As major league baseball reels from a designer steroid scandal, Boston Marathon organizers say they plan to maintain the same drug testing system they've run for several years: a urine sample taken at random from top finishers, looking for everything from steroids to hormones that increase endurance. "My sense, and it's only a sense, is that marathoning in particular is as clean as any sport out there in the world," said Dave McGillivray, race director of the Boston Marathon. "I feel the amount of abuse is minuscule."
In long-distance running, finding any abuse
that does exist can prove a daunting -- and, sometimes, impossible -- task. The drug that most worries officials in endurance sports is erythropoietin, or EPO, a potentially dangerous hormone that boosts the supply of oxygen to muscles and quickly passes from the system. Veterans of distance running said they can recall few instances of marathoners being caught cheating, although there was a high profile case involving the third-place finisher in the 2002 New York City Marathon, who had used the banned substance ephedrine and was stripped of her $45,000 in prize money. McGillivray said he could not remember any Boston runners testing positive.
Just last month, a cyclist from Sacramento, Calif., became the first US athlete to be suspended from competition after testing positive for EPO, which can be difficult to detect because while it disappears from an athlete's system relatively quickly its benefits linger for months.
And with rumors swirling about the designer steroids that may have been provided to major league ballplayers, some running enthusiasts said they have begun to wonder about the extent of drug use in their own sport.
"I'm becoming more of a doomsayer given what we're seeing in baseball," said Jack Fultz, winner of the 1976 Boston Marathon and current coach of the Dana Farber Marathon Challenge team. "The athletes who are taking these things are doing it to improve their ability to compete, pure and simple. And I really think it's more rampant than what we've thought.
"The real downside of that is that the clean, fair athletes end up getting splattered with it."
For athletes engaged in endurance sports -- marathons, triathlons, long-distance cycling -- stoking the supply of oxygen to muscles is far more important than the muscle-building regimens of football players or home run hitters.
"You don't want to be heavier or more muscular to run a marathon," said Dr. Harrison G. Pope Jr., director of the biological psychiatry laboratory at McLean Hospital and a specialist in the intersection between sports and performance-enhancing substances. "You want to be light."
That's where EPO comes in.
All humans have EPO. It's produced by the kidneys and primes bone marrow to churn out red blood cells, which function like molecular barges that ferry oxygen to muscles.
"At the muscle, the oxygen is off-loaded and therefore provides the energy source for that part of our metabolism that is oxygen-dependent," said Dr. Gary Wadler, a sports medicine specialist in Nassau County, N.Y., who sits on the panel that advises which substances should be banned by the World Anti-Doping Agency.
Once, marathoners would inject a donor's blood to boost their reservoir of oxygen-laden red cells. Later, they began storing their own blood for re-injection months afterward. Both techniques came to be known as blood doping, and were banned by track and field federations.
A less invasive way to accomplish the same effect is through training at high altitude, where the body responds to oxygen depletion by generating more red blood cells.
In the late 1980s, scientists developed a synthetic version of EPO -- not for runners, but for patients stricken with anemia that is often related to kidney failure or cancer treatments. Usually injected, synthetic EPO worked marvelously, reversing anemia in patients.
Within months of the 1989 federal approval of EPO as an anemia treatment, athletes recognized that it could help them, too. Reports began circulating in the international sports community that long-distance cyclists had begun injecting the hormone, which proved a far more palatable option than the messy process of blood doping.
"And in effect, it's very analogous with what you would see with blood doping," said Roger Fielding, a specialist in exercise physiology at Boston University's Sargent College of Health and Rehabilitation Sciences. "By improving the oxygen-carrying capacity of your blood, it essentially can improve your ability to perform endurance-type activities like the marathon."
Widespread testing for EPO began at the Sydney Olympics in 2000 and spread to other elite athletic events, such as the Boston Marathon, said Rich Wanninger, spokesman for the United States Anti-Doping Agency, which will assist marathon organizers in testing runners today.
Neither marathon organizers nor the Anti-Doping Agency would reveal precisely how many runners will be tested at the end of today's race, although McGillivray said a certain segment of the top 15 men and top 15 women will be sampled, as well as a group of other runners.
"It's not 100 [who will be tested]," McGillivray said, "but it's also not two."
Wadler said it's not realistic to expect events to test every athlete, given that each test costs several hundred dollars.
"You have to factor in costs, technical issues, burden on laboratories," Wadler said.
And then, at least when it comes to EPO, there's the question of how much universal testing really would prove.
It only takes two weeks for half of an EPO dose to entirely wash out of an athlete's system. But the red blood cells it has nurtured can survive on average four months.
That means an athlete could take an injection of the hormone two months ahead of the race and still be benefiting from it, and yet there would be no trace of the substance in a post-race test.
"In a perfect world, you'd want to be testing those people weeks before the marathon," said Frank Uryasz, president of the National Center for Drug Free Sport, a testing company that works extensively with the NCAA. "But we don't live in a perfect world. Sometimes, the post-event test is the best we have."
Measuring the red blood cell count of runners doesn't necessarily provide a lot of clues about illicit use of hormones. Kenyan runners have enjoyed sustained success in the Boston Marathon but because they train at higher altitudes, it wouldn't be much of a surprise if their red cell numbers were elevated.
Beyond the issue of cheating, there are very real health risks from the use of EPO to boost performance, sports medicine specialists said. Used excessively, the hormone can spawn too many red cells, which in turn can cause blood clots.
"Erythropoietin is a drug where you can kill yourself with it if you take too much," said Pope, author of "The Adonis Complex." "It's a very worrisome drug because of the fact there's a very strong temptation to use it because it works and because it's extremely hard to test for it. But on the other hand, to get the maximum benefit out of it, one would want to go just below the threshold of where it's potentially fatal."
Miriam Nelson ran her first Boston Marathon 20 years ago. Now, at the age of 43, she will put sneaker to pavement one more time. She has no intention of injecting herself with EPO or any other drug that could shave a few minutes off her finishing time. And running enthusiasts said there's little evidence to suggest that recreational runners such as Nelson are much tempted to use performance-enhancing substances.
"It would be silly. All these things have risks," said Nelson, director of the John Hancock Center for Physical Activity and Nutrition at the Friedman School at Tufts University. "I can't imagine recreational runners, even fairly competitive recreational runners, would even consider it."