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Tuesday, August 11, 2009

Doping control: Interview with Prof Schumacher

Doping control: The biological passport and new strategies in doping control. An interview with Prof Yorck Olaf Schumacher

Last week, we brought you our "inaugural" interview, with Prof Bengt Kayser of Geneva. The idea behind these interviews is to introduce to you a range of different opinions on sports science and training matters, as part of our desire to add value to the sports news, and to translate sports science. Hopefully these interviews become a regular feature of the site!

Today we bring you, as promised, an interview with the University of Freiburg's Professor Yorck Olaf Schumacher, MD, who is a member of the independent expert commission that evaluates blood profiles for the biological passport. Prof Schumacher's track record and research outputs speaks volumes of his area of expertise - blood doping, and sporting performance. Prior to his specialization in blood doping and research, he was a team physician for German Olympic Games and World Championship teams, so has a long history of involvement with elite athletes.

His views on doping control, including new strategies, cost-benefit ratios, performance profiling (which we featured in our previous post) and the overall status of doping control at the moment, can be found below!

Sports Scientists:
You've been very involved in the science against doping in sport - first with your research on blood doping and its detection, then with your work which has helped the UCI develop the biological passport concept. Can you describe the biological passport concept in a nutshell? What is it and how does it work?


Prof Schumacher:
The blood passport is a long standing concept that was developed many years ago, when it became visible that "traditional" doping tests that rely on the detection of "foreign" substances in the human body, would not be able to detect the use of many new drugs that are abused due to the fact that they are similar to endogenous substances produced naturally in the body. EPO was the first major example: For a long time, exogenous EPO was undetectable in urine, because it has more or less the same structure than the endogenous substance. However, its abuse altered different biological markers in the blood, such as haemoglobin concentration or haematocrit (those are the best known) in a very distinct manner.

From this knowledge, it became apparent that one of the key issues in the future of anti doping was not the detection of a forbidden substance itself, but its effects. Its a bit of a shift of paradigm. Before, you had to find a substance in an athlete. With the biological passport, we try to uncover distinct patterns of the effect of a substance. This technique has been in use in forensic science for a long time: You do not have to find the murderer with the knife in his hand stabbing his victim, but it is sufficient to assemble pieces of evidence from different areas (knife, whereabouts of the suspect, motivation, blood traces etc.) that demonstrate beyond a certain level of doubt that the suspect has committed the murder.

In the biological passport, we try to identify suspect constellations of biological markers that can not be caused or explained by other means than doping. This applies to markers of the haematological system, but extends to endocrinology and other organs.

SS: It seems that the fight against doping has had to really "raise its game" and it is becoming a very expensive, very time-consuming and very invasive exercise. Given the suggestion by numerous commenters in recent years that doping should be legalized, or at the very least controlled, do you think the "ends justify the means", and is it worth it?

YOS: It is definitely worth it. Sports has certain rules and the anti-doping rules are a fundamental part of them. These rules need to be respected and the fact that they cannot be fully controlled is not a reason to abolish them. One of the comments on your site used the speeding control as a comparison: There are certainly many people that drive above the speed limits on highways, as you can never control it 100%. Still, nobody thinks of abolishing speeding fines, traffic police etc. We just have to face it: We will never be able to fully eliminate doping from sports. The human kind has always tried to make given tasks easier, that is probably the key to the successful development of the human race in the course of evolution of the species, so to speak.

But I am convinced that by the appropriate measures, we can reduce doping to a level, where it won’t influence the results of a competition on a large scale anymore and give the gifted, clean athlete a fair chance to win over his less gifted, but doped opponent. The major point is the balance of risks. If the consequences that the athlete has to face in case of a positive drug test are heavy (long ban, financial disadvantages) and outweigh the benefits, the number of dopers will certainly drop.

The argument that it is very expensive is only true at first sight: The most expensive anti doping programs at present are in the range of single digit million US $ (UCI: approx. $8 million US). If you compare this amount from an economical point of view to the part of the budget used in any larger company for the "controlling" (which, in business terms, would be somehow comparable to the anti-doping or anti "cheating" branch), it turns out that this part ranges around 5-10% of the total budget, thus more than any anti-doping budget. Any governments deploy considerable amounts for the control and respect of their laws.

