BEIJING - Self-flagellation, mutilation, bladder constriction - welcome to the world of the Paralympic cheat who reaches for a belt or a sharp object rather than a banned substance to gain an edge in elite competition.
The grisly practice of voluntary autonomic dysreflexia - commonly known as boosting - involves disabled athletes beating, stabbing and strapping parts of the body to provoke an adrenalin rush that might improve their performance by up to 25 percent, or failing that, kill them.
"We are talking about headaches, gooseflesh, brain damage, arterial disruption... there have even been cases of athletes dying," said Peter Van de Vliet, medical and scientific director of the International Paralympic Committee.
While generally not regarded as a widespread problem, adherents were found in all sports that catered to athletes whose disabilities precluded a circular central nervous response, said Van de Vliet, such as those with spinal cord injuries.
In essence, athletes who could harm parts of their bodies without feeling pain.
"Typically athletes can induce this through strapping or clamping the bladder or sitting on something sharp because we know that pain stimuli can induce a similar reaction on the... nervous system.
"We find these athletes in table tennis in severe [disability] classes, swimming, in wheelchair racing, they are in cycling."
Recognised as an unfair advantage and a health threat, boosting entered the IPC's anti-doping code ahead of Athens in 2004 and officials at this month's Beijing Games are keeping a wary eye for tell-tale signs.
High blood pressure readings before and after competitions can lead to an athlete's disqualification though no mandatory bans are meted out, unlike in conventional doping cases.
Officials were still working out a suitable process for testing, which invariably could be disruptive to an athlete's preparations before competition, said Van de Vliet.
"We call it a health test, and that's the way we introduce it to our athletes. However, it's part of our doping programme."
In addition to random checks to weed out boosters, officials will carry out some 1100 urine and blood tests in Beijing, 70 percent more than at Athens, according to Wang Wei, a spokesman for the Games' organising committee.
Out-of-competition testing was also introduced in the lead-up to the Beijing Games, with Pakistani powerlifter Naveed Ahmed Butt the first casualty after testing positive for a banned anabolic steroid last week.
The second, German wheelchair basketball player Ahmet Coskun, was sent home on Wednesday after a pre-Games urine test revealed the presence of banned substance finasteride.
A tough anti-doping regime for the Paralympics is more necessary than ever, athletes and organisers say.
"I don't see it as a major problem but it's something that we have to be very, very careful about," Philip Craven, president of the IPC, said last week. "We've got more tests than ever and we're hoping for a very good outcome."
Notions of equal opportunity and participation often obscure the fact that the Paralympics is, for many athletes, an elite competition where a medal-winning performance can secure government funding and corporate sponsorship. - Reuters