Actovegin: The (unfortunately) Legal Performance Enhancing Drug

Have you ever wondered what Usain Bolt, Ronaldo, Michael Jordan, Paula Radcliffe, etc. all have in common? Obviously athletic super-stardom and its many physiological underpinnings and financial perks.  However, there’s an underlying thread that connects all of them, and it’s likely been a significant facilitator of their super-human sporting prowesses.  That underlying connection is the drug Actovegin and its primary peddler, Dr. Hans-Wilhelm Müller-Wohlfahrt.  Below, we will examine this magic and its magician.

Lately, the state of global athletics has had the gears in my mind spinning full bore about athletes, namely runners, at the extreme ends of the performance spectrum and the potential doping-related activities that may be knowingly or unknowingly supporting them.  A recent piece in the New York Times (link) discussed the sub-2-hour marathon project, and in it, it chronicled the struggles of world record holder Kenensia Bekele in his attempt to return to racing form.  The article mentioned a German doctor, Hans-Wilhelm Müller-Wohlfahrt, and a distant bell was rung in my brain, as I had heard this name associated with other big athletes (the article even mentions Usain Bolt) and his unconventional treatment methods.

After digging a bit deeper into this guy his main treatment go-to, Actovegin, a lot of pieces across a lot of sports unfortunately connected.  Many previous reports have tossed around mention of this drug, and usually just leave it at ‘ambiguous’, ‘questionable’, or ‘gray’, and move on.  It actually gained prominent media attention in 2000, when Lance Armstrong and the US Postal Team was caught trying to get loads of the stuff across the French border.  Since then, most people in the sporting world have acknowledged its use, but shrugged it off as homeopathic voodoo.  However, after reviewing some recent scientific literature on the drug (most notably a crazy study published just a few months ago, which will be discussed below), it’s benefits should absolutely not be ignored.  Given that this doctor has penetrated literally all of global athletics (Michael Jordan, Usain Bolt, Ronaldo, innumerable soccer stars, etc. etc.), it appears that the effects of Actovegin might just underlie most major world-record and Olympic performances in running, as well as many many other sports.

What is Actovegin?

The common phrase to describe it is “calf’s blood”.  I think this rhetoric is why most people simply dismiss it and leave it at that.  However, it’s not as if it’s just an injection of calf’s blood yanked straight from the cow (which would then be a really dangerous and kinda gross form of blood doping).  It’s much more complicated than that: the blood goes through many rounds of ultrafiltration processing, including vacuum distillations, titrations, and electrophoresis verifications.  The result is a substance that’s had all the protein removed, and leaves a soup of molecules that have been pretty tricky to pin-down.  Some studies have attempted to ID all the different compounds within it, yet there is no identified ‘active ingredient’ of any sort.  It seems to be a mess of protein fragments, intermediaries of steroid hormones, amino acids, sugars, electrolytes, and other organic compounds.  It’s an approved pharmaceutical overseas, but hasn’t been approved for use by the FDA.


What does it do?

Put simply, it enhances cellular metabolism and respiration.  That is, it helps get glucose (fuel) into the muscle cells faster and helps the mitochondria (energy producers) in the muscle cells burn that glucose more efficiently.  It’s marketed as a drug overseas for diabetic treatments (as it has an insulin-like effect of getting sugar into muscle cells) and is also used to treat patients who suffered from hemorrhages, strokes, or muscle injuries.  One pilot study of soccer players who suffered hamstring tears found that those receiving conventional treatments took 20 days to return to play, whereas those receving Actovegin injections returned after only 12 days.  It’s role in enhancing energy production in the cells is well documented in rat models, but until recently, purely anecdotal for humans.

Legality of Actovegin

Currently, it’s not on the World Anti-doping Agency’s (WADA) prohibitied substance list.  However, WADA does ban injections of any substance, including Actovegin, exceeding 50 ml every six hours.  Prior to the formation of WADA, the International Olympic Commitee (IOC) banned the use of Actovegin in December of 2000.  They had noticed that a multitude of countries had brought it to the Sydney Games, and it appeared to be a mainstay acorss many teams in that year’s Tour de France.  They proceeded to ban it in December as a performance-enhacing substance.  However, they curiously lifted the ban 2 months later in February of 2001 pending further research.  WADA’s current stance on it: legal, but illegal to inject more than 50 mL (which is 25 times higher than the amount that’s been reported for muscle tear rehabilitation).  It should be noted that this is completely arbitrary, as if someone were to want to use it along these guidelines, they could concentrate it to any dose they’d like and inject multiple times per day.