Additionally, the part of the budget for anti doping in sports in any given larger federation is usually much smaller than the yearly income of its best payed athlete (see the salaries of any sports star in a major sport). So there seems to some kind of imbalance, that needs some correction in the long term, if elite sports wants to preserve its credibility. From this perspective, the amount of funds devoted to anti-doping in sports is very low.

From an ethical perspective, I think that the athletes will realize in the near future that anti doping is necessary for them to give a credibility to their performance and not an annoyance. They will see the advantage in adopting a clear, transparent strategy to explain their performance. Cooperation with anti-doping measures, which, to a certain extend are certainly in conflict with human rights (whereabout system) might therefore be an option for them.

SS: The public perception is that dopers are always a step ahead of the testers - what will it take to turn that around? It can't simply be a question of money? Or is it?

YOS: This is not correct anymore. Some substances have been virtually eliminated from sports due to the efforts in Anti Doping (stimulants). The adoption of different testing strategies (out of competition testing) has massively influenced the abuse of anabolic steroids, so there is some impact. Some substances were detectable even before they were marketed (CERA, Aranesp) and this will certainly be the case for many new developments of the pharmaceutical companies (Hematide, Aicar etc.).

The next issue is the correct timing of testing, as athletes will use small doses of detectable substances that are rapidly cleared from the organism. Testing has to be done at the right time to detect them. So we are catching up in many areas and are surely ahead in some. The longitudinal monitoring such as the biological passport gives us valuable information in this context as we can see shifts in doping techniques and adapt detection strategies.

I think a major issue to improve the fight against doping is the adequate spending of resources. The analytical "weapons" to detect many substances are available, we just have to use them correctly. And at this point, there is, in my opinion, the largest margin of improvement: Considering the overall costs of a conventional anti doping test (about 1000 USD, including logistics), we have to, for each test, ask the questions: Who is going to be tested? (type of sport) When is he tested? (time of the season, time of the day..) What are we going to look for (substances..)? Where is the sample going to be analyzed? In fact, every single test should be somehow "targeted".

The problem is, that in most federations, there is no expertise to perform these tasks and tests are performed more or less at random, thus losing a lot of sensitivity. We therefore need new structures, some kind of independent organization with a similar role as the laboratory has in the analytical field for traditional doping tests. Such an organization could take over the management of the requirements and tasks indicated above and present the advantage to centralize independently the competences necessary for a skilled scheduling and interpretation of anti doping measures.

SS: Do you foresee a day when life-time bans are brought in a means to deter doping? Would that be feasible or enforceable?

YOS: I do think that there must be more options to differentiate between sanctions for doping offenses. At the moment, these are quite limited. In fact, it is easily understandable that somebody who used blood transfusions or EPO, doping techniques that need long term preparation, is to be treated differently from somebody who used a drug for a certain condition prescribed by his physician ignoring its not allowed. For severe offenses, the ban should be long enough to severely affect the career of the athlete, to shift the risk-benefit balance. In my personal opinion, 4 years for an offense such as EPO or blood doping would be justified. But I guess there are many legal issues that need to be considered in this context that I am not competent to comment on, life time bans included.

SS: A really interesting avenue of doping 'control', which you've published on, is performance analysis, to try to detect when human performance suddenly becomes "unrealistic". However, as we've seen on the site recently, there are a lot of assumptions and 'confounding variables' that make conclusions difficult. In your opinion, what value does performance analysis actually add? Do you see a day when performance analysis is accurate enough to be a reliable weapon in the anti-doping battle?

YOS: Every sport scientist knows that it is nowadays possible to evaluate or predict performance in certain disciplines quite accurately (see the posts that you have published on your site during the Tour de france). Cycling is just one example. The potential confounders in these calculations apply to all investigated athletes too and are therefore mere systematic mistakes which usually do not change the key message of such calculations: Is the performance credible in view of what we know from other athletes and the history of the respective sporting discipline or the individual development over time of the athlete in question? or isn’t it?

If the latter applies, then its worth to look at the athlete with some scrutiny or target him in doping control. So its about spending resources more effectively. I am confident that we already have a good pool of data to identify athletes that perform above credibility. It´s about putting performances into perspective, individually in a longitudinal setting and cross sectionally, by comparison with peers.

