Drugs in triathlon

by Dan Empfield 6.18-23.01 (www.slowtwitch.com)

Here we all were on America's West Coast, arising to the smell of coffee from our pre-set Starbucks private reserve home-brewed house blend, looking forward to armchair quarterbacking the mountainous Stage 18 of the Giro.

Hello! The stage is cancelled! Carbinieri have invaded the hotels and emerged with sacks full of pills and powders.

This inevitably leads a triathlete to ask, "How prevalent are illicit performance-enhancing drugs in our sport?"

I thought it worthwhile to give the best Slowtwitch effort to answering that question from a variety of angles, and this week we'll be publishing in serialized form our views and investigations into the subject.



THE ENDURANCE COMMUNITY'S LATEST DRUG

Before we address the question of whether––and to what degree––triathletes are drug cheats, we thought we'd dive right into the pharmacology of it and head straight to the state of the art.

The newest drug in the illicit endurance drug pipeline is RSR-13. It is made by a Denver-based company called Allos Therapeutics, Inc. How new is RSR-13? It is only in its clinical trial stage, which means it isn’t even approved yet for use anywhere in the world. Even though RSR-13 is on the FDA fast track, it won’t be available for use for at least two to three years in the U.S., and the timeline is about the same in other countries.

Yet it seems to have found its way into the dufflebags of European cyclists racing in the Giro d’Italia, according to news reports.

Allos' director of corporate communications, Monique Greer, questions this. "We’ve heard the reports, and we’re committed to cooperating, but we haven't received information to date from any public prosecutor's office or other appropriate investigating authority. And it’s been two weeks," she said.

What is RSR-13? It is not a blood booster per se, like EPO. It does not add blood cells; it does not raise hematocrit. But it does enhance the ability of blood cells––specifically the hemoglobin carried within red blood cells––to release oxygen. The solution Allos is trying to effect is the oxygenation of cancer cells. Poorly oxygenated cancer cells are not as susceptible to radiation treatment, and oxygenating them makes them easier to kill.

But the side benefit of increased oxygenation at the tissue site has caused Allos to seek to treat many diseases and clinical conditions attributed to or aggravated by oxygen deprivation, or hypoxia. In layman’s terms, this means that RSR-13 won’t give you any more red blood cells, but it’ll maximize the efficiency of those you have.

News sources are reporting that there is no test to detect RSR-13. The bad news for unscrupulous endurance athletes, though, is that this is temporary. Allos has certainly been aware—both from the history of other red blood cell enhancers like EPO and from the simple proximity of Allos Therapeutics, Inc., to two of the world's leading centers of endurance sports athletes (Boulder and Colorado Springs)—that RSR-13 would be attractive to drug cheats. And Allos has already developed a test in conjunction with Dr. Don Catlin, chief among the U.S. Olympic Committee’s anti-doping scientists and head of the drug testing lab at the University of California, Los Angeles.

"We’ve been pretty proactive, unlike a lot of companies," Greer said. "RSR-13 can be easily detected in urine within 24 hours of use."

Dr. Catlin echoed Greer’s words. When asked if Allos has in fact been a "good citizen" of the pharmaceutical industry by trying to keep this drug out of the hands of the unscrupulous endurance athletes, his answer was an emphatic, "Definitely yes."

The test is not yet entirely ready for use, but it appears close. We asked whether the drug's efficacy as an oxygenator is longer-lived than the test—which is to say, might somebody be able to benefit from RSR-13 past the point when the test would detect its usage?

"I doubt it," said Catlin. "But it has not been studied. We do not know yet because the work is in progress."

The RSR-13 threat seems to be just about over before it’s even started. Score one for the drug police.

ITU'S STAND ON ILLICIT DRUGS IN TRIATHLON

PUBLISHER'S NOTE: This is the one segment of this series written by an outside party. Mark Sisson is the architect of the International Triathlon Union's anti-doping policy, and he is charged with overseeing it on a year-to-year basis. The ITU is the ultimate authority for policing doping in the sport, and he has written an exhaustive overview of the process as it now exists. What follows are his words:

An Overview of ITU’s Anti-Doping Program

ITU’s anti-doping program has recently been called into question on a triathlon-related e-mail list. While I don’t feel compelled to respond to these charges directly, I do feel it would be instructive if the triathlon public developed an understanding of just how complex drug testing in sport has become. Also, I’d like to allay concerns as best I can by describing how the ITU and the sport of triathlon have managed to control doping as well as––if not better than––just about every international federation (IF) in the Olympic movement.