To further complicate things, WADA’s code now bans “any growth factor(s) affecting muscle, tendon or ligament protein synthesis/degradation, vascularisation, energy utilisation, regenerative capacity or fibre type switching” as well as the nebulous “spirit of the sport” legality, prohibiting “… the potentially unhealthy abuse of certain substances without therapeutic justification based on the mistaken belief they enhance performance is certainly contrary to the spirit of sport regardless of whether the expectation of performance enhancement is realistic…”.  The use of Actovegin certainly seems to violate even these somewhat foggy guidelines.

Unfortunately, because there are no identified “active ingredients” (which has been one of the reasons the FDA hasn’t approved it), it would be pretty difficult to develop a test for it, even if WADA wanted to.  There’s no scientific consensus on what’s in it, let alone how to identify it in an athlete.

Does it Enhance Performance?

“It’s a powerful performance-enhancing drug” – Victor Conte (BALCO infamy)

As stated above, it’s effects for athletes are two-fold: it helps get fuel into the muscles faster and helps them burn that fuel more efficiently.  Why would you want to be able to get glucose (fuel) into the muscles faster and more efficiently (hint: insulin helps with this, and is in fact a banned substance)?  Think recovery: restock the muscles’ energy supply so you can give another maximal effort, or so you can really “carbo-load” to the maximum.  Preparing for a marathon, riding a stage race, back-to-back tennis matches, repeated soccer games, rounds in track championships, and just day-to-day training recovery.  Moreover, because it has an insulin-like effect of enhancing glucose uptake into muscle cells but doesn’t seem to have the downside of increasing glucose storage as fat in fat cells (the other job of insulin), it seems like quite the gem for the athlete.

The other benefit, which was until recently, more anecdotal, was the effect that the drug had on energy production within the cells.  A study published just last January showed, for the first time (link), a clear enhancement of cellular respiration and energy production in human muscle cells.  The efficiency of the mitochondria in the cell were enhanced in a concentration-dependent manner (i.e. the more you take, the greater the benefit), meaning, essentially, that the muscle cells could burn more oxygen faster after being exposed to Actovegin.

Maximal rates of in vitro energy production in human skeletal muscle (Sondergard et. al.)

So for comparison, the infamous performance-enhancer for endurance sports (and likely many other sports) is EPO.  As we all know, EPO increases the number of red blood cells in your body, thereby delivering more oxygen to the muscle cells.  Actovegin essentially helps the muscle cells use that oxygen more efficiently.  This ability to enhance O2 flux and glucose-derived energy-utilization on the mitochondrial level may be ringing bells for the scientific minds out there.  Indeed, this mechanism is similar to the drug that most recently dominated headlines: Meldonium.  Maybe Maria Sharapova has a ‘legal’ alternative (though one can’t help but suspect it may have already been in the medicine cabinet…)!

So, it seems like it’s benefit is two-fold:

1.) it increases the energy-production capacity of the muscle cells, meaning more bang for your energetic buck.  It does this by getting fuel into the cell (like insulin, which is banned, but doesn’t have the potential downfall of fat storage or metabolic disruption associated with too much insulin) and then using that fuel more efficiently by enhancing the mitochondria (like Meldonium, also banned).

2.) It seems to be a powerful injury recovery aid (anecdotally and in rodent models), maybe through these metabolic enhancements, or maybe through other growth-factor related pathways that haven’t been explored.  Again, the stuff is a tricky, not-completely-understood chemical soup!

Who uses it?

Track and Field Current/Former World Record Holders:
Paula Radcliffe (for over two decades)
Usain Bolt (since he was 16)
Kenensia Bekele
Meseret Defar
Patrick Makau
Maurice Greene

That’s just from a quick Google search – by the sounds of it, many of the overseas agents/physios direct their major stars towards this before and after injuries

Other prominent persons:
Michael Jordan
Christiano Ronaldo
Andy Murray
Vladimir Klitschko
Luciano Pavoratti

Again, those are just people mentioned by major articles from news outlets.  From reading about Dr. Mueller-Wolfharft aka Healing Hans (more below), it seems like just about every soccer player in Europe goes to see him for Actovegin treatments (among other injectable enhancements), and many prominent athletic figures around the globe go seek his services.