As an example, you can follow the progression of an athlete over the different categories from a young age onwards. Some athletes have been better than their competitors through their entire career, from a junior age on. This gives somehow credibility to their performance. Others rise from nowhere, which might raise some questions.

However, as I wrote in the article, performance alone will/ should never be used as proof of doping alone as, after all, competitive sport is about the best performance. And this performance might be achieved by exceptional talent, superior training etc

SS: Final question - more your personal opinion. Given that you've worked in doping control and spent much of your research pursuing methods to detect doping, are you able to watch and appreciate human performances with maximum appreciation, or do you find that your skepticism detracts from the enjoyment of sport?

YOS: I certainly can. Not every good performance is doping. I have seen many athletes excelling at Olympic level where I am quite certain that they never used performance enhancing drugs. It´s possible, even against cheats! Definitely not for everyone, and not every day. But with the right talent, the right training and on the right day. Unfortunately, many careers of talented athletes have been cut short or shattered because of the presence of doping among their opponents. I have personally witnessed some tragic cases in the 1990s. There are many examples... And that is the sad thing about the whole story in certain sports: Its the victories, the careers and sometimes the lives that have been stolen from those who didn't dope.
_____________________________________________________

SS:
An enormous thanks to Professor Schumacher for the time taken to answer the questions in such depth and with such consideration. Prof Schumacher has been one of our most valued readers for his contributions to the content of the site, and we are very grateful to him for sharing his views!

Just to end off, here are a few of Prof Schumacher and his colleagues' recent publications, selected because I'm sure many of you will find them particularly interesting!

Ross

20 Comments:

Anonymous said...

When I see a blood doping expert from the University of Freiburg I am always a bit sceptical. I have no idea if the good professor is part of the solution or the problem but as this article which is no longer on the net, but has been web archieved, states, the University of Freiburg has been doing research into doping for about 55 years. Not all of it ethical as was discovered a couple of years ago.

You can read about it at http://web.archive.org/web/20080213062615/http://www.cyclingheroes.info/id617.html

but here is the opening paragraph

After the doping confessions of several former Telekom riders and team doctors Lothar Heinrich and Andreas Schmid of the university of Freiburg another doctor of the German university confessed to have doped riders. As reported former riders Jörg Müller and Christian Henn accused professor Huber of the university of Freiburg to have coordinated their doping programm on the German national team. Doctor Huber also was the leading doctor of the German Olympic team at the 2006 Olympic winter games and the German Ski Federation. After his confession he was sacked by the German Cycling federation, the German Ski Federation, the univerity of Freiburg and the German National Anti-Doping Agency (NADA)...........

Nick, Sydney Australia.
P.S. I have been visting this site on and off since the Beijing Olympics are seeing a link on Track and Field News. Great site and always insightful articles.

Anonymous said...

@ Nick

Thanks for your comment. I think it is a bit unfair to put me in the same bucket than the doctors mentioned in the article, just because I am at the same university. Please consider the facts, my research and my other activities in the world of sports.
Be fair !
Thanks,

Y.O. Schumacher

Ross Tucker and Jonathan Dugas said...

Hi Nick

Thanks for reading, glad you enjoy the site. And thanks for this comment.

I appreciate the association, and I dare say many would make it - I think we're "wired" that way, to link things together. I dare say we're about to do it in a big way for Jamaican sprinting, now that 5 of their athletes were first reported positive, now cleared, but now doubted and so on! It's a matter of time before every Jamaican, Usain Bolt, will be spoken of as part of a cover-up!

What I will say is that Prof Schumacher is right - one does need to be careful about grouping people together and creating guilt by association, it isn't fair. Those doctors may have tarnished the reputation of the University, but they haven't condemned everyone else at it to be discredited in the same way.

Cheers!
Ross

Anonymous said...

Hi Prof Schumacher and Ross,

I can see why my comment was seen as unfair. I guess it was more of a comment on the University rather than the individual, but it didn't necessarily come across that way. After being disappointed a few times by doped up athletes as a young sports fan 20 or so years ago, I have become a sceptic. I try and avoid becoming a cynic about PEDs.

