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Peter A. Ubel Headshot

Lance is Back: Time to Make EPO Legal?

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Lance Armstrong will soon be competing again in bicycle races around the world, meaning that the casual biking fan will once again show interest in the sport. It also means that doping allegations against Armstrong are likely to resume. If Lance wins some big races -- at his age and after so long away from the sport -- some people will be convinced he has found a way to cheat. If he loses, then who cares about his age and his time away from the sport -- his losses will be evidence that he must have cheated in the past and is failing at the sport now only because it's harder to cheat.

I confess to having mixed feelings about the cheating rampant in sports like bicycling. No system will ever pick up all the cheaters. Part of me, then, thinks we should let people do whatever they want -- mainline steroids, experiment with gazelle DNA, whatever -- and let the fastest creature win.

But a larger part of me yearns for clean, unadulterated performances. I'd like to see what humans can do when pushed to their natural limits.

When it comes to EPO, however, I am less conflicted. I don't see the point in banning this drug, when there are natural ways to reap its benefits.

EPO is a hormone secreted naturally by the kidneys, to stimulate the body to produce red blood cells. Red blood cells carry oxygen around our bodies. And oxygen, I have discovered, is a good thing to have in abundance when riding a bicycle up a relentless incline at high altitude.

Our bodies normally produce enough EPO to keep our hemoglobin level (that's the blood test we doctors rely upon to assess oxygen carrying capacity) at a standard level, a level that varies a bit person to person within a fairly narrow range. A person who takes EPO, however, will experience a rise in their hemoglobin count. A person who takes too much EPO, in fact, will get so many extra red blood cells that their blood will become thick, and they will risk experiencing a stroke.

Athletes who use EPO try to increase their hemoglobin level enough to increase their performance, without experiencing a stroke. This isn't too hard to do. There's a good margin of error.

In fact, athletes have found natural ways to increase their hemoglobin supply. The simplest way is to simply train in high altitude. When our bodies are regularly deprived of oxygen, our kidneys squeeze out EPO so we can absorb available oxygen more efficiently. Some athletes, rather than train at a high altitude, sleep in specialized tents that mimic the conditions of high altitude.

Do you see why I'm ambivalent about EPO? We live in a strange world, where it is wrong to boost your hemoglobin supply by taking synthetic EPO, but okay to do so by sleeping in a special tent. We live in a world where you're banned from sports if you live in Texas and inject EPO, but rewarded if you live in the Himalayas and benefit from your bodies natural EPO production.

I think we should lift the ban on EPO and make rules that set limits on hemoglobin levels. Athletes will be banned from performing if their hemoglobin exceeds some level, put on probation if it is in some gray zone, and allowed to compete if it's below the accepted cutoff. Professional athletes would monitor their own hemoglobin, take EPO or sleep in a specialized tent if their hemoglobin falls below their target, and drain some blood out of their system if their hemoglobin rises too high. With this system, everyone's hemoglobin will sit somewhere in the safe zone, whether it gets there naturally or unnaturally, and we wont have to worry about somebody having an advantage over anyone else. Nor will test monitors have to monitor that people have found ways to mask the use of synthetic forms of drugs like EPO.

I'm sure such a system would be more complicated than I've laid out here. Heck, this is a blog post, not an academic paper.

But isn't this idea worth serious consideration?