Doping For Gold

  Doping For Gold

Posted by FoM on September 11, 2000 at 07:02:21 PT
By Carl T. Hall, Chronicle Science Writer 
Source: San Francisco Chronicle  

Olympic officials are running their own marathon -- a race against performance-boosting drugs that has no finish line. The Summer Olympics officially begin Friday in Sydney, but one of the most closely watched competitions is already well under way. Drug-taking athletes, desperate for any edge modern medicine can provide, are squaring off against harried officials charged with upholding the integrity of sport. 
For now, at least, the anti-doping forces seem to have gained the upper hand, brandishing a sophisticated new testing scheme that includes, for the first time, a screen for Epogen -- a widely prescribed drug for treating anemia in cancer and kidney diseases. ``Nobody knows how many athletes have been using it, but we know EPO has been fairly widely used for years, certainly in some sports,'' said Dr. Don Catlin, a drug-testing expert at the University of California at Los Angeles and member of the International Olympic Committee medical commission. Designed to stimulate production of oxygen-carrying red blood cells in the bone marrow, the drug is a synthetic, bioengineered version of erythropoietin, a natural hormone, produced in the kidney, that regulates the process known as erythropoiesis. Medical experts say there is nothing natural about athletes taking EPO in massive doses. ``You're basically putting your red-blood-cell production into turbo mode,'' said David Okrongly, vice president for hematology at Bayer Diagnostics, based in Tarrytown, N.Y., a manufacturer of drug-testing equipment being used in the new Olympic anti-doping effort. Enhancing Performance:Athletes have long known that pumping up the red cells could turn an average performer into a superstar seemingly overnight. That used to require transfusions, but studies have suggested that EPO can achieve the same results with a lot less trouble, boosting performance by an estimated 5 percent. ``At the Olympic level, 5 percent is a huge difference, the difference between winning and losing,'' Catlin said. Until lately, the risk of getting caught using EPO was just about nil. ``It's been very difficult to detect because the same hormone is there naturally,'' Okrongly said. A much more significant risk is dropping dead. All those extra red cells thicken the blood and can impair circulation. In fact, EPO is suspected as a contributing factor in some 20 deaths of bicycle racers since 1987. In 1998, revelations of widespread EPO use led to the withdrawal of several top teams from the Tour de France. ``This particular drug has very significant, very serious negative health effects for people who don't use it correctly,'' said Jeffrey Benz, a San Francisco sports attorney and former international figure skating competitor. ``Basically, you can die.'' Science Plays Catch-Up: Although Epogen has long been banned from Olympic competitions, the science of drug-testing has lagged far behind the cutting edge of performance-enhancing medicine. Now, experts hope the new EPO screen -- a unique combination of blood and urine tests -- will survive legal challenges likely to arise in Sydney. Already, China revealed last week that it has cut 40 athletes and staff from its Olympic team, including seven rowers who had failed tests for Epogen. Reasons for the other 33 withdrawals were left unclear, but knowledgeable observers said the risk of embarrassment in Sydney may well have played a role. National teams suspected of doping in past Olympic Games appear to be taking the rules a lot more seriously. The next question is whether the new testing technology -- rushed into place just in time for the Summer Games -- will hold up. It works in two stages. First, a blood sample is tested quickly for evidence of abnormally high levels of immature red cells. Exactly what is the ``abnormal'' cut point is a closely held secret, based on some elaborate research involving speed skaters and other top athletes, including some who can achieve remarkable oxygen-handling capabilities through such old-fashioned means as high-altitude workouts. Anyone found to be packing a suspicious red-cell count must then provide a urine sample for a follow-on test that uses electrophoresis technology to take a molecular fingerprint. This second-stage test is said to be capable of picking out the subtle molecular markers of synthetic hormone not present in the natural version. ``This is going to send a shock wave through the sports world,'' Okrongly