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.
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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

• Power output during the Tour de France
• Cadence-power relationship on decisive mountain climbs in the Tour de France
  
• Cycling power output on flat and mountain stages in the Giro d'Italia: Case study
• Success in elite cycling: Analysis of race results
• Hemoglobin mass after 21 days of altitude training
• Performance profiling: a role for sports science in the fight against doping? (this is the article we used in our recent post on performance profiling)