Anti-Doping

By: Ross Tucker

My career in sports science is divided into pre- and post-“enlightenment” periods on the doping issues facing elite sport.  That’s not to say I was ignorant of doping – one of my earliest memories of sport was watching the television news in South Africa when Ben Johnson was caught for doping after his Olympic 100m triumph in 1988.  I was in high school for the Festina scandal in cycling’s Tour de France, and when I studied my undergraduate degree, I encountered numerous sporadic cases.

The “enlightenment” I speak of was not an epiphany, then.  It was a gradual process, a realization of the fact that like the iceberg analogy so overused in business, what you’re seeing above the surface represents only a fraction of what actually exists.  Perhaps as I studied exercise physiology as a specific field, and became ever more immersed in the limits of human performance during my PhD research, the dots were joined in a way that brought out the realities, of that time, that doping was pervasive, and so effective that winners were usually synonymous with dopers.

By the time I finished my PhD, there was little doubt in my mind that the sport was straining at the boundary of credibility, though unfortunately, not enough people seemed to care for it to really impact the all important “product”.

In the beginning, there were poor tools

In the first part of this awareness, the problem with anti-doping was different to what it is today, and this is an important concept.  From the early 1990s, up to around 2006, the main issue facing those on the side of clean sport was the power of their tools.  Anti-doping had been set up as a “catch-and-release” system, until you caught one that had the banned substance in the urine, and then you would pursue the case and seek a ban. 

It was smoking gun stuff, in the sense that the presence of a banned substance in the urine or blood sample provided by an athlete was conclusive evidence that the athlete had doped, and the ban would be issued.   Anti-doping needed the smoking gun.

One small problem – there was no test for EPO, there was no test for many of the steroids being used, or for growth hormone, or for blood transfusions.  The culprits were ‘invisible’ to the testers. Even those that were visible were detectable only if they were in high enough amounts, because the tests weren’t sensitive enough to detect them in really low concentrations. We had a tool problem.  Like a shed built by a carpenter without a hammer, anti-doping was flimsy and unsubstantial.

What this created was a system easy to bypass.  EPO could be used with concern only for the athlete’s haematocrit, because the stop-gap at the time was to say that any athlete whose hematocrit was too high (the point of using EPO is to raise the red blood cell count) had to rest for a period.  Other hormones were impossible to police, even indirectly.

So in that generation, the old adage that testers were two steps behind the cheaters was largely true.  The effective drugs were easy to use.  A solution had to be sought.

A better, smarter hammer

That solution fell to science, because in order to improve the tools, an advance in science was required.  New tests, for previously undetectable substances, and improved tests, for substances previously detectable only in large amounts, had to be developed.

And sure enough, that happened.  A urine test for EPO came along, and the sensitivity of various tests improved, which made the margin of error for an athlete increasingly smaller.  That’s not to say this solved the problem – the THG scandal that caught Marion Jones and Tim Montgomery, among others, showcased how a designer steroid would still be undetectable, and had it not been for a coaching rivalry provoking an anonymous delivery of that drug to authorities, it may still have been unknown.

Similarly, test sensitivity still falls below a required standard, which is why the retesting that we see six to eight years after big events nabs athletes and forces the clumsy reallocation of medals.  That situation can always improve, but progress is never bad.

And then, in 2006, the biological passport concept was introduced.

In the biological passport, an athlete is tested at multiple points in time, and certain blood parameters are measured.  They included young or immature red blood cells (called reticulocytes), haematocrit and haemoglobin, all indicators of the “health status” of a person’s blood.  The premise here was that any doping, whether it was EPO to boost red blood cells, or the removal of blood for later re-infusion, must change those blood parameters in the short term. 

For instance, when you remove blood, the body is clever enough to know this, and it increases the production of new blood cells. So for a short time, the reticulocyte count will rise, but the haemoglobin will be low, because of that blood loss. The opposite would happen with the reinfusion.

So, by testing the athlete at multiple points, and taking advantage of the fact that our blood values don’t bounce up and down like the stock market on a volatile Friday of trading, scientists were able to come up with a model that would squeeze doping right down, if applied correctly.

Was it perfect?  No, the sensitivity remains an issue, because these physiological outcomes are complex.  They can be affected by multiple factors, and so the ranges that are “allowed” before a passport result is deemed “suspicious” are necessarily wide.  That means that micro-dosing remains viable for athletes, who can use small enough doses to get some benefit, but not so large that they trip up the “alarm” set by these boundaries for what is deemed “normal variation”.

However, it was a step in the right direction, a tool that looked for the effects of a drug, rather than the drug.  Progress. That gap from tester to cheater was narrowed, maybe to within touching distance.

But that’s where the story turns for the worse. 

The will, the way, and the problem with anti-doping today

It is often said that where there is a will, there is a way.  The development of more sensitive tests, and new tests, had given anti-doping tools with which to fight the good fight.  They were, with limitations, a better “way”.

The problem this has revealed, sadly, is the lack of will.  Perhaps that lack of will is a new phenomenon, a product of the growth in commercial value of the sport – who wants to tarnish the golden eggs laid by those athletes?

Or perhaps that will was never there, but it was never required to show itself because the tools didn’t push it into a corner that demanded that the authorities, those people sitting a level above the scientists, take any action.

In any event, the common theme running through doping scandals in the last decade has been a lack of will, rather than a lack of a ‘way’.  And that, frustratingly, is a greater problem to overcome.

It was responsible for the massive cover-ups in Russia.  It was responsible for WADA and sporting body’s initial inaction to the information provided by whistleblowers. It was responsible the laxity of testing in labs around the world, which makes certain countries doping havens because they are inaccessible to international testers and lack the resources to conduct their own testing. 