Too many agencies with too many separate agendas

Until last year, with the introduction of WADA (the independent World Anti-Doping Agency established by the International Olympic Committee), there were many different "agencies" involved in drug testing athletes around the world. The system did not work well because it required the cooperation of too many different "autonomous" bodies, each of which usually had its own political and/or financial agenda. It wasn’t as simple as a federation hiring a couple of doctors to collect pee in a bottle and send it off to a lab. Bear in mind that there were (and still are) approximately 200 countries, each with complex human rights issues and political agendas surrounding their doping programs, and that each country has a national federation (NF) for each of approximately 50 sports. Each country has a national Olympic committee (NOC) as well, and in some cases governments have separate federally funded anti-doping agencies set up to act autonomously. In many cases the agenda of one agency or federation or government is completely at odds with another upon which it depends for funding or for providing services. Harmonization agreements notwithstanding, an international "cooperation" has been implied for years but has never been fully set forth and agreed to by all parties. (It would require, at the very least, a UN resolution.) As a result we have the following players:

1. The IOC sets the basic anti-doping guidelines for all Olympic and recognized sports, presumably to protect the integrity of the Olympic movement during the Olympic Games and at all times between games.

2. The IFs use the IOC guidelines to create more specific anti-doping rules and procedures, which they then attempt to enforce at the NF level.

3. The NOCs frequently create their own unique set of anti-doping rules based on the IOC guidelines, but often with additions or changes that take into account the laws of that country. NOCs are often charged with educating all athletes (through their respective NFs) within a country on anti-doping rules. In many cases, if not most, NOCs actually perform doping controls on behalf of NFs and IFs.

4. The NFs have the closest direct ties to the athletes and are ultimately most responsible for sanctioning athletes found to have committed a doping offense. Many NFs in turn create their own unique set of anti-doping procedures which reflect the specific nuances of the IF rules, as well as those of the NOC rules, but which often also reflect the legal requirements of their federal governments. NFs have an inherent conflict of interest because on one hand they are required to "prosecute" an athlete testing positive, but on the other hand they are often asked to "defend" the athlete at higher levels of appeal.

5. Government-funded sports drug agencies in some countries take it upon themselves to do the work of the NOCs in educating and policing doping control (which means they also collect the samples)—yet they are funded by, and answer to, their federal government. Often, the sports drug agency has its own unique collection methods and materials as well as its own system of hearings and appeals which can conflict with IF codes.

6. The IOC laboratories, autonomous testing facilities spread around the world, are charged with providing accurate, consistent sample analysis while maintaining strict objectivity and confidentiality. It’s not clear to whom they ultimately must answer. What has become apparent is that the IOC-accredited labs often use different methods to analyze samples, and even supply inconsistent reports for use in prosecuting positives, both of which can cause huge problems when the results are challenged by defense lawyers in court. These labs report their results only using coded numbers—they have no athlete names. The names that match the numbers may be held by the NOC, IF, NF or event LOC (depending on who is the "relevant authority" for a particular event), so it’s often difficult to track down the names of all who were tested.

7. The LOCs (local organizing committees) of various sporting events are occasionally assigned the title of "relevant authority" by virtue of the fact that they pay for the doping controls performed for a particular sport. In some cases, this means that the results of tests come to the LOC first instead of the IF, NF or NOC. The Goodwill Games is an example. In some cases the results never come to the IF unless there is a positive test (and in some cases, unfortunately, not even then).

8. The CAS (Court of Arbitration for Sport) is the IOC-constituted body that hears final appeals on behalf of athletes under the IOC system. An athlete found to have committed a doping violation and who has exhausted all appeals through the NF, NOC and IF may appeal to CAS. A conservative CAS bench and the fear of legal retribution probably gives the advantage to the athlete. However well-intended CAS is, it is often NOT the final level of recourse for an athlete accused.

9. The federal government in many countries offers the final means of appeal for an athlete who has been found guilty of committing a doping offense and who has been sanctioned by the IF. Many countries have "right to work" laws that supercede the IOC or sports ethics. Despite all signed athlete waivers, despite harmonization agreements, despite all the recognition of the work of the IOC and of sport in general, it is still possible for an athlete to not only sue to have a sanction and any financial penalties overturned by a federal government, but to actually extract penalties and be awarded "damages" from the IF, NF, LOC, sponsors and anyone else associated with the athlete and his/her sport.

All these different agencies, and we haven’t yet considered the ITU athletes who have agreed to compete according to ITU rules and abide by the IOC Medical Code, but have also signed agreements to compete according to their separate NF and NOC rules. Frequently, an athlete competes at an international event run by an NF to which the athlete does not belong. Positive test results can be communicated first to the host NF, then to the athlete’s own NF (which would hold the hearing) and NOC, as well as to ITU. Lawyers have a field day trying to show the CAS whose rules should prevail for that particular test.

When one reviews this complex web of mixed agendas and loose interdependencies, one can see that the system is not necessarily best designed to accomplish the stated objective: to prevent the unfair advantages gained by doping abuse. In many instances the inadvertent use of a cold remedy is more likely to result in detection and a penalty than overt steroid abuse, as has happened all too frequently in the sport of triathlon, where we have maintained very strict application of the anti-doping rules.

