Why Do You Think They Call It Dope?

This continues last month’s posting about Greg LeMond’s three Tour de France victories by exploring professional cycling’s “dark era” between 1991 and 2012. This period was characterized by the widespread use of blood doping and performance enhancing drugs (PEDs), as well as the failure of professional cycling to police itself. Sadly, LeMond may be better known for crusading against these infractions than for his three Tour victories.

As the 1991 Tour de France commenced, LeMond considered himself in better shape than in 1989 or 1990 and comparable to his condition in 1986, before his hunting accident. He started strong, capturing the overall lead after Stage 1 and regaining it in Stages 8 through Stage 11. Entering the Pyrenees for two days, LeMond finished about seven minutes behind each day’s stage winner and found himself just over five minutes behind the overall leader. When the Tour entered the Alps in Stages 17 and 18, he lost more time and found himself in tenth place, 14 minutes behind eventual winner, Miguel Indurain. Over the final stages, LeMond rallied to finish in seventh place, a bit more than 13 minutes behind Indurain.

Tour de France winners are typically determined in time trial and mountain stages, which are extreme tests of riders’ endurance. In the intervening stages, contenders ride surrounded by their team in the peloton, keeping track of rival contenders and conserving energy. However, the 45.4-mile individual time trial in Stage 8 of the 1991 Tour was not followed by a recovery day, and LeMond later commented, “the race never got slower, never slowed down on certain days, which it did traditionally, because everybody got tired at the same time.” One year after he won the Tour and his team won the top team classification, “not one of us could follow the pace in the pack,” he later told the French newspaper, LeMonde.

LeMond’s competition on the Tour was truncated by an era of other cyclists’ use of PEDs, and he retired from professional cycling in 1994. PEDs in professional cycling has too long a history to recount here, so I’ll skip the use of drugs such as strychnine and cocaine and concentrate on the more recent past. When the Tour de France initiated drug testing in 1966 after professional cycling banned PEDs in 1965, amphetamines were cycling’s drug du jour. As stimulants, amphetamines cause athletes to tire more slowly, so their appeal to cyclists in multi-stage endurance contests, such as the Tour, is obvious. Involvement by the International Olympic Committee led to improvements in drug detection methods, and by 1967, amphetamines became one of the first products detected through drug testing. However, pharmaceutical advancements soon produced other drugs that both enhanced performance and proved more difficult to detect, and enforcement efforts waned.

Physiologically, performance in endurance sports requires both muscle mass and aerobic capacity. Although first used in “strength” sports, anabolic steroids, particularly synthetic testosterone, creeped into professional cycling in the 1980s, and steroid use became widespread in the 1990s. Testosterone proved particularly beneficial to cyclists because it not only increased muscle mass, but also accelerated recovery. Testosterone gained even more favor when cyclists discovered that the drug remains active for only a short time and that they could thwart the urine test developed to detect its presence by using “masking” drugs to flush the drug’s remnants from their systems.

Also in the 1980s, biosynthetic human growth hormone (HGH) became commercially available and, by the 1990s, found its way into professional cycling where it was often paired with anabolic steroids. Human growth hormone is produced in the pituitary gland and regulates muscle and bone growth. As an FDA approved and regulated drug, the biosynthetic version was developed to treat children with growth deficiencies and later, became used to combat HIV-related weight loss. However, professional cyclists used it to build muscle and improve athletic performance, but this effect has not been proven and demonstrates the extent that professional cyclists would go to gain a competitive edge.

Blood doping had been part of the Tour before the 1990s. It is the introduction of additional red blood cells into a person’s blood stream, either as transfusions of someone else’s blood or re-infusions of the cyclist’s own blood. The science of doping is straightforward. Red blood cells carry oxygen to muscles, and muscles use oxygen to transform nutrients into molecular fuel that enables muscles to perform. Higher red blood cell levels mean higher oxygen amounts delivered to muscles, allowing them to perform harder and longer before fatigue, thus increasing endurance. For cyclists, transfusions and re-infusions posed logistical issues because blood has a shelf-life of only several weeks when it is outside the body, and it must be kept at temperatures of about 40° F, or less.

In the 1990s, these procedures fell out of favor with cyclists due to the emergence of a new drug, rEPO, or simply EPO. Developed for patients with chronic kidney disease and anemia, EPO became available in 1989, as a synthesized naturally occurring hormone, erythropoietin, which stimulates bone marrow to produce red blood cells. Cyclists on EPO were able to increase their hematocrit level, the percentage of blood comprised of red blood cells, to 55% to 60%. This compares to an average hematocrit level for a typical adult male of 38.3% to 48.6%, according to the Mayo Clinic. However, clotting occurs when hematocrit levels get too high, and the deaths of nearly 20 European cyclists over a 4-year period were associated with EPO. For many professional cyclists, this risk was outweighed by EPO’s enhanced performance boost and the recognition that there was no test to detect the drug. By the mid-1990s, EPO use by professional cyclists had become common, along with amphetamines, steroids, and human growth hormone.

