Types of Performance Enhancing Drugs:
A range of performance enhancing substances are being used by cyclists as well as other athletes to achieve their ultimate goal of optimal performance. The term ergogenic aid is an umbrella term for a substance, object or method used to improve or enhance performance1. Ergogenic aids are split up into three sub-categories; pharmacological, physiological and nutritional aids.
Examples of pharmacological aids include the use of human growth hormone, erythropoietin (EPO) and anabolic steroids (androgenic drugs). A recent survey carried out by BBC Sport showed that 14% of regular amateur cyclists said they had taken steroids and almost half knew someone that had2.
Whereas, blood doping and intermittent hypoxic training (altitude training) are examples of physiological aids. Even though altitude training is classed legal by the World Anti-Doping Agency (WADA) blood doping is not due to the underlying health risks involved. These health risks include the hyperviscosity of the blood which can lead to heart attacks, strokes and pulmonary or cerebral embolisms3. The most famous case of an athlete blood doping in recent times is the American Cyclist Lance Armstrong4.
Nutritional aids are essential in the upkeeping of a professional athletes diet. A competitors diet usually consists of 5,000 to 6,000 calories a day, therefore nutritional drinks (i.e. protein shakes) have been developed to provide the performer with the correct calorific intake whilst not over facing them with food. Examples of nutritional aids include caffeine and simple hydration through the consumption of fluids. The use of hydration in competitive cycling has increased massively over the years with teams now focusing on their riders hydration and nutrition levels by monitoring urine sample daily5. A good example of application of this knowledge is the Sky Team strategically positioning staff at pre planned points along the route of stage 19 of the 2018 Giro d’Italia6.
Pharmacological Aids Explained:
What is Human Growth Hormone (HGH)?
Human growth hormone is an illegal synthetic product copying natural growth hormone to increase protein synthesis for muscle growth, recovery and repair7. HGH can be administered intra-muscularly so taking the drug is a conscious act which means it is unlikely to be administered accidentally. Some cyclists take this drug to increase lean muscle mass and strength meaning they can exert a larger force of contraction (whilst concentrically contracting their muscles) to create a greater power output. Due to the size of the muscle increasing this allows for a greater force. Therefore the surface area (S) of the muscle is directly proportional to the power output (P). This can be seen in this equation S = KP (where K is the constant of proportionality) or S ∝ P. Greater power to a cyclist means an increased sprinting and climbing ability. As well as increased strength HGH also increases the speed of recovery. This means you can train for longer and at a greater intensity enabling the performer to repeat and go again.
The direct negative effects of taking HGH are diabetes in prone individuals; worsening of cardiovascular diseases; muscle, joint and bone pain; hypertension and cardiac deficiency; abnormal growth of organs; accelerated osteoarthritis8 and in some cases it can be even worse where life expectancy has been known to be significantly reduced. Furthermore, the indirect negative effect include the sanctions taken if caught and the knowledge of winning a race by unfair means.
An example of an elite performer abusing this drug in competition is Bjarney Riis throughout his illustrious career in cycling. He won the 1996 Tour de France but later admitted to abusing HGH during the race. He later said that “for a time doping was a part of everyday life for me”9.
What is Erythropoietin (EPO)?
EPO or recombinant erythropoietin (RhEPO) is an illegal synthetic product copying natural erythropoietin hormone responsible for red blood cell production7. Just like HGH, EPO is unlikely to be taken by accident due to the nature of how you intravenously inject it. The World Anti-Doping Agency (WADA) has deemed this drug illegal due to it having potentially dangerous side effects. However, some athletes, including cyclists, use EPO because it increases red blood cell and haemoglobin count which deliver oxygen to the working muscles. So the presence of more haemoglobin and red blood cells allows the performer to have a greater oxygen carrying capacity which can lead to an increased VO2max. An athletes VO2max is the maximum volume of oxygen inspired, transported and utilised during a minute of exhaustive exercise10. So, as an athlete the higher the VO2max the longer and harder they can perform. It has been reported that athletes show an increase of up to 15% in performance when using RhEPO11.
The direct negative impacts of taking RhEPO are that it can lead to an increased blood viscosity (hyperviscosity of the blood). Hyperviscosity relates to the thickness of the blood and leads to an increased risk of several deadly diseases, such as heart disease, stroke, and cerebral or pulmonary embolism. The misuse of recombinant human EPO may also lead to autoimmune diseases with serious health consequences12.
