During the 17th century, methods of performance-enhancement were equally bloody, but more invasive, as runners had their spleens removed in the belief that it would increase their speed: the operation sped a fifth of them to early graves. In the late 1800s, athletes experimented with ether-coated sugar cubes and wine laced with cocaine to offset the pain and fatigue of competition.

The growth of international competition gave extra impetus to those seeking an advantage over their fellow athletes. Most famously, America’s Thomas Hicks won the 1904 Olympic marathon dosed with raw egg, strychnine and brandy, all administered to him during the race. Perhaps unsurprisingly, he collapsed on crossing the finish line and remained unconscious for several hours – but he still got his gold medal.

In 1928, the International Amateur Athletics Federation banned the use of stimulating substances in sport for the first time, but lack of any testing made the ban ineffective. Drug tests were first introduced at the Mexico Olympics in 1968, the year after the English cyclist Tom Simpson died during the 1967 Tour de France. He had taken a concoction of speed and cognac.

By the 1970s, anabolic steroids were all the rage, especially in strength and power events. With the help of an organised system of steroid use, East German women dominated swimming for nearly two decades – at the first world swimming championships in 1973 they won 10 of the 14 gold medals available, and set eight world records. Blood doping was also becoming popular by the 1970s, particularly among cyclists. The removal and subsequent re-infusion of the athlete’s blood boosted his red blood cell count and thereby increased stamina and performance. The same effect was also achieved by the use of the hormone erythropoietin (EPO) or by using altitude tents.

The late twentieth century saw the emergence of creatine – used to boost anaerobic power and cut recovery time – as the legal performance-enhancing substance of choice. The illegal performance booster of choice became human growth hormone (HGH), which is thought to increase muscle size and red blood cell count, making the athlete more powerful and less susceptible to tiredness.

The future of performance-enhancing procedures lies in gene doping. Although genetically modified athletes are still some way off, a geneticist at the University of Pennsylvania has already experimented on mice, isolating the gene for muscle growth and producing rodents that are 50 percent stronger than normal mice.

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State-of-the-art performance enhancement

Hypoxic chambers, also known as altitude chambers, are enclosed sleeping spaces that simulate a high altitude atmosphere by lowering the oxygen concentration in the air. As the body adapts to these conditions, it produces more oxygen-carrying red blood cells. The increase of oxygen supplied to working muscles improves the athlete’s performance. The effect is similar to that produced by the use of illegal blood-doping. There was an increased demand for these chambers following the introduction of a test for the hormone erythropoietin (EPO) in 2000.

The chambers are popular with endurance athletes, such as marathoner Paula Radcliffe, and former Tour cyclist Lance Armstrong. But there have been concerns about the use of these aids; use of hypoxic chambers can thicken an athlete’s blood and increase the risk of thrombosis, and at the Sydney Olympics in 2000, competitors were forbidden from taking the chambers into the Olympic village on the grounds of health and safety.
In 2004, an Auckland University of Technology study found that the use of altitude tents increased endurance running performance by one to two percent. A one percent increase in speed endurance during the men’s 10,000 metre final at the Athens Olympics would have shot fifth placed Haile Gebrselassie to first.

Men’s 10,000m results, Athens 2004

1. Kenenisa Bekele (Eth) 27:05.10s

2. Sileshi Sihine (Eth) 27:09.39s

3. Zersenay Tadesse (Eri) 27:22.57s

4. Boniface Kiprop (Uga) 27:25.48s

5. Haile Gebrselassie (Eth) 27:27.70s

6. John Cheruiyot Korir (Ken) 27:41.91s

7. Moses Mosop (Ken) 27:46.61s

8. Ismail Sghyr (Fra) 27:57.09s

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In February 2008, Speedo, using NASA technology, produced a swimsuit called the LZR Racer that helps a swimmer to go faster. It is made of a special fabric that reduces muscle oscillation, skin vibration, and drag. It also incorporates a corset-like core stabiliser that helps a swimmer maintain the correct position in the water. The Australian Institute of Sport has performed a series of tests on the swimsuit, and found that it increases a swimmer’s speed over sprints by four per cent. During March 2008, its debut month, swimmers wearing the suit broke 17 world records. When seen in the context of the results of the women’s 50m freestyle final in the Athens Olympics in 2004, the implications are huge. In this race the time margin separating the gold medal from last position was six-tenths of a second. A four percent increase in speed would have last placed Flavia Cazziolato finishing in gold medal position.

Women’s 50m freestyle swim results, Athens 2004

1. Inge de Bruijn (Ned) Time:24.58

2. Malia Metella (Fra) Time:24.89

3. Lisbeth Lenton (Aus) Time:24.91

4. Therese Alshammar (Swe) Time:24.93

5. Kara Lynn Joyce (USA) Time:25.00

6. Michelle Engelsman (Aus) Time:25.06

7. Jenny Thompson (USA) Time:25.11

8. Flavia Cazziolato (Bra) Time:25.20
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Creatine occurs naturally in the body and is used by the muscles in energy production. It is widely used by athletes, including British sprinter Craig Pickering, because it increases muscular strength, delays fatigue, and promotes faster recovery. You can increase your creatine intake by eating more meat and fish, but athletes favour oral creatine supplements as the most efficient way of increasing their intake – 20 to 30g per day is the average dosage, and is equivalent to eating about 5kg of raw steak every day.

A variety of tests have proved the performance-enhancing qualities of creatine supplementation. In 2001, Norwegian researchers found that a group of male sprinters taking 20g of creatine daily for five days made significant improvements in their running speeds, reducing the average 100 metre time for the group from 11.68 seconds to 11.59 seconds – nine-hundredths of a second. The findings gain significance when we look at the results of the Men’s 100m sprint final in Athens 2004, where the time-gap separating first place from fifth place was nine-hundredths of a second. The gap between gold and bronze medals was only two-hundredths of a second.

Short-term side effects can include muscle cramps, vomiting and dehydration. Long-term side effects are unknown.

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