Monday, July 30, 2007

cheating (part 2) : doping, drugs, and deception

Note: This is part 2 of a multi-part series i'm writing to cover my thoughts on doping. you can check out Part 1. There'll be more parts, although i'm not sure how many.

The previous post dealt with the apparent prevalence of performance-enhancing drugs in sports, and discussed the possible motivations that drive people to use them. It was spurred by this year's Tour de France, which had a rash of new revelations about cheating by current and past tour riders, including names such as:
While these names are all from cycling, I should point out that performance drugs are also a problem in other sports, including triathlon. You can check my thoughts on the apparent sordid situation: Cheating (Part 1): The Easy Way.

To better understand the nature of the beast, I wanted this post to deal more with the ways athletes can cheat, and the various options there are for doping. It's not a secret in the sports world, and something that most serious athletes and coaches know about as a matter of educating themselves and warning each other. But it is something that most amateur athletes and spectators do not know about, and something which I figured would be enlightening. I think it goes a long way to helping people understand the scale of the problem, and just how much effort has been put into cheating in sports. It's equal parts sad, alarming, disappointing, and outrageous.

I should note that cheating, in the form of performance-enhancing substances, are not new to sports. It's been something that's accompanied sports history, and so not something unique to the modern era. You can compare the following references:

The doping and the drugs

I won't go down all the specific substances used for cheating in sports in this post. Regarding the larger array of drugs for cheating, I'll include at the end of the list below a couple of summaries that cover the litany of ways to cheat. For the sake of discussion, the list here presents the major ones that have made the news: EPO, blood doping, human growth hormone, and steroids (including testosterone). I'll also provide some links to each for references.

EPO's full title is erythropoetin. It regulates the production of red blood cells in the body, and is naturally produced by the human body. Boosting EPO in the body boosts red blood cell count, and so enables greater intake and processing of oxygen to fuel muscle activity. In sports, this allows athletes to process oxygen in higher quantities, thereby allowing them to sustain higher intensities of performance for longer periods of time. EPO tests involve taking urine or blood samples and measuring the concentration of red blood cells (i.e., the hematocrit levels) against a standard deemed to be normal--a hematocrit level above the standard is taken as a positive sign of injected EPO, a level within the standard is taken as a negative sign of EPO use. Useful references:

Blood doping
Blood doping is the process by which an athlete receives a transfusion of blood. The transfused blood (i.e., the blood being put into the athlete) has a high red blood cell count, meaning it carries a higher concentration of oxygen. Following the same theory driving the use of EPO, the extra oxygen allows an athlete's muscles to sustain higher intensities of output for longer periods of time. There are 2 methods of transfusion: homologous, where the transfusion comes from blood provided by a compatible donor, and autologous, where the transfusion comes from blood the patient previously extracted and stored. Cheating involving transfusions has increasingly involved autologous transfusions, because 1) homologous transfusions carry the risk of contamination, and 2) while tests exist for homologous transfusions (by detecting foreign cells in a person's body), there are no tests for autologous transfusions. Useful references:

Human growth hormone
Human growth hormone (HGH) is pretty summarized by the title: it is the hormone (or set of hormones) responsible for growth of tissue (muscle, bone, etc.) in the human body. As a result, it is used in sport to spur muscle growth and accelerate recovery to allow additional training and performance. While tests for synthetic HGH are available and relatively easy to identify, natural HGH is a major challenge for sports.This is because HGH is a natural product of the human body, and as a result it is not something that yields a productive test showing abuse (i.e., a positive test only confirms a natural process ongoing in all humans). Trying to measure HGH concentrations to a standard isn't effective, since the production of growth hormone in the body naturally varies widely depending on age, environment, diet, exercise, and stress. Recently, however, new tests (i.e., tests separate from those that detect synthetic growth hormone) have been developed that test for hormone-triggered protein markers that are not so susceptible to variation. Reference:

Steroids serve the function of helping athletes recover faster from workouts, letting them train harder and more frequently so that they generate greater improvements in performance. Steroids have historically not been popular in endurance sports, although testosterone (a type of steroid) has started to make a greater appearance. Testing for steroids involves taking urine samples and measuring the concentration of steroids relative to what is thought to be a normal level for the athlete's population. Useful references:

Other drugs
There are other performance-enhancing substances used for cheating in sports, such as androstenedione (boosts muscle mass), nandralone (builds muscle mass), stanozolol (increases muscle mass), clenbuterol (increases muscle mass), ephedrine (alleviates fatigue), amphetamines (mitigates fatigue and enhances recovery), and insulin (eases fatigue). A couple of good summaries listing them are available:

The deception

All of the above substances are amoral. By themselves, they have no innate good or evil nature, but are simply chemical compounds with certain properties that produce certain results in the human body. In many ways, they actually have valuable uses, since most of them are utilized for medical purposes--or at least, were developed for such purposes. Within a medical context, they serve a function in terms of treatment.

