The Explainer: Legalize it?

Tosh was talking about recreational reefer. Should the same argument apply to EPO?

Hello Charles,
I hope all is well with you and yours.

I know that you are immersed in the Live Updates and your practice at this time of the year but the latest charges against “The one who will not be named” started me thinking about one of the most quoted arguments I hear against continuing this investigation. On any story about this I hear people say, “Well everyone was doing it so it just leveled the playing field.”

On the surface, this sounds like a logical assumption, but like many logical assumptions, it may not stand up to daily reality. I have been trying to come up with a name of any athlete that was busted for PEDs, who returned, without PEDs, and was back at the top of their sport? In cycling, only David Millar and Ivan Basso continue to contribute to their team, but I don’t think anyone can argue that they are anywhere near the same competitive level in the peloton as before the ban.

So if that is the case, does that mean that the peloton is still doped, or was the peloton not as fully doped in the 1990-2007 era as some are stating? Looking at average speeds and some passport info that has been available, I would tend to believe the peloton is cleaner now, but reformed dopers are not back on top. So would it be reasonable to assume if the peloton were cleaner then, the podiums would have looked different, and the only reason for the people winning was the PEDs? In other words if no one was on PEDs then Riis, Ullrich and Armstrong would not have been winning tours.

Without the “Everyone’s doing it” argument, the “Sporting fraud” argument really stands out, hence the need for this trial.

Does any of this make sense?

Trying to stay classy,

– John in Milwaukee

Dear John,
You do raise one of the most common arguments used to justify doping. Los Angeles Times columnist, Joel Stein embraced the argument in a July 2006 column – “Level the playing field with cheating, doping, lying” – which, it should be noted, came out before news of Floyd Landis’ positive.

I don’t think it’s the cheating, or the medical danger, that makes people hate doping so much. They only hate it because it seems deeply unfair.

That’s why, to level the playing field, we need to legalize doping.

Gee, makes sense, right?

Well, it’s worth looking at just how level that playing field would be.

While the debate focuses on legalizing all performance-enhancing drugs, let’s just focus on what we must assume to have been the most commonly used pharmaceutical booster used during that “Golden Age of Doping,” synthetic erythropoietin – what we all have come to know and love as “EPO.”

Cycling’s Mo’ Better Blues
Now back in the cruder days of doping, before the UCI even bothered to manage hematocrit levels, the bravest riders in the peloton simply took a “more-is-better” approach to the question. In other words, if a little EPO would boost your performance, then a lot of EPO would really ramp things up for you. There was a reason Bjarne Riis’ nickname in the peloton was “Mr. Sixty Percent” and it had little to do with his score on that biology test he obviously flunked in high school.

In that environment, the playing field would be leveled only if riders would be willing to ignore the obvious risk factors of blood clots, thrombosis and cardiac arrest. With 60+ percent of your blood volume made up of red blood cells, your oxygen-carrying capacity would be phenomenal, but the viscosity of your blood would be akin to that of Jell-O™. Obviously, there would be something of a transient advantage for those riders willing to assume more risk … at least until they got to the point at which they died.

In his 2007 book, “The Death of Marco Pantani,” Matt Rendell quotes an unnamed cyclist who recounted the practice of riders sleeping with heart monitors set to trigger an alarm if that rider’s pulse rate were to drop below a given rate. Riders would then wake up – or be woken up – and ride rollers for a few minutes to get their pulse rates back to a point where the heart could comfortably pump that sludge through their circulatory systems.

“During the day we live to ride, and at night, we ride to stay alive,” the rider is quoted as saying.

Sometimes, it didn’t work. As you might recall, there was a spate of deaths of young, seemingly healthy, cyclists back in the late 1980s and early 1990s. More than a dozen cyclists died in their sleep, a horrible statistic that then UCI president Hein Verbruggen told me was an unfortunate coincidence of deaths that could be attributed to pre-existing heart conditions and not on illicit drug use. Of course, those deaths were also coincident with the commercial availability of EPO.

All of that changed for the better in 1996 when the UCI took the first significant step in addressing the problem of EPO use (and both autologous and homologous blood doping) by setting an upper limit on riders’ hematocrit levels. Based on data from a fairly large population sample, the UCI concluded that the mean hematocrit level was 45% in a healthy adult male. By taking the mean, plus two times the standard statistical deviation – or 50% – that standard should cover 95 percent of the population. Two-and-a-half percent would deviate below that range, so they would not present an enforcement problem. The other two-and-a-half percent would naturally exceed 50%, so those riders would have to provide medical records to justify their claim that they fell within that group.

Indeed, at the 1999 Tour de France, there was a ripple of excitement in the newsroom on the day of the prologue, after reporters learned that three riders had exceeded the 50% limit on their pre-Tour medical exams. The UCI soon followed-up saying that the three were able to prove that they had naturally higher rates than that and that three riders out of a population of 189 riders fit within a predicted statistical profile.

So, did that level the playing field?
While the 50% limit did address the immediate safety concerns, critics were justified in saying that it also just established a “license to cheat,” but with an upper limit attached.

