After filling a glass tube with his blood for the fifteenth time in a week, American decathlete Bryan Clay wondered whether it might be taking a toll.
"That's a lot of blood," Clay says.
Three days of testing during that week in early March, five vials each day. And he volunteered for this.
Clay swears he felt depleted later that week when he competed in the world indoor heptathlon championship in Valencia, Spain, even though he did win the gold.
But Clay signed up for this unprecedented level of testing because, when the meet was over, anti-doping experts say they were able to look at Clay and say they were nearly certain he had been clean. Maybe not with scientific certainty -- much more research would have to be done -- but with a greater assurance than anyone has had in more than 50 years.
"It's worth it," Clay says.
The U.S. Anti-Doping Agency, which is running the pilot program for Clay and 11 other athletes, won't even guess when the program might be operational. But "longitudinal" testing, as it is known, represents a shift that already is leaving American professional sports leagues behind.
Major League Baseball's new anti-doping agreement, ratified by the players' association on Friday, is arguably the strongest testing program in professional sports. But on the day it goes into effect, it already is all but obsolete. Despite the policy changes, baseball will not subject its players to blood draws and the kind of testing Clay is going through, nor will any other U.S. pro league. No one can look at an MLB player -- nor any professional athlete, for that matter -- and say he knows for certain the athlete is clean. And that underscores a point that many anti-doping experts have made for years: Current testing, no matter how rigorous, just doesn't work.
"I've been saying for many years that it is fairly easy, even today, to escape from testing positive," says Christiane Ayotte, the director of the World Anti-Doping Agency-accredited lab in Montreal. "You don't even have to use BALCO designer drugs to evade the testing."
In the Bay Area Laboratory Co-Operative scandal, nearly a dozen track and field athletes -- despite being pitted against the strongest anti-doping program in the world -- cheated with impunity by ingesting and injecting a wide range of banned drugs that included testosterone, human growth hormone and the endurance-boosting agent EPO.
Longitudinal testing, known in some quarters as an athlete's "passport" program, might be the only chance anyone has to prove he's clean. It's an approach that involves rigorous blood and urine tests and establishes a baseline against which an athlete is subsequently measured. Right now the best assurance an athlete can offer is that he or she hasn't failed a drug test. That was Marion Jones' defense. She'd said she was one of the world's most-tested athletes, but now she sits in prison, in part, for lying about her extensive drug use.
WADA already is set to start a longitudinal program. Its executive board approved a set of protocols for testing May 10, although none of the sports federations that subscribe to WADA has adopted the system yet. Both WADA and USADA have downplayed expectations, and USADA executive director Travis Tygart says he sees a longitudinal program as only one part of an overall plan, including traditional testing and the continued coordination of his agency with law enforcement.
Both USADA's pilot and WADA's system are untested in court and unquestionably invasive -- a combination that suggests pro leagues are unlikely to embrace the concept. Still, some experts say the Olympic sports world's move toward longitudinal testing represents the most exciting development in anti-doping they've ever seen.
"I think it's a brilliant idea," says Peter Sonksen, emeritus professor at St Thomas' Hospital and King's College in London, who's one of the world's leading anti-doping scientists. "I think the passport would be way ahead of everything else. They could make that mandatory. Why not? Perhaps it's too effective."
Sonksen, who has not worked on a longitudinal program and actually is hawking his own recently established test for human growth hormone, says he believes that when he looks at someone who has gone through the rigors of longitudinal testing, he is looking at a clean athlete.
When asked whether there ever will be such a test in professional sports, he says just as definitively, "Not a chance in hell. I don't know that they want to catch everyone."
Rob Manfred, MLB's senior VP for business and labor, says his instructions from commissioner Bud Selig have been to "continually seek the best science available," which could mean the eventual adoption of longitudinal testing. After WADA adopted its protocols, Manfred says MLB took note.
"Whenever WADA makes this kind of a change, we ask our internal experts to review it, which we're in the process of doing," he says. "It's standard operating procedure for us, but it just came out."
Union officials declined to comment.
Baseball has received generally high marks for tightening its testing program in the wake of the Mitchell report, which was released in December. But most American sports still have a long way to go just to make the most of current technology.
• The NBA and NHL test only during the season, which makes their programs effectively useless, numerous experts say.
• The NFL policy has called for offseason testing for years, but as a New York Daily News report showed in 2006, players weren't being tested from the end of their seasons until March 1, a two-month gap for teams that didn't make the playoffs. After first denying it existed, the NFL closed the loophole. The NFL also was testing players only at the stadium, so a player was able to leave practice, take certain mild steroids and return to work the next day knowing he wouldn't fail a test.
• No pro sport tests blood, and no pro sport uses either of the two tests available for human growth hormone.
• NASCAR effectively has no testing plan. Drivers sign contracts pledging not to use unspecified drugs the organization states "may affect adversely" the safety of competitors and fans, and NASCAR will test drivers and/or pit crews if it deems there is "reasonable suspicion."
