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Wednesday, July 23, 2008

Doping update: Two interesting stories, one positive, one negative

Two posts for you today (after a long absence, sorry!). This one concerns some doping news, and then directly below this post, you'll find a short summary of the Tour de France Alps stages, and a preview of today's big Alp d'Huez finish, which should shake the top of the leaderboard a little more. First, however, doping.

By "positive" and "negative", we mean "good" and "bad" as opposed to a Ricco-like positive test, incidentally (pardon the accidental pun)!

Ricco - thought he'd get away with it, but WADA was (for once), a step ahead

First up, it has been confirmed that Ricardo Ricco tested positive for a designer form of EPO (Micera, as we discussed in our last post). Nothing new there. However, what is quite amazing and was revealed this morning, is that the test that caught him was possible thanks to "collusion" between the testing authorities and the pharmaceutical company that produces Micera. It turns out that Roche Pharmaceuticals and WADA worked together to place a molecule in the drug that allowed testers to detect its presence.

In the words of John Fahey, WADA's President: "In the development of that particular substance close co-operation occurred between WADA and the pharmaceutical company Roche Pharmaceuticals so that there was a molecule placed in the substance well in advance that was always going to be able to be detected once a test was undertaken."

This is a very positive development, because for the first time, it suggests a proactive approach that is more integrated than what we've seen before from the authorities. One day, I'll discuss the "Wikinomics" approach to doping and what I believe will solve the problem, but let's just say that WADA needs to open its doors to external expertise if it wishes to remain in touch with the dopers. This positive test is a step in the right direction, maybe even a leap. Ricco did not believe that they could catch him, and so now all athletes in future should be warned that every once in a while, WADA will pre-empt their moves. Hopefully that will discourage doping...

All we need now is about 100 more similar tests, as the next story demonstrates.

China: Gene doping revealed in German TV documentary

On a more pessimistic note, a documentary that was aired in Germany showed how doctors in China offer gene-doping (the introduction of stem-cells) to a journalist posing as a swimming coach. The journalist approaches the doctor and requests stem-cell treatment for one of his "swimmers", and the doctor replies:

“Yes. We have no experience with sportspeople here, but the treatment is safe and we can help you.”

Asked how it would work, the doctor said: “It strengthens lung function and stem cells go into the bloodstream and reach the organs. It takes two weeks. I recommend four intravenous injections . . . 40 million stem cells or double that, the more the better. We also use human growth hormones, but you have to be careful because they are on the doping list.”

And the price? “Twenty-four thousand dollars,” the doctor said.

The documentary also reveals that doping products can be picked up for bargain discount prices in China - 100g of steroid hormones are sold for 100 Pounds, when the typical price in Europe is about 4500 Pounds per 100g.

Now, the knee-jerk reaction to this kind of information is to be hyper-critical of China, but it's probably prudent to point out that this same scenario is likely possible in any country, though of course the price would be different. China has been called the "world's doping pipeline", because it is able to make available ingredients so cheaply - that's nothing new, though. If your country is anything like South Africa, half your household goods were made in China. So economically, China can't be blamed for producing cheap drugs (though the impact of these drugs is a problem).

What is more disturbing and of concern is that in China, testing processes are likely to be far less transparent than anywhere else. Our first story today dealt with how WADA and Roche worked together to develop a test for a drug that was thought to be undetectable. This second story demonstrates just how much work they have left, because what happens in China is all too often insulated from the rest of the world. The relatively strict limits on foreign presence (and particularly "interference") means that if drugs are being made or distributed in China, which seems likely, no one will ever know.

Worrying times indeed...



Anonymous said...

I have ssen the TV feature about the "Gene Doping". I think one must be rather sceptical: In medicine, there are currently 3 gene therapies under evaluation. None is clinical standard. Why would it work in sports then? Especially if you consider the fact that a functional gene therapy in medicine would probably make you rich. Much richer than any doping method for a few athletes. Furthermore: What are the mechanisms of stem cells to improve sporting performance? How is it supposed to work on a physiological base? Maybe, the journalists were just ripped off by some smart chinese doctor who would sell them "stem cells" for a lot of money, but in fact give them normal saline...
We should be more critical (or should I say: more scientific) on the content of some journalistic reports that are not submitted to "peer review".

Ross Tucker and Jonathan Dugas said...

Hi Anonymous, and thanks for commenting here.

It seems you know more than we do about the clinical application of gene therapy, but we should make an important point here.

Even if none of the three current therapies is a clinical standard and still under evaluation, that would never prevent an athlete from using it to dope. Whether or not a substance actually improves performance via a physiological mechanism is irrelevant, for if the athlete thinks it will help him/her, then they will use it.

So the use of gene therapy in sporting performance could be totally bogus and ineffective from a physiological stand point, but I guarantee you that some athletes will still try it before it becomes common knowledge that it does not help.

I am not sure how stem cell treatment is meant to work. However, we do have medical researchers and other scientists who read The Science of Sport, and we welcome their input here to educate us on this topic!

Finally, your point about the doctor punting a "snake oil" treatment is valid. Indeed, that doctor could be selling a placebo and passing it off as something more sophisticated. However, this still illustrates that a market exists where coaches/athletes seek these types of "products." That was not a scientific documentary, but we try to look all of the available information and comment on it.