Natural vs. Unnatural

Some supporters of the drug’s legality may make the claim that because it’s a ‘natural’ compound from calf’s blood, that it’s somehow distinct from a drug like EPO or testosterone.  Flawed argument.  One, it’s no more ‘natural’ or ‘unnatural’ than something like recombinant EPO, which is made via bacterial cell culturing (which one could say is more ‘natural’ given that that comes from human DNA, rather than a foreign species).  Two, it’s not like they’re just injecting cow-blood into their veins; the blood goes through many rounds of industrial pharmaceutical processing steps to get the final drug.  Third, the fact that it relies on the method of injection should raise eyebrows for it’s claims of being ‘natural’ and within the spirit of the sport.

The Doctor: ‘Healing Hans’

The doctor at the center of all this is Hans-Wilhelm Müller-Wohlfahrt.  ESPN’s Outside the Lines did an incredible profile on him a few years ago (link), so I won’t go into the depths of his backstory (highly recommended read).  The cliff notes are this: He’s a German doctor who relies primarily on injectable treatments outside of the mainstream, regulated pharmaceutical and medical industry.  He has been in practice for many decades, and has been using Actovegin and other methods for 40+ years on a clientele of almost exclusively elite athletes.  However, though he claims his methods are completely legitimate and in fact, superior to most traditional medical treatments, he has not offered any of his findings or methods to the scientific community.  Despite having a global impact, he has no publications in medical journals or any other peer-reviewed outlet.  Most of this magic occurs behind closed doors in his Munich office.  He was the team doctor for the Bayern Munich soccer club and German national team for many years, and seems to be basically an institution across European soccer.  Through his career, he has worked his magic on global sports stars from all over the world.  Track fans have probably often heard about Usain Bolt repeatedly flying to Germany for treatments from Healing Hans, and Paula Radcliffe regularly got his magic for the better part of two decades.  I wouldn’t be surprised if many NFL and NBA stars make the trans-Atlantic flight to consult with this ‘wunderheiler’.

The Actovegin must be keeping that 72-year-old Flow ripe (source: Getty)

Final Thoughts

World Record holders (Paula Radcliffe, Usain Bolt, etc.) and other sporting megastars openly admitting to regularly using a drug that seems to be definitively performance-enhancing.  It really bums me out that this is legal, as it seems to be no different than any other injectable PED in terms of its unnatural enhancements.  Obviously, there’s no way to test for it, which further bums me out.  I guess my takeaway is that it’s at least informative to identify a cornerstone piece of the frustrating puzzle of what makes seemingly super-human performances indeed super-human.


Søndergård, S. D., Dela, F., Helge, J. W., & Larsen, S. (2016). Actovegin, a non-prohibited drug increases oxidative capacity in human skeletal muscle.European journal of sport science, 1-7.

Buchmayer, F., Pleiner, J., Elmlinger, M. W., Lauer, G., Nell, G., & Sitte, H. H. (2011). Actovegin®: a biological drug for more than 5 decades. Wiener Medizinische Wochenschrift, 161(3-4), 80-88.

Lee, P., Rattenberry, A., Connelly, S., & Nokes, L. (2011). Our experience on Actovegin, is it cutting edge?. International journal of sports medicine, 32(4), 237-241.

Lee, Paul, L. Nokes, and P. M. Smith. “No Effect of Intravenous Actovegin® on Peak Aerobic Capacity.” International journal of sports medicine 33.4 (2012): 305.

Incredible pieces from 2011 by ESPN OTL on Muller-Wohlfart:
The Doctor They Call ‘Healing Hans’
Making the Rounds with ‘Healing Hans’

USATF 100k National Championship – Race Report

The Background:

On April 9th, I walked into the wild.  I made my debut at the 100k distance (62 miles), racing the USATF 100k National Championships in Madison, Wisconsin. This undertaking was no less than 50 kilometers further than I had ever run (having run a couple 50 km races, I had dipped my toes in the ultra running waters, but was by no means initiated).  Thrilling, brutal, and overarchingly long, the experience was singular.  Luckily, I walked out (or hobbled), and I walked out a champion.