• The PGA, whose policy will begin July 1, will test players only at tournaments.
But as Ayotte and others say, even if the NFL, NBA and NHL were on par with Major League Baseball, much less WADA or USADA, they still would fall short of what longitudinal testing might provide.
U.S. Rep. Henry Waxman, D-Calif., whose House Committee on Oversight on Government Reform was largely responsible for pushing MLB as far as it has, says he will wait to see whether Congress needs to push professional sports to longitudinal testing.
"The league and the players' union have made a commitment to Congress to stay current with the science, and we expect them to live up to that," he said through a spokesman. "As the science evolves, the first criteria will be whether the tests are effective and the second will be whether they work in the context of professional sports."
So far every American sport has adopted that wait-and-see attitude, with leagues noting that USADA is only in the second phase of its pilot program, and WADA just adopted its protocols earlier this month.
But American sports are faring far better financially than the sports that were crumbling under doping scandals.
The International Cycling Union, the governing body of a sport that faced collapse as sponsors began to bail on it, adopted its own passport program last year. (Just recently, the federation announced that out of the 2,172 tests it has conducted, 23 required "further review," and at least one yet-unnamed rider is facing doping charges.) Cycling has been the canary in the coal mine for some, showing what can happen to a sport that its fans think is rife with doping.
"You may find that for certain sports, this kind of aggressive drug testing may wind up becoming a standard in all new endorsement contracts," says Marc Ganis, a Chicago-based sports marketing consultant. "When you're talking about sports that generally have a tough time getting significant endorsement opportunities, they have to go the extra mile in order to persuade a company to align with them, especially on a long-term basis."
Don Catlin, the former UCLA Olympic Lab director known as the father of modern drug testing, has talked about longitudinal testing for more than 10 years, but few considered it practical until the doping scandals of the past few years.
Catlin helped create many of the drug-testing methods in place in sports all over the world but saw how easily some cheats were beating the best science. The thing that convinced him that scientists had to head in an entirely different direction, he said, was BALCO.
Catlin led the team that decoded the once-undetectable "clear," and that recognition made him a hero in most quarters. But he also found the experience deflating. Catlin and federal investigators were able to discover that Jones, Tim Montgomery, Michelle Collins, Regina Jacobs and many of the world's greatest track and field athletes had doped their way to glory. Yet not one of them had failed a test.
"You wake up one day and suddenly there's an Olympics that happened just four years ago with medal winners who were dirty. We're not nincompoops, but where was the testing?" Catlin says. "In another five or 10 years, is BALCO going to come again? Of course it is, but can you eliminate it? That's what puts a limit on testing. There's only so much you can do. People are going to be pushing, and there are people who want to use drugs, and they'll keep trying."
If Catlin is thinking that way, it should be an enormous red flag to the world of sports, says Charles Yesalis, a professor emeritus of health policy and administration, exercise and sport science at Penn State University and an internationally known expert on doping.
"Here's Don Catlin, the smartest guy in the room, and this is what he proposes. Now what does that tell you about the efficacy of the current system?" Yesalis says. "It sucks."
Catlin felt the only way to know athletes were clean was to put the onus on them. Rather than have testers try to catch cheats in an expensive and possibly futile arms race, longitudinal testing puts the burden on the athletes to show they're clean.
American swimmer Dara Torres, who at 41 is enjoying a comeback that defied simple explanation, is one of the athletes in USADA's pilot program. When she was particularly competitive in the early 1990s, fans, reporters and other athletes didn't automatically assume someone was dirty. She knew that in a post-BALCO world, at her age, she rarely would get the benefit of the doubt.
"I spoke to my coach and some friends and they said, 'You don't have anything to prove,' but I do," she says. "Actually, right now, you're guilty 'til proven innocent. You have to prove it."
Torres, like many of the athletes selected for the pilot program, says she first went to USADA to ask what she could do to prove her innocence. Finally, in September, Tygart met with her to explain longitudinal testing.
"Basically, the biggest thing he said was, 'If you are taking something, we will catch you.' I said, 'Great, let me sign up.' I'm being criticized the most because of my age. I wanted to do something," she says. "He says, 'You need to think about it,' but I already knew I was ready to sign right there at dinner with him."
In any version of a longitudinal program, an athlete undergoes rigorous blood and urine testing to establish a baseline of his or her metabolic levels, or biomarkers. The downside for athletes is that rather than having to pee in a cup a few times a year, the way most professional athletes do, they have to have blood drawn numerous times while the baselines are established.
Once the baselines are set, USADA will test an athlete and compare the reading to the baseline. If something is out of whack and the experts who review the data decide there is no other explanation for it, the athlete is considered dirty.
When USADA put the pilot program together, officials say privately, they approached only athletes who they believed would be clean and willing to do it. They were told they didn't have to participate, that they could refuse with no penalty and that no one would know.
Tygart wouldn't say whether anyone refused, but says, "An athlete's involvement in this program proves that they're willing to do whatever it takes to compete clean."