Perhaps no single event is more indicative of drug prevalence among professional cyclists than the Festina Affair. Just before the start of the 1998 Tour de France, custom agents at the Belgian-French border uncovered a cache of drugs and drug paraphernalia in a vehicle of the Festina cycling team. Tour officials expelled the entire Festina team, and subsequent testing revealed the presence of HGH, amphetamines, steroids, corticoids, and EPO in its team members. As the investigation spilled over into other teams, a number of riders withdrew from the Tour. Arrests followed, and teams, riders, managers, and doctors were banned from the 1999 Tour.

By 1997, the Union Cycliste Internationale (UCI), cycling’s world governing body, became concerned about the prevalence of EPO in the peloton, but its enforcement efforts were hamstrung by lack of a test to detect the drug. Since EPO has the effect of increasing the number of red blood cells, UCI elected to suspend any rider whose hematocrit level exceeded 50%, although this gave riders the license to dope up to that level. Fortunately, two French doctors developed a urine test for EPO in 2000, and the first positive test by a cyclist promptly occurred in 2001. Later in the same year, Lance Armstrong recorded a positive test in the Tour of Switzerland, but his result was classified as negative because his red blood cell level did not cross the test’s established threshold.

The first EPO test was time consuming and difficult to administer, but testing enhancements soon followed. This led to re-tests of cyclists’ urine, stored from prior year events, and in 2005, Armstrong again tested positive, based on a 1999 sample. However, there was no established procedure for dealing with re-tests, so no penalties were imposed. As EPO testing improved, many cyclists returned to re-infusing their own blood, which testing could not detect. UCI responded by monitoring cyclists’ level of “young” red blood cells and establishing an acceptable range for them. Cyclists could be disqualified when young red cells measured either at a high level, indicating the presence of EPO, or at a low level, indicating a likely blood re-infusion. Thus, testing evolved into examining the effects of drugs on the blood, rather than looking for drugs in the blood.

In 2006, Floyd Landis became only the third American to win the Tour de France, but his team announced that his urine tested positive for testosterone after Stage 17. The French government’s anti-doping lab performed a second test and confirmed the positive result in August, after the Tour’s conclusion. In response, UCI stripped Landis of his Tour victory, and he was banned from professional cycling for two years. When Landis’ request to return to professional cycling in 2010 was rejected, he began to implicate his former teammates, including Lance Armstrong. This prompted investigations by the World Anti-Doping Agency, the U.S. Anti-Doping Agency (USADA), and several U.S. government agencies.

On August 24, 2012, USADA determined that in addition to other infractions, Armstrong had used “prohibited substances and/or methods including EPO, blood transfusions, testosterone, corticosteroids, and masking agents” during his career. Further, it “disqualified him from any and all competitive results” from 1998 forward and banned him from all future competitions covered by anti-doping regulations for the remainder of his life. Later in October, UCI upheld the USADA sanctions and stripped Armstrong of his seven Tour de France titles, from 1999 to 2005. Due to the prevalence of PEDs in the peloton, UCI did not reassign those titles.

Greg LeMond’s refusal to follow the peloton’s embrace of PEDs not only abbreviated his cycling career but also leaves LeMond’s true place in cycling history uncertain. At least one measure suggests LeMond may have been one of the greatest cyclists of all time. How the body takes oxygen from the air and delivers it to the muscles is measured as VO2 Max, the maximum volume of oxygen that a person can use during exercise. Factors that determine VO2 Max include the lungs’ ability to exchange air, the pumping power of the heart, the level of arterial blood flow to the muscles, and the muscles’ ability to utilize oxygen. Although these factors can be improved through high intensity interval training, a person’s VO2 Max is largely determined through genetics.

Laboratories conduct VO2 Max tests by measuring the amount of air that is inspired and expired by an athlete wearing an oxygen mask while exercising. Due to smaller heart muscles, women generally have lower average measures (38), than men (45), and male, world class endurance athletes have levels around 80. Greg LeMond’s VO2 Max measured 92.5, one of the highest levels ever recorded (higher scores have been recorded by a handful of Norwegian cross-country skiers). By way of comparison, four-time Tour de France winner Chris Fromme boasts an 84.6 VO2 Max, and Lance Armstrong measured 84.0. Behind LeMond, the cyclist with the next highest measure is Miguel Indurain (88.0), who won five consecutive Tours de France (1992-1996). While Indurain denies ever doping, his career has been subject to speculation, largely because his team was a client of Dr. Francesco Conconi, a pioneer of the use of EPO in professional cycling.

After widespread use in the 1990s and 2000s, the peloton’s use of PEDs is estimated to have decreased to 10% of riders by 2015 due to greater oversight and improvements in testing. Greg LeMond remains the only Tour de France winner from the United States. Today, he resides in Knoxville, Tennessee, where he is manufacturing his own line of carbon fiber E-bikes.

One of the first songs about drugs that I can remember is a tract on one of my initial album purchases. I was 14 when Jefferson Airplane’s Surrealistic Pillow was released (1967). Even if you disapprove of its drug theme, enjoy the Alice in Wonderland references in White Rabbit, or pretend you’re listening to Ravel’s Bolero!