This race had been a long time coming for me – I was pushed to start racing ultras last year by my running co-pilot and 50km national champ, Zach Ornelas; it was pretty apparent through all of high school, college, and beyond that I had an engine and recovery capacity that suited the longer and longer and longer training and racing.  So, going into the race, I had the confidence that this distance might capture my abilities in a way previous racing endeavors hadn’t.  

My primary goal was to qualify for the World Championship team, which would require either a victory or at a very good performance and time.  I figured if I at least came close to the course record, regardless of victory I might stand a chance to get a team selection.  That time was 6 hours and 44 minutes (6:29/mile).  Weeks leading out from the race, this pace had been on my mind quite a bit, and I had this sneaking suspicion that I could handle that pretty well.  I even had a little voice in my head suggesting I could scare the American record someday (6 hours and 27 minutes – 6:15/mile).  My rational, analytical side would brush these quiet ambitions off, as it seemed a little arrogant to think I could do something like that with literally no supporting data, no experience in anything even close to that race distance.  

In terms of potential failure mechanisms, my nervousness/apprehension/terror was two-fold. First, the fuel depletion – not knowing where this bankruptcy would occur (35 miles, 45 miles, 55 miles?) and for how many minutes or perhaps hours I’d still have to produce forward movement after going broke.  Second: the mechanical destruction – just the thought of running for 6 or 7 hours on hilly pavement will make most individuals cringe, and the effect it would have on my performance was totally unknown and not at all something I could prepare for.  What both of these boiled down to was the fact that, unlike all shorter running events (and most athletics in general) you really just cannot completely simulate these conditions before the competition.  Unknown territory, or simply, the wild.

The Course:

A ten-kilometer loop repeated ten times.  The symmetry would be beautiful if it weren’t for the fact that this 10 km loop was like a strip of bacon.  The first 3 miles rolled uphill, the next 1.5 rolled back down (so the descent was a little steeper), and then the last 1.5 were flat but garnished with a cheeky headwind.  Now, these aren’t elevation changes anywhere near the scale of what you see in trail ultramarathons (i.e. mountains), but constant ascent and descent over asphalt, not matter the grade, becomes pretty troublesome when the mileage totals are in the double digits.  Last year, I ran the 50k race at MadCity, so I had some familiarity with the course.  Last year, I bonked and broke down on the final downhill in the 50k race at MadCity, so I had some Pavlovian-esque terror associations with the course.  To round out the experience, the temperature was a über-brisk 22 degrees at the start, and barely broke above freezing by the race’s end.

The Competition:

I knew it was going to be a tough go with the other men in the race.  There were three characters I was expecting to contend: Mike Bialick, the reigning champ; Nick Accardo, a former champ; and Patrick Reagan, a debutante like myself who, unlike myself, boasted credentials of a 2:18 marathon and a 1:04-low half-marathon.  In the weeks leading up to the race, I figured it was going to be a ten-round title fight, and I thought I maybe had an outside chance to win, and if I did, it would come late in the game.

The Race, Part 1:

The things about which I had spent weeks fretting: fueling, the course, the competition, the temperature, etc. were all absent from my mind as I popped out of bed on the morning of the race.  I zipped over to the start, and decided to jog a mile to warm-up (I refrained from doing any strides or drills, deeming those warm-up staples relatively inconsequential for the task I was about to undertake).  After I started moving, I was pretty surprised at how easy I was running.  Normal runs take me quite a few miles to get rolling, let alone ones at 6 am, so to be moving so fluidly so easily felt kind of exciting.

The race started, and immediately the guys packed up with 6 or 8 of us bouncing along in the pre-dawn.  The pace felt pretty soft, but my plan was to stay really comfortable and un-taxed for the first loop or two and just work into it, planning on running even a few minutes slower than the goal pace of 40-41 minutes per lap.  Up the first hill, I was surprised to find myself drifting away from everybody despite trying to hold back, and by the first mile I was probably 50 meters clear of the group.  I really did not want to lead the race at this point, as I had no idea what I was doing, but I knew the rhythm I was on felt just about right, so I committed to what was going to be a potentially very long and very lonely day.