Even athletes who were caught by law enforcement, not by testing, left a longitudinal trail, Tygart says. Tammy Thomas, the former cyclist recently convicted of perjury for lying to the BALCO grand jury, was one of the first cases.
In 2002, before most of the world had heard of BALCO, Catlin saw that Thomas' natural testosterone levels were abnormally low. Only a few scenarios could explain what they found. She might have a tumor, or her body might just have trouble producing the hormone. The more likely scenario was that she was taking a steroid, which would have caused her body to shut down its own testosterone production.
But "there was no sign of a steroid in the sample," Tygart says.
Catlin looked at previous samples from Thomas and saw that her testosterone levels had been normal before. He started trying to figure out what she might have taken and eventually discovered the previously undetectable drug Norbolethone.
When Catlin started decoding THG months later in 2003, and officials later learned that Jones and Collins were connected with the lab, USADA looked at the women's previous readings and saw wide swings in their biomarkers, even though neither had failed a test. For example, Collins' hematocrit levels, which reflect how many red blood cells a person has, fluctuated implausibly from 39.1 to 49. Her testosterone-epitestosterone levels, which should have stayed the same, fluctuated 1,000 percent. They didn't know what she was taking, but she was taking something.
"It was conclusive proof of doping," Tygart says.
Brian Getz, Collins' attorney, says that even though his client had never failed a drug test, the fluctuations in her biomarkers were impossible to explain.
"It was like a fingerprint or some kind of physical evidence in her file," he says.
And ultimately, after Collins appealed her case, the Court for Arbitration in Sport, which has the final say on such matters, agreed with USADA that the longitudinal evidence it provided was evidence she had doped.
That precedent is one reason Tygart believes the longitudinal program will survive the legal challenges sure to come.
Others, though, are far from convinced, suggesting that each case will be different and the science will need to have answers to a string of variables.
"If they're planning on bringing cases based on those types of changes, which I assume they are, it strikes me they're going to need a long history to established baselines," said Howard Jacobs, a leading attorney in representing athletes charged with doping offenses. "And then the first cases will be pretty interesting."
The primary question is, of course, could someone beat the test? Could someone cheat from the start and just maintain the same levels? Or could he or she take something after a baseline is established and get away with it?
Catlin says it's all but impossible: Drugs cause too great a fluctuation, and they rise and fall too dramatically to maintain consistency. Other scientists agree.
Sonksen says he can't say with certainly that the test is foolproof. Dopers have not had a chance to dissect the proposal yet and test its potential weaknesses, Sonksen says, so he doesn't want to say with any certainty that the world finally has a foolproof system.
"It would have to be someone extremely clever," he says. Not Victor Conte clever, "Stephen Hawking clever."
One of the best elements of a longitudinal system is the ability to detect all-but-undetectable drugs such as HGH, insulin and insulinlike growth factor (IGF), Sonksen says.
There is no urine test for those drugs, and the HGH blood test WADA uses can only detect whether the person has taken it roughly within the past 12 hours. No one has ever failed that test.
But biomarkers for those drugs "change within days of starting growth hormone, and they stay up for a while after you stop," he says. "We know that some people they're elevated 14 days after the last one, and some of them stay up for months afterwards."
Under a normal blood test an expert might see that a person's IGF is high but wouldn't be able to detect the presence of HGH or IGF. Compare that test to a well-established baseline, however, and the test would show whether that's a normal level for that athlete.
One convicted steroid dealer, who spoke on the condition of anonymity, said "there has to be a way to beat it."
When asked what he would do, the source said, "You'd have to make sure that you kept the levels the same."
He was asked how he would do that, given the following problem: Because some drug levels in the body rise and fall dramatically within hours, an athlete would have to take the same amount of drugs every time he or she was tested, and take them the same amount of time before blood and urine were tested.
An athlete could be on the same regimen every day, but if that athlete usually took testosterone at 9 a.m. and was tested one time at 10 a.m. and another day at noon, the levels would be significantly different. People also tend to cycle on and off certain drugs, rather than take the same thing the rest of their lives. The former dealer was silent for a minute.
"I don't know," he said. "That's tough. I really don't know. I guess I'd really have to look at it."
Catlin, Ayotte, Tygart, Sonksen and any other proponent knows dopers will look at it. Yesalis, of Penn State, who always has looked askance when WADA and USADA claimed victories against doping, thinks the cheats eventually will find something.
"It's more smoke and mirrors," he says. "The first spin was always, 'There are only a few bad apples in the barrel.' Now people have figured out there are many more bad and only a few good. The second spin is, we had a problem before, but now we've got it fixed.
"They've said this [stuff] before every Olympics. It would be really neat in print to list out how many times they keep talking this trash. They said virtually exactly the same thing before Atlanta, Barcelona and so on. They've been doing this forever."
T.J. Quinn and Mark Fainaru-Wada are reporters for ESPN. Fainaru-Wada can be reached at email@example.com. Quinn can be reached at firstname.lastname@example.org.