Dathan Ritzenhein, an Olympic distance runner for the United States, was starting to feel sick from his thyroid medication — a drug that was not medically necessary but one that his coach, a powerful and combative figure in the sport, had strongly recommended to improve his performance.
The coach was Alberto Salazar, a running legend himself who after his competitive career had teamed up with Nike, the world’s largest athletic apparel manufacturer, to train elite runners. He was dismissive when Ritzenhein expressed concerns, Ritzenhein later said under oath. Salazar was focused on revving Ritzenhein’s endocrine system for a coming race, he said, “instead of just whatever was best for my health.”
The tension between Ritzenhein and Salazar over medical issues and methods of performance enhancement was not uncommon in the Oregon Project, the vaunted team financed by Nike and led by Salazar that includes some of the world’s most celebrated runners. Ritzenhein’s experience, along with incidents involving several other athletes, were laid out in vivid detail in a confidential report written by the United States Anti-Doping Agency that was obtained by The New York Times.
The report, some aspects of which have been reported by The Times of London, describes, over 269 pages, a culture of coercion, secrecy and possible medical malpractice in the Oregon Project, an effort to make American distance running relevant again on the international stage.
Salazar has emphatically denied violating antidoping rules. He has said that he and his athletes closely followed all protocols established by antidoping authorities.
But in the report, antidoping officials depicted Salazar as a medicine chest whose door swung open for the world-class athletes on Nike’s payroll. They said he provided or helped gain access to prescription-dose vitamin D; calcitonin; ferrous sulfate; Advair; testosterone; and various thyroid medications. Many of the drugs have no proven benefits for runners.
The antidoping agency began investigating Salazar and the Oregon Project in 2015, after former team members and a staff member described cheating within the program in a report by the BBC and ProPublica.
United States antidoping officials now believe that Salazar and a Texas endocrinologist administered an infusion procedure in violation of antidoping rules, colluded to cover it up and then lied to their athletes about its legality.
“Salazar’s conduct here is patently calculating, misleading and dishonest,” the antidoping officials wrote in the report, which was drafted in March 2016 as an appeal to the Texas Medical Board to compel the release of the endocrinologist’s medical files.
Salazar, who refused to cooperate with the antidoping agency’s investigation, did not respond to interview requests. Nike declined to respond to questions about the report.
Ritzenhein declined to comment on specifics of his time with Salazar, instead deferring to his sworn testimony in the report, in which he and other athletes described an environment in which they felt immense pressure to do as their coach instructed or lose their livelihoods.
The Nike athletes, the report said, “were acutely aware that these opportunities could be withdrawn at Alberto Salazar’s discretion and were dependent both upon Salazar’s favor and their own athletic performance.”
“These facts created huge pressure to conform to Salazar’s wishes and use substances and training methods advocated by him.”
For Ritzenhein, getting a contract with Nike in 2004 was the culmination of years of hard work. “It’s every kid’s dream to sign a professional contract,” he said in a recent phone interview.
He moved to Oregon in 2007 but did not start working directly with Salazar and the Oregon Project until June 2009. He told antidoping officials that as soon as he joined the team, he “started taking a lot of supplements that Alberto had in a room in his basement, pretty much everybody on the team took them.”
In June 2010, after an unproductive season of injury, Ritzenhein and Salazar’s conversations moved from supplements to “synthetic thyroid,” Ritzenhein testified, saying it was “to help with low testosterone levels.” Blood work performed at Nike’s lab showed that Ritzenhein’s thyroid-stimulating hormone and his testosterone levels were both within the normal range. Regardless, Salazar sent him to see Dr. Jeffrey Stuart Brown, an endocrinologist who is known for his belief that synthetic thyroid medication enhances athletic performance.
The next day, Dr. Brown prescribed Levoxyl, a thyroid drug. (Levoxyl is not a banned substance.)
