The undisputed facts of the case are that the South African cyclist Daryl Impey — the first African rider to wear the leader’s jersey at the Tour de France — visited a pharmacy in Durban on the eve of his country’s national road cycling championships in February. He purchased some pills to boost his race performance. A few months later, authorities announced that he had tested positive for probenecid, a substance sometimes used to mask the presence of other drugs.
It would be a familiar story, except that Mr. Impey has now been exonerated. The pharmacist, it turns out, had sold him empty gelatin capsules but used a pill-counter contaminated from selling probenecid to a previous customer. Mr. Impey then stuffed the capsules with his pedal-pumping drug of choice, sodium bicarbonate, and rode to victory the next day. Yet somehow, that’s different.
For sports fans, doping controversies are part of the scenery, with the Yankees slugger Alex Rodriguez’s leaked confession and the Kenyan marathoner Rita Jeptoo’s positive test merely the latest in a long and ignominious parade. But Mr. Impey’s case reminds us that the dichotomy between clean-cut, Wheaties-fed role model and dope-fueled cheat is a little blurrier than you might think.
Popping pills to gain an edge is ubiquitous in the sports world, and the apparent arbitrariness of the distinction between good and bad pills is one reason some commentators think we’d be better off ditching doping rules altogether. As Malcolm Gladwell wrote last year in The New Yorker, poor Mr. Rodriguez might be “genuinely baffled about why baseball has drawn a bright moral line” between the performance-enhancing effects of, say, orthopedic surgery and those offered by forbidden drugs. One could ask the same about any number of non-banned substances that boost performance, also called ergogenic aids.
Drawing the line is straightforward in some cases. Erythropoietin, known as EPO, the drug that may cost Ms. Jeptoo her $500,000 World Marathon Majors winner’s check, increases the number of red blood cells carrying oxygen from your lungs to your working muscles. The drug is estimated to boost endurance by 5 to 15 percent, a huge gain in athletic performance.
In excess, however, EPO causes the blood to thicken, which can lead to heart attacks and is suspected by some to have played a role in the deaths of as many as 100 cyclists since the early 1990s. Banning the drug is an easy call. Yet moving to or being born in the rarefied air of Colorado, or Kenya, which also boosts red blood cell count, is perfectly legal. So is sleeping in a depressurized tent that simulates thin mountain air.
It’s the middle ground that’s trickier. Mr. Impey’s sodium bicarbonate, the same baking soda found in kitchen cupboards, is used as a “buffering” agent. During intense exercise, the acidity of your blood increases and eventually interferes with muscle contractions; baking soda neutralizes this rising acidity. In theory, this is a performance-enhancing benefit, but a significant side effect, as a teammate on my university track team discovered, is explosive diarrhea.
More recently, athletes have turned to beta-alanine, an amino acid found in meat. Like bicarbonate, beta-alanine counteracts rising acidity during exercise, but does so inside muscle cells rather than in the bloodstream. Both substances are legal, because, after all, you can’t ban muffins and hamburgers, but the megadoses used by athletes bear no relation to their presence in foods. Like Mr. Rodriguez, we might wonder how using these pills differs from doping.
The World Anti-Doping Agency’s code rests on three pillars, any two of which are sufficient to merit a ban: First, if use of a substance may enhance performance; second, if it carries potential health risks; and third, if it violates the “spirit of sport.”
Of course, the spirit of sport has evolved considerably over the years. As cynics note, doping — the word is thought to come from “dop,” a stimulant drink consumed by the native peoples of South Africa — is as old as sport itself. Ancient Greek athletes ate hallucinogenic mushrooms; the Tarahumara, the famous running tribe of northern Mexico, goosed their endurance with peyote.
Things got even wilder with the rise of professional sport in the late 19th century, as Charles E. Yesalis and Michael S. Bahrke, the authors of “Performance Enhancing Substances in Sport and Exercise,” recount. Cyclists in grueling six-day races downed sugar cubes dipped in anesthetic ether, and sprinters looked for an explosive edge from nitroglycerin, which dilates blood vessels. Thomas Hicks’s victory in the 1904 Olympic marathon “demonstrated that drugs are of much benefit to athletes,” his doctor proclaimed, after dosing him en route with a mixture of brandy and strychnine, a toxin that is potentially fatal but was used as a stimulant in small amounts.
It was only in the 1920s that drugs began to be viewed as contrary to the spirit of sport. Stimulants were first banned by track and field authorities in 1928. In the decades since, the anti-doping authorities’ lists of banned substances and testing protocols have been repeatedly updated in an effort to catch up to new waves of drugs, like steroids in the ’60s and ’70s, and hormones such as EPO since the late ’80s.
Still, no matter how long the list of bans gets (the 2015 edition fills 10 densely packed pages), athletes have plenty of options. Steroids may be banned, but creatine is a legal muscle builder, increasing the energy stores available for short-term all-out efforts like weight lifting. Pseudoephedrine, the decongestant in over-the-counter meds like Sudafed, is a stimulant that was taken off the banned list after 2003, only to be restricted again in 2010 after the World Anti-Doping Agency’s monitoring of test results showed widespread and growing abuse.
Then there’s caffeine, the most versatile ergogenic aid of all, which fights mental fatigue and may also have effects on muscle contraction and metabolism. Even Tylenol has been shown to boost endurance performance by 2 percent.
The hottest endurance booster of the last Olympic cycle, meanwhile, was beet juice concentrate. It turns out that the nitrates in beets — the same nitrates everyone worries about in hot dogs — are converted with the help of friendly bacteria in your saliva into nitric oxide, which enables your muscles to use less oxygen when they contract. The result: a speedup of 2 percent or more in endurance races.
And these are just the ones that actually work. You don’t have to look far to find stories of athletes experimenting with everything from Viagra to hornet larvae extract in search of an edge. So where, then, is our bright moral line?
“If one wants to do an action which a certain practice specifies,” argued the philosopher John Rawls, “then there is no way to do it except to follow the rules which define it.”
The spirit of sport says that we play by the rules. Thus we formulate a list of banned drugs so that athletes can compete without endangering their health. While we accept that the list will be somewhat arbitrary and subject to debate, we punish dopers because they cheated — that’s the difference between Mr. Impey and A-Rod.
“One might contend that baseball would be a better game if four strikes were allowed instead of three,” Rawls wrote — but you can’t make that argument after you swing and miss.
Alex Hutchinson is a runner and author who writes the Sweat Science blog for Runner’s World magazine.