If you look at hematocrit data over the years after the imposition of the 50% limit, you will notice that there was a discernible increase in mean hematocrit levels among cyclists. In other words, the data used to establish that limit showed the mean to be 45%. Among cyclists after the limit was imposed, it inched upwards to around 47.3.

There were some notable examples of that. In the 2004 case involving Tyler Hamilton, USADA submitted blood profiles dating back months before he was cited for homologous blood doping at the Vuelta a España. Back at the Tour of Romandie, he purportedly had a hematocrit of 49.2%. That would vary over the months, but USADA also pointed out that medical records showed that Hamilton’s natural hematocrit level was closer to 41 or 42%. He was not the only one whose levels fluctuated.

Now in his “Level the playing field” article, Stein seems to suggest that it would be fair to let everyone ride at – or just below – 50%. It would, theoretically, be a quite level playing field, no?

No, it would not and here’s why.

First, there are qualitative as well as quantitative changes that occur in the blood profiles of riders using EPO.

In a 2001 study conducted by the Australian Institute of Sport – “Detection of recombinant human erythropoietin abuse in athletes utilizing markers of altered erythropoiesis” – researchers found that different test subjects react differently to identical levels of erythropoietin and even to identical hematocrit levels. My 50% hematocrit might provide more or less oxygen transporting capacity than your 50% hematocrit level.

We are, after all, men and not machines. Taking the approach that might work in establishing standards for bikes or Formula 1 racing cars and trying to apply that same standard to human beings doesn’t always work.

And those individual variations may best answer your question about returning dopers.

What doping appears to have accomplished is to select a new population of highly trained, talented and strategically savvy athletes who may have been genetically pre-disposed to derive the maximum benefits from the added boost of performance-enhancing drugs. That doesn’t necessarily mean that those same athletes would necessarily rise to the top in a world of clean riders.

Now let assume for the sake of argument only – I am, after all, doing my best to remain “classy” – that the top 20 finishers of the Tours de France, between Riis’ win in 1996 and Landis’ win ten years later, were all juiced to the gills. Stein’s playing field would be level, right? Wrong.

Were that hypothetical scenario true, it would merely show that the athletes who derived the greatest benefits from doping emerged at the top of the heap in those years. Were the reverse true – that no one had doped – we might see an entirely different set of riders at the top of the results list. We will never know.

So when a rider suspended for doping returns to the peloton, assumedly now clean, and begins to ride not as top GC rider, but as a strong lieutenant, that doesn’t necessarily mean that the riders currently at the top of the results are continuing to dope.

We see slower Tours these days. Times up climbs like l’Alpe d’Huez have actually declined since the record-setting days of the late 1990s and early 2000s. When taken in their entirety, the numbers seem to suggest that cycling is cleaner these days.

Risks both known and unknown
Finally, the level-the-playing field crew fails to take into account the unknown risks of pharmaceutical use, even if it’s seemingly benign at the time.

We all remember Dr. Michele Ferrari’s now-infamous statement that “EPO is not dangerous, it’s the abuse that is. It’s also dangerous to drink 10 liters of orange juice.”

As offended as people were at the time, Ferrari’s assessment was actually pretty reasonable. Anything used in excess presents a danger. He was merely suggesting that medically monitored use of certain drugs, like EPO, might not pose a danger to riders.

Well, on the surface, that actually makes sense. Careful medical monitoring would probably help riders avoid those late-night cardiac deaths. However, that monitoring is conducted with the best medical information available at the time. The long-term consequences of that use may not be part of the picture.

There were, for example, concerns raised about the effect recombinant erythropoietin might have on the body’s ability to produce its own after long-term use.

And we may learn of other consequences only when sufficient data has been collected. For example, in past years, one common recommendation for cancer patients suffering from chemo-induced anemia was to inject something known as “ProCrit,” an EPO variant that would help boost declining red counts. Indeed, I even asked my doctor about that when my own hematocrit levels dropped below 30 last year while I was on chemo.

Nope. The doc said that the Food and Drug Administration had issued a “black label” warning against that use, because the rate of cancer recurrence was actually higher among those patients than those who did not get the injections. Carefully medically monitored does not mean that the law of unintended consequences doesn’t apply.

So, this “level playing field” argument would simply mean that anyone hoping to compete at the top tier of the sport would have to assume – or ignore – the potential risks of taking drugs, simply to participate in the sport we love.

Call me crazy, but I’d much rather see the halting – and hopefully improving – efforts of WADA, USADA and the rest of the pee-in-the-cup crew than I would a laissez-faire approach that would relegate clean riders to fighting it out for lanterne rouge “honors” at the world’s greatest bicycle races.
– Charles

The Explainer is a weekly feature on Red Kite Prayer. If you have a question related to the sport of cycling, doping or the legal issues faced by cyclists of all stripes, feel free to send it directly to The Explainer at [email protected]. PLEASE NOTE: Understand that reading the information contained here does not mean you have established an attorney-client relationship with attorney Charles Pelkey. Readers of this column should not act upon any information contained therein without first seeking the advice of qualified legal counsel licensed to practice in your jurisdiction.