According to the report, Dr. Brown was Salazar’s personal physician and was being paid a monthly retainer to work with the Oregon Project athletes. Ritzenhein said he did not know any of this at the time.
Last summer, the United States Anti-Doping Agency, or Usada, tried and failed in court to compel a deposition from Dr. Brown. His lawyer said at the time that the agency was engaged in a “fishing expedition to see if they can find some kind of a problem.”
Dr. Brown is known in the track world for diagnosing hypothyroidism in distance runners. The condition involves an underactive thyroid that can lead to weight gain and fatigue, but is considered relatively rare among athletes.
Some experts say that thyroid hormone can serve as a stimulant, lead to weight loss and improve alertness among athletes.
“Throughout my career the health of my patients has, and always will be, my absolute priority,” Dr. Brown said in a statement through his lawyer. “I will not be bullied or coerced regardless of tactics used, and I intend to fully defend myself against any baseless allegations brought against me in any forum.”
In January 2011, Salazar became aware of research from the University of Nottingham in England that appeared to show significant improvement in performance when athletes raised their L-carnitine to extremely high, unnatural levels. (L-carnitine is a substance that occurs naturally in the body and helps convert fat to energy. As a supplement, it is not a banned substance, according to the World Anti-Doping Agency.)
After contacting the researchers, Salazar learned that one was about to bring an L-carnitine drink product to market. He spent thousands of Nike dollars on pallets of the preproduction drink and began distributing it to his runners, telling them that access to this special L-carnitine product was something to be kept secret. Salazar knew he would lose his advantage if competitors used it.
L-carnitine levels are notoriously hard to increase, however, so it would take up to six months of loading with the drink before the promised enhancement in performance could be realized on the track. Salazar was impatient; Ritzenhein had the 2012 Olympic marathon trials coming up in just two months.
The Nottingham researchers had written about a method in which they were able to infuse patients with L-carnitine to bring levels up thousands of times compared with the baseline. This procedure took 4 hours 10 minutes instead of six months of drink consumption. Acting with urgency, Salazar decided to test the process on an employee. Steve Magness, an assistant coach, was the chosen guinea pig.
Magness, who was at first unwilling, eventually relented to Salazar’s demands and soon took a preinfusion treadmill test. Medical records obtained by the antidoping agency showed that Dr. Brown then gave Magness a continuous gravity drip infusion of L-carnitine on Nov. 28, 2011, that lasted 4 hours 10 minutes. The records note that Dr. Brown used the same duration, method and solution of L-carnitine and dextrose outlined by the Nottingham researchers.
Even though L-carnitine is not a banned substance, the method of infusion used by Dr. Brown was prohibited, antidoping officials believe. Antidoping rules prohibit “infusions and/or injections of more than 50 mL per 6 hour period except for those legitimately received in the course of hospital admissions, surgical procedures or clinical investigations.”
Fifty milliliters is about three tablespoons of liquid, an amount that would not take four hours to infuse.
Dr. Brown left crucial information out of Magness’s medical records, the report said, including the quantities of L-carnitine that he infused. However, from Magness’s sworn testimony, the antidoping officials concluded “it appears very likely that the infusion volume administered to Steve Magness by Dr. Brown was at least 1000 mL (i.e., one liter).”
Magness said in a recent interview that he was not aware at the time that the treatment would be more than 50 milliliters and a violation of doping rules. “Both Dr. Brown and Alberto told me it was good with Usada and I mistakenly trusted them,” he said.
Magness described the results of his post-L-carnitine treadmill test as “almost unbelievable.” Salazar was enamored, and quickly focused on making sure Ritzenhein got the treatment as soon as possible.
After learning about the procedure, however, Ritzenhein said to Salazar: “Is this legal? This doesn’t sound legal.”
Realizing that the procedure was a breach of antidoping rules, the report said, Salazar and Dr. Brown changed the infusion protocol. From now on, the athletes would be infused for just over an hour, instead of the more conspicuous four.
