When it comes to drugs in sport, what matters is how the incentives are aligned: the incentives of the people who might take them and the incentives of the people who might stop them. In some sports the temptations for the athletes are relatively slight. Premier League footballers might mess around more than they should with recreational drugs; but the use of performance-enhancing drugs is unlikely to be commonplace, since the skills required at the highest level in football are so various. The clearest evidence for this is the wide variety of body shapes you see in the top leagues. The world’s best player, Lionel Messi, did take growth hormones as a child to compensate for a height deficiency. Without them he would not have grown much above 4’7″; even now he is only a dumpy 5’7″. He is also amazingly durable (he has played the full ninety minutes in his last hundred appearances for Barcelona), which can be an effect of steroid use. But you don’t get to be like Messi by taking steroids: no one sets out to be a dumpy 5’7″. In American football, by contrast, steroid abuse is almost certainly widespread. Here, being the right shape – big and strong – and having the ability to recover quickly from injuries are the primary requirements in many positions. NFL players do not often fail drugs tests, but that does not mean the sport is clean. It means the people who run the sport are not overconcerned about the players’ underlying health: it would be bad for business. The clearest evidence for this is the brain damage we know is caused to American footballers by the repeated head trauma they undergo, which the helmets they wear do little to protect them from. The people who run the sport have done next to nothing about that either.
However, there has never been a sport where the incentives of the drug-takers and the drug-testers have been so out of kilter as in professional cycling during the Lance Armstrong era, which ran from the mid-1990s until a few weeks ago. The temptation for the cyclists to cheat was almost irresistible, once it became clear that ‘blood-doping’ – the use of erythropoietin (EPO) and blood transfusions to increase the levels of oxygen-carrying red cells in the bloodstream – could give them a clear advantage in the big races, including the three-week-long Tour de France, the sport’s premier event. How large an advantage is open to dispute: one study puts the increase in ‘peak power output’ for recreational cyclists taking EPO at 12-15 per cent, which translates into an 80 per cent increase in endurance (time riding at 80 per cent of maximum capacity). Professional cyclists are already operating at much closer to maximum capacity than recreational riders, but even if EPO gave the top riders only a 5 per cent boost, that could be the difference, as Tyler Hamilton puts it, ‘between first place in the Tour de France and the middle of the pack’.
But it would be a mistake to assume that most cyclists doped in order to give themselves a shot at ultimate glory. In many ways the biggest difference is not between coming first and being in the pack, but between being in the pack and not being in the race at all. Professional cycling is a team sport, and most members of the team are there to support the team’s star riders, who might have a chance to win. Their job is to do the donkey work, protect their leader, chase down rivals and sacrifice themselves for the common good. It is often soul-destroying work; it can also be very well paid. Tyler Hamilton started taking drugs, as he reveals in this gripping tell-all memoir, to give himself a shot at being part of a successful team. It meant the difference between scraping a living on the fringes of the circuit and becoming rich. Not Lance Armstrong rich; but non-sportsman rich. When Hamilton got onto Armstrong’s US Postal team he went from living on scraps to earning a six-figure salary. When Armstrong won the Tour de France with Hamilton’s help, that salary went up from $150,000 to $450,000. Hamilton’s fear when he was starting out was that he would not make the cut to be a Tour rider: blood-doping gave him the boost he needed to get in the game. This is consistent with the evidence from other sports. In baseball, for instance, studies suggest that the highest prevalence of steroid abuse is among players on the fringes of the major leagues. These are the guys with the most to lose by not taking drugs. It makes sense: the difference between the salaries of the top players can be measured in millions, but that’s because they are all being paid millions; the difference between being an obscure major league player and a permanent minor league player can be the difference between earning $500,000 a year and earning $50,000 – all the difference in the world.
Taking EPO was not without risks: the medical consequences were often unpredictable. It makes your blood ‘healthier’ in the sense that it makes it thicker, which can cause your arteries to clog up entirely if you are not careful. It is not clear how many cyclists died of heart attacks in the experimental phase of the EPO era, during the late 1980s and early 1990s, when the athletes were less adept at monitoring their reaction to the drug. They didn’t die on their bikes; they died in their sleep when the blood stopped moving (‘stories from that era tell of riders who set alarm clocks for the middle of the night so they could wake up and do some pulse-increasing callisthenics’). Why would super-fit athletes take such insane risks with their health? Part of the answer, as Hamilton explains, is that professional cycling is an inherently unhealthy sport.