While ITU has been famously unsuccessful in pursuing positive nandrolone cases––largely for legal loopholes beyond our control––we routinely suspend athletes for what I would consider "minor" offenses like ephedrine. It hardly seems right, but athletes caught for minor offenses usually admit to the offense (like taking a cold medication) and serve their 90 days, while the serious offenses involve lawyers who tear apart every aspect of the test looking for "reasonable doubt," and they frequently find it. One example of minor, inadvertent use happened three years ago when we suspended an athlete for nine months for use of an over-the counter-vitamin preparation that contained a small amount of "prolintane", a little-known, almost obsolete stimulant. Investigation showed that the athlete had obtained the product on advice from his sports doctor. Unfortunately, the athlete was from a poor province within a "developing nation." His NOC had no drug education program (nor did the NF) and therefore a list of banned substances was never made available to the athlete, or his doctor, both of whom knew only that he was "not supposed to take steroids." The athlete received a suspension and no one argued that it was not appropriate. Still, we would have preferred to have penalized the NOC for failing to inform the athlete or the physician of the risks. But how can the IF possibly make certain the NOC is doing its job in educating its athletes? Answer: Unless it can penalize the NOC or NF, it can’t. Furthermore, if the IOC-accredited lab makes even a minor mistake in reporting (as has happened to us), an entire case can be thrown out––but we have no recourse against the labs, either.

The press often assumes that every positive is a doping violation

There is a very good reason the public does not hear about every positive test. That is because a positive test reported to us by an IOC lab does not necessarily mean that a doping violation has actually taken place. In fact, it would be a gross violation of an athlete’s basic rights to announce that a positive test had occurred when the ensuing investigation might easily clear the athlete. And this happens with greater frequency than it does with cases we pursue.

In the past few years, we have investigated several cases of reported high "T/E" (testosterone to epitestosterone) ratios, which were ultimately found in favor of the athletes usually due to the use of birth control pills by female athletes. Unfortunately, each reported case requires a rigorous further testing protocol to determine that a doping violation has not been committed. Frequently, we get positive reports from IOC labs of salbutamol (an asthma drug) in athletes’ urine. The rule is quite clear on this: an asthmatic athlete who has gone on record with his or her NF for requiring salbutamol (or other IOC-approved asthma meds) is NOT guilty of a doping violation. The IOC still requires the lab to report it as a positive. We, in turn, do not report the athlete on any form, nor do we sanction the athlete in those cases. Unfortunately, the list of athletes who take such approved asthma medications continues to grow exponentially throughout all sports. (So much so that a prudent outside observer might deduce that elite sports participation is unhealthy because it will eventually cause exercise-induced asthma in every athlete!) Maintaining lists of athletes who have been approved for use of these medications is next to impossible given language barriers, non-compliant NOCs, differing medical certification requirements from country to country, differing asthma test protocols, and different NOC forms to be filled out and deciphered. As a result, none of this can effectively be sorted out until after a test comes back from the IOC-approved lab marked "positive" for restricted medication. If the athlete is appropriately already on file, the result is deemed negative and the case is dropped. If the athlete is not on file, it’s considered positive. But what of cases where the athlete had actually had appropriate testing done well before the event proving asthma, but his/her physician or NOC simply failed or forgot to file the form or notify the NF? Do you not sanction in that case? How fair is that to those who have fully complied with the rule? Do you half-sanction? Full sanction? How fair is that when another asthmatic who is "on record" can use the same meds with no penalty?

Two years ago, the test results of three Australian athletes were somehow "leaked" to the press as "positive for salbutamol" and having "violated doping rules." It made Australian national headlines and was even reported in the Los Angeles Times. Of course, the news articles failed to report that each of the athletes was appropriately on file for approved use of salbutamol with both the NF and ITU, so there was no actual cause for concern. A simple phone call cleared it up. But the fact that the lab had to report these as positive until proven otherwise, and the fact that those results had to pass through a foreign NF (the relevant authority), the athlete’s own NF and a sports drug agency before being resolved posed a huge privacy problem. These athletes all had careers in jeopardy and sponsors who might have abandoned them if there had been any sign of impropriety. So when you read that a lab reported 28 positives in a single federation in one year, this does NOT necessarily mean that any athletes were guilty, or that they should have been sanctioned or that they should have been reported in the press.

The costs of doping control are enormous

The cost of doing a test at an event can range from a few thousand dollars to $10,000 per event. Over the years, the usual cost for ITU events has worked out to about $300-$400 per test. The urine sample is taken by trained sample collectors (and their staff) using fairly expensive disposable collection equipment. These people are flown to an event, stay overnight, eat several meals and receive a "per diem," all of which adds up to a considerable expense. Then the urine samples are air-freighted to an IOC-accredited lab and put through an extremely expensive battery of tests looking for banned substances. These labs are often profit-making entities which justifiably mark up the costs of performing their tests, such that the lab fee itself might be several hundred dollars per sample.