About a half mile into the race – right before the solo flight began. photo: Larry Iles

Keeping this pace going, I put a lot of ground on the field in the first loop, and coming into its finish, I couldn’t hear or sense them at all, as I think they were now several minutes behind.  Not having looked at my watch through the first loop at all, I was blown away when I saw 38:27 on the clock. This was what I had imagined, in an ideal world, trying to run over my final loop, after having run 9 of the of them significantly slower.  So, I backed off, and tried to keep a very relaxed rhythm.  I figured I might have an outside shot at running low 6:30s if I slowed a bit and maintained.  Wonderful realization! So, the next loop went by (again, trying to back off a little and stay relaxed) and it was 36:45. I really felt like I was holding back (which maybe is what it’s supposed to feel like and I was just ignorant to this key detail), but running any slower was going to feel uncomfortable.  At this point, I was kinda grinning for awhile while running, and all that was running my mind was, “Que sera sera… game on.”

So, I popped along and remained oblivious to splits (I hate checking splits in races, as my number-crunching mind starts to go crazy and turns vicious).  I actually had to stop on the third lap to download a brownload, but I figured it was a necessary evil of 6-7 hour race, and that earlier was favorable to later.  I must have been rolling pretty good, because even with that stop I still knocked out a 36:25.  By the time I came through 50k, I saw 3:04 on the clock.  Now, I had been refraining from calculating exactly what I was running, but the math couldn’t be ignored here.  The world record is 6:10, and it is the oldest world record in running. I literally laughed out loud (an actual lol) when I saw this.  My mind jumped to my friends, who I knew were following it back home.  I knew they saw it, and I knew they were probably staring at their freshly-refreshed web browsers with a big “What The Francis?” expression.

As I realized where I was at in the race and the context of what I was doing, the magnitude sunk in a little bit.  I didn’t want to be self-limiting, but it was admittedly pretty absurd.  And I, fortunately or unfortunately, told myself that.  However, I had no intention of making a conscious effort to back off (though perhaps my subconscious was plotting otherwise).  Going into the second half, my sentiment was, “I have no idea what’s going to happen, but I’m not backing off.”

First half 10k splits: 38:27 – 36:45 – 36:25 – 36:25 – 36:17
Course Record pace: 40:20 per 10k
American Record pace: 38:45 per 10k
World Record pace: 37:00 per 10k

photo: Wayne Gruhlke

The Race, Part 2:

The second half of the race is pretty hard to re-imagine, as much of it was spent in a pretty awful place mentally.  However, the sixth and seventh laps were still feeling very smooth, and I semi-merrily rolled along.  I could feel an augmentation in the effort required to move forward, and for the first time on the seventh lap, I could really feel my legs loose fluidity.  This was likely their way of requesting that I cease the ridiculous adventure that they were being forced to drive.  Also, I hadn’t warmed up yet, as my fingers had been rendered free of blood and nearly immobile from the first lap onward, and I still had goosebumps on the legs.  These factors started to frustrate me (as 4+ hours into a 6+ hour race, you apparently relish the opportunity to get mad at things, and probably understandably so), though retrospectively, being too cold is likely less disastrous in an ultra marathon than being too hot (but can’t we have it just right!). Literally from the first lap, I dreaded each time I came around the loop to grab a water bottle, as this meant exposing my crippled fingers to the cruel air in attempt to open and consume a gel that had taken on the viscosity of silly putty.  Not to mention the water that would inevitably spill on my hands and sleeve, which after a couple laps, had frozen into a nice ice-cuff.  

So, by the eighth lap (less than 20 miles to go!), all these factors, coupled with the increasingly difficult uphills and really painful downhills, and just the general fatigue brought on by running an absurd and arguably suicidal pace up to that point, really started to snowball.  On this eighth lap, I was thinking I could push through the discomfort and try and nab a good 50 mile time (I was on pace to run well under 5 hours, which until a few hours prior, had been a pipe dream of a goal).  However, gastric distress struck again, and I had to stop for the second time at about 75k to download another file.  While this brought relief, I had markedly less determination once I started again, and I settled into what felt like a protective pace.  Now, I honestly was not sure if I was going to crush the American record, run over 7 hours, or crush my body and not even finish.  I’d say until that point in the day, my racing and pacing was Golden State Warriors offense, and then after that for the last two loops, I was running gloves-up defense, just hoping to finish.

