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Hacking your body: Lance Armstrong and the science of doping

Lance Armstrong Flickr

By now it's widely known that Lance Armstrong finally admitted to doping in an interview with Oprah Winfrey that will air tonight and tomorrow. Armstrong's confession is notable in part because no athlete has fought charges of doping as hard as he has, from public denials to libel suits as well as informal intimidation of teammates, rivals, co-conspirators, and outsiders. But although the two-part interview, spanning two and a half hours, is advertised as having no restrictions, it's unlikely that Winfrey and Armstrong will spend much time explaining the science and technology behind sports doping to the world. This is a shame. With the US Postal Service Cycling Team, Armstrong led what appears to be the most sophisticated doping program ever documented. This may be an ignominious achievement, but it is a remarkable one.

Athletic doping in the 21st century, whether in cycling or any other sport, is part of an athletic enhancement regimen as scientific as nutrition and weight training. It is systematic, both in its programmatic nature and its pervasive reach. In the 1990s and 2000s, these systems may have reached their peaks: besides cycling, baseball is grappling with doping's legacy, as sportswriters pass up giant stars for the Hall of Fame because of suspicion about their use of banned substances.

Doping is thoroughly part of our culture's established obsession with overachievement and competition, and its emerging obsession with posthumanity and biohacking. Both genealogically and philosophically, doping is part of the legacy of Silicon Valley, as are the machines used to test for doping. This isn't cheating in the narrow sense of running a red light or lying on a resumé. This is the credit default swap of cheating. This is the Stuxnet worm. But since it may also be our future, it helps to understand how it works.

What's the difference between doping and blood doping?

"Doping" is used in the broad sense to describe the use of any banned performance-enhancing drug or procedure directly on the body. "Blood doping," which is what Armstrong primarily engaged in, is a specific kind of doping that involves manipulation of the blood, whether through transfusions or hormones. Doping also includes performance-enhancing drugs or PEDs: steroids to boost muscle growth, narcotics to suppress pain, beta blockers to slow the heart rate (particularly helpful for fine motor control), and stimulants to add pep. Banned drugs are generally defined by detection thresholds: caffeine in the blood typical to a cup of coffee is okay, but an amount suggesting a direct injection into the bloodstream is not. The specific substances and methods used and prohibited shift, but these have been the broad categories used by the International Olympic Commission and later, the World Anti-Doping Agency, more or less unchanged since serious testing began in 1972. Arguably, not much has changed since jockeys began giving caffeine and narcotics to racehorses in the 19th century.

Besides PEDs, athletes are typically tested for diuretics and masking agents, which conceal the direct evidence of doping. They are also often tested for non-performance-enhancing recreational drugs as part of morals clauses with leagues or sponsors. This isn't really doping, but it's important because it gives athletes (or parolees, or anyone else subject to drug testing) an incentive to hide their drug use. It's also important in Armstrong's case since he's subject to a federal whistle-blower case regarding the US Postal Service sponsorship of his cycling team, because of the morals clause in his endorsement deal.

Structurally, a doping regime consists of four parts:

  1. taking the stuff;
  2. hiding the stuff you took;
  3. making the stuff work in competition;
  4. maintaining the conspiracy.

Cheating is easy; winning and not getting caught is hard

Besides being a skilled cyclist with natural talent, Armstrong was particularly good at all of these things, successfully evading detection with clean tests over 200 times over a decade, while apparently doping nearly the entire time. According to the USADA's 2012 report, he used the hormone Erythropoietin (or EPO) to boost red cell production and oxygen intake. When blood and urine tests to detect EPO became more accurate, he switched to blood transfusions, essentially an older method of reaching the same outcome. (A retest of Armstrong's 1999 Tour de France sample using current equipment is positive for EPO and tests in 2009 and 2010 suggest the use of transfusions during the event.) He also used human growth hormone as well as testosterone and cortisone, both steroid hormones that build muscle, control pain, and help athletes recover from injury.

An unending arms race between athletes and testers

All of these substances were well-chosen. EPO couldn't be meaningfully detected before 2001, and blood doping and HGH couldn't be detected by tests before 2005. The testosterone would be administered in slow-release skin patches or infused with olive oil, which helped the hormone bypass the liver. Direct injections of EPO also helped avoid metabolization into the urine. As the testing technology got more effective, the riders, coaches, and doctors changed their methods — a kind of unending cold-war arms race between athletes and technicians that's characterized doping for over 40 years. There is still no standard threshold to conclusively determine evidence of blood doping from tests alone so long as an athlete uses his or her own blood.

Armstrong's doping methods were also as sport-specific as the rest of his training. Cycling is less about strength and muscle mass than it is about endurance. Sprinters like Ben Johnson would use steroids during training, administered by doctors and coaches who would rigorously work out the timing to stop using banned substances well before an official event. (In 1988, Johnson was recovering from a hamstring injury shortly before the Olympics and appears to have botched his window, resulting in his famous disqualification after a world-record race.) That long pre-race window doesn't work for doping cyclists; they typically have to take PEDs or perform blood transfusions during events, so everything about their doping regimen must be much more precise.

Athletes use low-tech and high-tech hacks to avoid testing

Besides mid-tech methods like precise timing of injections the night before a race, low-tech methods like infusing testosterone in olive oil, and beyond-low-tech practices like literally running and hiding from official testers, Armstrong and his teammates used a range of masking agents. The most common way the cyclists confounded blood tests was through saline injections, a banned but undetectable practice. The extra hemoglobin and hematocrit cells that help a racer retain oxygen and avoid fatigue can be watered down below official thresholds by adding a saline solution to the blood within just 20 minutes' notice of an imminent test. The USADA report describes how at the 1998 World Championships, "Armstrong’s doctor literally smuggled past a UCI official a liter of saline concealed under his rain coat and administered it to Armstrong to lower his hematocrit right before a blood check."

