Blood-doping: how elite should athletes be?

The elite women's group quickly make their way off of the line at the sound of the starting pistol on Monday, April 17th, 2017. Photo by Gaelen Morse/BU News Service

By Sarah Wells
BU News Service 

As runners tightly knot their sneakers and apply numbered bibs to their chests in the dim morning light of marathon day, the hard work is behind them.

After months of training and careful physical preparation, the only thing left between them and a celebratory meal is a 26.2 mile stretch of road. At this point, runners may lightly stretch or eat a fueling breakfast, but the outcome of the race is out of their hands.

Some runners, however, take a more drastic race day approach: illegal blood-doping.

In 2014, Boston Marathon winner Rita Jeptoo was stripped of her title and prize money when post competition blood work showed that she had tested positive for a substance called erythropoietin (EPO),  a hormone used to stimulate red blood cell count in patients suffering from kidney failure. It is also commonly abused for blood-doping.

In addition to losing her title and prize, Jeptoo has been banned from competing in the competition until the 2019 race.

But what exactly is blood-doping, and why is it illegal?

As defined by the World Anti-Doping Agency (WADA), blood-doping is a process through which an individual artificially increases their red blood cell count, which increases the amount of oxygen their blood is carrying.

This process differs from illegal steroid injections, which focus on increasing muscle mass instead of physical endurance.

According to Dr. Douglas Comeau, medical director of sports medicine at Boston University’s Ryan Center for Sports Medicine, the increased oxygen flow from blood-doping is what gives athletes a competitive endurance advantage.

“[In] an endurance race your muscles won’t fatigue as much and you can push further than you typically could before,” he said. 

There are two popular methods athletes use to increase their red blood cell count: blood transfusions and medications, like EPO. While preparing naturally for a marathon takes months of incremental training, blood transfusions and EPO are respectively effective within hours to weeks.

WADA includes both of these tactics in their list of prohibited substances and methods in competition. In 2013, the Boston Athletic Association tightened their regulations on drugs and doping to require stricter athlete contracts that outline drug and doping penalties, including prize money repayment.

Part of what makes blood-doping illegal in sports, Dr. Comeau said, is that it goes beyond what an athlete’s body can naturally create.

“If you’re giving yourself a liter of very oxygenated blood then [that’s] performance enhancing because you’re going to have a higher percentage of oxygenated blood not processed by your body [alone],” he said.

While legal specialized training and supplements can increase your body’s natural ability for endurance, methods like blood-doping are artificially increasing that ability beyond natural limits.

But more importantly, said Dr. Nathan Cardoos, an instructor of medicine at Boston University’s Medical Center, it all comes down to protecting the well-being of the athlete.

“The main reason [they’re illegal] is that they are dangerous; they can lead to heart attack, stroke and blood clots,” he said

In a professional sports landscape where athletes feel they need to take such measures to continue to compete competitively, Dr. Cardoos said he wonders what this means for the future of sports. 

“Do we want to see superhumans doing superhuman things?” he asked. “If that’s the case, maybe we should let people push the boundaries of sport. [But] to me, the line is really what’s going to potentially cause harm to the athletes. [It’s] not fair to expect an athlete to put themselves in harm’s way [to] compete.”

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