Sleeping your way to the top

Cathal Sheerin investigates altitude chambers in world-class sport and asks if it's breaking the Olympic sporting spirit, giving an unfair advantage to athletes that can afford to use them
August 2008

The Beijing Olympic Games are upon us and competitive sport is under greater scrutiny than ever before. In the United States, a federal investigation into a sport-wide steroid scandal in baseball has implicated the biggest names in their sport.

In the world of athletics, Marion Jones, winner of five medals at the Sydney Olympics in 2000, is in prison for lying to investigators about her steroid use. Jones' coach, Trevor Graham, was found guilty in May 2008 on similar charges. In June, Olympic 100m champion Justin Gatlin failed in his appeal to have his four-year drugs ban halved. And in July, British steroid cheat Dwain Chambers failed in the courts to overturn his lifetime ban from competing in the Olympics. There is a long list of athletes banned for taking outlawed substances, and with the World Anti-Doping Agency (WADA) test for human growth hormone in place for Beijing, that list is likely to grow much longer.

According to WADA's promotional DVD - Level the Playing Field - we care about performance enhancement in sport simply because we want 'fair play.' In the words of the organisation's Ethical Issues Review Panel, 'we want athletes to exemplify aspects of character that we admire in people more generally, such as fortitude, dedication, self-discipline, courage, and strategic wisdom.' What matters is 'not just the outcomes', but also 'the means used to achieve those outcomes.' This is what WADA calls 'the spirit of sport'. And it is borne out by the public reaction to sport - we like to see records broken, but when one is broken with the help of an illicit substance or method, we dismiss it and condemn the athlete.



But determining what is legal, and what is not - in effect, deciding what is cheating or 'doping' - is a process mired in confusion and inconsistency, and made more difficult by advances in science.

The spirit of sport
WADA was set up in 1999 to regulate anti-doping activities in sport worldwide. It sets the policies and the rules and decides the annual list of prohibited substances and methods. According to WADA, a substance or method goes on the list if it meets at least two of three criteria: first, it must have the potential to increase sporting performance; second, it must pose an actual or potential risk to the athlete's health; third, it must be contrary to the spirit of sport. Thus, for example, anabolic steroids, which enhance performance by increasing muscle growth, but also damage the liver and increase the risk of prostate cancer, are banned.

But, as Professor Barrie Houlihan of the School of Sports and Exercise Science at Loughborough University says: 'there are grey areas'. There are substances and technologies, such as creatine, or frictionless swimsuits, that fulfil WADA's two-out-of-three criteria, but are still permitted. And by boosting performance and violating the spirit of sport, they potentially deny fair play to all athletes. The most controversial of these grey areas is the use of hypoxic chambers, also known as altitude chambers.

Altitude chambers boost an athlete's red blood cell count, increasing endurance and recovery time. The athlete sleeps at a simulated high altitude, but trains at the optimal sea level, all without having to undergo the rigours of travel. He or she benefits simply by sleeping, and gains the same performance benefits as someone using the illegal hormone erythropoietin (EPO).

For Houlihan, it is an ethical issue. He describes the use of the chambers as 'a highly ambiguous area' that will 'never be reconciled' with the current anti-doping criteria, and says that WADA must 'not only establish a set of anti-doping regulations and protocols, but also give a moral lead in areas where there is this kind of ambiguity.'

WADA actually attempted to do this in a review in 2006 but failed. Its then chief, Dick Pound, condemned the chambers as 'tacky' and 'artificial', and the Ethical Issues Review Panel said that they were 'a violation of the spirit of Olympic sport.' But the chambers stayed off the list.

WADA never explained why. In a 2007 report produced by the House of Commons Science and Technology Committee, entitled Human Enhancement Technologies in Sport, UK Athletics' Dr Bruce Hamilton criticised WADA's lack of transparency - its 'behind closed doors' decision-making. But Dr Arne Ljungqvist, chair of WADA's Health, Medical and Research Committee, merely says that there was 'a clear message' from WADA's stakeholders 'not to include it on the list.' The Canadian Centre for Ethics in Sport was representative of the stakeholders who went public with their opinions, when it argued that 'there would be no way to monitor the use of hypoxic tents', and that 'a ban would subject anti-doping authorities and their approaches to criticism and even ridicule.'

