A very different view on anti-doping

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!


Sports Scientists:
What are the primary reasons to permit controlled use of performance-enhancing substances?

Bengt Kayser:
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?

SS:
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?

BK:
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.

SS:
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?

BK:
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?

BK:
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?

BK:
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?

BK:
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.

Jonathan

The Mitchell Report at a glance

Fishing for guppies and landing a whopper

Former Senate majority leader George Mitchell's report on drug use in baseball was released on Friday afternoon, and sent the pundits and talking heads venting over the airwaves this past weekend. It is a behemoth of a report at 409 pages, and for all of those with some spare time this holiday season, you can download it here, while those with admittedly less time can view the executive summary here.

In the beginning many thought this was a fishing expedition of epic proportions, and was destined to return empty handed, or with only a few small time offenders. However in the end they landed a legend of baseball, the seven-time Cy Young winner Roger Clemens. Many other names were included in the report, and a history of drug use in baseball over the past 15 years is an important addition.

Also, on Sunday night Alex Rodriguez appeared in an interview on 60 Minutes, denying any drug use and also stating that he never once saw any illicit activity, although mentioning that there was always talk about it here and there.

Besides the players who were named in the report, the biggest loser is probably the Players Association. Mitchell states plainly that the association was "uncooperative" in many ways:

1. Rejecting requests for relevant documents
2. Granting only one interview with the executive director Donald Fehr
3. Rejecting an interview request with the chief operating officer Gene Orza
4. Denying a request to interview the director of a Montreal laboratory that analyzes samples
5. Actively discouraged players from cooperating with Mitchell's investigation

This is a real pity for the players as cooperation with Mitchell could only have benefited them in the long term, and therefore the lack of cooperation by the Players Association to us represents an extremely short-sighted view intended to try to protect themselves from harm. A more mature decision would have been full and transparent cooperation that would help legitimize the players and strengthen their credibility.

"The problem is serious"

Ok, so tell us something we do not know! As obvious as Mitchell's statement sounds, it is an important step in this process. Yes, the pundits and bloggers would all agree, and have all been saying for a long time, that indeed the problem is serious. However we lacked the hard evidence and inside information to back this up. Mitchell's report now goes on the official record and we hope this leads to future steps in the right direction for baseball (and perhaps other sports). Namely, admission by the players and teams that indeed there is a problem is what must occur before the sport takes a serious turn towards cleaning up.

Cycling and baseball both miss the boat in the 1990's

Mitchell identifies the turning point as sometime after the 1988 Summer Olympics when Ben Johnson tested positive. In fact there were many news reports during the 1990's about steroid use in baseball, and as early as 1988 many fans were already jeering Jose Canseco about his alleged steroid (ab)use. So the interesting thing is that as players' power increased and rumours began to make the rounds, baseball found itself in a similar position to pro cycling.

In the peloton during the 1990's the same thing was happening---average speeds were increasing, rumours were lurking, and the media suspected something was up. Admittedly, hindsight is 20/20, yet it is interesting that neither sport moved on these signs and "symptoms." Cycling introduced the 50% Hematocrit rule, which was pretty weak and easily manipulated, and baseball just ignored the problem for as long as it could.

And now the two sports find themselves in equally sticky situations. Wide scale and official reports (Mitchell's report in baseball, and The Operacion Puerto report in cycling) have torn open each sport and exposed its biggest stars.


And now. . .?

The fallout from the Mitchell report is still heavy and sinking in as more and more people read it and analyze its contents. At 409 pages, the full report is a handful, but the executive summary is an excellent place to start and anyone interested should definitely read it (it is only 40 pages). In the weeks and days to come still more bloggers and writers will weigh in on what all of this means, but one thing for certain is that Commissioner Bud Selig and MLB now go in to bat. This is their call to action, and we can only hope they choose to be courageous and think about the long term health of the sport.

As we said, at 409 pages this one is a handful, but join us this week as we try to pick it apart and look at the greater implications not just for baseball, but what something like this means for all of sports. Also, don't forget about the impending IAAF report on Oscar Pistorius, which we wil analyze in full and is due out any day now. Finally, we will run a short series on exercise in the cold, as the northern hemisphere winter is in full swing.

Stay with us for a busy couple of busy weeks ahead!

Drugs in sport - could it possibly be bigger than we thought?

