23 July 2014

A few thoughts on blood doping and performance enhancing drugs

One of my earliest memories growing up was watching Tug McGraw strike out Willie Wilson to win the World Series for the Phillies over the Royals in 1980. I was a baseball and Phillies fan for life. I was devastated when the Phillies lost to a young Cal Ripken and the Orioles in 1983. I would have never guessed that it would be ten years before the Phillies returned to the World Series (1993), and another fifteen years after that (2008) when they would finally win it again.

The mid-1980s also saw the emergence of American cycling on the world stage. The success by American cyclists at the 1984 Olympics (undoubtedly buoyed by the Soviet boycott) and Greg LeMond's breakthrough as the first American to win the Tour de France (LeMond won the Tour three times, but could have won at least five
and potentially more if it weren't for a hunting accident in 1987 which caused him to miss two Tours; he likely have won in 1985 too if he wasn't riding in support of Bernard Hinault). Cycling made it onto the big screen, too: Breaking Away in 1979 and American Flyers in 1985 (which is one of my favorites). Racing around the neighborhood on my bike, I often imagined I was LeMond while a friend often became "the Russian" (the "Belov" character from American Flyers). As clycing goes, I never became more than that kid riding around the neighborhood, but l've always considered myself a dedicated fan of cycling. Even then, though, cycling was not really popular in the United States.

That all changed when Lance Armstrong returned from cancer to win seven straight Tour de France victories (1999-2005); no one had ever won more than five. Lance was a master of the time trial and a menace in the mountains. In one of his finest victories, while riding in a small group of leaders up the Alpe d'Huez (one of the most famous and difficult climbs in the history of the Tour), he turned to look at his fiercest competitor Jan Ullrich (immortalized as "The Look") and then left Ullrich and everyone else in the dust. It all seemed like a fairy tale story that was too good to be true (and as it turns out, it was).

Over the past 25 years, both baseball and cycling have enduring scandals involving doping and performance enhancing drugs. It is impossible for me to know how widespread these practices were in either sport, but it seems at least likely that it was, at times, commonplace among at least some competitors. There is also evidence that athletes have been artificially enhancing their performances long before the 1980s. In one infamous incident, British cyclist Tom Simpson died on the ascent to Mont Ventoux during the 1967 Tour de France. Simpson died from a mix of amphetamines and alcohol. In many cases, both in baseball and in cycling, these practices weren't even illegal at the time. Baseball players like Mark McGwire, Barry Bonds, Sammy Sosa (and now perhaps Alex Rodriguez), all surefire Hall of Famers by their numbers, may never reach Cooperstown because of the taint of performance enhancing drugs (and at least in McGwire's case, most or all of his use of Androstenedione came before it was even banned by baseball).

The impact on cyclists has been less uniform. Lance Armstrong has been disgraced by his admission (costing him all seven Tour victories and every other competitive result from August 1998 onward) despite having never had an official positive test. On the other hand, Eddy Merckx tested positive at least three times during his career. Merckx won the World Championship three times, the Tour de France and Giro d'Italia five times each, and the Vuelta a Espana once. He also won all of professional cycling's classic "monument" races at least twice each (totaling 19 Classics victories in all); and is generally regarded as the greatest pro-cyclist in the history of the sport. The three positive tests have not really tainted his career nor did they void any of his victories. Of course, it is fair to speculate that the hit to Lance's reputation may be greater because of the alleged extensive nature of his team's doping scheme, the constant denials, and the bullying of his teammates and friends.

My position has generally been that if you are doping or using performance enhancing drugs, then you have, on your own volition, tainted your performance. You deserve whatever scorn comes your way, even and especially if that includes voided victories or reduced Hall of Fame consideration. On the other hand, it seems harsh to punish someone for doing something that was legal at the time. Some of the cyclists on the 1984 Olympic team later admitted to having had blood transfusions; they were not illegal in 1984 and no one has questioned the validity of the medals they won. On the other hand, McGwire's Hall of Fame chances seemed perpetually doomed despite having taken a substance that wasn't banned when he took it.

My position has evolved somewhat, perhaps because I have spent a lot of time looking at the issue from a more critical perspective. As a result, it is not so clear to me that we can draw definitive lines about right and wrong in regards to blood doping and performance enhancing drugs. Let me highlight a few observations that have driven me in this direction.

First, although I have highlighted that it is impossible to know how widespread the use of these substances were in baseball or cycling during these periods, it seems pretty obvious that the use was far more common than positive test results or admissions by athletes would suggest. I doubt that anyone believes that Lance Armstrong (and his team) were the only cyclists doping during Lance's incredible streak. Jan Ullrich, Armstrong's biggest rival, has said that Armstrong's wins should be reinstated because doping was so prevalent at the time. A recent survey found that 12 of 25 living Tour de France winners believed that Lance's titles should be reinstated. I'm not sure that result is ever likely to happen (perhaps the same likelihood as McGwire reaching the Hall of Fame), and I'm not sure that full reinstatement is even appropriate, but I don't think I'd be adverse to the "asterisk" approach. More importantly, it seems clear that other cyclists and baseball players were enhancing their performance during this period and did not get caught. In one sense, it's about athletes who used versus athletes who didn't use. But it's also about athletes who got caught versus athletes who didn't get caught. Frankly, it is impossible to make a clear distinction between these two. Do we really know for sure that Hank Aaron (or any other great player) never used a performance enhancing drug? According to one player, the use of performance-enhancing drugs were widespread in baseball during the 1960s and 1970s. As a result, I'm not sure that a ticket to the Hall of Fame or a decision to keep a yellow jersey should based upon one athlete's ability to avoid getting caught. I appreciate the fact that it is not fair to those who never used to be tainted by those who did. But that's the reality of the situation. If we don't treat everyone as suspect, then those who used and got away with it become the real winners.

Second, it is not clear to me that the line between permitted and denied is drawn at the correct location. For example, Erythropoietin (EPO) is banned (synthesized EPO is used to stimulate red blood cell production). Blood transfusions are also banned, including autologous blood transfusions (the athlete receives his or her own blood which had been taken prior to the competition and presumably has a higher red blood cell count). Although there are some potential health complications from autologous blood transfusions, it is unclear to me if these reasons are really sufficient for them to be banned. Transfusing someone with their own blood seems to me a considerable stretch (added to that, testing for autologous blood transfusions requires the testers to maintain a biologic profile of the athlete. As a third example, some athletes may use an altitude tent to stimulate the body to produce more red blood cells. Altitude tents are not banned by the World Anti-Doping Agency. All three of these methods are designed to introduce more red blood cells into the athlete's body to carry more oxygen to the muscles. Two of these methods are banned while the third is not. Have we drawn the line at the correct location? I don't know. But I think it is reasonable to have this debate, rather than just assume that the line drawn by USADA or WADA cannot be questioned.

Third, these anti-doping organizations can preach zero tolerance, but athletes in competitive sports will always be searching for the smallest of advantages. Is cycling or baseball (or any other sport) really clean now? Or are athletes just one more step ahead of the anti-doping authorities? When today's legal advantage becomes tomorrow's prohibited substance, another generation of athletes will be tainted by accusations or doping or the use of performance enhancing substances. Once again we will have to confront the impossible dilemma of the innocent, the caught, and unknown guilty. The results won't likely turn out any differently.

Lastly, I am obviously not a doctor. I do not pretend to know more than the absolute basic biology of how certain substances affect the human body. To be sure, I do not question the science of performance enhancing drugs or of blood doping. I'm not apologizing for Lance Armstrong or defending doping. My focus should be seen in the context of how those medical decisions affect the perception of the sport by the public at large.
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