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  1. Chris

    Great article Charles. I would also point out that if EPO were legalized, and testing suspended, riders driven to win at all costs would start taking their EPO with a side of growth hormone, amphetamines, steroids and whatever other agent they thought might help. Not so even afterall.

    Finally, imagine you’re a young cyclist from a poor country who just joined a small Pro Continental team. You dutifully take your EPO but you base your dose on something you found on the internet because you don’t have a medical team. Then you line up against the World Tour teams whose riders have been doping for a decade and fine tuning their dose and mixture of agents to get the optimal benefit, with the help of experts like Dr. Ferrari.

    This poor young cyclist won’t stand a chance in this peloton. I firmly believe we would not know the names of people like Peter Sagan, Thibaut Pinot, Pierre Roland, Marcel Kittel, John Degenkolb etc. in an “even playing field”.

  2. Jesus from Cancun

    It sounds a bit like the debate about legalizing recreational drugs to stop mafia shootings and cartel wars.

    I don’t know what is it, but there HAS to be another way. I believe that legalizing tobacco and alcohol has contributed to too many tragic deaths worldwide already.
    I have been very close to lung cancer deaths, and also deaths caused by drunk driving, and I have wondered how an utopic world without them, and without doping, would be.

    I hope I can live to see it sometime.

  3. scaredskinnydog

    Thanks for a great article. I think a big step in ending PED’s in sport is educating young athlete’s about the potential long term health effects they cause. If you’re aware of the hazardous effects PED’s can have on your body then you’ll be less likely to be tempted to go down that road. My Mom worked in medicine her whole life and one day when I was an adolescent she sat me down and gave me a talking to about steroids. She told me how they worked and the potential side effects. I was offered steroids many times in years to come but never even remotely considered it (even though I have friends who did). A little education early can make a big difference later when it comes time for an athlete to make those kinds of decisions.

  4. Hank

    Great article. Even if doping is legalized, cheating will not go away. The same incentives wil exist as a previous poster pointed out to gain an advantage on those following the rules. SO now you will have doped up athletes already at grave risk adding other enhancements to the PED cocktail.

    There is no way getting around the fact that whether it’s sports or other forms of commerce regulation is needed even though it will never be perfect or completely eliminate fraud.

  5. Alex TC

    “I have been trying to come up with a name of any athlete that was busted for PEDs, who returned, without PEDs, and was back at the top of their sport?”

    Me too. That is, until today.

    Vinokourov has JUST won the Olympic gold!

  6. Rick

    Prohibition works. Not 100%, but it works. Allowing PEDs because some do it is akin to ending any law because some break it. Speeders? Get rid of speed limits. Murder? Make it legal, because some do it. This is a cultural problem, the culture is changing.

  7. bigwagon

    “I have been trying to come up with a name of any athlete that was busted for PEDs, who returned, without PEDs, and was back at the top of their sport?”

    Valverde won a stage of this year’s Tour after a suspension for doping.

  8. Ettore Bombino

    Ivan Basso is one of the few exceptions
    1st Overall Giro del Trentino
    1st AC Arona
    4th Overall Giro d’Italia
    4th Overall Vuelta a España
    5th Overall Tirreno–Adriatico
    1st Overall Winner Overall Classification Giro d’Italia
    1st Stage 4 (TTT)
    1st Stage 15 Mestre – Monte Zoncolan
    1st Gran Premio Industria e Commercio Artigianato Carnaghese
    9th Overall Tour de France

  9. Robby Canuck

    Interesting question, but the quintessential comeback from doping has to be Vinokourov at the London Olympic road race. Talk about redemption.

  10. Mike

    I’m sorry, but @Rick, you must be kidding. Prohibition has never worked in any context, not in the 20’s-30’s for alcohol nor in the greatest waste of public funds in US history (the so-called “War on Drugs”). Arguments about legalizing speeding (really, when have you ever seen anyone doing the speed limit) and murder (again, prohibition doesn’t seem to stop people from doing it) miss the point. The current “anti-doping” regulations distinguish between legal doping and illegal doping. You can use corticosteroids, with the doctor’s prescription even as an elite athlete to treat everything from asthma to saddle sores. Arguably, this increases performance but for some reason we don’t have a problem with it. I’m not advocating a complete elimination of doping rules, I don’t think anyone is. However, to ignore the realities of drug use by 20 year old athletes facing the possibility of millions of dollars in contracts and lifelong glory because of long-term health risks? Cyclist die in their sport from just racing, look at Wouter Weylandt. If they were concerned about their health, they would not race at all.

    Finally, I have had a hard time hearing about the USADA talking about protecting the rights of “clean athletes” only. I find it hard to believe that real due process is happening in any of these processes when dopers have become some kind of boogeymen in our consciousness. Therefore, I do not think that USADA is going to get much traction in the long-term.

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