How Doctors Help The Dopers

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Enhancing oxygen delivery is a broad frontier. The process theoretically can be manipulated at many points. "It is inevitable that other pharmacological avenues to stimulate red-cell production will be explored — and exploited," says Dr. Michael Ashenden, project coordinator for a global blood-doping research consortium funded by WADA and USADA. "Putting in an EPO gene is only one way to get the same result."

Instead of finding novel ways of delivering EPO, for example, some researchers are hoping to harness modified versions of hemoglobin, the oxygen-carrying workhorse in red blood cells. Artificial blood has long been a dream of doctors who face perpetual blood shortages, and in recent years that dream is closer to becoming reality. One promising approach involves extracting hemoglobin from living cells and using it alone as an oxygen transport system. Unfortunately, naked hemoglobin is quickly broken down in the body. Housing the hemoglobin in an artificial cell, or modifying the hemoglobin so it remains stable, could solve this problem. Two such artificial hemoglobin-based blood products in the final stages of development are already rumored to have made the rounds in the track-and-field community.

Beyond hemoglobin, there are totally synthetic blood substitutes like perfluorocarbon (PFC), a cheap, inert molecule with an enormous capacity to carry oxygen. Those fluids behave like an additional reservoir of oxygen for the body to utilize during exercise. However, because PFC has a short half-life and is effective only when individuals breathe abnormally high concentrations of oxygen, it will probably remain a very difficult technology to abuse.

For athletes tempted to cheat, a word of caution: advances in technology cut both ways. Ashenden's group is researching a powerful new tool able to precisely measure a person's metabolic profile. "Athletes who are doping are altering their metabolism, whether it's by taking a drug or inserting a gene," Ashenden says. "So if we can look at their metabolic profile and see it isn't normal, then that's evidence they have doped — even if we might not know what exactly they've done."

That may be wishful thinking, but what we can be sure of is that as long as there is a pipeline of medical innovation, athletes will continue to feed off its bounty despite potential health or legal consequences. And researchers will obviously not be deterred by the possibility that their work will be exploited. "I'm not going to let an insane athlete keep me from curing muscular dystrophy, that's for sure," says Jeffrey Chamberlain, director of muscular-dystrophy research at the University of Washington in Seattle. Patients, after all, have more to lose than a gold medal.