Through the ninth lap, it was all about just continuing forward progress.  I knew if I ran, no matter the pace, I’d still actually wind up with a respectable time (though I had no idea and no capacity or interest to figure out what that time might be).  On the tenth lap, I didn’t take my gel or water, as my stomach’s and head’s sentiment towards food and drink was pretty much exactly the same as it has been following an evening of too much merriment and ethanol.  Vomit would surely ensue.  So, the last lap became a farewell shuffle.  I actually blew kisses goodbye to several of the mile markers. Psychosis may have been setting in.  

As I rounded the final turn to the finish line and task completion became a feasible outcome and victory likely, I felt like someone hit me with fourteen epi-pens. It was the most potent stimulant I have ever felt in my life: an overwhelming and overflowing cocktail of pride for the work had I put in, relief for the suffering that was over, and joy for the success that came of it.  

Second half 50k splits: 36:54 – 38:21 – 41:57 – 44:54 – 44:07
Final Time: 6 hours 30 minutes 37 seconds
Championship Record and Course Record
3rd Fastest American Performance All-time (fastest on US soil)

Joy of joys! photo: Larry Iles

The Denouement:

After the race finished, I was bouncing around (or had the perception that I was bouncing around – I was probably disjointedly and semi-frighteningly stumbling), talking to the officials and volunteers.  Timo Yanachek, the race director, puts on such an incredible event and The MadCity Ultras are truly the best races I’ve ever run.  There are no big sponsors, no annoying coupons in your packets, and no nauseating expos.  It’s truly an ultra marathon for the passionate by the passionate.  And the excellent conversations and kind words from all the incredible individuals at the finish  line affirmed this.  

Movement functionality is operating on low-power mode

While I was buzzing with excitement, I was still freezing cold, so I bundled my body up, packed my equipment up, and took off for what would certainly be a shower to empty the water heater.  The stairs at my lodging were a formidable opponent, but I was not to be deterred.  Cleaned up, I went and capped the morning/early afternoon in the most proper of post-run fashions: massive brunch.  Despite still having some lingering food aversion, I made quick work of some eggs benedict (having had hollandaise on my mind for laps 4 through 6), and then some extra bacon, and then some extra bacon-and-cheddar grits.

Victory Feast, part 1
All still there!
Because the best trophies require white gloves to hold them

Reflecting back on the race, it was a surreal experience of the highest order.  I felt an electricity the whole way, even in the darker parts, generated from the realization that I found a calling.  Moreover, for the first time in my running career, I ran truly uninhibited and unrestrained; I was irrational.  Going out into the wild, into a physical state void of certainty or survival, was not something I ever do. I’m really glad I did.


A Silver Lining to Doping

News of widespread doping, corruption, and collusion within the Russian Athletic Federation and the IAAF (organizing body) has rocked the Track & Field world the last few days. My reaction (and likely that of anybody within or close to the sport) was a blasé, “Duh”.

I credit HBO’s The Wire and a passion for mafia-genre film with turning me into a jaded skeptic of any power structure, thus putting me somewhere along the analytical spectrum of pessimistic realist to conspiracy theorist while assessing any political, business, or athletic story. That being said, the Russian Federation and IAAF’s complete and systematic cheating was a bitter validation of my not-at-all-novel suspicion (Cycling fans are yawning right now) that the top levels of endurance sports management (and likely all sports, probably even more so that endurance sports… FIFA, NFL, MLB, etc. I’m looking at you) are nothing more than organized crime.

To WADA’s credit, this investigation was by all accounts a success. Going after Russia was a bit like being pitched a beachball underhand and getting to swing with one of those Vortex bats, but happily, they hit a home run by identifying all the key components: financial transactions, athlete testimonies, shadow labs, evidence of destroyed samples, etc. So, after they seemingly got full points on the exam’s gimme-question, it remains to be seen if they can move onto the tougher sections of the test. Organizations like Kenya and Jamaica clearly emit similar stenches, but it may be trickier to take down these federations characterized by less infrastructure and more starpower, and further federations like Morocco and the Soviet-Established Ethiopian Federation (yes, the Russians set up sports in Ethiopia… Why they have flown under the radar through all of this is beyond me, but I guess even Burger King got to laugh as the world demonized McDonald’s) will be even trickier given their smaller comparative size (and thus less expansive organization and easier cloaking). And then the final Bowser – certain corporations with expansive influence and financial interests in absurd athletic performances…

If the Prohibition Bootleggers, Tony Soprano, or Al Pacino collectively taught us anything (geez, does this mean that Sebastian Coe is our Michael Corleone – the suave, politically correct figurehead to transition a corrupt machine into the next generation?), it’s that inadequate regulation coupled with large profit-potential will create organized and systematic disregard for the rule-of-law. The victims in these systems are the citizens (the fans here), and punishments are quickly doled out to the mercenaries doing their job (the doped athletes). The guys pulling the strings are untouched and the guys trying to make an honest living (the clean athletes) might succeed, but many are just killed in the wake.