said. No Foolproof Approach: Other tests are already in place to combat the use of the more traditional performance enhancing drugs, notably the anabolic steroids and amphetamines. But while the addition of an effective EPO test may tip the balance in favor of a clean Olympics, nobody expects it will be so easy to keep performance-boosting drugs out of the supercharged top echelons of athletics. There is no reliable test for synthetic human growth hormone, for example, a biotechnology drug designed to treat hormone-deficient children, but long touted as a muscle-builder in adults and long suspected of tainting sporting events. Dr. Stephen Rosenthal, a professor of pediatrics at the University of California at San Francisco, noted the hormone has complicated effects, both direct and indirect, which can vary widely depending on dosages, natural hormone production and the age of the person taking the extra jolt. ``The potential benefits in adults who are not hormone deficient have not been thoroughly studied, at least not in young adults,'' he said. ``It does potentially lead to an increase in lean-muscle mass, so you can certainly see how an athlete might find it beneficial. ... But there's a risk and benefit in anything you do, and anybody on a drug like this really should be closely monitored.'' An Uzbekistan team official faced expulsion from the Games last week after he was found carrying vials into Australia labeled as containing the drug. Chemical tests were ordered to confirm the substance was growth hormone, which is banned from Olympic competition. Tests have been developed for detecting potential abusers, but current methods yield a large number of false positives and so will not be used for this summer's Games. Dr. Ray Hintz, an authority on growth hormone at Stanford University Medical Center, said ``there appears to be a great underground belief in the efficacy of growth hormone among athletes,'' even though controlled studies show the hormone brings no significant improvement in athletic performance. Long-term risks also are unknown, but theoretically could include an increased incidence of cardiovascular disease and diabetes. Future Challenges:As if biotech drugs that mimic natural hormones weren't enough to bedevil the sporting world, even more exotic trickery may be just around the corner -- including the distant possibility of performance-enhancing gene therapies. Someday, it might be possible for parents to bestow all sorts of athletic gifts on their children by using the latest fruits of medical research. That's still a long way off, but the issue is already starting to come up as the Games get under way in Sydney. ``Our whole legal and conceptual framework doesn't address this issue at all,'' said Benz, the San Francisco sports attorney. ``It's something the anti-doping authorities will need to take a look at very seriously. Maybe there will be interventions in the womb to create a `superathlete,' which may have to be treated differently than interventions later in life or right before a competition. If it becomes possible to use that kind of technology to somehow change the ability of the human body to perform, then we are going to have to fundamentally redefine the whole idea of doping.'' Perceptions Compromise Games:Even if only a handful of the 10,200 athletes arriving in Sydney actually are using banned substances, the Olympics still suffer from the widespread public perception that cheaters are going uncaught. ``Maybe the wrong people are winning,'' said John White, strength and conditioning coach at the University of San Francisco. ``The Olympics is the elite of amateur competition. I don't like knowing for a fact that a lot of those athletes are taking illegal drugs.'' The Clinton administration has urged stronger measures against Olympic drug offenders, charging that sports authorities have tended to be lax in the past. ``There are too many gaps -- some scientific and some of commitment -- in existing anti-drug and doping programs,'' said White House drug czar Barry McCaffrey. ``Too many athletes still feel they must cheat to compete. As it stands, we risk creating new records that cannot be bested without chemical engineering.'' Banned Substances:You almost need an advanced degree in pharmacology to understand the efforts to fight doping at this year's Summer Olympics. Here are some of the substances that are banned by the International Olympic Committee: -- Stimulants: Used to enhance alertness and provide an extra kick of energy. Includes amphetamines, ephedrines, asthma medications (except