Choose Performance-Enhancing Hugs: The Health Fundamentals of Doping

Half of elite athletes said, in surveys, that they would take an undetectable drug if doing so meant they would win an Olympic gold medal, even if it would kill them within five years.

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Christophe Ena/AP

As in most discussions of the topic, Lance Armstong's everyone-was-doing-it rationale for using performance-enhancing drugs focused on ethics and availability. This emphasis ignores a fundamental reason why PEDs are banned -- they can kill you.

The World Anti-Doping Agency (WADA) was created in 1999 to systematize and enforce a long list of prohibited performance-enhancing drugs and practices. (The U.S. Anti-Doping Agency, which Armstrong fought for so long, is the American branch of WADA.) WADA generally prohibits something if it meets at least two of three criteria:

  • it improves athletic performance
  • it violates what WADA calls "the spirit of sport"
  • it poses a health risk to athletes

The need to protect elite athletes from themselves is real. In surveys administered between 1982 and 1995, half of elite athletes said they would take an undetectable PED if doing so meant they would win an Olympic gold medal, even if the drug were guaranteed to kill them within five years. When that hypothetical was posed to 250 normal Australians, less than one percent said they would take the gold-then-death drug.

Libertarians of the sport world who say athletes should be free to do what they want to their bodies neglect an aspect of PEDs' health risks: The effect on young athletes when doping pervades a sport. Alex Hutchinson, who ran for Canada in the world cross country championships and writes a column about science and fitness for The Globe and Mail, puts it this way: "If you allow doping, then there's a trickle-down effect. You'll have to dope just to get to the professional level, at which point you'll have doctors supervising your red blood cell count and so on. So it's the kids who will be most at risk, forced to dope just to reach the level where doping can be done 'safely.'"

Note that cost doesn't factor into this attempt to create a level playing field. The blood booster EPO, one of Armstrong's go-tos, is prohibited, but hyperbaric chambers, which simulate high altitude and therefore theoretically impart some of the benefits of EPO, aren't. Three-time American Olympic runner Dathan Ritzenhein spends 12-14 hours a day in his sealed-off bedroom; the device that simulates high altitude in the room costs between $15,000 and $20,000, depending on the size of the room. A month's supply of EPO for a cheating endurance athlete can cost just a few hundred dollars.

There are some oddities on the list of banned substances, if we're considering the combination of athletic boost and health risk. Marijuana and heroin (!) are prohibited, although it's hard to imagine a scenario where you would say, "I would have won if the guy who beat me wasn't strung out." Caffeine, meanwhile, was removed from the banned list in 2004, even though it's a proven performance enhancer that, when taken in excess, can land you in the hospital.

What are some of the most popular types of PEDs and their health risks?

Blood boosters are used primarily by endurance athletes to increase the oxygen-carrying capacity of their blood. EPO, a drug used to treat anemia in cancer patients getting chemotherapy, is the best known, and not just because of the irony of Armstrong's post-cancer embrace of it. Early attempts to cheat with EPO were often fatal. In the late 1980s and early 1990s, at least 20 elite European cyclists died suddenly while sleeping or at rest, as did seven Swedish orienteerers. The deaths are now attributed to EPO, which increases hematocrit, or the percentage of red blood cells in blood. Too much EPO causes the phenomenon known as "blood to mud": as hematocrit gets higher, blood gets thicker. The risk of blood clots, which can lead to stroke or heart attack, increases. "Thick blood" is even more dangerous when athletes get dehydrated, as tends to happen when you ride or run hard for hours at a time.

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Scott Douglas is the editor of Runner’s World Newswire. He has also written for Slate, Outside, and The Washington Post.

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