It is, to start with, extremely dangerous: cyclists crash all the time, breaking bones and risking permanent injury. Then there is the need to eat the bare minimum consistent with surviving the demands of a long race. Along with having thick blood, the other crucial requirement for a Tour de France rider is to be extremely thin. Hamilton says that during his doping years he also had a borderline eating disorder, which meant he spent far more time thinking about the food he was keeping out of his body than he did about the drugs he was putting in. The truth is that long-distance road racers only feel healthy when they are on their bikes: the rest of the time they feel horribly out of shape. They are achy, wheezy, bent up; they walk like old men; they sit when other people are standing, and they lie down when other people are sitting. When Hamilton was at the height of his cycling powers, he infuriated his wife by being unable even to take a short walk with her to the shops: he never felt fit enough.
The other thing cyclists need is an extraordinary tolerance for pain. That, in many ways, is what the competition is about: who can hurt the most, for the longest, without cracking or doing something stupid. Hamilton’s calling card was his superhuman pain threshold: he became a legend of the sport in 2003 when he continued in the Tour de France despite having fractured his collarbone in a crash. The pain was so bad that he ended up grinding his teeth down to stumps. But he got to the finish, eventually placing fourth overall, and he even managed to win one of the most arduous mountain stages. It hurts just reading about it. Blood-doping does nothing to take the pain away; if anything, it makes the sport hurt more, because riders can push their bodies harder and for longer. For Hamilton, as for many of the other leading cyclists, doping did not constitute an unfair advantage. Instead, it was a way of sorting out who was really the toughest. In an extraordinary passage, Hamilton writes that EPO made the sport fairer, because it ‘granted the ability to suffer more; to push yourself farther and harder than you’d ever imagined, in both racing and training’. Races ‘weren’t rolls of the genetic dice, or who happened to be on form that day. They didn’t depend on who you were. They depended on what you did – how hard you worked, how attentive and professional you were in your preparation.’ One of the frustrations for a rider like Hamilton had been the moments when he was willing to take the pain, but his body packed up anyway: cyclists call this ‘bonking’, the point where the metabolism shuts down regardless of the rider’s will to keep going. Blood-doping meant that if you could take the pain, your body would keep up. Now success would simply go to the person who wanted it more.
No one in the history of the sport has wanted it more than Armstrong. The blood-doping era rewarded his insatiable appetite to win. But Armstrong was also lucky. Hamilton is being slightly disingenuous when he suggests that the drugs simply levelled the genetic playing field. Because there was no effective test to detect the presence of EPO in the bloodstream, the cycling authorities instituted a rule that suspended cyclists whose hematocrit level (the percentage of red cells in their blood) rose above 50, which was taken to indicate something was amiss. Normally the level for men shouldn’t be much above 45. But people differ. Some are naturally closer to 50, others struggle to get much above 40 without artificial help. These latter included Armstrong, whose standard hematocrit reading was around 39 (Hamilton’s was 42). So Armstrong benefited disproportionately from EPO, gaining nearly a 30 per cent boost while staying within the rules compared, say, to a rider whose normal level was 48, who would get only a 4 per cent boost before breaching the limit. Without EPO, Armstrong wouldn’t have been at the races…
Inside the Hidden World of the Tour de France: Doping, Cover-ups and Winning at All Costs
November 29, 2012
I was one of those Olympics gloomsters who, as Boris Johnson gleefully pointed out when the Games had finished, were scattered and routed by the rip-roaring success of London 2012. I assumed something would go wrong; everything went right. I thought people would complain about the cost; no one seems to have begrudged a penny. It was a triumph: I accept that now. But in one respect I still refuse to buy it. Before the Olympics began there were fears that the event would be overshadowed by a drugs scandal or by the steady drip-drip of multiple failed drugs tests. In the end, although a few athletes were caught (including the winner of the gold in the women’s shot put and an American judo competitor who blamed his positive marijuana test on eating the wrong cakes), the Games were more or less drugs-free. There were some dark rumours early on about the Chinese teenage swimming sensation Ye Shiwen, but she passed her tests and kept her medals; Colin Moynihan, the chairman of the British Olympic Association, declared that she was a natural talent and told the doubters to shut up. These Games were ‘clean’, which was a big part of the success story. That’s what makes me suspicious. In an event on this scale, where the stakes are so high for competitors and organisers alike, an absence of failed drugs tests does not prove no one is cheating. More likely it indicates that no one is really looking.