So, how do we reconcile with this depressing realization that athletics is a mafia-esque criminal organization? Give up sports and pick up the piano or origami or something, I guess. No, there has to be a silver lining to this madness. The reason athletics are so appealing and so beautiful in the first place is that physical competitions are a raw expression and celebration of humanity – they are tests and displays of our own our uniquely human machinery, both physical and psychological. This is clearly the reason doping is so offensive – it dirties this purity with a definitively non-human element.
Amidst the disgusting and saddening reality of cheaters in the sport, it’s hard to find a positive takeaway. I mean, not only have people been robbed of medals, prize money, sponsorship, and fame, but races themselves have been manipulated and dictated by those under the influence of aid. Therein lies a paradoxical benefit – they’ve forced the clean athletes to up the ante and push themselves further than what they otherwise would have thought possible in effort to compete.

Said another way, the dopers have expanded the perceptions of human limitations for the clean athletes. When an athlete toes the line, he or she has to try and beat everybody in the race, period. Without knowing 100% whether someone is clean or dirty, the clean athlete aspiring for greatness can only take everyone for what the world takes them as: innocent until proven guilty. Therefore, the cheats put on extraordinary performances and essentially tow (figuratively and perhaps literally) the clean athletes with them. They expand the sense of what is possible.

For example, after the 1990s and subsequently early 2000s, there was a glut of runners running under 13 minutes for the 5000m, with 12:50s becoming commonplace for success in major international races (the world record being lowered to 12:37! Ha!). It’s pretty likely that most of these performances were chemically aided, but the result was that it forced the clean athletes to accept that they had to run that fast to be successful. Today, we’ve seen some guys who are most likely clean run under 13 minutes, and certainly many more clean guys in the 13:00s (whereas in the early 2000s the US couldn’t even get 3 guys under 13:20).

The effect goes beyond just absolute performances – the drug-aided training raised the bar for the clean athletes. Lance Armstrong going out and crushing 6-8 hour sessions on the reg likely redefined training for a lot of aspiring cyclists (both clean and dirty!). Maybe some recognized that he was dirty and that they couldn’t match that, but it may have inspired them to go from 4-5 hours a day to 5-6 hours. The same could be said in running; if kids coming out of college in the US were used to the idea of running 90-100 miles per week to be successful, but they hear that guys in Africa are logging 140 miles a week, it may seem absurd, but it makes 120 seem reasonable. Furthermore, in attempt to replicate or come close the the intense training that the dopers put together, clean athletes have been forced to optimize recovery strategies in ways never examined before. Shortcomings in diet, sleep, and muscle maintenance are forced to be addressed in effort to keep up. Without drastic re-districting of human limits by other questionably-human competitors, the clean athletes would not have had the stimulus to yank their way up the development curve. This natural performance evolution therefore happened on a much faster timecourse than what would have otherwise progressed. In a Darwinian sense, dopers created an artificially hostile environment that sped up natural selection and evolutionary adaptations in training and racing!

Now, I’m not making the claim that because something is possible with drugs means that it could then be theoretically possible without drugs, but rather that human performances to date are far below what could be possible. Therefore, if we imagine a long-term scenario where you reach the absolute edge of human output in an event, drugs could surely push that edge a little further, but I think we are so far from that edge that drug-aided performances actually psychologically pull everyone, clean athletes included, a little closer to it.

In this vein, it’s my firm belief that in running, and perhaps other endurance sports (but especially running, given the completely self-powered and self-supported nature of the output), the human body is capable of SO much more that what has been done currently. The biggest variable affecting performance in a trained athlete isn’t his taper, recent training patterns, exact sleep schedule, etc. but rather the mental state that he or she is in and what he or she believes to be possible (which can often be dictated or framed by the aforementioned factors). Samuele Marcora’s psychobiological model of perception of effort has begun to corroborate this, and Matt Fitzgerald summarized these sentiments nicely in his recent book How Bad Do You Want It?