An example of an athlete who was reported to have abused RhEPO was amateur Belgian cyclist Johan Sermon who died in his sleep due to a heart attack on 12th February 2004. It is rumoured that he was taking RhEPO which lead to the heart attack. Even though his autopsy was unclear 29.2% of 150 riders at the time showed that they used RhEPO when tested by the French cycling federation's doctor, Armand Mègret13. However between 1990 and 2007 at least 30 otherwise healthy competitive cyclists died of complications connected to EPO14 and in 2013, the French Senate published results of new tests from the 1998 Tour de France, showing traces of RhEPO in the blood of 18 riders including Pantani and Jan Ullrich. Cycling’s governing body, the UCI, dispute the validity of these findings15.
What are Androgenic Anabolic Steroids (AAS)?
Androgenic anabolic steroids are a group of illegal synthetic hormones resembling testosterone to promote protein synthesis for muscle growth, recovery and repair16. They can be administered orally or injected intra-muscularly (just like HGH). Supplements being sold in the health and fitness industry were examined by a group of leading scientists and found that 23 out of 24 of those tested included anabolic steroids when not advertised to contain them, this shows that anabolic steroids can be accidentally taken by performers17. Some performers, such as cyclists, take anabolic steroids because they can increase muscle mass and strength. This will benefit a cyclist because it will mean that they will have a greater power output, so will therefore be able to improve their sprinting and climbing performance. Furthermore, anabolic steroids lead to a decrease in fat mass. This enables a rider to become lighter so their power to weight ratio will allow them to improve their climbing ability.
The direct negative impacts of a cyclist taking AAS include liver damage and potential heart failure. Furthermore anabolic steroids lead to a potential decrease in fertility. Also, abuse of AAS can lead to mental problems as well. These include; psychosis, irritability and impaired judgement. People who intravenously inject AAS have an increased risk of AIDS due to them injecting themselves using syringes18.
An example of a cyclist using Androgenic Anabolic Steroids is Lance Armstrong. He was banned in 2012 from all competition after finally admitting to using performance enhancing drugs (PED’s). The US Anti-Doping Agency (USADA) filed doping charges against him and placed Armstrong at the centre of a large doping programme. He was also stripped of his 7 Tour de France titles as well as the other races he won in his career19.
Physiological Aids Explained:
What is Blood Doping?
Blood doping is an illegal method of increasing red blood cell content by infusing blood prior to competition20. The process of blood doping isn’t a quick procedure, in fact it can range from 2 weeks to even 2 months to complete. The process of blood doping is very simple and the final outcome is very similar compared to the outcome of using EPO. Around four weeks prior to competition blood is taken out the performers body. Whilst this blood is out of the body it is frozen in ideal conditions. At the same time the body is naturally replenishing the lost blood cells to make up for the deficit. Then a couple of hours before competition the blood is then re-injected into the athlete, this means that they will have a higher blood cell count, so therefore will have a higher oxygen carrying capacity. This is very beneficial for cyclists because they will be able to exert a greater force for longer due to an increased VO2max. Most successful blood doping attempts result in a 10% higher haematocrit, which is the index used to measure blood solids, including red blood cells21.
The direct negative impacts of a professional cyclists using blood doping as a method of enhancing their performance is that they will have a higher risk of becoming HIV positive and therefore could develop into the AIDs virus due to them injecting and extracting blood from their bod with needles. In addition, another risk of blood doping is that an increase in blood viscosity can increase the risk of blood clots and heart failure.
A famous cyclist who has partaken in blood doping during competition is Tyler Hamilton, a rider alongside Lance Armstrong. In an interview Tyler said that “Eventually, I talked myself into it [by thinking] everyone is doing it, it's not cheating.”22. Further evidence to back up his claim was later discovered. During the 7 year period that he rode alongside Lance Armstrong 61 out of 70 riders (80%) that finished in the top 10 each year were confirmed as dopers or were suspected of doping23.
What is Intermittent Hypoxic Training (IHT)?
Intermittent hypoxic training (IHT) is interval training with work intervals performed under hypoxic conditions24. IHT is another term used to describe altitude training. This physiological aid is classed as legal by the World Anti-Doping Agency (WADA) because it does not harm the performers health to the same extent as illegal methods of performance enhancing. Athletes such as cyclists prefer to train at altitude because it can increase the rate of adaptation to training, increase red blood cell and haemoglobin volume, oxygen-carrying capacity and red blood cell production. A study carried out by Arnie Baker and Will Hopkins found that the average athlete had an enhancement of 2-3% in performance whilst merely living at an altitude of around 2500m (8000ft)25.