Over the years the ITU, with its limited budget, has developed a number of ways of maximizing in-competition testing. As a result, our true costs are very little but we have had almost all of our athletes tested. Many federations operate this way––in fact, very few actually perform their own testing. Within the sport of triathlon, virtually every major NF has an anti-doping program patterned after ITU rules. Each of these NFs performs a number of in- and out-of-competition tests each year on not only its own athletes, but also athletes from other countries competing in non-ITU events within that country. All samples are sent to IOC-accredited labs and all results are communicated to the IF. The vast majority of top ITU athletes are tested through this system each year. The net effect is that there are no direct costs to ITU, but "our" athletes are tested and the results reported to us.

With each of our ITU World Cup and ITU World Championship events where doping control has been performed, we have placed that cost on the shoulders of the local organizing committee as part of their bid to produce the event. This is not to say that they can run out and hire a couple of minimum-wage lackeys to collect urine. Depending on the country and/or the NF, the tests are performed by the usual collection body for that country—the same accredited people ITU would have to hire if ITU were paying for tests in that same country. Sometimes this process would mean an additional cost item for the LOC, sometimes the government or the NOC would pay for the testing, but in each case ITU has received 50-80 tests a year in its own events. Add this to all the many hundreds (if not thousands) of tests done cumulatively by NFs and you can see that event testing of triathletes has been more than adequate—to the point that some athletes are tested in competition five, six or more times a season.

With all the event testing we have done, it has become clear that we (the sport) have been perhaps "wasting" money testing so many events. What savvy athlete is actually going to show up at a high-profile event with a banned substance in his or her urine? Therefore, without abandoning event testing––because we still do lots of it––we have focused more for the past four or five years on "out-of-competition" (OOC) testing. Here the cost variables skyrocket, but the likelihood of catching someone "using" increases and, hence, the intended preventive effect is far greater. OOC testing involves paying a certified sample collector to fly or drive into the hometown of a single athlete (or in some cases Boulder or San Diego, where several might live) and literally go to the home of the athlete, knock on the door and collect the sample right then and there. In theory this is a great idea, but in practice it’s difficult to accomplish. OOC tests can sometimes average $800-$1,000 per test. Tracking the whereabouts of the athletes is the biggest issue. Athletes are often "on the go", training in another town, visiting friends, or at an event. The sample collectors can’t really "call to confirm their appointment" so it is often hit or miss. They sometimes show up at great cost only to find no one home. Nevertheless, the number of OOC tests performed on ITU-ranked athletes last year is estimated at in excess of 250.

Once again, ITU has kept its costs to a bare minimum utilizing its NF constituents and their relationships with NOCs and sports anti-doping agencies to drive the program. These third-party agencies and NOCs are often obliged to perform the tests on triathletes as part of their charter. Most of the top 20 NFs test OOC routinely through their own programs. Bottom line: very little cost to ITU, but the effect is the same because "our" athletes are tested by the very same people we would be hiring to perform the test in each country if we had to do so. Since we are informed of the results of each test, ITU is, in effect, overseeing the OOC testing of all triathletes around the world—and we haven’t actually "commissioned" a single test. Recently, WADA was engaged to perform additional OOC tests around the world––at no expense to ITU––but most NFs and/or NOCs will continue with their own programs as well.

With the new WADA program, ITU’s primary function is to maintain a database of athletes and where they are or will be at all times. WADA then allocates a portion of its budget to perform standardized OOC tests on a random sampling of the athletes in our database––at no cost to ITU. We are still working out the kinks of this arrangement––like when WADA showed up at an ITU event two years ago to do OOC testing on athletes who had just finished an ITU World Cup and who had already given a sample for that event! But we are working with WADA to streamline the collections and make them more economical.

Legal costs are the biggest hurdle in doping control

When we do have a positive case that we feel warrants pursuing, we do so aggressively. By way of example of the costs, in the past two years we have had two positive tests for nandrolone (among others) that required massive legal work to orchestrate and pursue. In the first case, the athlete lost at the NF level, appealed to ITU and lost at that level, appealed to CAS and eventually won. In the second, the athlete won at the NF level, a different NF appealed it to ITU, the athlete prevailed at the ITU appeal, but ITU appealed it to CAS, where the athlete won. In each case, a new hearing was required at each level, entailing literally several hundred hours of legal time. The true billable costs to a small IF like ITU would easily have run into the hundreds of thousands of dollars and bankrupted us (as doping cases have bankrupted more than one NF). However, in my function as ITU legal coordinator, I was able to arrange for "pro bono" legal services in most instances, so our costs totaled less than $15,000. Some costs are just unavoidable, such as paying a lab official to testify as an expert witness at a hearing.

