NO ONE KNOWS how long athletes have taken supplements, but it's been going on quite a while, since well before the modern era of drug manufacture. The coca leaves that South American runners used for centuries provided a natural boost. Back in the early 1900s, when racers in the first years of the Tour de France ate bull testicles as snacks, they were simply trying to increase their testosterone levels.
According to sports historians, the use of drugs in athletics appears to have been routine by the post-World War II era. Amphetamines were the favored way to improve endurance, while steroids were the muscle builder of choice. At the Olympic level, abuse was rampant, and it wasn't until the 1968 Summer Games in Mexico City that any rudimentary drug testing was enforced, largely in response to the obvious doping going on by Eastern Bloc teams. Much later, in the breakthrough 1998 lawsuit that several hundred former East German athletes brought against their trainers, doctors, and coaches, the "vitamin" regimens they were duped into following—in fact, they were given steroids—were compared to torture by the Nazis. East Germany's state-supported system of doping, which often began before puberty, left a legacy of Olympic medals—along with deformed offspring, heart attacks, facial disfigurement, and lifelong sexual dysfunction. Sometime in the late 1970s, what was called "blood packing" began to supplement amphetamines. More red blood cells translates into more oxygen being distributed throughout the body, thus resulting in increased endurance. This was before EPO, and in those days blood was drawn, usually by team doctors, spun in a centrifuge to increase the concentration of red blood cells, and reinjected into the body.
This worked just fine until a certain line was crossed—different in every individual and hard to predict—and thickened blood started turning to sludge. Heart attacks and strokes followed. Athletes would mysteriously die in their sleep, because their lowered heart rates were unable to pump the enriched, heavy blood. According to Dutch media reports, from 1987 to 1990, 17 Dutch and Belgian professional cyclists died as a result of abusing EPO.
Because no foreign substances were involved, blood packing was considered legal, if unethical. At the 1984 Los Angeles Olympics, eight U.S. cyclists, including gold medalist Alexis Grewal, gave themselves transfusions of previously frozen packed blood inside their hotel rooms before competing in the 118-mile road race. The International Olympic Committee tested the riders, detected the doping, and briefly covered up the results before announcing, in 1985, that new rules were being written to ban any "artificial" means of altering one's blood chemistry.
When EPO emerged in the late eighties, blood packing became passé. EPO occurs naturally in the body, but only in tiny amounts. Researchers at Amgen Inc., a California pharmaceutical company, figured out how to synthesize it in quantities that could help people who weren't producing enough red blood cells, like cancer patients suffering from anemia. EPO was also a gift from the gods for athletes looking to cheat. It was easy to administer—a clear liquid injected with simple shots—always effective, and, until recently, impossible to identify, because there was no chemical test to alert doctors to its presence.
The difficulties of detecting EPO finally drove anti-doping officials to decree that they would disqualify any athlete found with a red-blood-cell concentration—known as the hematocrit level—of more than 50 percent. (The hematocrit level for an ordinary, active person is between 34 and 46 percent.) Of course, the 50 percent mark only gave athletes a defined limit. You could use EPO to jack up your levels higher than that while training, and as long as you competed with a level of 49.9 percent, you'd be fine.
It wasn't until the Sydney Olympics in 2000 that anti-doping experts, led by Françoise Lasne, a researcher at the French National Anti-Doping Laboratory, had come up with a method to distinguish the red blood cells produced by EPO from those produced naturally—enabling chemical detection of the drug. But each year, with new generations of drugs, cheating becomes more sophisticated, and EPO isn't the only substance that boosts red-blood-cell production.
Johann Muehlegg, the German cross-country skier who in 1999 left Germany's team to race for Spain, relied on a drug called darbepoetin—a genetically engineered version of EPO—to raise his levels at the Salt Lake Games. He won three individual races: the 30-kilometer freestyle, the 10K pursuit, and the 50K classic. When his darbepoetin use was detected by a chemical test before his third win, he defended taking it, since the drug, at that time, was not officially banned. Under the tortured rules of the Olympics, he was allowed to keep his 30K and 10K golds, which he won before he was tested, but had to return the 50K medal, which he won afterward.