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.

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.

A urine test for EPO was introduced in 2001, by which time dopers better knew how to use EPO without killing themselves. When the EPO test came out, some athletes reverted to a more old-school version of blood boosting known as blood doping, in which the athlete receives a blood transfusion (either someone else's or their own). This is what Armstrong's former teammate Tyler Hamilton admitted to, which cost him the gold medal he had won at the 2004 Olympics. Blood doping carries not only the blood-to-mud risk of EPO but also the small but significant contamination risk inherent in any blood transfusion. Blood doping wasn't prohibited until 1986.

Anabolic steroids are most often used by athletes in power sports to build muscle and shorten recovery time. The list of health risks is long, as is the list of elite athletes who are known to or widely suspected of using them: Jose Canseco, Roger Clemens, and Barry Bonds in baseball; Bill Romanowski and Shawne Merriman in football; and Marion Jones, Ben Johnson, and basically every Eastern European Olympian of the 1970s in track and field. Oh, and of course cycling -- testosterone is considered an anabolic steroid, and is what Floyd Landis got busted for.

You know a PED is prevalent when it gets its own phrase. "Roid rage," or uncontrollable aggression, stems from taking anabolic steroids. So do kidney and liver damage, plus shrunken testicles and enlarged breasts in men and facial hair, a deepened voice, and enlarged clitoris in women. Writing last year in Forensic Science International, Italian doctors described four cases (three bodybuilders, one cyclist) of fatal cardiac failure in steroid users.

Human growth hormone is often used by the same sorts of athletes who get performance boosts from steroids; Marion Jones isn't the only busted Olympian to have taken it in conjunction with steroids. Armstrong also took HGH. It can lead to heart failure, arthritis and its outward tell-tale sign: acromegaly, or disfigurement of the jaw, skull, hands and feet. Track and field fans tend to get suspicious when sprinters in their twenties suddenly get braces at the same time their performances improve.

Dopers are almost always ahead of the testers. The next great area of exploration for athletic cheaters is likely to be gene doping, or genetically modifying muscle cells.

Gene doping has been banned since 2003, even though there's no evidence anyone is doing it. But if and when it becomes common, look out, because it could be like cheating on, well, steroids -- potentially greater performance effects with less detectability. The potential health risks read like they're ripped from a science fiction movie, including immune reactions gone haywire, overexpression of the desired genetic trait, and gene silencing, or "turning off" the gene one is trying to manipulate.

And while such a scenario remains theoretical at this point, it's possible that gene doping could be practiced via germline gene therapy methods, which target sperm or egg cells. This could result in genetic modifications being passed to future generations, in which case the sins of the cheating father will be visited upon the son.