At this point I should mention that, due to the substantial time requirements of my position as chair of anti-doping and as legal co-coordinator (which far exceed my duties as volunteer elected secretary general of ITU), I was granted an annual stipend of US$10,000 by ITU three years ago. That $10,000 is far less than we would have to pay a qualified legal employee or a subcontracted attorney to coordinate these doping-specific legal challenges, so I consider this a reasonable allocation. I should also mention that I have yet to take the stipend.

In closing, let me restate that, in my humble opinion, I feel that ITU has done a great deal to uphold its pledge to eradicate doping in the sport of triathlon (as well as duathlon and related multi-sports). The Olympic movement anti-doping program is a complex system that is constantly subject to legal challenge, yet we are required as a "program sport" to work within this system. There are few, if any, IFs that perform more tests per elite athlete than we do. We try not to announce positives until they are proven positive (although every once in a while, an athlete’s attorney files a lawsuit during the appeal process and the matter becomes public record). When we do have a positive, we suspend the athlete. (Actually, the way our rules are written, the NF suspends the athlete. ITU can increase it or overturn it if we see fit.) I am proud that we have managed so much on such a minimal budget, and I hope to be able to continue to do so into the future. The formation of WADA will help, but it will not entirely absolve the IFs of their ongoing responsibilities. There remain many issues to resolve within WADA, such as who manages and pays for legal "prosecution" when a positive test arises, so we will proceed with cautious optimism.

The war against doping in sport is a very tough fight. Every step of the way, there are new super drugs emerging, new methods for avoiding detection, huge ethical questions surrounding what should and should not be banned (EPO is bad, but altitude chambers that achieve the same thing are OK?). And always, always new lawyers are looking for every loophole to get the offender off.

DRUGS OF CHOICE FOR A CHEATING TRIATHLETE

I know nobody who'd resort to performance-enhancing drugs. Let me rephrase that: I know nobody who'd admit to resorting to drugs. But it's silly to think that drugs do not exist whatsoever in our sport. If a triathlete were so inclined, what would he or she take?

Let's start with drugs taken during training. A top triathlete will want to train, and train, and train some more. That is only possible if recuperation and recovery are high. The drug of choice here is an anabolic steroid.

It is mythical to think that this class of drugs is efficacious only for the body builder and power athlete. Endurance athletes will not grow larger muscles when using an anabolic steroid, but they will recover faster, become leaner, and will undergo hypertrophy in all the desired places: muscles, capillaries, etc. But the biggest boost comes from the ability to do a boatload of work and have your muscles rebuilt and ready for the next workout a few hours later, or overnight.

Other substances that likewise help in anatomical and physiological hypertrophy (generation of muscles, connective tissue, capillaries, myoglobin, etc.) are testosterone and human growth hormone. These are naturally occuring "drugs," and so it is not possible to ban their presence altogether. What is banned is a level that is over a threshold amount. Athletes will supplement with intramuscular injections up to the threshold limit.

Here is a gray area. Let us say you're far below the threshold. What do you do? Let's say that you're an older, age-group athlete, and you're even further below the threshold, because of the naturally diminished level of testosterone. What then? If you think it's OK to supplement because your testosterone is dimished through age, what about the others in your age-group that are also lower in testosterone for natural, age-related reasons? Ought you to put them at a disadvantage through your own supplementation? This is how the justification goes.

For the aging athlete, though, testosterone has the same effect for men in retaining bone mass that estrogen has in women. Is male testosterone supplementation therefore the moral equivalent of female estrogen supplementation? The problem is, testosterone does so many other things––even female athletes who want to dope will sometimes choose testosterone. Indeed, though it is generally not lopped in with this class of drug, testosterone has been called "the chief of anabolic steroids."

Then we get to the race. The other class of steroid is of use here. Catabolic steroids, also known as corticosteroids, help in a variety of ways. The best known of these is cortisone, and its cousin is generated naturally by the body. This is one of the two classes of "drugs" for which the adrenal gland is responsible. The first is adrenaline, also known––in its synthetic form—as epinephrine. The other is cortisol, and one of the ways we know an athlete is chronically overtrained is that he can't get his cortisol levels high during activity.

The drug of choice is a slow-acting corticosteroid, sort of a "timed-release" steroid. The natural analog goes like this: During stress––not like when a lion is chasing you (that's what adrenaline is for), but when, say, you are facing starvation, or freezing––your body secretes cortisol. This hormone runs around your body breaking down muscle tissue and using it for fuel through a process called gluconeogenesis. Muscle is converted to glucose. Your body's mechanisms are saying, "We like the muscle, and we wish we could keep it, but we're freezing to death here! We need fuel!" If you're in a stage race, or, say, in an Ironman, there's no problem using a corticosteroid here as long as this process only occurs for a day, or a few days. If you've got a couple of weeks to recover from all this muscle-burning, you'll be OK (more or less).

