Blood Doping Goes Back to the Future

High-tech performance enhancers are easy to detect. Not so with the original doping strategy: reinjecting your own blood.

Three-time Tour de France champion Alberto Contador is now facing the possible loss of his 2010 title after two suspicious substances turned up in his system. One is a banned muscle-builder and metabolism-accelerator whose presence he attributes to "the consumption of tainted beef." The other substance: plastic. Detected by a brand-new test awaiting validation, traces of a chemical known as a plasticizer suggest he may have stored his own blood in plastic IV bags before it was transfused, mid-Tour, back into his body.* They also suggest the nebulous, ever-evolving art of blood doping is returning, full-circle, to its rudimentary inception in the early-1970s.

The etymology of "doping" is as hazy as its origins; the name may have been derived from "dop," the Afrikaans term for a stimulating beverage of fermented grape skins drank pre-battle by Zulu warriors. In its modern form, however, the practice doesn't necessarily involve any foreign substances. The World Anti-Doping Agency defines it as "the use of products that enhance the uptake, transport, or delivery of oxygen to the blood." The best such product is the red blood cell, which carries the oxygen that converts glucose to energy. In the most elemental form of doping, athletes boost their energy-efficiency by withdrawing up to two quarts of blood, allowing the body to replenish what it lost, and then, in the week of competition, re-injecting their stored RBCs. Essentially, these dopers gain the benefits of rigorous training at altitude--where oxygen-thin air prompts the body to make more red blood cells--with less of the rigor.

In distance running circles people vaguely acknowledge Lasse Viren as the godfather of doping. The lean Finn won the 5K and the 10K in successive Olympics, but his performance during the intervening years was so modest that many onlookers, ABC's Erich Segal included, accused him of doctoring his blood for the Games. Amid the hoarfrost of the Cold War, Viren was easy to vilify. He had a stubbly beard, a laconic demeanor, and a dubious government job as a policeman in his native village of Myrskyl. Socialist Finland seemed a step away from communist East Germany, which had sponsored a state-wide doping program. And Viren didn't do much to clear his name. When indignant reporters asked him his secret, he quipped, "reindeer milk."

Since then he's denied the doping allegations. A 1977 Sports Illustrated profile ascribes his Olympic success to a training regimen of 150 miles per week, an uncanny natural hematocrit, and a coach who knew how to peak his athletes. We know his teammate Kaarlo Maaninka doped (not because he was caught, but because in retirement he became evangelical and confessed), as did eight members of the 1984 U.S. Olympic cycling team. But we know nothing about Viren's purported doping and little about transfusions of his era. Two reasons: no one tested for doping until the International Olympic Committee banned it in 1985, and shortly afterward athletes began using something else.

In the late '80s, researchers at a California pharmaceutical company found out how to mass produce erythropoietin (EPO), a hormone that controls the production of red blood cells. Developed to help anemic cancer patients, synthetic EPO became a way for athletes to dope without withdrawing large quantities of their own blood. Health concerns remained the same--blood thickened by too many red blood cells clots more easily--but the process was cleaner and, for a long time, untraceable. According to Dr. Don Catlin, who runs the Anti-Doping Sciences Institute, "athletes abusing EPO enjoyed free rein for over a decade."

That freedom was reined in just before the Sydney Olympics in 2000, when researchers at the French National Anti-Doping Laboratory found a way to detect high levels of immature red blood cells, which indicate the use of synthetic EPO.** Though athletes continued to elude officials with rogue forms of the hormone, dopers turned increasingly to injecting other people's blood into their bodies. Often there were complications, most famously in 2003 when cyclist Jesus Manzano nearly died from a transfusion of somebody else's poorly stored blood. A year later, an Australian team of researchers developed a way to detect the blood-borrowing. The test, derived from hospitals' methods of differentiating maternal and fetal blood, busted high-profile cyclists like Tyler Hamilton and Alexander Vinokourov. Suddenly, the most reliable option for dopers became the oldest and simplest: stick to your own blood.

If you're going to cheat, there's a pleasing purity to the notion of doing it solo, with no supplementary drugs or pints from cousins. I gave it some thought (in the spirit of participatory journalism), before realizing the viscosity of blood over-rich in red blood cells can induce heart attacks, strokes, and embolisms. Fortunately, there are alternatives. Alberto Salazar, who coaches several of the top U.S. distance runners at the Nike Oregon Project, has had his athletes sleep in altitude tents, a tamer, domesticated way to artificially enhance one's red blood cell count. Some have dismissed the tents as placebos, but they're forbidden in the Olympic Village. A prohibition outside those walls, however, seems too impractical to enforce. As American marathoner Ryan Hall said to The New Yorker, "What are you going to do, ban altitude?"

On the moral spectrum of performance-enhancing methods, these tents are on the accepted side. But here's the question they raise: is doping with your own blood any less ethical, or merely less safe? And if, in some brave new world, a safe method to maximize your red-blood-cell count without introducing foreign substances becomes available en masse, would it be so wrong? It's a far-out proposition, and before that mythical means comes about, athletes are more likely to find a container for their blood that leaves no plastic trace. With a sigh, Dr. Catlin admits they probably will. If so, officials will have to develop a new test, and the never-ending race between blood-dopers and their lab-coated assailants will continue. As of now, they've completed one lap.

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*Originally this article implied the new plasticizer test has been validated; it is awaiting validation, and thus the high levels of the chemical in Contador's system do not currently constitute a doping violation. 

**The article initially claimed the test could detect red blood cells produced by artificial EPO. It actually detected high levels of immature red blood cells, which suggest use of the synthetic hormone. We regret the errors.