In the 1904 Summer Olympics in St. Louis, the American Thomas Hicks won the marathon gold in a bold display of performance enhancement: His handlers fed him steady doses of whiskey, egg whites, and strychnine — though now used as a pesticide, the drug was marketed as a tonic into the 20th century, like some sort of Victorian energy drink. He reportedly lost eight pounds over the 26.2 mile race. But poisoned or not, he won.
Doping, in other words, is not a new Olympics problem. Over a hundred Russian athletes have been banned from the Rio Games; in a caper fitting for a Guy Ritchie movie, Russian intelligence agents and anti-doping officers reportedly combined to swap drug-positive urine for the clean stuff in Sochi — no wonder Russia won 33 medals and 13 gold in the 2014 winter Games. It’s been happening forever — even ancient Olympians gnawed on testicles in a bid to boost their strength — and enforcement is relatively new. The International Olympic Committee didn’t start testing for drugs until 1968, after a Danish cyclist had died following an amphetamine-related crash in the 1960 games. But as the Russian saga attests, doping has turned into a full-fledged, international, cat-and-mouse intrigue. And as people start transfusing their own blood and genes start getting edited, it’s only getting intrigue-ier.
Given the surreptitious nature of doping, it’s hard to get precise numbers on its prevalence. A 2015 study in Sports Medicine found that that somewhere in the (wide) range of 14 to 39 percent of elite athletes do some sort of doping. The U.S. Anti-Doping Agency estimates that over 3 million Americans use performance-enhancing drugs. For 2014, the year with the latest data, the World Anti-Doping Agency handed out over 1,600 “anti-doping rule violations” to people from 109 nationalities in 83 sports. As Dr. Dennis Cardone, chief of primary care sports medicine at NYU Langone Medical Center, tells Science of Us, it’s not just Olympians using performance-enhancing drugs. It’s prevalent across sports and age groups, from recreational leagues to world championships. “It’s not uncommon,” he says, “for a 34-year-old to come in and say, ‘I’m going to the gym on the weekends and I do some weight training, and I’m doing anabolic steroids,’” which mimic testosterone and trick your body into building muscle mass, but age you like crazy.
While the drugs themselves haven’t changed that much from year to year, Dr. Cardone says, the way athletes and their staff administer them has. The greatest hits include anabolic steroids and human growth hormone, which, living up to its name, helps with muscle and organ growth — though there’s conflicting research as to how much it really aids athletes. Athletes will also use more common drugs for a boost, like asthma medication or insulin. But the real innovations, Dr. Cardone says, are in the strategies in staying ahead of regulatory agencies: A competitor might schedule their drug use so that they peak at a time when they won’t be tested, so that by the time it’s game day, their biometric levels will be back to normal. The oxygen in your blood is one of the most hackable things. Beyond medications, athletes will use blood transfusions — including their own. “They take their blood, and store it, and then time it according to an event,” Dr. Cardone says. “They will transfer back their own blood, so that they’re getting a thicker blood with more red blood cells to increase oxygen-carrying capacity and improve performance.” (Increasing blood oxygen works: Disgraced cyclist Lance Armstrong used the hormone erythropoietin to increase his red-blood-cell production, which comes in handy in endurance sports.) But if it’s your blood that you’re using — not some foreign substance — it’s harder to track. Which is why regulatory committees are getting more innovative, too. One tactic is WADA’s “Athlete Biological Passport,” where biomarkers are tracked over years, with the goal of finding the effects of doping — a spike in hemoglobin concentration for instance — rather than trying to detect the substance itself. It also acts as a sort of testimony: When American cyclist Chris Horner, then 41 years old, won the Spanish grand tour the Vuelta in 2013, he answered critics by releasing six years of biological passport data, though his results only sparked more controversy.
But, as Oxford ethicist Julian Savulescu noted to Science of Us in an email, performance enhancement isn’t a negative in and of itself. “When the thruster surfboard was developed with 3 fins, rather than 2 or 1, it revolutionised surfing,” he says. “A motor on the surfboard would not. Why is that? It is something to do with what surfing is.” That’s why, he says, the drugs that violate the “spirit” of a given sport — as defined by experts within a sport — are what should be made illegal, like how a drug that removes fear would violate the ethos of boxing. Even though they’re safe, he thinks that beta blockers that reduce anxiety or hand tremors should be banned from shooting or archery, since part of the “test” of each sport is being able to control your nerves.
Regulating doping is only going to get harder. In a column for the British Medical Journal, Savulescu notes the story of Finnish cross-country skier Eero Mäntyranta, who won three golds in 1964; it was later discovered that he had a genetic mutation that gave him 40 to 50 percent more red blood cells than the average person, something that Lance Armstrong would have killed for. But when gene editing where you snip a section of genetic code out for other, more athletic ones — becomes A Thing (which it very quickly is) it will be near impossible to tell whether a red-blood-cell count was a “natural” mutation like Mäntyranta’s or something done in a secretive Russian lab. You could track family histories at a genetic level, Savulescu says, but it won’t be definitive. “You will have difficulty telling the difference between a natural-born freak and a gene-edited freak,” he says. “Of course, if they have 4 legs it will be easy.”