Not only does a corticosteroid make more fuel available for you in the latter stages of a several-hour endurance event, it is a painkiller. It's a great drug for cheating. But you've got to time it right or you'll actually perform more poorly! And you've got to slide through doping control undetected.

Then there are the aerobic enhancers. Blood boosters. EPO––erythropoetin––is chief among them. This drug is used for cancer patients. Chemotherapy is designed to work against cells that reproduce quickly. What cells are these? Cancer cells. And hair cells (which is why a chemotherapy patient's hair falls out). And blood cells. Especially red blood cells. EPO is a terrific drug for the stimulation of red blood cells in anemic cancer patients. But it's also used by unscrupulous athletes who wish to generate more than their normal allotment of God-given red blood cells.

EPO is notoriously difficult to test for. The UCI––cycling's governing body––has essentially said: We can't test for EPO, so we'll test for the effects of EPO. Athletes who take too much EPO die because their blood becomes so thick with red blood cells it won't move around their bodies. So the UCI says if your hematocrit, a measure of the amount of red blood cells in your system, is above a certain level, you can't race—"for health reasons." But everybody knows what the UCI means: You can't race because chances are you're on EPO.

An on-the-ball doctor can keep your hematocrit below the UCI's limit of 50 by injecting you with other blood components to keep the ratio of RBCs correct. And what is the state-of-the-art blood volume expander? Hydroxyethyl starch (HES), which is used for treatment of hypovolemia during surgery (or just before a race by athletes with improbably high levels of RBCs). This is what the Finnish cross-country skiers got caught using in their most recent world championships.

Funny thing, though. The hematocrit level––which must be less than 50 in order to race in a UCI event––averaged 44 in the Giro d'Italia, and went down from there as the race progressed. That's a very mortal figure. Were riders eschewing blood boosters? Did they all have a religious experience just before the race? Perhaps. There was, however, one suspicious drug that was reportedly found among the possessions of one or more in the peloton. RSR-13 is so new that it's not yet on the market. It's undergoing its clinical trials in the U.S., Europe, the Middle East, Australia and elsewhere, but it's not approved anywhere. In fact, its maker––Allos Therapeutics, Inc.––hasn't yet earned a dollar in revenues. RSR-13 is its first drug. But somehow it's apparently already made its way into the peloton.

This drug enhances the ability of the red blood cells to unload their cargo of oxygen at the level of the tissues––muscles, etc. It doesn't raise the number of blood cells in your body, it just turns your mortal RBCs into super RBCs. One assumes—though I don't know this—that a thusly empty RBC will become a super-transporter of carbon dioxide (its return cargo) to the lungs.

RSR-13 does this without raising the hematocrit of the user. For the truly enterprising (and rich) athlete, I can't think of any reason why EPO and RSR-13 need be mutually exclusive: More efficient RBCs, and more of them.

Of course, you may grow a second head, or a third arm, or a big fat brain tumor before you're 40. But what the hey? Forty is a lifetime away for a pro triathlete or bike racer. Besides, there'll be a cure for cancer by the time they all reach 40, right?

This is certainly not the comprehensive list. There are stimulants one might take during the race, and pre-race diuretics to mask the presence of anabolic steroids. As for the latter, though, this would be problematic for an endurance racer, as a diuretic would cause the kidneys to draw water out of the bloodstream instead of delivering it to the skin for evaporation.

There is one drug that has been recently talked about by the IOC medical commission. We believe it's much ado about nothing. We'll mention it only to debunk the idea that this drug is widely used for illicit purposes.

If you listen to the IOC medical commission, the latest threat to mushroom into a drug problem is a class of drug called a "beta-2-agonist." The most prominent example is salbutamol––also called albuterol––and it's found in Ventolin and Proventil rescue medication inhalers used by asthmatics.

The IOC feels that beta-2-agonists––even those which are inhaled––have anabolic effects. This is frankly ridiculous, for two reasons. First, it's very hard to get much of the drug across one's plural (lung) walls and into the bloodstream. Better to take the drug orally (and this is banned, and has been for many years). Second, although the IOC has said, "It has been proven that the systematic abuse of these substances produces anabolic effects," our own investigation has shown that the "proof" is far from "proven."

The IOC has decided that starting with the 2002 Winter Olympics asthmatics must "provide clinical and laboratory proof of their ailment," and such evidence will be weighed by a panel of experts. This action is being taken, "to protect athletes from the dangers of mistaken diagnoses." Ahem.

The IOC is taking this action because, it says, "It has noted a significant increase in the use of asthma medication containing beta-2 agonists during recent editions of the Olympic Games, especially in endurance sports." Fox Sports Australia quoted the head of the IOC medical commission, Prince Alexander de Merode, as saying "'...in the Sydney Olympics seven percent of the athletes had asthma. In the rest of the population, only one percent suffer from asthma. Very bizarre. At times it looks like Games for the Sick."