Even though IHT is classed as a legal ergogenic aid by WADA it still has its health drawbacks. A direct negative impact of using IHT as a training method is that any benefits gained can be quickly lost unless the training is maintained. Furthermore, one of the more serious health impacts of using IHT is that it can cause high altitude cerebral edema (HACE), this is where fluid can cause brain tissue to swell, and high altitude pulmonary edema (HAPE), this is where fluid builds up in the lungs26. These both can be caused by training and spending a lot of time at high altitude.
An example of a cyclist that uses IHT as a main training method is Nairo Quintana who is nicknamed “El Cóndor de los Andes” (Condor of the Andes). He was born in a town called Cómbita which is 2825m (9268ft) . This town is classed being at altitude. He is known for his strong hill climbing ability and high power output. However, other professional cycling teams ,such as Sky, use this method a lot. For example the sky team complete a high altitude training camp each year in Tenerife and focus their riding around Mt Teide.
Nutritional Aids Explained:
What is Caffeine?
Caffeine is a stimulant used to heighten the central nervous system and mobilises fats to prolong aerobic energy production27. Caffeine is a legal method of enhancing performance and is not just used by elite athletes. For example caffeine is contained in tea and coffee which millions of people consume every day. However, athletes consume the substance a different way. Energy drinks, tablets and gels have been developed into easily stored and accessible products that contain caffeine and are convenient to consume by an athlete (cyclist) whilst competing and training. There is evidence that consuming 3-9mg per kilogram of body weight (2-6 cups of coffee) an hour before performance can increase the aerobic capacity of performers28.
A direct negative impact of taking caffeine is that it has a diuretic affect. This means it can lead to dehydration, insomnia and anxiety. Furthermore it has been found lead to complicated gastrointestinal problems. In addition Jack James (a professor at the university of Reykjavik) investigated the affect that caffeine has on a cyclist. His results showed that although it increased performance it also led to problems such as; physical dependence and withdrawal symptoms. These consisted of sleepiness, lethargy and headaches29.
In cycling (whether it be professional or amateur) caffeine is widely used. Sky cycling team is a good example of using caffeine in professional cycling. This is because their director of cycling , Sir Dave Brailsford, is a firm believer in ‘marginal gains’. At Sky they make sure everything is correct in order to be the best. Brailsford is quoted to have said “The whole principle of marginal gains came from the idea that if you broke down everything that could impact on a cycling performance — absolutely everything you could think of — and then you improved everything little thing by 1%, when you clump it all together, you're going to get quite a significant increase in performance. So we set about looking at everything we could.”30.
What are Nitrates?
Nitrates are inorganic compounds which dilate blood vessels, reducing blood pressure and increasing blood flow to the working muscles31. They are contained in natural organic products such as; beetroots, cabbages and other root vegetables as well as being found in supplements in its chemical form. Nitrates enhance the performance of a professional cyclist by decreasing the viscosity of the blood (hypo viscosity). This helps the athlete perform to a higher aerobic standard because more blood can be pumped out the heart per beat (a higher stroke volume). Therefore, due to Starlings law, the higher the stroke volume the higher the venous return (blood returning to the heart). Swedish researches in 2007 investigated the molecules impact. Their research was then carried on by Andy Jones of Exeter University and found that it can make an amateur cyclist 2% faster, even though the effects weren’t as prolific on elite cyclists there was still some improvement observed32.
Direct negative impacts of athletes using nitrates and nitrate supplements as ergogenic aids include; headaches, dizziness/light-headedness. Even the long term effects are unclear there is some evidence behind there being a carcinogenic risk involved when taking nitrates.
An example of a professional cycling team using nitrates is Orica Scott. In the 2017 Tour de France they employed a high performance chef, Hannah Grant, who travelled the route with the team around France in order to find fresh and new ingredients to fuel the riders. One of the main ingredients she liked to use was beetroots and broccoli. Both of these vegetable are rich in nitrates33.
Why do Some Athletes Take PED’s and Others Don’t?
Athletes are generally in peak physical condition. However, some athletes may have long-term conditions, such as asthma, that require medical intervention. Additionally, athletes, like any member of the general population, are not immune to short-term conditions such as coughs and colds. Drug treatment for any of these conditions requires vigilance in relation to athletes.
Drugs are used widely within society, throughout the world, for social and recreational purposes. These drugs range from caffeine, a constituent of many beverages, through to illegal drugs of abuse, such as cocaine. As members of society in general, athletes may follow these trends towards social or recreational use of drugs.