Unfortunately when it comes to drugs in sport, it is a fine balancing act between innocent until proven guilty and guilt by association. If you ignore the associates, you can be naive to the depth of the problems. But at the end of the day each individual should be judged on their own merits. I guess I didn't really do that in my comments.

I guess it makes sense that a leading anti-doping expert isn't going to put himself out there if he has been involved in doping like some former employees of the University.

I will read the articles linked by Ross to get a deeper understanding of Prof Schumacher's work.

I look forward to the next instalment of articles on anti-doping and the Athletics World Championship analysis to come on here.

Cheers

Nick
PS I guess I should sign up for an account.

Anonymous said...

Hi Nick !

Thanks for your reply! If you need any information/ article of my work, let me know. I am happy to share it!

Cheers,

Y.O. Schumacher

Ross Tucker and Jonathan Dugas said...

hi Nick

Thanks for the follow up - that's very gracious of you to say that.

I agree that the environment we are in compels us to doubt. More often than not, we'll be right to doubt, which is sad. And it is true that many times, where there is smoke there is fire, but I guess the balance you talk about is the one where we have to identify where that smoke originates!

Cheers!
Ross

Edla said...

As by now it has come clear that Professor Schumacher is from Freiburg, you must be the same person who was interwieved in Finnish tv a year or two ago. You said then - when pushed by the journalist - that you believe that every medal in cross country sking between 1990-2000 was won by dopers (mainly epo). I (almost) agree. But this is a very interesting statement as it says also that all time greatest skier Bjorn Dahlie was a doper (and his career lasted just as long as it was safe to use epo). How do you comment on that now? Cycling and cross country sking are pretty much synonymous what comes to performance requirements (even high altitude is a norm in both). And so same statement is valid also for cycling?

Another question. Epo testing is very complicated - with 70-80 phases, I´ve been told - and I´ve seen in a letter from Finnish Antidoping Agency an estimate that roughly one third of people filtrate so little epo molecules to urine that they are always cleared in tests. Is this still true today? Are there racial differences in this respect like there are with testosterone? Or are there differences between men and women what comes to epo tests? Does the biological passport help to catch even those who can fool urine epo tests?

And finally, when do we have a test for HGH? Are there any scintific studies about the impact of HGH for sports performance? Still it is widely used as "street knowledge" exists. Lausanne´s Martial Saugy said ten years ago that he suspects that HGH might somehow boost the effects of epo. Do you see any grounds for that?

Ross Tucker and Jonathan Dugas said...

Hi Edla

Thanks for the comment. I'm not Prof Schumacher, so I'll leave him to answer your questions still

I will say that I were pushed on that question, regarding cycling, I'd say the same thing - I find it very, very unlikely that any of the champions in the mid-90s up to about 3 years ago were clean. Only the advent of better doping controls, and now the passport "might" be able to reduce the incidence.

Of course, I am a sceptic, so I always err on the side of doubt! However, given what has emerged from cycling, the positive tests, the names who have been caught, the confessions and cover-ups, I believe success was inextricably linked to doping.

Today, I believe it is changing, but not there yet. Certainly, riders are more careful, more controlled, but I still think it's a problem. Attenuated, maybe!

I'm as interested to hear the Prof's thoughts, if he can give them (he can only disclose so much, given his position within sport, I'm sure you'll appreciate that!).

Cheers
Ross

Anonymous said...

Hi edla,

Thanks for the message and your memory of the interview for YLE some years ago. Don´t get me wrong: Not every good performance is caused by doping or associated to it! There are athletes out there that deliver exceptional performances CLEAN! And so might Bjoern Dahlie..
But we have to face that during the 1990´, when EPO was undetectable and there were no blood tests, every endurance sport was affected by EPO, the advantage it provided was just too good. For cycling, its hardly a secret. For track and field, you just have to look at the graphs illustrating the 5 and 10k times published recently on this site. And for cross country skiing, there is even scientific evidence for it: There are articles on blood values of cross country skiers over the years:

Videman T et al. Changes in hemoglobin values in elite cross-country skiers from 1987 to 1999. Scand J Med Sci Sports 2000: 10: 98–102

Morkeberg J et al. Blood profiles in elite cross-country skiers: a 6-year follow-up. Scand J Med Sci Sports 2008

Stray-Gundersen J. Abnormal Hematologic Profiles in Elite Cross-Country Skiers: Blood Doping or? Clinical Journal of Sport Medicine, 13:132–137

Prof Bengt Saltin, who has been following the skiing scene for many years, always gives some nice examples of these facts in his talks. I particularly remember one slide, where he showed that in the 1995 skiing world championships, there were some skiers with Haemoglobin concentrations of 20-21g/dl, all medal winners had Hb´s above 17.5 g/dl. (the normal range for a male athlete is around 15 g/dl).

