Q&A with Dr. Bengt Kayser on the doping dilemma in sport
Le Tour de France has now passed us by, although news from the cycling world is still coming thick and fast as rumours abound about who might and might not move to the new Team Radioshack in 2010. Also, the million dollar question is where will Alberto Contador ride in 2010? So many questions remain about Astana's future makeup---and Vinokourov's comeback---and Radioshack seems to have scooped many of the very good support riders from the current Astana. For some it might read like a soap opera on wheels, but that is part of the drama of cycling!
And we all know that drama is never far from cycling, even after the tour, because it was just announced that Mikael Astarloza, winner of Stage 16 into Bourg-Saint Maurice, tested positive for EPO on 26 June, just prior to the start of the tour. This follows on a positive test for Inigo Landaluze for CERA back in June during the Dauphine Libere stage race, announced during the Tour de France, which kind of flew under our radar. As an aside, there are very interesting Wikipedia pages listing all of the positive tests in sport, and also in cycling. Unfortunately, you have to check back often for updates!
But just when it seemed that cycling was getting things under control we see that the positives still persist and are very much still part of the scenery. Thankfully Landaluze admitted outright to his doping and saved us from any kind of protracted legal battle about lab procedures and test results.
Interestingly, the same day we received this news about Astarloza, we also received answer to a Q & A from Dr. Bengt Kayser, a medical doctor and also a Ph.D. and well published sports scientist from the Faculty of Medicine at the University of Geneva in Switzerland. Back in early June I attended the American College of Sports Medicine annual meeting, and Bengt was one speaker in a symposium titled, "Anti-doping efforts: Is it worth it?" Bengt presented across from Tom Murray, president and CEO of The Hastings Institute in New York.
The symposium was not really a "for/against" debate, but both Tom and Bengt presented thorough and compelling arguments to strive to a 100% clean sport (Tom) and to consider some alternatives to the current situation (Bengt). To sum up, Bengt's main position is that attempts to prohibit doping are doomed to failure, and therefore the only pragmatic response we should be striving for is regulation or control, not prohibition. Bengt has kindly rewarded us with the answers to a few questions, which come to us just as this most recent positive test was announced.
So, is it worth it?
The primary message I took away from this symposium is that even as much as I think about doping in sport and consider myself a very well-informed fan due to my sports science background, there are many valid questions and challenges to the current situation. Mostly, these are important arguments that apply more to our society but are nevertheless important to how we frame and approach the problem of doping in sport. The problem---not how much doping, but rather the fact that it exists---is much bigger than you think when one stops and places it in the much bigger picture of life. Sport is not isolated in a little box outside of our cultures and societies, and as such the larger cultural and societal forces influence sporting culture and sporting "society." But enough social science already. . .On with the Q&A!
What are the primary reasons to permit controlled use of performance-enhancing substances?
1) Public health aspect: because doping and doping-like practices are forced into hiding, especially outside elite sport, there is increased prevalence of dangerous behavior including sharing of syringes and the use of products of uncertain origin. The best example is anabolic steroid use for body building. Repression will not work, certainly not in a democratic society; therefore evidence-based controlled use and harm reduction must be discussed as potential alternatives for more pragmatic solutions. This is already partly being done for steroid users in the UK and Australia, with some success since more syringes are being exchanged for steroid injection than for heroin in the UK. [SS: Very interesting fact, that speaks to the larger societal issues at work in this debate.]
2) Anti-doping cannot be successful. There are limits to testing technology and in order to prevent false accusations from laboratory uncertainty (sensitivity and sensibility) the cut-off levels anti-doping uses have to remain on the safe side leaving considerable space for well-accomplished athletes to stay under the radar.
This is problematic since the aim of anti-doping is to be 100% certain that the winners are clean, but there is no way to tell that with certainty. Remember that Rasmussen and Jones never tested positive despite numerous tests. [And let's not forget Bernard Kohl, who alleges that he doped for a long time before finally testing positve--SS] Today a champion is unfortunately a suspect by definition. The discussions in the press and on the web of the 2009 Tour and other championships show this perpetual suspicion clearly.