In an email message obtained by antidoping officials, Salazar then appeared to mislead Ritzenhein: “Hi Dathan, we are cutting edge but we take no chances on a screw up. Everything is above board and cleared thru Usada. They know me very well because I always get an okay before doing anything!”
In its report, the antidoping agency said, “Salazar’s statement about always getting clearance with Usada ‘before doing anything’ is both ironic and inaccurate.”
Nike had begun making fewer payments to Ritzenhein based on his disappointing performance, he said. He believed that his options were to submit to the infusions or leave the Oregon Project. “There’s no way for me to get around it at that point, in my eyes,” he said in the report.
He received the infusion — which now took just 1 hour 10 minutes — in Dr. Brown’s Houston offices on Dec. 13, 2011. He also mentioned that Dr. Brown or someone on his staff would come in every few minutes and squeeze the infusion bag.
Dr. Brown provided antidoping officials with Ritzenhein’s medical records, but the report says the version he sent was altered. A page was removed and an added annotation read “45mL.” Antidoping officials said they were able to determine the alteration by comparing the records with those provided by Ritzenhein.
Antidoping officials suggest that administering an infusion of less than 50 milliliters “continuously and uniformly over a one hour period is a practical impossibility and Dr. Brown knew this,” concluding that Ritzenhein “received 9.67 grams of L-carnitine over 1 hour, which demonstrates that Ritzenhein likely received an infusion far in excess of 50 mL.”
Ritzenhein did not run fast enough to qualify for the Olympic team at the marathon trials in 2012, and Nike paid him only half his expected $200,000 salary for the year, he said.
As previously reported by The Times of London, the report also said that Galen Rupp, an Olympic silver medalist, and Mo Farah of Britain, one of the most successful runners in Olympic history, also received infusions of L-carnitine. Rupp, Farah and Salazar have repeatedly rejected any claims that they violated antidoping rules.
Among the others identified in the report as having used L-carnitine was Tara Welling, a standout at Loyola Marymount University in Los Angeles who moved to Oregon to work with Salazar in 2012. (Her surname was Erdmann when the report was written.)
Welling declined an interview request but sent a statement through her husband, a Nike employee. “I had nothing but the utmost respect for Alberto and the staff,” she said. “At this time Usada has not yet been able to share with me the details or evidence that supports these allegations.”
Her testimony in the agency’s report was starkly different. Welling recalled Salazar’s abusing medications by giving her the prescription drug Celebrex out of his personal supply. Her testimony under oath also spoke to the secrecy of the program, in which she said Salazar demanded that athletes remain closemouthed about all things related to the Oregon Project.
An investigator with the antidoping agency first interviewed Welling in the summer of 2015, and she insisted that she had never seen Dr. Brown and knew nothing about infusions. After reviewing Oregon Project emails, the agency found messages from Salazar in which he wrote that Welling “got the L-carnitine injection yesterday from BrownD.”
In a subsequent interview, Welling admitted that she, too, had received an infusion of L-carnitine. She said that Dr. Brown had drawn blood and performed a physical exam, a bone exam, a lower leg jump-test and an asthma lung-capacity test, and had poked her with a “roller thing.” Regarding the L-carnitine infusion, however, she said she could not remember a single detail.
Welling’s medical records showed a nearly 11,000 percent increase in her muscle L-carnitine levels after the infusion. For the antidoping officials, this was evidence of illicit performance enhancement.
When pressed about the infusion during her interview with the agency, Welling began crying. “I don’t know if Alberto did something to me,” she said.
Ritzenhein still runs competitively, but is without a sponsor, having left the Nike-funded program in May 2014. He no longer has a relationship with Salazar and has moved back to his home state, Michigan. Welling left the Oregon Project in December 2015. She is no longer sponsored by Nike, and now runs for Skechers.
Antidoping officials have not announced sanctions against anyone implicated in the report.