Outside of a medical context, however, they become tools for questionable activities--including enhancing performance in sports. In medical treatment, these substances are largely used in a controlled manner as a component of a program intended to restore physical function approaching a patient's existing or original capabilities. In contrast, in sports these substances are used to exaggerate physical function beyond an athlete's capabilities, effectively letting them exceed their pre-existing limits. Moreover, it does so in a way that bypasses the typical demands of time, energy, or dedication involved in improving athletic performance. This is what is seen in the sports world as cheating. As a result, it's not necessarily the drugs that are the problem; it's the purpose of their use and the way they are used that are the problems.

In terms of how athletes use any of the above methods to deceive anti-doping efforts, there's a number of methods used in relation to the above substances:

  • food--adjusting food intake (by reducing calories, fasting completely, or radically altering diet) can produce dramatic changes in biochemical composition. Manipulating food intake allows athletes to modify their biochemistry in time to pass drug tests, while still allowing them to retain the benefits of their drug regimen
  • diuretics--diuretics encourage the flushing of the body's waste products via urine, and so can be used to reduce the concentration of performance-enhancing substances in the athlete's body. Taken in sufficient dosages, they can remove enough of the peformance drugs or their associated markers that their concentrations fall within drug test limits
  • masking agents--drug tests sometimes observe performance drugs indirectly by measuring chemical markers connected to the presence of those drugs in the body. These markers can be masked by other chemicals that dilute the concentrations of the markers or mitigate their activity, so that they appear to have lower concentrations that pass drug test standards
  • cocktails--drug tests frequently measure for concentrations of banned substances individually. Athletes can still get the benefit of higher concentration doses by using drug cocktails composed of multiple drugs, where each drug in the cocktail is taken in low (and legal) concentrations. Measured individually, the concentration of each drug in the cocktail still passes drug test standards, but the total effect of all the drugs taken in legal concentrations together sums to the same potency as an individual drug taken in illegal concentrations.
  • scheduling--drug tests can be predicted, either from the nature of competition season (e.g., an athlete will know every race in their season calendar will have a drug test) or from informant tip-offs (e.g., sources connected with anti-doping agencies can leak advance notice of drug tests to athletes). In which case, an athlete can halt use of illegal performance-enhancing substances in time to let their body flush the drugs out, bringing biochemical concentrations to levels sufficient to pass drug tests. This way, an athlete can still get the benefit of drugs during training, and rely on the gains made in training to give them a competitive edge in racing.

Some links referring to these methods:

In terms of how athletes hide their drug use from the observation of friends, family, fans, and strangers in their daily lives, it should be pretty easy to imagine how performance-enhancing substances are smuggled and used outside of public view or institutional testing (e.g., someone who is intent on cheating isn't going to take a blood transfusion in public, or have vials and syringes delivered openly to their hotel room door). Any athlete who is cheating is likely to use the stealthiest approaches possible (e.g., anonymous deliveries in the night, unmarked bags smuggled to remote locations, etc.). Moreover, cheating athletes are often assisted by the help of enablers--doctors, team-mates, sponsors, acquaintances, even family & friends--willing to engage in escapades to help in the cheating. Illustrative examples abound in newspaper and literary accounts of controversial athletes (notable ones being those involving Tour de France riders). In terms of succinct, general internet references, there are a few useful sources:

For the future, the next frontier in performance-enhancement is genetic technology, either in the form of manipulating genes during gestation or at birth, or in the form of gene therapy in living subjects. This poses a host of ethical and medical issues, none of which appear to be resolved. To see the nature of this, check out the following sample of sources:

Given the history of performance-enhancing substances in cheating in sports, the current armada of ways to cheat, and the future threats looming on the horizon, it's pretty clear this is a problem that's thriving. I won't call it an institution; the more accurate term is a black market, and one which has many connections into the legitimate one, to an extent that any evolution or changes in the legitimate sports community is matched by evolution or change in the cheating community. It's essentially an arms race, with every new advancement in testing, detection, and elimination being countered by another advancement in cheating.

And unfortunately, as long as we have sports, this race will never end.

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