Some of this comes from a genuine lack of resources, and that’s something I’m sympathetic towards.  But that lack amplifies, rather than diminishes, the implications of situations we have seen too often, where authorities are alerted to doping, but do little, until a persistent journalist digs and digs to discover a thread that they can pull on in order to expose an anti-doping failure.

I cannot forget how between the IAAF and WADA, there was synchronized and repeated outrage against one doping allegation after another, made because of investigative work by the media, against Russia, only for it to later be confirmed that hundreds of emails had already been sent to them about it. 

When authorities talk of “shock” and even go so far as to declare reports of cover-ups as a “declaration of war”, the outside world cannot but wonder whether those tasked with policing the sport have the integrity to do so, or whether they are engaged in a complex “House of cards” game of PR and spin?

When authorities know, and fail to act within their own mandate, that suggests a failed system brought on by a lack of will.  This was highlighted most recently by the revelation that retesting of Beijing samples revealed “numerous” cases of athletes with clenbuterol in their urine (this is an example of how the tools improved – that urine had the clenbuterol in 2008, it just could not be detected then).

The IOC, and then WADA, did not pursue a single one of these, because the levels were too low, which they said was indicative of food contamination, not doping. And certainly that may be true, but clenbuterol is what is called a non-threshold drug – any clenbuterol, no matter how tiny in amount, should trigger an adverse finding and subsequent investigation.  Also, low levels don’t have to mean contamination – they could mean small doses of drugs, or a long time between use and testing. 

So the IOC and WADA, however you view it, failed to act in accordance with good science, and their own procedures, instead making an arbitrary decision based on risk of contamination in China and low levels.

It is the latest in a series of events that undermine anti-doping, and hence explain why elite sport is struggling for credibility.  It’s not solely the fault of science, not anymore.  It’s a failure of management, strategy, and ultimately, will.

Changing the incentive balance

 So what is the solution?  A lack of a “way” is solvable with better tools, and that’s happening, and needs to continue happening.  It needs to be supported by better legal backing, and more effective sanctions when dopers are caught.  False positives undermine it, as do grey cases where science cannot provide answers that meet an acceptable legal standard, so they must be dealt with.  As a result, progress on the “way” will come from the same steps, in the same direction, as were taken to develop the passport and more sensitive tests.

I honestly believe that many, if not most, of the people actually using the tools within anti-doping are sincere and committed to eradicating doping.  I know many, and I believe them to be good people using the tools they have as well as their resources allow.  But the consistent thread in the sport’s biggest scandals points to something above them, at both the national and international level.

That something is “will”, and it is much more difficult to create.  It requires a revision of the entire system.  Why is will lacking? At the risk of oversimplifying, it is absent because pursuing and sanctioning dopers is at odds with selling the sport for commercial gain.  It’s a negative message, it “spits in the soup”, to borrow a phrase from cycling, referring to people who spoke out about doping.

Until the incentives of those responsible for anti-doping are changed, I do not see how the will to enforce anti-doping can be created.  When authorities are tasked with simultaneously promoting the sport and catching its cheats, the balance will always tilt to one side.  In this world, a whistleblower will always be viewed as a threat who cannot possibly be welcomed.  Retests that threaten the positive veneer of historic events cannot be fully acknowledged (“Quick, blame the meat!”) or indeed done.  Until such whistleblowers can be welcomed as an opportunity, and until authorities win back lost trust, progress will remain stalled.

So anti-doping has to be taken away from sports, and potentially, even WADA’s structure must be changed.  It has been called a “PR arm” of the IOC, perhaps a little harshly, but there is something counterproductive in the too-close relationship they have, as well as the funding structure.

Athletes, ultimately, may hold the key.  If you step back, and look at the sports system, they are the ones most incentivized to stand up for clean sport.  Yes, I realize they’re also the ones most incentivized to dope to win, but this becomes a volume balance.  Athletes who wish to be clean have the purest incentives in the sport to press an anti-doping agenda.  They also have the most to lose when doping is prevalent (compare this to the regulatory bodies, who have most to lose when doping is revealed).

Therefore, whatever structure is created, it is athletes who must be given the most important, loudest voice in it.  If the commercial interests can be aligned to this voice, it would help enormously. If sponsors and media pulled in the same direction, then even the commercial drivers for cover-ups might start to erode. It is those three – athletes, supportive sponsors, and media invested in the truth, that may save sport from a doping black hole.

I would argue for the creation of a body whose incentive is to catch cheats, athlete-led and supported by independent scientists. A contract that allocates a portion of TV rights money to anti-doping should be entered into, with no option to change for the foreseeable future, so that money can never become a tool for leverage, bargaining or outright bribery.  The police cannot be made vulnerable to a bribe or pressure from the criminals.

Whether that happens, unfortunately, is down to existing organizations, who would have to change themselves.  That of course, brings us to the need for a “will”, and puts us into a perpetual cycle. Breaking that is going to be the next phase of the enlightenment.

 

Ross Tucker is an exercise physiologist and is currently the Head Scientist at World Rugby, ambassador and scientific advisor to Virgin Active and adidas.  In the past, he has consulted with a number of teams in high performance sport, including SA Sevens (including the 2009/2010 World Series winning team), SA Kayaking, SA Triathlon, USA triathlon and the UK Olympic Committee. His current research interests include the physiology of East African runners, high performance culture, talent identification and management, the limits of human performance, and performance and wellness in companies. He recently started up a company, Vivendi Wellness Pty Ltd, which audits and innovates corporate wellness and performance strategies. In 2013, he was named by Mail and Guardian in their list of Top 200 Influential Young South Africans, and by the Minister of Sport as one of the 100 Influential people in South African Sport.