Athletes are constantly striving to achieve excellence within their chosen sport. There are many factors which can influence an athlete’s attempt to reach this goal which may include resorting to the use of performance-enhancing drugs. In addition to an athlete’s innate ability and commitment to training, through research I found out that there are many external factors that influence performance and the attainment of the ultimate goal of being ‘the best’ which I will outline here.
Why Performance Athletes Take Performance Enhancing Drugs:
Politicians often want to enjoy their nation’s success in sport and this can lead to a great deal of pressure on an individual athlete and teams to use whatever means at their disposal to win and attain status for their nation. The Russian athletics scandal highlights the pressure put on coaches and athletes recently, but this is not just a contemporary issue. Throughout history, and particularly during the cold war, nations have put undue, illegal and immoral pressure on sportsmen and women. In the 1970’s and 1980’s, drug taking was rife among East German sports competitors. This state-sponsored doping regime played a decisive role in the massive success of East German athletes in international competitions, especially in the 1976 Montreal Olympics and the 1980 Moscow Games2nd book.
The monetary gains today are so substantial for winning-high profile sports competition, along with the associated status and future earning capacity. This significant level of reward can motivate sports performers to cheat and to take performance-enhancing drugs. Successful athletes not only receive large amounts of prize money, they also attract lucrative sponsorship deals with global commercial companies2nd book. An example of this is Lance Armstrong losing his contracts with Nike, Anheuser-Busch and Oakley after he was found out to be doping. However from the name he created for himself whilst cycling he formed his own brand ‘Livestrong’.
Another reason that elite performers take illegal drugs or use blood doping is because some of them think, ‘Everyone else is taking them so why shouldn’t I?’. In some activities, such as competitive cycling, illegal use of sports-enhancing methods has become much more the norm, with a record number of cyclists being caught cheating. Some people in sport promote the idea that because there is so much drug taking and because it is now so hard to detect new and developing substances you might as well accept drug taking as part of sport. This latter depressing view may not be prevalent, but it shows how difficult it is for those who want sport to be fair and healthy for all to keep sport drug-free2nd book.
Elite performers are under an immense amount of pressure to succeed – from coaches, family, friends, other performers, and of course, themselves. This pressure affects the performer’s judgements and decision-making, resulting in decisions that they will ultimately come to regret. The pressure can lead to performers to resort to illegal means to make just enough difference to win. The influence of coaches is often underestimated because they, too are under pressure to succeed and some strive to bask in the glory of the performers they coach.
Some performers take performance enhancing drugs because they don’t think they are good enough to push up to the next level in their sport. For example, if a sprint cyclist was at county level but not quite the standard of international then they might take androgenic anabolic steroids to increase muscle mass and to decrease their sprint time. Therefore they could then push on with their sport and rise to a higher standard. Just 3 years ago 46 year old amateur cyclist, Robin Townsend, has been banned for four years following an Adverse Analytical Finding (AAF) for recombinant erythropoietin (EPO). This means that his haematocrit was found to be above 50%37. Also, in a poll carried out by BBC Sport they found that 35% of amateur sports men and women knew someone who had doped and 8% had admitted to have taken steroids38.
For other athletes they think the risk I worth taking and believe that they won’t be caught even with all the new procedures in place. This can be helped by some athletes having specific genes that can outwit doping tests. An example of this is that a group of 55 men in Sweden were all injected with the same hormone which was testosterone. They then had to carry out a doping test and provide samples of urine. 33 tests came back positive however, 17 tests came back negative. Researches have blamed this on them being able to build muscle with testosterone but because they are missing both copies of a gene responsible for converting the testosterone into a form that dissolves into urine. The result is that they may be able to take testosterone with impunity39. A graph on the mail on Sundays website shows that 22% of Africans, 10% of Caucasians, 7% of Hispanics, 66% of Asians and 77% of mixed raced people carry the impunity gene40.
Why Performance Athletes Don’t Take Performance Enhancing Drugs:
Even though some athletes can avoid becoming caught via doping tests, the tests themselves have come a long way in the last 20 years. Equipment used is a lot more sensitive and specific to individual substances. This means testers can find smaller amounts of PED’s being used. Since 2001, WADA has committed US $73 million dollars to research. Furthermore, WADA has funded projects to crack down on performance enhancing, examples include: compounds/methods enhancing growth and oxygen delivery, exogenous and endogenous anabolic steroids and detection of prohibited substances/methods41.