Ultimately, just as firewalls can be hacked, tests can be fooled, whether through fancy chemistry or brute force. The problem with doping is the problem with any conspiracy: too many people know. Someone has to prescribe the drugs or obtain them on the black market. Someone has to administer infusions of blood or saline. Someone has to alert the other athletes that testers are on the way. You need doctors and athletes who are willing to compromise themselves, and compromised people often end up in situations where they're compelled to talk.

Armstrong, by all accounts, wasn't just the USPS's star athlete and public face, but also its disciplinarian. If a team doctor was caught red-handed with PEDs, or convicted of doping-related charges, as Armstrong's doctor Michele Ferrari was in 2005, Armstrong would publicly shun and denounce him; if reporters wrote that Armstrong was using PEDs, Armstrong would sue them; if a teammate seemed reluctant to use PEDs, Armstrong encouraged him or removed him. The best means of enforcement was shared complicity: if Armstrong went down, everyone would go down.

There are always doctors and scientists who will cross the line

In many ways, figures like Dr. Ferrari are more fascinating than athletes like Armstrong. Competitive athletes obsessively tracking blood cell counts like interval times or routing around the rules to beat opponents is pretty much par for the course. The physicians' and consultants' motives and backgrounds are impossibly wide-ranging, but almost always include great technical skill and an element of hero worship.

Many of them are obsessed with the sport, and with bringing a scientific attitude toward it. Long after he had supposedly been jettisoned from Armstrong's team, Dr. Ferrari (who Armstrong nicknamed "Schumi," after Formula One racecar driver Michael Schumacher) would regularly communicate with Armstrong not just about drugs and recovery times, but with advice to raise his bicycle saddle by 2 millimeters. (Armstrong also paid Ferrari over a million dollars, which is a pretty healthy incentive too.)

Doping technology is part of Silicon Valley history

Victor Conte, on the other hand, was a funk-rock bass player whose wife Audrey Stein ran a holistic health shop near San Francisco before he founded the Bay Area Laboratory Cooperative (BALCO) in Burlingame, California. BALCO was nearly the perfect Silicon Valley startup, a mix of new age ideals and clear-eyed capitalism. Conte's dream beginning in the early 1980s, was to use biometric data, nutritional supplements, and eventually, designer steroids to revolutionize human fitness:

Conte [was] a mercurial eccentric, a driven entrepreneur who built a prosperous nutritional business without any formal scientific or medical background. He did so with unique skills, they said, including a photographic memory that made it possible for Conte to instantly recall complex molecular structures and expertly link them to test results from clients who had been examined weeks, or months, earlier. At the same time, simple details, like routine accounting procedures, could be entirely disregarded, they said.

Conte's primary innovation in doping was the steroid tetrahydrogestrinone, or THG, which was undetectable at a molecular level until the early-2000s. Eventually BALCO was implicated in drug scandals for a huge list of top athletes in all fields, from sprinter Marion Jones to home run champion Barry Bonds.

The enemies of true drug testing have always been money and time

Meanwhile, just down the road in Santa Clara, Hewlett-Packard spinoff Agilent had developed the chemical analysis and computing technology to detect THG. HP performed chromatography and spectrometry tests for the Olympics, beginning when mandatory drug testing was introduced in 1972; now Agilent supplies equipment and technical expertise for the Tour de France. Much like athletes and their bodies, the basic procedure of testing for PEDs, their masking agents, or the signature chemical signs of blood doping or hormone therapy hasn't changed much. The equipment is better, but it's still about heating substances mixed with a gas or liquid (chromatography) or ionizing compounds to detect the "fingerprint" of their molecular weight (mass spectrometry). What's really changed are the software programs that analyze the data, distinguishing noise from signal, processing and matching compounds quickly enough and inexpensively enough to do fairly thorough testing for hundreds or even thousands of athletes. Pitted against the testers are the doctors and athletes, who are still using for the most part the same substances, but with better algorithms and countermeasures to avoid getting caught.

Agilent_-_1972

Hewlett-Packard's Dr. Manfred Donike in the Olympic drug testing trailer in Munich, 1972

After the athletes and the testing technicians come the sports officials, sponsors, team owners, commissioners, players' unions, press, and fans. All of these figures have at least as much incentive to look the other way at doping as they do to root it out. Lance Armstrong will reportedly testify (to Oprah and in federal court) that cycling officials knew there was widespread doping and did nothing to stop it.

This leaves open the question of why doping matters. Contracts were broken; doctors violated the law and ethical standards; competition between athletes was unfair. But professional athletics at the global stage is in no small part about exploring the limits of human potential. We're already in a world where surgery, prescription drugs, and new technology enable us to break our natural limits. If doping were made legal, open not just to professional athletes but to anyone willing to experiment on themselves, who would be harmed? Where is the next Bay Area Laboratory Cooperative?

The only consistent anti-doping policy, whether in medicine or in sports, is that use of banned substances, whatever their effect on performance, risks serious harm while posing no benefits to health. If the long-term and short-term risks of PEDs could be eliminated, and a boost to overall health, not just racing times or home run counts, could be shown, then we all may find ourselves tinkering with our chemistry. Quantified self, you haven't seen anything yet.

The Verge
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