3) The trend of anti-doping is towards serious intrusion into the private sphere of the athlete. Reporting one’s whereabouts 365 days a year is quite something. There is even talk of carrying a GPS to be tracked at all-time. Genetic profiling is being used for forensic use. This all points towards a potentially dangerous slippery slope towards wide-spread controls in society at large. I find the prospect of a totalitarian system of ubiquitous control rather disconcerting. Are we going towards urine control in students before an exam? Blood passports in kids who exhibit talent in a given sport?
Do you feel athletes should be able to take any drug in therapeutic doses so long as the doctors disclose the information? If so, what will this accomplish?
I presume you mean therapeutic in the sense not to treat a disease but in doses that come with acceptable risk. [Correct---SS] Yes, that is a potential way to go about it. Disclose and observe. It would lead to transparency and potential for evidence-based advice. It is very likely that the majority of the drugs on the WADA list do not have performance improving effects. If this can be proved the use of such products may become less popular.
Was there a time when you bought into the current model of doping control? Or was there perhaps a time when your views were more "innocent" towards doping in sport?
Before the introduction of the present coercive system I thought that the system was more or less well self-regulating. But I never believed in the current model, certainly not when I discovered the whereabouts rule and other intrusions in the private sphere of the elite athlete. But in principle, as long as the ‘no-doping’ rule is in effect I find that one should not dope. This is cheating, which is presumably not right. I find that one should, again in principle, obey to the prevailing rule, but one may question the rule finding it in part ineffective, potentially dangerous, and not anchored in sufficiently solid reasoning to accept its side effects. Rules can change and do change when it is found that they do not work as well as hoped.
I predict that the anti-doping rule will change, probably not in the next 10 years, but thereafter. Think about how the world will look like 50 years from now---not many more world records to beat since we will have reached the limit of human performance (one cannot run the 100m in zero seconds and therefore the improvement of the record will become less and less). And a prospect of a performance enhanced society, where most citizens use technology to enhance, whereas the modern gladiators still stick to ‘natural means’ while competing, looks rather unrealistic to me.
SS: When did you first realize that we needed a different approach to anti-doping, or when did your paradigm shift?
I first realized what was happening when I attended a symposium at an international sports federation and heard anti-doping officials, including physicians, talk about their work and the anti-doping rules. It was truly an eye-opening experience, I was shocked. I thought we had escaped from Big Brother, but there he was. Also the way with which the anti-doping officials talked about athletes who were potentially doping was rather chilling. It all came with a strong flavor of ‘the end justifies the means’, even if this would imply sacrifice from (of) athletes.
SS: Do you feel the new biological passport is the answer to sports doping problems? What are its pros/cons, why will it or why won't it work?
Again, it can never be 100%. Of course, many doping practices will become extremely difficult or impossible, but many others continue, at low levels, or undiscovered since not included in the panel of measurements.
The accusation of innocent athletes (false positives are certain to occur the more we test) is something very uncomfortable to me; the sacrifice of innocents on the altar of what is known as ‘the spirit of sport’ is in my view difficult to accept. There is also the strict liability rule that is causing quite some harm, when athletes, clearly not because of willingly doping, find themselves accused and punished with potential devastating consequences on their private and professional lives.
SS: What can you say to the sports fans who still believe that the current controls are working?
Open your ears and eyes and think.
So there you have it, thanks very much to Bengt for taking the time out from his busy academic schedule to answer these questions, because part of our Vision and Mission is to translate the science that surrounds our sports, but also to provide the extra insight, analysis, and viewpoints that one cannot find anywhere else.
Admittedly this is a concise piece considering that one can write an entire thesis and then some on this topic. Fortunately, Bengt has published about this topic recently:
"Viewpoint: Legalisation of performance-enhancing drugs." The Lancet, v 366, 2005.
"Current anti-doping policy: a critical appraisal." BMC Medical Ethics, March 2007.
"Globlisation of anti-doping: the reverse side of the medal." British Medical Journal, July 2008.
as well as some other comments and letters in many journals. It might seem like a radical viewpoint, but the problem is that currently we are not winning the "war" against the cheaters, and so it is important to ask hard questions and think about things differently. One can only hope that the result, although perhaps radical at first, is something better in the long term.
Join us for more debate on the FINA Swimsuit debacle (talk about drama!) as the swimming world champs from Rome wrap up shortly, and then don't forget that the IAAF World Champs start on 15 August.
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Friday, July 31, 2009
Q&A with Dr. Bengt Kayser on the doping dilemma in sport