David Ewing Duncan for The New York Times: So Long, Lance. Next, 21st-Century Doping.

So Long, Lance. Next, 21st-Century Doping.

Published: January 19, 2013


LANCE ARMSTRONG’S sad saga of doping and lying is over, allowing us to turn our attention to a far more important issue arising from the Armstrong era: what to do about the rise of ever more potent bio-enhancers in sports.

Blood and urine samples at the antidoping laboratory of the Insitute of Biochemistry at the German Sport University in Cologne.

The “arms race” in this new age of augmentation has already begun, said the bioethicist Thomas Murray, former president of the Hastings Center in Garrison, N.Y. It pits enforcers like the World Anti-Doping Agency, armed with strict bans on certain enhancers, against elite athletes — and their trainers, technicians and financers — who are determined to get away with doping.

Antidopers justify their crackdown as a means of protecting athletes from potentially dangerous enhancers, and because the use of bio-boosters is unfair to nondoping competitors. Enhancers also threaten the “spirit of sports,” in the words of the World Anti-Doping Code, which now guides most elite sports.

Currently, WADA bans a growing list of enhancers, including anabolic steroids, human growth hormone, amphetamines, beta-2 agonists (which relax the muscles around the airways and make breathing easier) and erythropoietin, or EPO (which increases oxygen levels in the blood). In future years this list might also include an arsenal of as-yet unimagined chemical compounds and technologies. Those could include everything from genetic alterations (so-called gene doping) to the regeneration of tissue using stem cells.

Today’s dopers try to avoid detection by administering microdoses of enhancers that quickly clear the body, and by using natural versions of growth hormone and erythropoietin that cannot be easily differentiated from an athlete’s own onboard supplies. They also use the Lance Armstrong techniques of avoiding testing when possible, and timing the use of banned substances to appear clean.

“The technology is there to detect minute levels of most substances,” said Matthew Fedoruk, science director at the United States Anti-Doping Agency. “The challenge is that athletes are turning to substances that mimic natural substances in your body.” Dr. Fedoruk added that resource constraints and athletes’ sophisticated schemes to avoid detection can thwart investigators.

Drug companies, meanwhile, are developing a raft of new medications for diseases like muscular dystrophy and anemia that could one day be used as enhancers. Scientists are studying genes associated with physical performance and muscle growth to see if drugs — or, someday, gene-modulating technologies — can be developed to activate the strengthening or other positive effects of those genes.

Beyond chemical fixes, neuroscientists are experimenting with noninvasive technologies that augment brain activity by bathing targeted regions in low levels of electricity (transcranial electrical stimulation) or a magnetic field (transcranial magnetic stimulation). Both appear to enhance cortical excitability and cognitive performance.

Bioengineers are in the early stages of developing artificial limbs and exoskeletons that one day may be better than real limbs. Andy Miah, an ethicist at the University of the West of Scotland, has suggested that scientists in the future might create embedded nano-devices to stimulate muscles to a sustained peak of performance. Hugh Herr, a biomechanical engineer at the M.I.T. Media Lab, recently told the journal Nature that “stepping decades into the future, I think one day the field will produce a bionic limb that’s so sophisticated that it truly emulates biological limb function.” He predicts the emergence of new human-machine sports. These might combine, say, track and field and Nascar.

The motivation of athletes to win at all costs remains a potent incentive to gain an edge. Competitors in the ancient Greek Olympics tried enhancers that ranged from exotic herbs to animal testicles. Nothing was banned, however, except the fixing of competitions, and also the use of black magic — a prohibition that didn’t keep some athletes from casting spells against their competitors.

Not even the reported dangers of using enhancers have stopped millions of amateur and elite athletes from taking them. One reason is that the side effects stemming from the use of lower doses of some boosters are poorly understood. Studies indicate that healthy people taking anabolic steroids raise their risk of increasing LDL (bad) cholesterol levels and of having blood clots, though much more research is needed. Higher doses increase the odds of damage to the heart, mood shifts, reduced sperm counts and masculinization in women.

For other popular enhancers, like human growth hormone and erythropoietin, the evidence of harm is less clear. Large numbers of people take them with no obvious injury, though again more research is needed. “We don’t really understand the long-term implications of many of these compounds,” said Dr. Fedoruk of the United States Anti-Doping Agency. For some bioethicists, the risks of taking enhancers must be compared to the dangers inherent in many sports. “You are at risk for head injuries in football,” said David Magnus of Stanford, a bioethicist. “Throwing a baseball at 100 miles per hour at a batter is dangerous. So is riding a bicycle at 60 m.p.h. with no protection. Are steroids really more dangerous than this?”

Dr. Magnus and others also challenge the idea that the use of certain enhancers is inherently cheating. “Of course it is if rules are violated, whatever they are; that’s the definition of cheating,” he said. “But what if the rules make no sense?”

He and others complain that rules are arbitrary and unevenly applied to some athletes and not others. For instance, erythropoietin is banned because it increases oxygen-rich red blood cells, but the use of special tents and rooms that mimic high altitudes that also increase red blood cell production is not. Amphetamines are banned, but not caffeine, nicotine and other “natural” stimulants. Elite athletes also have the resources to fine-tune their bodies by using food chemists, physiologists and other enhancement experts that most competitors can’t afford.

Ultimately, the decision to enhance or not will ride on how society views the value of sports. For some people, the purity comes from competition among untainted humans. For others it’s about speed and strength and taking risks — with many in this group embracing whatever excesses might be allowed. Freakishly huge wrestlers and monstrous right tackles? Machine-men with bionic wheels instead of legs racing across the Bonneville Salt Flats? Bring it on!

Dr. Miah of the University of the West of Scotland and others have proposed holding enhanced sports contests, including an enhanced Olympics. “If the goal is to protect health, then medically supervised doping is likely to be a better route,” Dr. Miah told the journal Nature. “If athletes want to use these substances, they should be up front about it and compete just against each other,” said Dr. Linn Goldberg, a sports medicine doctor and researcher at the Oregon Health and Science University.

The question would then become: which version of sports would you watch — the natural or the enhanced?


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