prescribed inhalers) and even caffeine (which can be injected as well as taken in coffee drinks) above certain limits. -- Narcotics: Morphine, methadone, heroin and related opiates prone to abuse are banned outright. But codeine as a painkiller is OK. -- Cannabinoids: Use of marijuana or synthetic THC, marijuana's active ingredient, is prohibited. If cannabinoid traces above certain levels are detected in drug tests, the athlete may be disqualified for blood doping. -- Anabolic steroids: Muscle-building male sex hormones and hormone precursors are banned, including nandralone, androstenedione, androstenediol, DHEA and testosterone. Also banned are certain bronchodilators, known as beta-2 agonists, such as salmeterol and terbutaline, unless prescribed and taken by inhaler. -- Hormones: The banned list includes many synthetic forms of natural proteins that can affect sugar metabolism, oxygen-carrying capacity of the blood or other body functions. These include human growth hormone, erythropoietin, ACTH, insulin-like growth factors and insulin not prescribed for diabetes. -- Beta blockers: Blood-pressure drugs known as beta-adrenergic receptor blocking agents can decrease oxygen requirements of the heart and increase work capacity. Examples on the banned list include propanolol (Inderal) and related substances. -- Analgesics: Locally injected pain medications are allowed only when ``medically justified.'' -- Prohibited methods: Authorities also have enacted general prohibitions to cover any form of blood doping, use of artificial oxygen carriers or blood-plasma expanders, and other ``pharmacological, chemical and physical manipulation.'' For more information, visit: Source: International Olympic Committee Medical Commission, Olympic Movement Anti-Doping Code. Secrets In The Blood:Use of performance-enhancing substances is thought to be widespread in the top echelons of sport, prompting a crackdown at the Summer Olympics in Sydney. Much of the attention has focused on Epogen, a hormone drug that boosts red blood cell production. Origin of EPO Epogen is a genetically engineered version of a naturally occuring hormone called erythropoietin. Made by Amgen Inc., it is prescribed for life-threatening anemia in cases of cancer and kidney disease. Use Among Athletes: Studies show EPO can boost athletic performance between 5 percent and 15 percent. However, heavy use can impair circulation. Too much EPO has been blamed for heart problems and the deaths of 20 racing cyclists. Testing in Sydney: The International Olympic Committee approved a new blood-urine test for EPO last month, announcing plans to test 300 to 700 athletes. Pumping Up: Known as erythrocytes, red blood cells are produced in the bone marrow. By increasing the amount of EPO, athletes can increase red-blood-cell production. Blood cells form in bone marrow, a network of blood vessels and connective tissue. Oxygen Shuttle: Athletes burn up enormous quantities of oxygen, the main fuel for the muscles. Red blood cells, which contain hemoglobin, pick up oxygen from the lungs and transport it throughout the body. Doping Scandal: Concern about Epogen use by athletes increased markedly in 1998, when a blood-doping scandal engulfed the Tour de France cycling classic. French customs officials stopped Willy Voet, a Belgian employee of a prominent race team led by Frenchman Richard Virenque, crossing the border carrying large quantities of EPO and other banned substances. Subsequent investigation led to the disqualification of Virenque's team, while several other teams quit the race. Testimony suggested widespread drug use. Sources: The Human Body, An Illustrated Guide to Its Structure, Function, and Disorders and The MacMillan Visual Dictionary How To Reach Us:Comments, questions and suggestions for The Chronicle's Science page are welcome. Reach us by e-mail at: science by fax at (415) 896-1107 or in care of Science Page, San Francisco Chronicle, 901 Mission St., San Francisco, CA 94103. For updated science news throughout the week and links to science Web sites, go to: T. Hall, Chronicle Science WriterE-mail Carl T. Hall at: carlhall Published: Monday, September 11, 2000 Source: San Francisco Chronicle (CA)Copyright: 2000 San Francisco ChronicleContact: chronletters Website: Articles & Web Sites:International Olympic Committee: http://www.olympic.orgNational Commission on Sports and Substance Abuse: Drug Report Draws Ire of IOC Criticizes IOC in Drug Fight Pot From Banned List, Says Doctor Report Will Criticize I.O.C. on Drugs 

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