Professor Houlihan sees the stakeholders' point. He says that because these chambers have 'the same impact as illegal substances, but also the impact of perfectly legal occurrences' (such as living at high altitude) 'it would be hard to envisage having rules that could be enforced.' So, there remains a suspicion that the use of altitude chambers remains legal because practicality has trumped ethics. Dr Olivier Rabin, director of sciences at WADA, will not be drawn on this issue, stating only that practicality is 'not an element we take into account at the scientific level'.

Since the review, a 2007 study by scientists at the University of Verona has noted increased blood viscosity in athletes who use the chambers. It concluded that there were 'tangible health risks to the widespread use of hypoxic devices, which would make them as unsafe as other forms of blood doping.' So altitude chambers now potentially meet all three of WADA's doping criteria.

But for Dr Rabin it 'remains an open issue'. He does not rule out a future ban, and says that the subject has been referred to the International Olympic Committee ( IOC). He says: "We asked the IOC to further investigate this element via their medical commission and we are waiting for their feedback about whether they think there is a risk to health. And then WADA will be in a position to re-open the dossier and to decide whether there are grounds for a ban or not.'

More grey areas
The use of altitude chambers is part of a wider debate about the role of science in athletic performance. For Professor Houlihan this is yet another grey area. He says: 'If you see doping as the appliance of science to gain an advantage, then the development of frictionless swimsuits or super-light fast bicycles for the velodrome all come under that heading.'

Describing the ambiguities in deciding what role technology should play in sport, Houlihan says: 'We have tended to see the development of equipment and sportswear as acceptable areas of innovation and the appliance of science, whereas doping - taking a substance - has been considered unacceptable. At one level there is no difference between the two. I've read lots of attempts to try and rationalise the distinction, saying that one is external to the body and one is internal.

'Then there's the difference between natural and unnatural substances. But these distinctions all fall down eventually. I think it comes back to be what is eventually considered to be acceptable and unacceptable. But there's no neat distinction between them at all.'

And these grey areas not only erode the ethical high ground taken by WADA, they also have far-reaching consequences for competitive sport. Sleeping in a space-age chamber that alters your blood chemistry costs anything from $7,000 for a small tent, to $25,000 for a room. A single Speedo LZR Racer suit that will make you four percent faster costs $550. It is an expensive business, and a lack of money disadvantages the athletes from poorer countries.

Retired sprinter and 2004 Olympic gold medalist Darren Campbell voices some concern about this issue, especially in relation to altitude chambers. Although he does not think that their use is unethical, he worries that the cost of this technology puts medals beyond the reach of poorer athletes: 'If it's only the top people that can afford it, it means the top people progress and everybody else doesn't. I can see the argument with regard to fair play: the top people will get better and no-one will catch them up.'

But Dr Rabin dismisses expense as an issue: 'We shouldn't be too naive. Many of the top athletes in the world, even if they wear the jersey of a one country, very often train in another country. So, many of them are wealthy enough to have access to a lot of devices and resources.'

The sporting divide
But the statistics suggest it is Dr Rabin who is being naive. Professor Houlihan has studied the economics of international sport, and says: 'The share of medals won by the G8 countries - the richest eight countries in the world - is almost the same as their share of world trade. There's a close association between being wealthy and winning medals. And it's because it's expensive science. It's interesting when you look at athletes from poorer countries who win medals. They tend to win in those sports where the application of science is still in its early days - middle and long distance running - rather than in highly scientific and technical sports such as diving and short distance running, or high jump and long jump. And the athletes from poorer countries who win those events tend to be those who get scholarships to American universities.'

What does this mean for the future of international sport? Houlihan says: 'I think there is a danger that there will be a growing divide between a small group of sports superpowers and the rest, who simply can't afford the technology.'

And this divide has already started. The final medal tally of the 75 countries which took part in the 2004 Olympics showed seven of the G8 countries represented in the top ten medal-winning nations. Only two of the UN's poorest 50 countries in the world managed to win any medals at all: Ethiopia, at number 28, and Eritrea, in last place. Over the last four major international competitions - two World Championships and two Olympics - the G8 countries have won on average 45 per cent of the medals awarded.

Against this evidence, the WADA Ethical Issues Review Panel's words that 'Sport is about the athlete and not about the equipment or expert systems upon which the athlete may rely' seem almost naïve. And the level playing field that WADA is so keen to promote in its DVD is already long gone.

See It\'s just not natural for a history of performance-enhancing drugs






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