Furthermore, teams are forced to disband due to the bad publicity they have built when one of their riders are caught doping. Not only this, but the companies that sponsor the cycling teams can be affected as well. The company won’t get the same brand recognition as they did before because the companies name will not appear on the front of the riders jerseys. For example, in the case of ‘Festina’ they had to create a foundation in order to counter doping. This was called the ‘Fondation d’Entreprise Festina’ which took investment but gained very little publicity.
A lot of athletes choose not to participate in the consumption of performance enhancing because they want recognise the importance of being a good role model for young athletes and for generations to come. Furthermore, the side effects and negative impacts of taking performance enhancing drugs are better known. This is evident by looking back at history and the case of Tommy Simpson, the cyclist who died riding his bike in the 1967 Tour de France whilst under the influence of amphetamines and alcohol (two popular PED’s at the time). Another reason is that some competitive cyclists value their health over the course of their whole life compared to success during a short cycling career.
Since the early days of cycling, training methods, equipment, analysis and nutrition have been improved dramatically, this means that elite cyclists can improve performance without using illegal methods. For example, the use of cryogenic chambers are now common in elite sport to aid recovery. To the extent at which this is now being used in amateur teams as well e.g. Caldy RFC. Wind tunnels and other aerodynamic analysis has helped to develop ‘teardrop’ shaped helmets in order to reduce air resistance acting upon the rider. This is evident in the new Boardman Performance Centre. Performance analysis has also improved over time with the use of limb kinematics and improved data obtained from a rider, example being power metres equipped to a bike. Finally, Hannah Grant (a nutritionist and Michelin star chef) who works for team Orica Scott has revolutionised the way that nutrition is used in cycling. This is by using freshly sourced ingredients and reinventing dishes to prevent tedium33.
Also, countries don’t want their athletes doping because it builds a bad reputation for the country and can cause national embarrassment if they are caught to be cheating. For example Russia was recently found to be carrying out a state sponsored doping regime for Winter Olympic athletes. Consequently 47 athletes and coaches were banned from travelling to the South Korean Winter Games. However 169 Russians competed as independents42. Therefore, this reduces the chances of hosting other major sporting events, this can reduce the funding they get for sports and can overall reduce the country’s economy.
Should Performance Enhancing Drugs be Allowed?
The debate regarding the legalising of performance enhancing drugs has been around for years but has never really reached an outcome. The information above gives a purpose to this debate by providing an insight into how people cheat and specifically how they enhance performance.
The debate about drugs in sport consists of two sides. Legalising the use of PED’s in cycling and keeping them illegal to use. Many scientists over the years have started to believe that they should be allowed and that there should be a control of substances. This is where the National Governing Bodies (NGB’s) control who they gives the drugs to, how much they give out and what individual drugs they provide as well. An example of this is Julian Savulescu a professor of ethics at the University of Oxford, argues that governing bodies should regulate rather than ban drugs used to enhance athletic performance43.
Why Performance Enhancing Drugs Should Be Allowed in Competitive Cycling:
Increase in Commercial Activity:
The use of PED’s in sport will increase the tempo and standard that the game is played at. This will lead to more ‘spectacular’ sport. Consequently there will be an increase in commercial activity because the sports will attract more spectators to watch a better game. Also, the sports themselves will become wealthier because they won’t receive the same amount of bad press because the use of PED’s will be legal. An example of a sport losing funding and commercial backing is the Tour de France when it came to light that Lance Armstrong had been doping. This made companies think twice about being associated with individuals or sports where there may be a doping culture. This resulted in them losing TV rights etc44. Cycling is still not clean, and never will be. The financial rewards involved in the sport always create a temptation to cheat. But thanks to the anti-doping agencies (like Wada and its affiliates such as USADA), it is cleaner than it has been for decades. Thanks, too, to outspoken anti-doping advocates like David Millar and Jonathan Vaughters – who have seen the damage done to the sport by their own and others' doping experiences – the image of the sport has changed, and with it, the attitude of sponsors. The smart money in cycling now favours clean teams.
Creates a Level Playing Field:
Natural talent plays a big part in elite sport as many scientist look at sport being a ‘genetic lottery’. An example of this is the ACE gene. This gene is responsible for the control of blood pressure by regulating volume of fluids in the body. If you have one variation of the gene you will be better at short distance events whereas if you have the other variant of the gene you will be better as long distance events. This is a prime example of why Black Africans do perform to a better standard in short distance events because they have a higher proportion of fast twitch fibres compared to slow twitch fibres. Finish skier Eero Maentyranta was found to have a genetic mutation that meant he ‘naturally’ had 40-50% more red blood cells than average45.