Finally, apart from the de facto psychological and perceptual contributions of dopers to the sport, there is an actual physical barrier they’ve literally sliced through for all competitors: the air (i.e. breaking wind). This effect is a little different across the sports. In cycling, this effect would have in significant tactical implications: you could imagine race scenarios where dirty teammates pull along clean teammates or a clean athlete uses a dirty athlete’s slipstream to close a time gap. There’s a fun thought experiment in ethics for the clean athlete… In a track race or a road race, a clean athlete can tuck into the slipstream or zone out behind a doped athlete, theoretically being provided an artificial benefit. Second-hand doping?

The initial implications of that notion make me sick to my stomach, but I reconcile by putting those mobile Petri dishes on the same level as a pair of shoes or the track surface – external physical components of the competition. If this seems a little inhuman, deal with it, as those bastards already forfeited their homo sapien card for the epo sapien variety when they pumped their blood with extra RBCs and gave themselves a few more androgens than nature dictated.

These infinite mental scenarios, bottomless speculations, and confusing extrapolations are one of the reasons we hate drugs so much – they introduce confounding variables to performances and races in sports that should be beautifully simple combats of human physiology. In a cycling race defined by mind-boggling complexities of tactics, cheaters can blow everything up and have obviously altered decades of plotlines dramatically. How many people in championship track races have not only been kept off the medal stand, but left out of the finals due to absurdly inhuman scripts written by chemists?

The aforementioned “contributions” of dopers to the sport are merely my own sadly optimistic attempts to reconcile with an otherwise atrocious problem. The drug culture has ruined lives, robbed honest heroes, and tarnished beauty. Why doping offenses are not prosecuted criminally as theft is still beyond me, given that the cheaters are breaking the law of the sport and literally monetarily robbing the person behind them (not to mention the intangible emotional larceny). So, it’s with extremely bittersweet sentiments (think like 95% cacao dark chocolate – just barely palatable) that I muse over this “silver-lining” of enhanced perceptions of ability afforded to us by the cheaters.

Maybe the true silver-lining of doping is ultimately the less-tangible psychological benefit enjoyed by clean athletes. That is to say, they do not have the stress of managing their “cycles”, the anxiety of test results (even if they’re 99% sure they’d be in the clear, there is still a psychologically taxing sliver of doubt that would be in their minds), or the logistical challenges of maintain and transporting all these chemicals. I get overwhelmed by the complexities of training and recovering without having to deal with all that nonsense. Think about not only having to decide when and what workout to do, but how that stimulus is going to interact with when and what chemical you’re introducing. The potential for error is exponentially magnified, and the probability of enhanced performance is certainly tapered below our assumption of absolute benefit. Further, the subsequent anxiety seems kindof undesirable, and this isn’t even touching on the long-term health effects with which the dopers are going to enjoy in the coming years (like multiple heart-attacks before age 50).

I have to believe that being clean is so much less stressful, and I really hope that the clean athletes embrace this small win, don’t not get worked up about what they can’t control, and revel in the stress that they haven’t imposed upon themselves.  Heck, think of being clean as the counterfactual: you’re avoiding performance-degrading hormones! This begs a nearly comical thought-experiment: if an athlete is injecting hormones (EPO, testosterone, etc.) into his system to benefit his performance or enhance his training capabilities, the stress (even if it’s subconscious) from the complexity and illegal-nature of this regimen likely causes an uncontrollable rise in undesirable hormones (namely cortisol) as a response, thereby negating some of the benefit. No masking agent for stress?  Sorry I’m not sorry.

So, maybe there are a few nuggets of positivity for the clean guys and gals to reflect on. Having to do business in an industry controlled by the mafia must be more than a little frustrating, but I really do think that despite the couple percentage points gained by drugs, humans are actually capable many more percentage points naturally, we just haven’t realized it yet. So, to everyone out there doing it clean – you’re better than you think you are and enjoy the lack of complexity-induced stress that accompanies drugs. For these athletes committed to training and performing without chemical aid, a corrupt playing field may be a tough pill to swallow. But that’s the beautiful thing about the clean athletes – they choose not to swallow it. They’ll keep doing what they do for the same reason recreational athletes do it – for the love of the game, for the thrill of venturing into the physiological and psychological unknown, and for the indescribable joy upon discovering that we can be better than we ever thought possible.