Thanks again for posting!

Kind Regards,

nickgavey said...

Jonathon/Ross -

I enjoy your blog, and have noticed the number of posts about the scourge of doping in sport. Have you given any thought to legalising performance enhancing grugs? From the tone of your posts I am guessing that you are opposed, but I would be interested to hear your reasoning.

Ross Tucker and Jonathan Dugas said...

Hi Nick, and thanks for your question about doping.

We responded to a similar comment from another reader on an earlier post. I will summarize it here.

You are correct that we are opposed to it, but perhaps the biggest reason after fairness for banning these substances is for the health of the athletes. As this post indicates, there is a market for banned substances, and also for techniques that remain unproven and probably dangerous.

Therefore if we were to legalize drugs I suspect we would see the untimely death of many athletes in all sports. This would be due partly to drugs that are untested and have deadly side effects, but also to the abuse of these drugs and others that often follow the use of performance enhancers.

Just a quick story I recall in Time magazine several years ago was about a former domestique. He said it starts with corticosteroids to numb the pain of hard training and racing. But these cause muscle atrophy and so in the off-season he said they take steroids. He was still in the era of amphetamine use, and so they took those for racing and training, coupled with tranquilizers to help them sleep later. This in turn lead to him taking the amphetamines for recreational reasons, and after he was washed up and cut loose by his team his use escalated due to depression. . .which lead to cocaine addiction.

Some will argue that it is their body and they can do with it what they like---but no professional organization or coach can ethically condone the use of such substances as there is a mountain of evidence that they are damaging on many levels.

Finally, let's not forget that many of these substances are controlled and therefore illegal to possess without a prescription and some are illegal to possess period.

This probably warrants an entire post, and perhaps after the tour or during the Olympics we can tackle this topic properly!

Thanks again for the comment.

Kind Regards,

Andrew said...

That's great that Roche and WADA cooperated on a molecular tag and it seems like a model for future drugs, but what happens when the patent expires and generic forms hit the market?

Christopher Tassava said...

Or - extending Andrew's point - when an Indian or Chinese pharma plant starts making an unmarked version of Micera? I was very excited to read that Roche had helped WADA catch Ricco and the other cheats, but marking the medicine seems to me to be more a stopgap than a long-term solution.

Philippe said...

I'm shocked that it was worth it for Roche to "plant" this molecule in their CERA formulations. What is the advantage for Roche - to bust dopers? How does that positively impact their bottom line (and responsibility to shareholders)? What if the planted molecule caused side effects in some portion of the population? I guess it didn't because CERA made it through clinical trials, but why would Roche take that risk? Call me pessimistic on this one, but I think it is more likely that Roche alerted WADA that there was a way to test for a molecule that they were already planning on including.
Nevertheless, I think a test for a secret molecule is a catch-22. You can't tell the dopers what the "molecule" is because then you open the door for dopers to use a different substance or develop ways to take CERA and still evade the test. However, is CERA the only product on the earth that contains the planted molecule? Is the planted molecule linked to CERA or is it simply in the formulation? Is the planted molecule itself on the banned list? How do you respond to a defense that claims "I didn't know what you were testing for, so I didn't know to avoid it in my normal nutritional regime"
Without knowing the details of the planted molecule and the test, its impossible to know if that defense is valid. Nevertheless, I hope for WADA's sake that there is no other way on earth to end up with the planted molecule in your system other than taking CERA.

nickgavey said...

Re legalising doping in sport -

Could you not make an argument that the act of legalisation would help mitigate many of the harmful health effects of drugs?

Under the status quo it seems that the two priorities for athletes that take drugs are:
1. That they enhance performance, and
2. That they are undetectable.

Since athletes don't admit to the use of drugs it is much harder to know of any negative health affects. If drugs were permitted, clinical trials could be carried out and research could go into making the drugs both effective and safe. Of course, I'm sure performance enhancement would still be the first criteria but I'm sure we would also see a general trend in safer drugs.

Also, it would avoid the whole situation of never knowing which athletes are cheating, and having virtually every record in some sports hang under a cloud of drug suspicions.

Piotrek said...

Nickgavey, if I may, what would be the purpose of using PED's if everyone was free to use them?

Ross Tucker and Jonathan Dugas said...

Hi Andrew, and thanks for your comment about the patent on these drugs.

By now you should have heard that in fact the drug was not labeled, but rather that Roche assisted WADA in developing a test for Micera.

However, if there were a label, indeed it would become (or already be!) redundant as there could easily be black market versions of the drug available. Or, the patent situation would occur where Roche's patent expires and generics start being produced.

I think the encouraging thing about this situation is that WADA is enlisting the help of the pharma companies. To be sure, WASDA still has a long way to go, but it is a step in the right direction.

Kind Regards,

Anonymous said...

The German "gene doping" report ignored many facts:

- Stem cell therapy does not alter anyone’s gene
- The only type of gene therapy associated with doping is Repoxygen, but that’s not being offered
- Stem cell’s efficacy remains unproven, there’s even less evidence of performance enhancement

Last April ABC had a “Sports Medicine Miracle” story about stem cell therapy by Dr. Rick Matsen. For some reason the same thing in China is called “doping”.