Like her competitors, two-time gold medalist Katerina Neumannova is preparing for the 2002 Winter Olympics by doing intense high-altitude training. But unlike some of these elite athletes, the Czech cross-country skier does it in her sleep.
Neumannova uses the Hypoxic Tent System, a device that simulates altitudes up to 9,000 feet. So even though she lives in the Czech Republic, she can acclimate her body to the same rarefied air as those living in the Alps or training in Salt Lake City, Utah.
"The tents have very much leveled the playing field," said former British Olympic cyclist Shaun Wallace, who is vice president of manufacturer Hypoxico.
But while such altitude-simulating systems are popular among world-class athletes, they have also spurred an intense ethical debate over whether they are a legal way to boost performance of a naturally occurring hormone or simply a form of doping.
For decades, athletes have traveled to high altitudes to enhance sea-level performance. When they climb to high altitudes their body starts to produce erythropoietin (EPO) in response to hypoxia (lack of oxygen in the blood).
That's where the controversy lies: EPO is the same hormone that many athletes use as an undetectable performance-enhancing drug.
While nobody could argue that living at high altitude or traveling to a training session in the mountains is unethical, using a device to simulate the effects of altitude is a different matter.
"It's a very interesting ethical challenge," said Benjamin Levine, director of the Institute for Exercise and Environmental Medicine at Presbyterian Hospital of Dallas. "It's in a gray area between a clearly legal and ethical training strategy and a clearly illegal and unethical injection of EPO."
Simulated altitude training in non-mountainous locations isn't new. Scandinavians initially built "nitrogen houses," facilities that pump nitrogen from cylinders into dormitory rooms to dilute the air, that have been used for more than a decade. East German national teams used hypobaric chambers at the 1968 Olympics at 7,400-foot-high Mexico City. At the 2000 Summer Olympics in Sydney, local athletes used an altitude chamber at the nearby Australian Institute of Sport.
While systems like the Finnish nitrogen rooms can cost up to $100,000, athletes can purchase their own altitude tent from Hypoxico for approximately $6,000.
The Hypoxic Tent System works by removing a portion of the oxygen from the air. A generator feeds low oxygen content air into a specially coated tent. Athletes sleep in this portable, altitude-simulated environment right up until competition day, thereby maximizing their performance.
Wallace estimates that there are approximately 500 athletes who use the Hypoxico tents. He says that those who use the systems average about a 3 percent improvement in performance.
That boost can make a huge difference for athletes like Wallace, who have had to regularly journey to places like the U.S. Olympic Training Center to train at 6,000 feet, a height that is unreachable in his native Britain.
"I spent far more money traveling each year to Colorado for altitude training," Wallace said. "The tent system would have saved me a lot of money."
But despite their benefits, the "sleep-high, train-low" devices have prompted ethical concerns.
While no official decision has been announced yet, the International Olympics Committee has decided to ban hypoxic tents from the Olympic village, according to a spokeswoman for the Salt Lake Organizing Committee for the Olympic Winter Games. However, athletes who have used these tents for training will not be penalized.
The IOC will begin a study of altitude systems shortly after the Winter Olympics, according to the The New York Times..
But since nothing is added to the air, Hypoxico claims that its tents can't be considered doping "any more than using a carbon filter to remove elements from the water could be."
Anti-doping advocates such as Tour de France winner Lance Armstrong and British track star Paula Radcliffe have championed the use of altitude tents as an alternative way to boost peformance without using drugs.
"(The tents) have given people who don't want to use drugs a chance not to compete at such a disadvantage," Wallace said.
"I think personally that any creative way of challenging the body to adapt, so long as it is adapting naturally, should be ethical and legal," said Levine, a renowned expert on altitude training.
In this respect, simulated altitude training devices are inherently no different from interval training or weight training, Levine said. However, "it's fundamentally different from taking a needle and injecting foreign substances."
Athletes who use the tent system benefit far less than those who inject the artificial EPO hormone to boost their red blood cell counts and oxygen-carrying capacity do. Also, the "dose" of altitude is often difficult to control; simulated altitude systems may boost EPO levels for some athletes while decreasing levels for others.
"There are no guarantees (for boosting performance with the tent system), and that's one main difference," Levine said.
Some have also questioned whether the tents might be unsafe for athletes, possibly raising carbon dioxide levels too high or lowering oxygen levels too low.
But Wallace says that there are no more short-term or long-term health concerns with the tent system than with flying in a commercial airliner across the Atlantic or driving to the top of a mountain.
"It's exactly the same as going to altitude," Wallace said. "The body produces EPO naturally. When you go to altitude, it just produces more."
In fact, he says that there are more safeguards with the tent system than with natural altitude training.
"It's safer with a tent because you can be out at sea level in two seconds if you get a headache."
"There is little evidence, theoretical or empirical, that these things are harmful," Levine agreed. "The manufacturers have gone a long way to improving (these devices)."
The IOC must decide where they're willing to draw the line between what's legal and ethical and what's illegal and unethical, Levine said.
"I think it's wonderful and appropriate for the IOC to examine the issue in a critical way," Levine said.
However, he questions how the IOC's move to ban these devices so close to the Olympics would make any difference.
"I don't see any logical consistency in banning (these devices) at the Olympic Village and not banning them a few weeks before."
Forming an ethics committee established by the IOC that includes a broad spectrum of representatives of coaches, athletes, sports scientists and bio-ethicists "is the only fair and reasonable way to address these problems," Levine said.
Even if the IOC decides to regulate the use of altitude systems, enforcing such a ban could be difficult, especially when it could mean raiding athletes' bedrooms or monitoring the content of the air that they breathe.
"Even questioning the tents is a big step backwards," Wallace said. "There are athletes out there that are using EPO or synthetic blood and maybe the tents are an alternative for them. But if you have to be secretive about using the tents, then what's the point?"
Rather than focusing their efforts on regulating altitude systems, some say the IOC should concentrate on fighting drug abuse.
"The anti-doping agencies are always behind the cutting edge of the athletes," Wallace said. "That's certainly where they should focus their efforts."