RhEPO has been used in cycling for many years like I mentioned above. RhEPO is used to increase the amount of red blood cells and the amount of oxygen that is carried to the working muscles. It also raises the packed cell volume (PCV) which is the percentage of the blood compromised of red blood cells46. Increasing your PCV above 50% can increase the risk of a stroke and hypertension47. Furthermore, EPO is extremely hard to detect, therefore its use has continued. Italy’s Olympic anti-doping director observed in 2003 that the amount of EPO sold in Italy outweighed the amount needed for sick people by a factor of six48. Increasing your blood cell count by using RhEPO and using altitude training result in the same outcome, although the first method is illegal. Some athletes can afford to go to foreign countries to train at high altitudes however many athletes don’t have access to this. Is this fair?
Permitting drugs in sport could decrease the amount of economic discrimination. A hypoxic air machine and tent (which provides the same effect of altitude training but at sea level) costs around £3,85049. Sending an athlete to a high altitude training camp can cost even more. This method of raising an athletes PCV can discriminate against the poorer athletes. In this case the illegal forms of performance enhancing that will level the playing field in this case. This shows that it will be economically fairer to allow illegal drugs in sport.
Epogen is a popular form of RhEPO which is used in cycling and costs around $86 for 6000 international units (IU). The maintenance dose of EPO is typically 20 IU a week, or 8,600 IU a month50. This means it will cost an athletes around $120 a month to use. Even if an athlete used Epogen 4 years before competition (a macro cycle) it would still be cheaper than using a hypoxic air machine or sending an athlete to an altitude training camp. Naturally there is a limit on how much haemoglobin a person can produce which puts a ‘natural cap’ on how much money can be spent on using this method. This means it is cheaper to dope than to train at altitude. Finally, instead of spending so much money on the testing of athletes it should be spent on providing poorer athletes with EPO and PCV testing kits so they can test the viscosity of their blood.
Control of Substances:
There is only one major concern in the legalising of drugs is safety because safety always comes 1st in sport. The International Olympic Committee (IOC) would not want athletes dyeing before, during or after competition. The control of substances would result in only the safe drugs being permitted and to continue to ban and monitor drugs that are safe. An example of taking unsafe drugs is the East German Athletes in the 1960’s. They underwent systematic government sanctioned prescription anabolic steroids, and were awarded millions of dollars in compensation in 2002. In addition, some of the female athletes had been compelled to change their due to the large quantities of testosterone they had been given51.
A strategy to prevent the consumption of unsafe drugs is to permit the use of drugs that aren’t harmful – for example amphetamines. The main goal should be to ban performance enhancing drugs based on whether they are harmful and not their ability to performance enhance.
Due to the increases testing of an athletes health instead of testing for drugs there would be a greater incentive to develop safe drugs compared to nowadays where the main goal is to develop non detectable drugs. The drugs used in sport would then become safer which could potentially lead to less drug related deaths in sport.
The American Sailor Kevin Hall lost his testicles due to cancer, meaning that he required testosterone injections to remain healthy. As testosterone is an anabolic agent, he had to prove four separate governing bodies that he was not using the substance to gain an advantage52. This shows how the control of substance abuse can lead to the safe use of drugs in sport.
Some sports are dangerous enough without the use of performance enhancing drugs. For example, heart attacks, high blood pressure and pulmonary edema (HAPE). Deaths related to sport was a huge problem in the 1980’s and 90’s. At least 121 US athletes collapsed and died directly after or during a training session or competition – most often because they had hypertrophic cardiomyopathy or heart malfunctions53. Therefore the main priority is the athletes safety, for example if a cyclist is anaemic and needs RhEPO to treat that then the main focus shouldn’t be on the fact that they are using performance enhancing drugs it should be how can we treat them safely with RhEPO in order to allow them to compete.
Increase in Spectacular Sport:
Ancient Olympic athletes attempted to boost testosterone (the hormone that anabolic steroids are designed to produce) by eating sheep testicles, a prime source for testosterone. In the Roman era, horses were fed substances that were believed to make the horses run faster in chariot races, and gladiators ingested substances that were supposed to make their fights more spectacular by pumping them up for the contests54. Furthermore, the use of performance enhancing drugs in sport will lead to faster and stronger sport. Which, coincidentally, are two of the three parts of the Olympic motto. Sport will be more aesthetically pleasing as well. Bigger power outputs on climbs and more speed will lead to a greater spectacle to watch.