Is It Fair To Ban Performance Enhancing Drugs?
As we tune into the Tokyo Olympics over the next couple of weeks, we’ll be humbled and inspired watching many awe-inspiring feats of skill and athleticism.
Here and there though, we’ll see a winning distance or a record time and question if there might have been something other than just years of dedication and training underpinning that success.
And sadly, we’ll be right to wonder.
If previous Olympics are anything to go by, around 1% of those competing in Tokyo will fail a drug test, and that’s probably not anywhere close to the real number of athletes using a banned performance enhancing drug (PED) - that figure’s thought to be nearer to an astonishing 40%.
(For anyone worried about testing positive after winning the school sports day parent’s race, click here for the World Anti Doping Authority’s 14 pages of substances to avoid to stay “clean”!)
With that mismatch between those caught and the actual number of doping athletes, It’s understandable that WADA’s focus has been on the creation of more effective detection methods, but what if that’s not the only question we should be asking?
What if we need reconsider what we define as cheating?
What if it’s not only PEDs but where an athlete lives, their genes or their nighttime activities that might be giving them the edge on the track or in the pool?
Nothing demonstrates the difficulty of knowing where to draw the line more than the PED and naturally-occurring hormone, erythropoietin (EPO).
Our kidneys produce EPO and use our blood to move it to our bones where it nudges red bone marrow to make invaluable oxygen-carrying red blood cells (RBCs).
No EPO, no nudge, no RBC production.
On the other hand, the more EPO in our blood, the bigger the poke and the greater the number of RBCs coming off that bone marrow production line every second.
Normally, the amount of EPO released by the kidneys is controlled by the levels of oxygen in the body. For example, donating a pint of oxygen-carrying RBCs will mean less oxygen traveling through our blood vessels. It’s our kidneys that will detect that and then respond by churning out extra bone marrow-nudging EPO.
In about a week, we’ll have made enough extra RBCs to replace the ones we altruistically gave away and our kidney’s EPO output can drop back down to normal levels.
The first form of blood doping used exactly this science: an athlete donated a pint or two of blood, not to a blood bank but to their own freezer where it would remain while their kidneys and bone marrow busily remedied the RBC deficit. Close to competition, that same athlete whose body had by now made new RBCs to replace the “missing” ones, would be infused with their stored RBCs. Compared with their “normal” selves or non-doping athletes, this would give them an additional 15-30% RBCs.
For the doping athlete, this dramatic increase in RBCs lead to an equally significant increase in the amount of oxygen they could move around their body every minute - incredibly advantageous in aerobically demanding sports like cycling, distance running and skiing, and almost impossible to detect!
All this freezing, defrosting, transporting and re-infusing of blood was quite a bother though, especially after 1985 when it was banned and had to be done secretly!
And so the hunt was on for an easier method.
Enter synthetic EPO.
Although originally used for kidney failure and chemotherapy patients unable to make sufficient RBCs, athletes (or more likely their trainers) quickly made the mental leap that they could inject EPO to increase their bone marrow RBC production - no messing about with bags of blood, just a tiny, easily hidden shot and as with the previous method, equally tricky to detect.
The rest as they say, is history.
Despite the testing difficulties, competitors in sports from cycling to boxing and that weird, “only see it in the Olympics” 50km distance walking have been found guilty of injecting EPO and most people would have no problem defining this as cheating.
What then, of athletes born and raised at altitude or those who can afford a mountain training camp?
I ask because as we move above sea level, less oxygen moves from the atmosphere into our blood and in those less than ideal conditions, one of our body’s key adaptations is to produce more EPO. Extra EPO means more RBCs which in turn, ensures our blood can still collect and transport enough oxygen.
Any athlete lucky enough to spend time living and training at altitude, makes extra RBCs that when they compete at a lower, more oxygen rich atmosphere, will be super useful in moving extra oxygen to those needy muscles.
Of course, not all athletes have the financial backing for Colorado training but because there’s no needle and the athletes are living and exercising in uncomfortable, low oxygen elevations for their body to boost the RBC output, does it feel okay?
Are we a little more uncomfortable thinking about major stars like Michael Phelps and David Beckham, spending weeks prior to big competitions, sleeping in tents with artificially created low oxygen, high altitude-mimicking atmospheres? No training in the thin mountain air for these athletes, they just Z z z z their way through the night to boost their EPO levels and RBCs.
Hmm.
But for me, the ethical challenges provided by the above examples are nothing compared with the mother of all dilemmas provided by Eero Mantyranta and his choice of parents!
Finnish athlete Mantyranta, won nine Olympic and world championship medals during the 1960s in the most aerobic, oxygen-demanding sport there is, cross-country skiing. Yet, it wasn’t known until a couple of decades later that Mantyranta had been competing with an enormous and legal advantage – a genetic mutation causing his EPO to be more potent than almost everyone else’s on the planet!
(Full disclosure here, it’s impossible to find a picture of Mantyranta from way back when, but he probably would’ve worn something like this and besides, what’s not to love about this picture?!)
Throughout his competitive life, Mantyranta had a RBC count around 50% higher than normal males and way, way higher than Lance Armstrong or any of those cheating, EPO-using athletes ever got close to.
Now, to be clear, legalizing EPO to allow athletes to increase their RBCs up to Mantyranta’s natural level would be a horrible idea -elevated numbers of RBCs come with major side-effects, including death! But as we gasp at the almost super-human feats of the winning Tokyo athletes and quite rightly, hear talk about the many sacrifices and years of training that got them to that podium, let’s spend a minute thinking about the athletes who didn’t make it as far.
The difference between the winners and everyone else might not be the result of using a PED but instead, the inheritance of a great genetic hand, being raised at altitude or having the financial backing to buy a tent for one.
Perhaps the question isn’t so much, is it fair to ban performance enhancing drugs but is it unfair not to ban some of these other advantages, natural or otherwise.
Give us your thoughts on where we should draw the line and if there other ways to get ahead in sports you’d like us to talk about? Get in touch, we always love hearing from our B&B community.
And as always,
Stay curious,
Doctor P
