Hemoglobin data have been available from ski teams beginning from 1987, and from 1989 to 1999 we have followed hemoglobin values in elite cross-country skiers in international competitions. The mean values at the 1989 World Nordic Ski Championships were lower than population reference values, as would be expected from plasma volume expansion associated with endurance training. However, an increase, particularly in the maximal values, became obvious in 1994 and rose further in 1996. These extreme values provide both a health risk to the individual athlete and unfair competition. After a rule limiting hemoglobin values was introduced, the drop of the highest values was remarkable: among men 15 g/l (0.23 mmol/l) and among women 42 g/l (0.65 mmol/l). It would appear that the rule had achieved its goal of limiting extreme hemoglobin values. Yet the mean hemoglobin concentrations in men and women have continued to rise, suggesting the continued use of artificial methods to increase total hemoglobin mass.
The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.
These data suggest that blood doping is both prevalent and effective in cross-country ski racing, and current testing programs for blood doping are ineffective. It is unlikely that blood doping is less common in other endurance sports. Ramifications of doping affect not only elite athletes who may feel compelled to risk their health but also the general population, particularly young people.
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