Meanwhile, the well-regarded Allergy and Asthma Foundation believes that 17 million Americans have asthma. The American Academy of Allergy and Asthma and Immunology gives roughly the same total. The census conducted last year reports that there are 281 million Americans. Simple math yields that these organizations believe that more than six percent of Americans are asthmatic. So much for the IOC's math. The truly bizarre statistic is that there aren't more endurance athletes using inhalers, for a variety of reasons (listed in a news article on the subject in our sister publication, Triathlonlive).

One must conclude, therefore, that an asthma inhaler is not the choice of drug cheats (or frequently misdiagnosed athletes who are in danger) as is assumed by the IOC medical commission.

CYCLING VERSUS TRIATHLON: CULTURAL DISCONNECT

Yes, there are probably drugs in our sport. But I'm not overly worried. I don't perceive that the example set by cycling has much intersection with triathlon. Here's why...

Drugs appear to have been an integral part of the pro peloton for generations. That is the essential truth now coming out, if you believe the reports of those who've been caught and who are now spilling the beans in books and interviews. I've found little reason to doubt them as of yet.

Though this phenomenon appears to have been the historic norm in cycling, it has mainly been a European historic norm. Furthermore, it appears to have been team-driven. In other words, a young up-and-comer joins a top-grade team and is only then introduced into the ways and means of drugs or, to put it another way, he's traded in his amateur drugs for professional drugs.

Even in cycling, the team concept has only been around in America for 20 years. Yes, American cyclists were on teams, but we behaved as individuals on teams. Only when Yanks started riding as a team––which didn't happen until the '80s––did we become any good. The American ethic that drives us away from performance-enhancing drugs isn't our loathing for drugs as much as our loathing for authority and subjugation. We aren't team players. That's why we––most of those who are reading this––are triathletes. We don't want managers telling us what to do, and we certainly don't want them telling us we have to take drugs in order to be competitive.

The ethic in the peloton of "it's OK if you don't get caught" shouldn't take us by surprise. That's precisely the American ethic concerning gays in the military. It's OK to be gay, just don't get caught being gay.

In cycling, then, the twin historic axioms of Do what you need to do to perform, and here's the name of Dr. So-and-so, but we don't want to know about it, and It's perfectly legal if nobody finds out, ought to explain why drugs are notoriously hard to boot from the peloton.

Triathlon has several things going for it.

First, it was primarily a U.S.-based sport in its formative years, and while Americans seem to have little problem taking drugs that will inhibit performance, we seem––as a society––to pooh-pooh the converse.

Second, we don't get our top athletes from cycling. We get them from swimming and running. This is not to say that there are no cheats in these disciplines, but that cheating is not historically a skill one is taught by mentors like it has been in European cycling.

Third, ours is not a team sport. Drugs don't come to you in triathlon. You've got to go find them. On which street corner does one go for black-market EPO?

Fourth, the economics of drug-taking is better effected in team sports. If you're a corrupt doctor or pharmacist you've got one-stop shopping and a deep pocket with a group of 20 or 30 willing fellas wearing the same jersey colors. Where does a struggling triathlete go for financial relief? Might Blue Cross have negotiated a group discount with Amgen on behalf of 50 or 100 needful pro triathletes seeking EPO?

For those who think I'm being unfair to cycling, or that I'm beating a good sport when it's down, the drug-related dynamics to which I refer in cycling are those which take place at the highest level and not, I perceive, at the club or recreational level. Furthermore, when I'm talking about drugs in triathlon, I'm of course referring to drugs at the pro level (except as stated further below). Cycling is a great sport––too great for the stain of drugs to bring it down.

There are some worrisome occurrences on this side of the pond, though. You can go to seminars where doctors and coaches will make the case that it's perfectly legitimate to inject yourself with supplemental human growth hormone and testosterone. Their reasoning? That as you age your endocrine glands naturally dimish their production, and it's only smart to make up the difference.

Not only that, they say, it's only the practice of good health, since testosterone is responsible for bone mass retention in men just as estrogen is for women. But testosterone does a lot more than that, and it would be silly to think that male athletes are testosterone-boosting just to prevent osteoporosis. The problem is that there are "health and training professionals" who're justifying it, and that sounds so very much like what we hear from those in the European peloton who've been caught.

True, these workshops are generally marketed to cyclists, but I shudder at the implications. These seminars are not for pros, but for age-group athletes. Imagine that. Age-groupers armed with vials and needles.

EPILOGUE

Several things have happened since I finished the series above only five days ago.

