Note: This is part 2 of a multi-part series i'm writing to cover my thoughts on doping. You can check out Part 1. This article is a shortened version of the full entry made on my blog Jonathan in the Distance, which goes further into the methods used to hide drug use from anti-doping tests.

The previous post dealt with the apparent prevalence of performance-enhancing drugs in sports, and discussed the possible motivations that drive people to use them.

To better understand the nature of the beast, I wanted this post to deal more with the ways athletes can cheat, and the various options there are for doping. It's not a secret in the sports world, and something that most serious athletes and coaches know about as a matter of educating themselves and warning each other. But it is something that most amateur athletes and spectators do not know about, and something which I figured would be enlightening. I think it goes a long way to helping people understand the scale of the problem, and just how much effort has been put into cheating in sports. It's equal parts sad, alarming, disappointing, and outrageous.

I should note that cheating, in the form of performance-enhancing substances, are not new to sports. It's been something that's accompanied sports history, and so not something unique to the modern era. You can compare the following references:

• Total Bike: Doping in Cycling
• Steroid.com: Anabolic Steroids
• Royal Society of New Zealand: The Science Behind Drugs in Sport
• Play the Game: Doping in Sport
• World Anti-Doping Agency: History of Drug-Free Sport

The doping and the drugsI won't go down all the specific substances used for cheating in sports in this post. Regarding the larger array of drugs for cheating, I'll include at the end of the list below a couple of summaries that cover the litany of ways to cheat. For the sake of discussion, the list here presents the major ones that have made the news: EPO, blood doping, human growth hormone, and steroids (including testosterone). I'll also provide some links to each for references.

EPO
EPO's full title is erythropoetin. It regulates the production of red blood cells in the body, and is naturally produced by the human body. Boosting EPO in the body boosts red blood cell count, and so enables greater intake and processing of oxygen to fuel muscle activity. In sports, this allows athletes to process oxygen in higher quantities, thereby allowing them to sustain higher intensities of performance for longer periods of time. EPO tests involve taking urine or blood samples and measuring the concentration of red blood cells (i.e., the hematocrit levels) against a standard deemed to be normal--a hematocrit level above the standard is taken as a positive sign of injected EPO, a level within the standard is taken as a negative sign of EPO use. Useful references:

• http://www.insidetri.com/portal/news/news.asp?item=102983
• http://www.cyclingnews.com/news.php?id=features/2005/epotest_problems)
• http://www.boston.com/sports/articles/2004/04/19/marathon_drug_testing_is_an_uphill_task/

Blood doping
Blood doping is the process by which an athlete receives a transfusion of blood. The transfused blood (i.e., the blood being put into the athlete) has a high red blood cell count, meaning it carries a higher concentration of oxygen. Following the same theory driving the use of EPO, the extra oxygen allows an athlete's muscles to sustain higher intensities of output for longer periods of time. There are 2 methods of transfusion: homologous, where the transfusion comes from blood provided by a compatible donor, and autologous, where the transfusion comes from blood the patient previously extracted and stored. Cheating involving transfusions has increasingly involved autologous transfusions, because 1) homologous transfusions carry the risk of contamination, and 2) while tests exist for homologous transfusions (by detecting foreign cells in a person's body), there are no tests for autologous transfusions. Useful references:

• http://www.velonews.com/news/fea/12924.0.html
• http://www.newscientist.com/article.ns?id=dn6456
• http://en.wikipedia.org/wiki/Blood_doping

Human growth hormone
Human growth hormone (HGH) is pretty summarized by the title: it is the hormone (or set of hormones) responsible for growth of tissue (muscle, bone, etc.) in the human body. As a result, it is used in sport to spur muscle growth and accelerate recovery to allow additional training and performance. While tests for synthetic HGH are available and relatively easy to identify, natural HGH is a major challenge for sports.This is because HGH is a natural product of the human body, and as a result it is not something that yields a productive test showing abuse (i.e., a positive test only confirms a natural process ongoing in all humans). Trying to measure HGH concentrations to a standard isn't effective, since the production of growth hormone in the body naturally varies widely depending on age, environment, diet, exercise, and stress. Recently, however, new tests (i.e., tests separate from those that detect synthetic growth hormone) have been developed that test for hormone-triggered protein markers that are not so susceptible to variation. Reference:

• http://news.bbc.co.uk/sport2/hi/front_page/3101343.stm
• http://www.iht.com/articles/ap/2007/06/18/sports/EU-SPT-Human-Growth-Hormone.php)

Steroids
Steroids serve the function of helping athletes recover faster from workouts, letting them train harder and more frequently so that they generate greater improvements in performance. Steroids have historically not been popular in endurance sports, although testosterone (a type of steroid) has started to make a greater appearance. Testing for steroids involves taking urine samples and measuring the concentration of steroids relative to what is thought to be a normal level for the athlete's population. Useful references:

• http://en.wikipedia.org/wiki/Anabolic_steroid
• http://www.scq.ubc.ca/?p=186
• http://www.cyclingnews.com/news.php?id=features/2006/testosterone_testing)
• http://www.mja.com.au/public/issues/185_08_161006/han10124_fm.html

Other drugs
There are other performance-enhancing substances used for cheating in sports, such as androstenedione (boosts muscle mass), nandralone (builds muscle mass), stanozolol (increases muscle mass), clenbuterol (increases muscle mass), ephedrine (alleviates fatigue), amphetamines (mitigates fatigue and enhances recovery), and insulin (eases fatigue). A couple of good summaries listing them are available:

• http://www.cbc.ca/sports/indepth/drugs/glossary/dictionary.html
• http://www.chron.com/disp/story.mpl/health/4967873.html
• http://news.bbc.co.uk/2/hi/health/medical_notes/3559882.stm
• http://www.swimmersden.com/BndDrgs.htm

The deceptionIn terms of how athletes use any of the above methods to deceive anti-doping efforts, there's a number of methods used in relation to the above substances involving food intake control (i.e., fasting), diuretics, masking agents, and drug cocktails wherein concentrations of individual drugs are legal but their sum effect as a whole has the potency of illegal levels.
In terms of how athletes hide their drug use from the observation of friends, family, fans, and strangers in their daily lives, it should be pretty easy to imagine how performance-enhancing substances are smuggled and used outside of public view or institutional testing (e.g., someone who is intent on cheating isn't going to take a blood transfusion in public, or have vials and syringes delivered openly to their hotel room door). Any athlete who is cheating is likely to use the stealthiest approaches possible (e.g., anonymous deliveries in the night, unmarked bags smuggled to remote locations, etc.). Moreover, cheating athletes are often assisted by the help of enablers--doctors, team-mates, sponsors, acquaintances, even family & friends--willing to engage in escapades to help in the cheating. Illustrative examples abound in newspaper and literary accounts of controversial athletes (notable ones being those involving Tour de France riders). In terms of succinct, general internet references, there are a few useful sources:

• Daily Peloton
• Coach Science
• Times Online
• Royal Society of New Zealand: The Science Behind Drugs in Sport

For the future, the next frontier in performance-enhancement is genetic technology, either in the form of manipulating genes during gestation or at birth, or in the form of gene therapy in living subjects. This poses a host of ethical and medical issues, none of which appear to be resolved. To see the nature of this, check out the following sample of sources:

• MSNBC
• BBC News
• Catalyst
• US State Department
• Sportingo
• The Observer

Given the history of performance-enhancing substances in cheating in sports, the current armada of ways to cheat, and the future threats looming on the horizon, it's pretty clear this is a problem that's thriving. I won't call it an institution; the more accurate term is a black market, and one which has many connections into the legitimate one, to an extent that any evolution or changes in the legitimate sports community is matched by evolution or change in the cheating community. It's essentially an arms race, with every new advancement in testing, detection, and elimination being countered by another advancement in cheating.And unfortunately, as long as we have sports, this race will never end.