For Biathlon, you will find similar findings as in the above articles reported in

Manfredini F et al. Blood Testing in Biathlon: Observation of Hematocrit Values During Competitive Periods 1994 – 1997. Int J Sports Med 1999; 20: 403 -406

The data clearly show a change in blood values that is strongly suggestive of being caused by EPO abuse. But I let you read the articles to make your own conclusions. I know its maybe a shock to see this, but its unfortunately true.

When it comes to biochemical issues in the detection of certain substances, I am not competent enough to give you information on every detail, but just this: The EPO urine test has improved a lot, there are some interferences (Exercise, Urine concentration etc.), but it is pretty reliable, if the testing is timed right. Furthermore, with the biological passport, it is possible to see changes caused (likely) by EPO even if the substance is not detected.

Cheers,

Y.O. Schumacher

Anonymous said...

And for the HGH´s influence on erythropoiesis:
There is still a large scientific debate on the performance enhancing effects of Growth hormone itself. I refer you to the following two articles to get a balanced view of the topic:

RIG Holt and PH Soenksen. Growth hormone, IGF-I and insulin and their abuse in sport.British Journal of Pharmacology (2008) 154, 542–556

Liu H et al. The Effects of Growth Hormone on Athletic Performance. Ann Intern Med. 2008;148:747-758.

IGF1, which is the main effector of HGH has certainly effects on erythropoiesis, there are studies on this topic, too.

Kling PJ et al.(2006)'Insulin-like growth factor-I stimulates erythropoiesis when administered enterally',Growth Factors,24:3,218 — 223

The HGH test is worked on very hard, so there is certainly some advance in the area.

Cheers,
Y.O. Schumacher

Anonymous said...

Hi guys,

Great stuff - I have degrees in health fitness, so, it's fun to see some of the extremes of what we learned in all those ExPhys and chemistry classes.

To doping and testing which I don't know much about... LA says that he was "at the front" when he came into the sport and has been "at the front" as his career has waned. After all of these drug tests, a) wouldn't he have been caught by now if he was doping and/or b) haven't his levels been at an acceptable range (i.e., not spiking) consistently?

Thanks for all your work and I look forward to more!

TG

Edla said...

Thanks a lot prof. Schumacher for your comments and a very good reference list. I fully understand that you won´t step in testing loophole discussion because someone might read them as hints...

I am roughly aware of those skiing blood issues. So no shock for me. I presume that endurance athletes invented this HGH (and later IGF) boost effect vis-a-vis epo use as scientific evidence seems only to have developed basicly during 2000´s. And isn´t this dilemma there all the time. Athlete´s stack and mix up things taking risks and finding out something scientists find difficult to verify because you do not have those risk taking guineapigs?

You seem to indicate that doping boosted performances in endurance sports during 90´s so much that if someone achieves the same level today, he/she is a dope-suspect?

And just for fun for all to guess. How many dopers would be caught in Berlin t&f WC´s if there would be a bullet proof HGH and IGF test. ...and how much slower would men's 100 m dash winning time be?

Anonymous said...

Thanks for focusing on doping, but let us be honest. As long as countries like the USA, China, Spain, Italy, Germany, Austria, Russia, Bulgaria, Greece, etc, etc will not fight doping, what is happening in the laboratories does not matter.

Doping is political, not science. How can I say that? In the xc-skiing communities in Norway and Sweden everybody knew that the Finns, Austrians and Russians were doping. But FIS would not do its job, and the national associations did nothing.

The same can be said about the USA and doping. Do anyone think that the American sprinters of the 70, 80, 90 and 2000 were/are clean???

Germany has old dopers as coaches, just look at biathlon.

