Blood Doping
Blood doping refers to the practice of artificially increasing the number of red blood cells in the bloodstream to enhance athletic performance. This increase in red blood cells allows for greater oxygen distribution to muscles and organs, improving endurance, speed, and strength in athletes. While effective, blood doping is illegal in professional sports due to its health risks, which include serious complications such as heart attacks, strokes, and infections. The practice gained attention in the mid-19th century and was officially banned by the International Olympic Committee in 1985, although the methods used to achieve blood doping have evolved over time. These methods range from pharmaceutical interventions, like erythropoietin (EPO), to more direct approaches such as blood transfusions. Testing for blood doping has become increasingly sophisticated, with multiple strategies developed to identify the various techniques athletes might use. Notably, cycling has been significantly impacted by blood doping scandals, affecting the reputation and integrity of the sport. Despite ongoing efforts to combat this issue, blood doping continues to adapt in response to evolving detection methods, illustrating the ongoing challenge in maintaining fair competition in athletics.
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Blood Doping
Engineering the increase of red blood cells carried in the bloodstream is known blood doping. Red blood cells distribute oxygen to organ systems as well as muscle tissues. Higher levels of red blood cells elevate the ability of an athlete to perform in a given sport. More oxygen in the blood results in increased endurance, speed, and strength. In professional sports, the practice is now illegal and is considered dangerous. The methods of blood doping are varied and complex, and can require intervention from health care professionals. The practice of blood doping existed under the radar of sport governing bodies until 1985. Health risks associated with blood doping include heart attack, stroke, pulmonary embolism, and contamination. Blood contamination can also lead to sepsis, a systematic bacterial infection of the blood and organs that often fatal. Pharmaceuticals used to increase blood oxygen levels can decrease the function of the liver and cause permanent damage to this organ.
Background
Though various dates are recorded, blood doping was developed and practiced in the mid part of the nineteenth century. Before the practice was declared illegal, Kaarlo Maaninika received blood previous to winning two gold medals in track at the 1980 Olympics. Champion cyclist Joop Zoetmemelk in 1976 and many in the US cycling team in 1984 received transfusions preceding their wins. The International Olympic Committee ruled blood doping illegal in 1985. However, there was no test for it.
In 1993, the US Army began procedures to develop a strategy to give soldiers extended stamina, alertness, and persistence. It was named blood loading. Red blood cells were collected and stored, and then administered just before battle. The same procedure was adopted by the Australian and Canadian military after scientific testing proved blood loading preferable to other performance-enhancing approaches.
A wide array of methods are used to increase red blood cells before a competition. Manipulating the messages sent to the body’s bone marrow is a common pharmaceutical method. Erythropoietin (EPO) is a hormone originally created for managing the effects of cancer treatments such as radiation and chemotherapy. EPO signals increase the production of oxygen carrying capacity as blood cells are built.
Related to EPO is another approach that involves Hypoxia Inducible Factor (HIF) Stabilizer. This medicine was created for patients with chronic and terminal kidney disease. HIF recalibrates the body’s natural ability to produce EPO, and manipulates proteins in the body such that a natural increase in EPO is achieved.
Transfusion is a nonpharmaceutical approach. The blood of another person, who is typed and crossed to match the recipient, can provide red blood cells for transfusion. However, the athlete’s own blood, also known as autologous donation, can be used. Transfusing requires substantial assistance from medical staff to ensure patient safety in the various stages of this procedure. Timing, as with all blood doping methods, is perhaps the most important aspect of the procedure. The donor’s own blood must be taken out weeks before a high-endurance competition in order to rebuild the loss of blood. Similarly, at least three days must pass between consecutive donations. Blood is frozen to preserve the quality of the red blood cells until the time of transfusion.
The synthetic compounds of perfluorocarbons and hemoglobin-based oxygen carriers can perform the work of blood elements. These compounds are engineered oxygen carriers that have the capacity to increase blood oxygen at greater levels than EPO and HIF pharmaceuticals.
Just as the methods of blood doping have been elastic and creative, so are the testing processes developed to monitor and track them. Transfusions from a donor can be identified by studying blood cell surfaces. Donor plasma will show a variance within a drawn sample. Identifying autologous donation requires that the athlete breathe a gas mixture for several minutes and CO measures are then taken. Blood testing for synthetic elements meant to stimulate bone marrow production are also available, though highly complex and costly. There are as many testing procedures for blood doping as there are methods to achieve it.
Impact
In 2000, the first cyclist to test positive for EPO was Niklas Axelson of Sweden. American cyclist Tyler Hamilton tested positive for the presence of other genetic blood cells in his system in 2004. He appealed the finding and was able to keep his Olympic gold medal because of errors revealed in the drug testing procedures, but eventually admitted to doping and returned the medal in 2011. Hundreds of Spanish professional athletes were implicated in blood doping in 2006. Alex Cherepanov, a Russian hockey player, died during a game in 2008. He frequently engaged in blood doping during the year before his death.
Cycling has endured the most coverage and is most responsible for educating the public about blood doping. The most winning cyclist in the history of the sport, Lance Armstrong, was banned for life from cycling and lost all seven of his Tour de France medals. The US Anti-Doping Agency revealed a programmatic doping system employed throughout the trajectory of the cyclist’s career. Hamilton, a long-time racing team member with Armstrong, details the systematic training approach he endured in The Secret Race: Inside the Hidden World of the Tour de France (2013). While Armstrong's is the highest-profile case, blood doping was widespread in the sport in the 1990s and the first decade of the twenty-first century, and cycling has struggled to rid itself of this reputation. Though the sport avoided any major doping scandals for most of the 2010s, in 2017 Giro d'Italia winner Danilo Di Luca was banned from the sport after testing positive for EPO. Andre Cardoso, a Portuguese cyclist who was scheduled to compete in the Tour de France, was also banned that year for blood doping.
In 2018, a minor blood doping scandal occurred in the lead-up to the Pyeongchang Olympics when the British newspaper the Times announced that it had been given "secret data" showing that hundreds of endurance skiers, including more than fifty who would be participating in the Olympics, had recorded abnormal blood test scores, yet had not been banned. The secretary-general of the International Ski Federation (FIS) denied this allegation.
What recent history has demonstrated is the continual reinvention of pathways for achieving higher oxygen blood levels for athletic performance. Blood doping as a practice continues to evolve in response to the testing mechanisms for identifying unfair bioengineered advantages in athletic competition.
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