Most notably I received my copy of Breaking the Chain in the mail the day I finished this series. It's not a long book, perhaps 20,000 or 30,000 words, and I immediately interrupted a good Joan Didion read to learn more about performance-enhancing drugs in one afternoon than I'd picked up during the past year. I learned, for example, that corticosteroids are best used in one-day classics, not stage races. Here is a further bit about corticosteroids, from Breaking the Chain, by Willy Voet:

"The effect of corticoids is perverse: they are natural painkillers produced by the adrenal glands, but when they are injected the glands shut down. This is why sportspeople who abuse them can end up with deficiencies, notably of calcium; their immune systems are weakened, too. If they break a bone, the fracture can take an immensely long time to knit. Prolonged use of cortisone is therefore utter madness..."

The book is full of references to catabolic steroid injections down through the years nonetheless.

I learned about the "Belgian mix," an injectable cocktail of amphetamines, caffeine, cocaine, heroin, painkillers, and sometimes corticosteroids.

And I learned that among a peloton full of stars whose halos now dip and sag were true shining lights, like Charlie Mottet, who knew all about the drugs but quietly raced an entire star-studded career without taking one.

Also during the last couple of days the silence is starting to break on "races for sale"––long an urban myth of cycling but now corroborated by several "insiders."

The code of silence in the peloton is starting to crack. Good. The sport is strong, and can support a good housecleaning. Many in the old guard have got to go, in team management and in governance. As to the latter, Hein Verbruggen, the long-time head of cycling's governing body, the Union Cycliste International, either did or didn't know what was going on in the peloton. This means, if you put the best face on it, that he was grossly naive. There is a "rule" in cycling: When you're the one who's allowed a gap in the paceline, it's "your gap to close." Law enforcement outside the sport have had to come in and close the gap that belongs to Verbruggen and his regime. Too bad he couldn't close it himself.

I received an e-mail just after this series ended. The sender gently chided me for thinking that Americans are above doping, and rightly pointed to, "an NFL or NBA star [who] gets busted for cocaine use, or a baseball slugger [who] uses a drug which is not banned in his sport, but banned everwhere else."

Let me be clear. I don't believe Americans have any special virtue. We've just been privileged to found and grow a sport in some happy and fortuitous circumstances. If triathlon had been a big-dollar pro sport ongoing for several generations we'd be having the same problems that our pro footballers have. We're just lucky that triathlon is relatively new, poor, and not team-based.

My statement about "our loathing for authority and subjugation" describes pretty much all those whom I count as longtime friends in triathlon. If we––Yanks and non-Yanks alike––wanted to be joiners and followers we'd not have taken up triathlon. In this sense, I think––and have always thought––triathletes are fairly similar the world over. This is why I doubt we'll have much of a drug problem, or at least not the pervasive problem you see in cycling's top levels.

I do think that Americans' resistance to authority made for fertile ground when the seed of triathlon was planted here on America's West Coast. As a group gringos are cranky and don't like being told what they have to do to succeed—which is sometimes good and sometimes not. I therefore conclude that drug peddlers would have to work evenings and weekends to break the door down and enter our sport in a pervasive way.

Yes, our sport's triathletes are very concerned about drugs. That's just the point. If 80 to 90 percent of our sport is concerned about––and diligent in prohibiting––drugs in our sport, ipso facto we've not got an endemic drug problem.

But there are some things that do concern me. There are doctors in cycling who are widely rumored to be dirty. Cyclists who use these doctors––and there is one doctor in particular I'm thinking of who has a particularly notorious reputation––have little, I think, to complain about if people consider them dirty by association. If you have lunch every Tuesday with John Gotti––and more so if you're writing regular checks to him––you won't have to go to jail for it, but you can't blame people for suspecting you of foul play.

In that same vein, there are some prominent pros in multisport who have used this particular doctor. To them I say, don't be surprised when you're suspected of taking drugs. And by the way––you're widely suspected. If an American used this particular doctor, I'd suspect him or her as well.

I've heard rumors about triathletes from two particular countries who've been caught with performance-enhancers in their possession. If it's true, I can only hope they get same treatment that cyclists get when they're caught.

I also notice that, just today, an International Olympic Committee lab in Cologne is reiterating findings that test users of many "clean" supplements have tested positive for nandrolone (story in Triathlonlive). I've heard rumors that less expensive sellers of supplements such as creatine––some from labs in the former Eastern Bloc––produced positive tests for nandrolone in those who took them. This is likely because, as many have feared, trace amounts of nandrolone made their way into substances in which nandrolone was not an intended ingredient. On the other hand, there has been speculation that a little dose of nandrolone might give the user of said supplement results designed to keep the user a happy customer. Who knows?

In any case I'm gratified that there is an alternative explanation for all the nandrolone busts (which does not necessarily exonerate those who've tested positive but gives us a happy thought on which we can hang our hats, if we so choose). I'm not a cycnic. When my faith in human nature teeters, I'm always on the lookout for anything that might restore it.



(NOTE: For others who live in the U.S. or Canada and who'd like to order Breaking the Chain, you can only get it in English from a UK publisher. I bought mine from Amazon UK (the link will lead you straight to the order page)––and you can use your regular Amazon account).