Finnish doctor would allow use of plasma expanders in Olympic marathon and long-distance walking events

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Jussi Jouppila, M.D., a member of the Medical Commission of the Finnish Olympic Committee, and one of the doctors with the Finnish track and field team in Athens, has expressed concerns about the health of distance runners in the blistering heat of the Greek capital.
      Jouppila would even be willing to approve the pre-race use of banned plasma expanders for Olympic marathon runners and long-distance walkers. He notes that competing in extreme heat, where the risk of dehydration is great, is safer with the help of intravenous albumin than without. Albumin has a high water-binding capacity - 1 gm of albumin binds 18 millilitres of water.
     
Plasma volume expanders were banned shortly before the Lahti Nordic Skiing World Championships in 2001. The news of this apparently slipped under the radar of the Finnish skiers who tested positive for the substance in Lahti, sparking a major doping scandal. Regardless of his good intentions, Jouppila's remarks are almost certain to revive memories of this less-than-illustrious moment in Finnish sports medicine (see links below).
      At the time, the disgraced skiers were suspected of attempting to lower abnormally high haemoglobin levels and mask the use of EPO hormone (erythropoietin, for which no test existed at the time) by means of the plasma expanders Haes-Steril and Hemohes (the "hes" stands for hydroxyethyl starch). Albumin is another well-known plasma volume expander.
      Jouppila stresses that the use of plasma expanders could be sanctioned only for health reasons, and absolutely not as a doping agent. Plasma volume expanders are routinely used by hospital physicians to maintain circulatory system fluid volume and blood pressure after large losses of blood occur during surgery or trauma.
     
The body's temperature is regulated by sweating. There is no other means of getting rid of excess heat. Jouppila charges that if the outside air temperature is 30°C, then it is already risky to run or to make people run competitively.
      The sportsman or woman has to drink all the time in the heat, not just to quench his or her thirst. If the salts and minerals present in the bloodstream evaporate, then cramp strikes. Sodium chloride is the most important, and acute deficiency can even lead to death in marathon runners. Magnesium and calcium are also necessary.
     
The problem with running in extreme heat such as athletes have faced in Athens is that maintaining the fluid balance becomes an impossible equation. The body can absorb something like 800 millilitres of fluid in an hour, but a 60-kg runner will see three to four litres of fluid evaporating in the same period. The men's 50 km walk is a four-hour exercise, the fastest male marathon runners are in action for just over two hours, and the women's marathon winner's time on Sunday was just under two and a half hours.
      The walking events and the marathons in Athens have been scheduled for the early mornings and the evenings. Running during the day would be out of the question, and as was seen on Sunday, even with a start at 18.00, sixteen of the women did not complete the gruelling marathon course. Among them was the British hope, unofficial world record holder Paula Radcliffe.


Previously in HS International Edition:
  Finnish skiers used plasma expander for years prior to Lahti doping scandal (26.3.2002)

Links:
  Doping Disaster for Finnish Ski Team: a Turning Point for Drug Testing? (Sports Science)
  Albumin (Octopharma)

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