In a companion post to this article, we discussed three MAJOR doping stories of the last week, and how we seem apathetic to them. First, Floyd Landis was stripped of his 2006 Tour title, then Michael Rasmussen returned a "non-negative" result during the 2007 Tour, and then perhaps the biggest sports drug bust in history went down in the USA. Yet it seems to be business as usual. In this post, we take a closer look at this huge drug bust, named Operation Raw Deal, and what it means for doping control in sport.

Operation Raw Deal exposed - a summary of the bust

Operation Raw Deal, a campaign run by the Drug Enforcement Administration (DEA), is the story that should be sending shivers down our spines. Just look at the numbers again:

• 124 arrests
• 56 labs shut down across 27 states
• $6.5million worth of steriods
• 240 kg (530 lbs) of raw steroid powder!

Most of the raids took place in "quiet, suburban neighbourhoods, with reports of DEA agents "knocking down doors in suburban cul-de-sacs and pushing their way into basements and kitchens". According to this report from ESPN:

"The owners weren't exactly secretive. One Long Island man had 800,000 doses of raw steroid powder stacked in plain view in his garage, right next to his shiny new Corvette; nearby, a locker housed empty vials and printed address labels for thousands of clients throughout the country. An electrician who was running another lab, in New Jersey, had stashed 40,000 doses in his basement, along with the tub and centrifuge he used to turn the powder into street-ready drugs. In a third raid, on a Midwestern home, the living room floor was so thick with steroid powder that agents left footprints behind."

This is absolutely extra-ordinary, and has far reaching implications for doping control in sport, because it is a symptom of a much, much bigger problem and illustrates just how easy it might be to get away with the manufacture and distribution of drugs.

Tracing doping to its source - all roads seem to lead to China

What should be most concerning about this is the ease with which the products are obtained and manufactured. For a frightening illustration of how easy it is to obtain steroids and Human Growth Hormone, check out this story, also from ESPN.

The journalist goes over to China, attending a "Convention on Pharmaceutical Ingredients". Armed with nothing more than a 'shopping list' of ingredients (all banned), he meets many people who are only too willing to offer him steroids and growth hormone for the right price. Apparently, you can buy 1kg of testosterone for the bargain price of $266! That becomes 10,000 single doses, which can be sold at $12.50, according to the article. Do the math on that one - buy at $266, and sell for $125,000! I wonder how many Corvettes one could afford from a year of dealing in that kind of industry!

As for getting the drugs from China into the USA (or any other country, for that matter), that's no problem. A quote from the article: "Asked if shipping to the U.S. is a problem, she replies, "Is Federal Express okay? We do it for our other American clients."" All they do is change the name on the labels...growth hormone is called "watermelon extract" in one such story!

Of course, it's illegal for the Chinese to sell steroids in this way, but when your salary in China is only $230 per month, a kilogram of testosterone here and there does not go unnoticed, or unsold! Human growth hormone is even more lucrative...world wide sales are reported at $600 million, of which $480 million are said to originate in China!

Implications of Operation Raw Deal - do drug tests even mean anything today?

If an electrician, a suburban white-collar worker, can set up a laboratory and a distribution network for steroids, imagine what is possible with some management and financial backing.

Truth is, you don't have to imagine anything. Because in 2003, stories began to emerge of a massive underground steroid operation which was to become known as the BALCO affair. To cut a long story short, Victor Conte, a small-time supplement dealer for many years, enlisted the help of an organic chemist, Patrick Arnold, and set about creating products that would have the same effect as steroids but would be undetectable. The result? "The Clear", which is the name given to tetrahydrogestrinone (THG), an undetectable steroid developed by Arnold, and used by athletes including Dwain Chambers, Kelli White and Barry Bonds. Had it not been for a coaching rivalry and a secret tip-off that led to the discovery and development of a test for THG, athletes would still be using it today.

This story illustrates what a relatively 'small-time' businessman, with the right connections and the right "vision" can achieve. What Operation Raw Deal shows us is that this phenomenon - underground labs, creation of undetectable steroids - is more common that we thought. Even a suburban white collar worker now has this "vision" in his grasp.

It would be naive to think that Victor Conte and Patrick Arnold are the only people capable of creating a drug that evades detection. Operation Raw Deal shut down 56 underground steroid labs - any one of these labs could have achieved the same thing! Imagine 56 labs all producing undetectable steroids - that adds up to a minimum of 56 UNDETECTABLE STEROIDS on the US market alone, from suburban homes. Now add China, the professional supplement industry, and the rest of the world - sport will never be the same.