As you can see, doping is political and as long as countries want to win, state sponsored doping or non testing will happen.

Anonymous said...

@ Edla

You are exactly right. Athletes are mixing all kind of substances at low doses to get an addditive effect.

@anonymous

Your skiing example: Hm, I can hardly believe that only the Fins, the Russians and the Austrians doped big time and the Norwegians and Swedes were still able to keep up and win races. Doping is not about nations, its about human nature.

I do agree that the states have to step in to make the sanctions harder and increase the risk for the athlete.

Martin said...

wow. I thought I was a cynical person when it came to trusting endurance athletes. But then I read this and it seems it is even worse than i thought. The bits about cross country skiing are like pouring cold water down me back. Thank you prof. Schumacher. (reading this back i see it can be taken as sarcasm but it isn't. seriously!!)

Edla said...

Anonymous who suspects that 90´s skiing doping was nationbound, look what prof. Schumacher says about those Hgb levels, all medallists, no reservations for the country. I really do not believe that there was any such superhuman who could have beaten as clean those who used very powerful doping stuff with zero risk being caught. Observe also that many of those best 90´s skiers career ended abruptly just before first epo test came around.

Anonymous said...

Edla
The 1995 world championship is a really good example of my point. Norway and Sweden did bad and countries where doping is accepted did well. While Norway and Sweden are fighting doping and do all in their power to catch cheaters, other countries like Finland and the USA (+ a lot of others) are supporting the dopers.

I am not saying that some countries are free from doping, just that the fight against doping is political and not chemical. And as long as countries like the sport superpowers like Russia, USA and China are doping supporters, cheating will happen.

I got shocked when I moved to the US from Norway. Doping is everywhere in high school sport and at colleges. But do they test, NO. Testing in the US is PATHETIC. I would like to take a off season test of the top 10 ranked college football teams. I can guarantee for a positive result.

Anonymous said...

@ anonymous

I appreciate your faith in norwegian skiing. But the Lillehammer Olympic Games were just one year before the 1995 Worlds and as far is I remember, Norway did very well in these Games in the middle of the EPO-era. The Norwegians are still great skiers, but some were certainly doped, like everybody else at that time. Just like in cycling. I guess if you took doping away from everybody in these sports, where it was widespread, you would still have the same results.

Rupert said...

Any comment on the blog controversey (cycling news forum):
http://forum.cyclingnews.com/showthread.php?t=2278&page=23
regarding Lance Armstrongs recently self-posted blood values? Can any conclusions really be drawn? Could altitude training explain the rise in HCT befor the Tour? Are the values reported during the tour (called "spikes" on the blog) conclusive? Hard to tell how much of the discussion is based on science/facts and how much is smoke and blather... Someone did a very nice chart of OFF score and HCT over time which looks very impressive. What does it mean? I would like to hear some sober analysis of it..

Anonymous said...

I realize I'm way behind and that this thread is an old one, but I've just recently discovered this site (just before the TdF this year). I think it's a great site with lots of interesting stuff and stimulating discussions. I've really enjoyed the recent posts analyzing the performances of the riders in this year's TdF.

Now for the interview with Prof Schumacher, I wanted to just briefly touch upon what was said about the blood values of xc-skiers in the 90s and whether or not the Norwegians and Swedes were just as dirty as everybody else has been accused of. For Bjørn Dæhile it is quite interesting, as he has actually released his blood profile both on and off season and his values were extremely consistent (between 16 - 17 g/dl) throughout his career. Additionally, he actually won his first world championship before EPO was broadly available (1991, 15 km Val Di Fiemme) and his performances were consistent both for the big events and during the rest of the season. His V02 max was measured at 96 ml/kg/min and that was off-season, which does in fact speak to an exeptional talent or whatever you want to call it. Now, these facts stand in stark contrast to the skiers from Finland, Italy, Austria, Russia etc on at least two counts:
1) Their performances were highly volatile, usually they would perform poorly during the season overall, only to come from nowhere and claim top-notch results in World Championships and the Olympic (Mika Myllala, Verpaalu, Fauner, Botvinov etc).
2) Their blood values were highly abnormal (e.g. at Thunder Bay 95)

THanks for a great site!

br,

Jonas