The whole world hasn't stopped talking about 15-year-old Russian figure skater Kamila Valieva after it was revealed last week that she tested positive for a banned substance prior to the 2022 Winter Olympics. Valieva was still allowed to compete at the Games, placing fourth in the women's single free skating final on Thursday.
Wait, "doping" refers to more than steroids? Why is everybody talking about some non-FDA-approved heart medication now? How does that affect an athlete, and why would it be banned?
If any of this saga has left you scratching your head about terminology, you are not alone. Let's learn break down what everybody is talking about.
What is blood doping, exactly?
Your heart pumps blood. Your lungs take in oxygen, which gets into your blood and circulates through your body. When the body is exercising, muscles need more oxygen. Your heart rate increases and you breathe harder.
Blood doping refers to any use of a banned substance or technique to manipulate an athlete's blood to get a competitive advantage. Usually, the goal is to boost the red blood cell count or increase the blood's ability to carry oxygen.
According to the American Society of Hematology, blood doping really took off during World War II as a way to treat soldiers' hypoxia, a condition where the body's tissues aren't getting the oxygen they need. Soldiers were given transfusions to help their blood more effectively carry oxygen through their bodies. The practice has also been referred to as "blood packing" or "blood boosting."
Athletes and trainers soon realized that manipulating blood might help boost endurance and performance, and athletes started blood doping via transfusion, which wasn't outlawed until the mid-1980s.
Besides transfusions, there are a few other documented ways to blood dope: taking the hormone erythropoietin (which stimulates the creation of more red blood cells), or taking a substance to boost the blood's ability to carry oxygen, known as a synthetic oxygen carrier.
How is blood doping different from normal doping?
It can be confusing, but the term "doping" broadly refers to any usage of banned performance enhancers, whether that's steroids, narcotics, beta blockers, huge doses of caffeine, or other performance enhancing drugs (PEDs).
"Blood doping" only refers to the illicit tactics that manipulate an athlete's blood to gain an advantage.
When has blood doping occurred?
The first known Olympic case of blood doping via transfusion occurred at the 1980 Summer Olympics in Moscow, according to "Erythropoietin: Blood, Brain and Beyond," a book by Arthur Sytkowski. At those games, a runner received two units of blood before winning medals in the 5- and 10-kilometer races.
Following the 1984 Summer Olympics in Los Angeles, the American cycling team sparked a scandal when it was revealed seven cyclists, including medal winners, had received blood transfusions before competing.
Outside of the Olympics, Tour de France winner Lance Armstrong confessed to blood doping along with testosterone, HGH and other performance enhancers to get a competitive advantage.
Why is Olympic skater Kamila Valieva accused of blood doping? What drugs did she test positive for?
A sample from Valieva taken on Dec. 25 was positive for the drug trimetazidine, which can treat angina, a chest pain caused by low blood flow and oxygen supply to the heart. The drug is not approved for use in the United States but is legal in other countries.
"What it really does is it improves blood flow and endurance," Dr. Daniel Bober, a psychiatrist and addiction specialist, told NBCLX. "This is the reason it is considered doping, or a drug that is athletic-enhancing."
"It could be potentially harmful if it was used in the wrong way," Bober added. "But I think their concern at this point is that it was enhancing her athletic abilities and that it wasn't a level playing field."
Trimetazidine is on the World Anti-Doping Agency's list of banned substances, as a forbidden "metabolic modulator."
"There's no question about the fact that this 15-year-old has a sample for heart medication, and she obviously does not have a prescription for it," former federal prosecutor Jim Walden, who helped craft the Rodchenkov Anti-Doping Act, told LX News. "It's obviously a drug of choice, or it's become a drug of choice for Russian dopers."
The 15-year-old skater also declared two legal oxygen-boosting substances on an anti-doping control form, according to the Associated Press. One was hypoxen, a drug which can increase oxygen flow to the heart and the U.S. Anti-Doping Agency has lobbied to be banned. The other was L-carnitine, another oxygen-booster.
United States Anti-Doping Agency CEO Travis Tygart believes the combination of hypoxen, L-carnitine and trimetazidine is "an indication that something more serious is going on," he told AP.
Given Valieva's age, much of the focus of the doping scandal has been on her doctor and coach.
How does testing work?
American athletes can be tested on any day of the year with no advance notice, according to the U.S. Anti-Doping Agency. Urine and blood can be tested.
When athletes aren't competing, they have to provide information on their whereabouts in case they need to be located and tested.
The World Anti-Doping Agency has an 84-page document outlining how to run a testing program. Testing has gotten a lot more sophisticated over the last few decades, and can detect a lot more than just a drug or supplement in an athlete's system. For example, if an athlete received a blood transfusion, trace chemicals from the plastic IV bag could show up on a test and trigger further scrutiny.