Should “artificial” high altitude environments be considered doping?

This summer’s doping scandals surrounding the 2006 Tour de France serve as a stark reminder that despite current anti-doping efforts, cheating remains quite prevalent in sport. Indeed, it was following a major scandal at the Tour de France of 1998 that the modern World Anti-Doping Agency (WADA) was born. The events of the 1998 Tour focused the international community on the problem and led to the first World Conference on Doping in Sport, held in Lausanne, Switzerland in February 1999. This conference led to the ‘‘Lausanne Declaration’’ which ultimately resulted in the establishment of the Olympic Movement Anti-Doping Code and the foundation of WADA by the International Olympic Committee. ‘‘The Code’’ was revised at the 2nd World Conference on Doping in Sport in Copenhagen in March of 2003 and the formal World AntiDoping Code that was established by this conference serves as the foundation for WADA’s current antidoping policies and procedures. A detailed copy of this document is available from the WADA website: http://www.wada-ama.org/en/dynamic.ch2? page Category.id=250. The Lausanne Declaration initially defined ‘‘doping’’ as ‘‘. an artifice, whether substance or method, potentially dangerous to athletes’ health and/or capable of enhancing their performances . ’’ Since this very broad definition encompasses many things, including normal athletic training, the 2003 Code added a third criterion, violating the ‘‘spirit of sport. ’’ At present, in order for a substance or method to be considered for placement on WADA’s Prohibited List, it must meet two of three criteria: (1) Scientific evidence or experience demonstrates that the method or substance has the potential to enhance, or enhances sport performance. (2) Medical evidence or experience suggests that the use of the substance or method represents an actual or potential health risk to the athlete. (3) The use of the substance or method violates the spirit of sport. One method that has recently attracted the attention of WADA is the use of ‘‘artificial’’ hypoxic or high altitude environments to simulate high altitude training. Altitude training has a long history particularly in endurance sport. In the early 1990s, Jim Stray-Gundersen and I performed a series of experiments that ultimately led to the formulation of the ‘‘living high–training low’’ model of altitude training, where athletes live and sleep at high altitude and train at low altitude or even at sea level to allow the process of altitude acclimatization to occur, yet still maintain normal high intensity training. Following demonstration of the success of this model, Heikki Rusko from Finland came up with a brilliant idea – since there are no mountains high enough in Finland to practically use this training model, he decided to use an old industrial technique designed to filter oxygen molecules and dilute a room with nitrogen to create a hypoxic environment similar to the mountains. Athletes could then live and sleep in the ‘‘nitrogen house’’ and train at sea level. This concept was rapidly disseminated through the athletic community and multiple technologies are now available to create such environments, including placing a tent over a bed and experiencing simulated altitude only during sleep. However, athletes sleeping in a hypoxic tent, with the intent at least in part to increase endogenous production of erythropoietin, present an image that makes some in the sporting community uncomfortable. Therefore, WADA has turned its attention to these devices to determine if they meet the criteria for placing this method on the Prohibited List for 2007. In doing so, they convened a panel to help clarify the meaning of the ‘‘spirit of sport. ’’ Although the attempt to clarify the concept of the ‘‘spirit of sport’’ is laudable and indeed critical for WADA to fulfill its mission, unfortunately the ethics committee report has a number of serious problems. Most critical of these is the argument that it is the ‘‘passive’’ use of the high altitude simulation that constitutes the most egregious violation of the spirit of sport. As discussed below, this concept is based on false premises which undermine the conclusions of the committee. An analogy which I call the ‘‘flat earth’’ premise may Scand J Med Sci Sports 2006: 16: 297–301 Copyright & 2006 The Author