerobically.

There is a cat and mouse chemistry battle between the athlete who dopes and the regulatory agencies that try to keep sports clean. The BALCO controversy revealed that anabolic steroid use can be successfully masked from testing but the 2002 Salt Lake Olympic testers were able to uncover the use of darbypoietin, a long acting EPO that had just been released on the market. Presumably, the athlete’s chemist may have a little time advantage initially, but the monitoring agencies catch up quickly. The question though, is why would an individual athlete want to cheat? It’s all about work ethic and philosophy.

Consider this one way of grouping athletes:

  • Group one has innate talent and work hard to maximize their potential
  • Group two does not have elite talent but does work hard to maximize potential
  • Group three has innate talent but lacks the motivation to work
  • Group four has neither talent nor motivation.

Group one athletes will generally succeed but should injury occur, fear of not returning to pre-injury levels might allow a pharmaceutical option to be a tempting proposition. Group three athletes might consider using drugs to substitute for work in the weight room to improve their performance the field.

The use of performance enhancing drugs might allow an athlete to leapfrog from one group to another. The rewards can be impressive and may mean the difference between playing varsity in high school as a showcase for getting a college scholarship. It may allow the college athlete to make a pro roster or an athlete to move from the B team to the Olympic squad. For a country to develop a system wide approach to performance enhancing drug abuse, it seems to make competition on the playing field a proxy for conflict on the battlefield. Based on the WADA report, the Russians were determined to assault the Olympic podium.

Interestingly, there are ways to artificially enhance performance that are quite legal. What is acceptable and what is cheating usually has to do with safety. Imagine a baseball player who can improve his vision by LASIK surgery to 20/15 and can then see the ball that much better than with glasses. Fans would cheer his dedication to his sport to undergo surgery to improve performance.

It gets complicated though. That same thinking to get LASIK surgery would be acceptable for an archer or a trap shooter.  If those two athletes would use a beta blocker, a common medication that blocks the effects of adrenaline in the body, slowing the heart rate and perhaps steadying a shaky hand, it would be considered doping. However, if that athlete had high blood pressure (hypertension) and was prescribed the beta blocker, a medical waiver might be issued.

It’s all about trust. Each competitor trains hard and hopes that their best is better than their opponent and as long as the playing field is level, may the better player win. It’s nice in theory but only works when everybody plays fair. One might argue that we should allow athletes to compete better by chemistry. The “only” downside are the complications of that chemistry, including but not limited to issues like cancer, stroke and death.

The next column talks about blood doping. Stay tuned.



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the rules for cheating

Monday, January 21, 2013

Lance cheated. Deep in our hearts we knew it, but until the words came out of his mouth, there was a glimmer of hope that he still could be our hero. Now he has fallen, admitting that he blood doped, used steroids and EPO and exhibited disdain to those around him, friend and foe both. The problem, however, is that sports is always filled with cheating, with some acts that the public accepts as part of the game. The distinction between what is ethically acceptable and what is not, continues to be a blurred line.

Muscle cells are a factory that take raw materials, oxygen and glucose, and turn them into energy. Training increases the ability of the body to deliver oxygen to the cells and increases their size. More efficiency and more power yield better athletic performance. Increasing the number of red blood cells in the body increases the oxygen carrying capability and that’s where blood doping and erythropoietin (EPO) come in.

EPO is a naturally occurring hormone in the body that stimulates the bone marrow to produce more red cells. Used medically, it can help patients with anemia of chronic disease whose bone marrow is suppressed to have more energy and increase daily function. But, inject it into an elite athlete and the extra oxygen increases their aerobic capacity. If the cell factory runs out of oxygen, it turns to anaerobic metabolism whose waste products shut down the ability to perform. The risk? Too many red cells can cause blood to sludge and clot in arteries and veins, causing bad things like stroke and heart attack.

Blood doping has the same end result as EPO. In effect, the athlete donates a unit (about a pint) or two of blood to himself. The blood can be stored for a month or two while the body replenishes it and just before competition, the save blood is transfused back into the athlete, increasing the red blood cell count and the oxygen delivery capacity. The risk? The same as EPO, blood clots and potential death.

Blood doping and EPO are illegal acts…cheating. But if money is no object, the same end result can be achieved quite legally. Runners who train at altitude, about 6000 feet above sea level can see an increase in their erythropoietin level. This is the body adapting to low oxygen concentrations. But intense training is difficult at altitude and performance increased but not to a great extent. However, if an athlete could sleep at altitude and train at sea level, the effect on performance could be much more dramatic. This the development of hypoxic tents (hypo=low  + oxic= oxygen), where an athlete could sleep and lounge for hours on end and then step outside and train at sea level. Erythropoietin increases in the body as do red blood cell counts and oxygen carrying capacity. It’s a perfectly legal strategy and accepted by WADA, the World Anti-Doping Agency because of its safety record.

As research improves the capabilities of training to safely enhance performance, the line between cheating and legal will continue to blur. Imagine being able to see a baseball or a tennis ball with vision better than 20/20. Will that extra split second help turn a ground out into a hit or a backhand in the net into a winner? Lasik surgery is an accepted procedure and unlikely to be considered an unethical performance enhancing operation. Oscar Pistorius, a double amputee, used Cheetah carbon fiber blades to run in the Olympics. His accomplishments were amazing as he overcame too many obstacles to count, not the least was making certain that the blades did not provide him a mechanical advantage over his non-amputee competitors. How long though before technology does create the advantage and then what?

An Olympic gold, a Super Bowl championship or a World Series ring demands years of sacrifice and training. The seduction of fame and riches often causes those with those aspirations to make unethical decisions. As much as the public adores a champion, it loathes somebody who cheats, but one person’s cheater is another’s crafty veteran. Throwing a spitball and not getting caught might get you into the baseball hall of fame, but as seen in the latest writers’ vote, drugs are a nonstarter.

Repeated studies have asked athletes whether they would choose use steroids and die early or win an Olympic medal, and the temptation of gold wins every time. Lance cheated and then lied about cheating. Perhaps the world would have forgiven the drugs but it won’t forgive the lie.

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