"There will be 100 drugs that are undetectable by the Beijing Olympic Games"

This quote (I forget who it was who said it, it may have been at a conference I attended) could easily be dismissed as hyperbole. But Operation Raw Deal makes us sit up and take notice. The same article from ESPN makes mention of a "sting" operation set up to see whether drugs could be obtained that were undetectable. The findings are frightening. Having set up a supplement company, the journalist orders products that are sold to him on the premise that they work and are undetectable. Sure enough, he has them shipped to his address from a company based in the USA, and has them tested for the 11 known classes of steroids. The result - negative.

He then consults with Don Catlin, a renowned expert in the fight against doping. Here, a different picture, because Catlin's deeper analysis showed very definite evidence of anabolic steroids in the sample. In Catlin's own words:

"This wasn't done by someone with a high school degree," Catlin concluded. "Whoever made it knew what he was doing." An industry source to whom the label was shown went even further: "No one is making this stuff in the U.S. The only place you can get it is China."

Suddenly, 100 undetectable drugs is not impossible. There are already three of four - even blood doping, if done properly, would be counted in this group. But one should shudder at the thought of hundreds, if not thousands of labs across the USA, China and the rest of the world, all working at designing drugs that cannot be detected. And then sticking a label on them to say they are "watermelon extract", sending them to the rest of the world, where they find their way to athletes of all levels, who rest comfortably, knowing they will not get caught because the testers and administrators are blind men chasing them in the dark.

The next time an athlete stands up and says "I have never tested postive", you have to wonder - is he innocent, or is he just gloating about the fact that he's full of steroids, but you'll never find out?

Ross

Drugs in sport - our apathy reveals the state of the sport

Two days ago, we interrupted our series on running technique to bring you news of a massive steroid bust, named "Raw Deal". Incredibly, this story barely reached South Africa, and certainly didn't make the impact that it should have, given the numbers, and the possible implications of this operation. Of course, it may yet do so, if WADA gets hold of the names of some high-profile athletes who have "benefited" from the 11.4 million doses of steroids that were confiscated!

Other doping news - just "by the way"

This is not the only doping related article to hit the headlines in the past week or two. In other news, Michael Rasmussen, of "You can trust me" fame, returned what is bizarrely called a "non-negative" test at that Tour de France. According to news reports, the Dane, who was kicked off the Tour by his Rabobank team for failing to inform them of his location leading up to the Tour, had traces of a substance called "Dynepo" in his urine. This chemical is similar to EPO, but under current WADA rules, a "positive" test can only be declared if the EPO is obtained chemically. Since Dynepo is made from human cells, WADA feel the risk of a false positive is too great, so they call it "non-negative" instead.

And then in another cycling-related story, the never-ending case of Floyd Landis ('winner' of the 2006 Tour de France) finally came to an end (at least, a chapter did), when an American arbitration panel ruled that he should forefeit the 2006 Tour title. A three man panel voted 2-1 against Landis, following what was an exhaustive court case which centred on numerous errors made by the French lab that tested the samples. The panel decided that these errors were not sufficient to undermine the positive result, and issued a two-year ban which makes Landis the first Tour winner to be stripped of his title. Landis still has other options - he can now approach the Court of Arbitration for sport in Switzerland, and was reported to be weighing his options. His statement after the verdict was announced suggests there may be more to come: "This ruling is a blow to athletes and cyclists everywhere". Those are not words of a man who seems willing to accept a ban. Whatever happens, let's hope it's not another 15 months before we have an answer.

Our apathy - an indication of the times

What is most worrying about these two stories is our lack of reaction to them. "Just another doping story", when in fact it's the first time in 105 years that a Tour winner has been disposed. It doesn't help that it takes them 15 months to deliver a verdict. As for Rasmussen, at the time, his axing was huge news in the world of cycling, but it was soon forgotten and then replaced by allegations over the involvement of the eventual race winner, Alberto Contador, in just another doping scandal. There seems no end to it, but it's sad day when our reaction to such stories is one of apathy.

In our companion post, we look at Operation Raw Deal, which should make us stand up and take notice. We will discuss what this means for sport and drug testing procedures.