vineri, 25 februarie 2011

The state of doping control: Dangerous waters

The state of doping control: Dangerous waters

Friday, February 25, 2011 1:34 AM
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The state of doping control: Dangerous waters

Posted: 24 Feb 2011 01:53 PM PST

Doping control in dangerous waters - the fight is immeasurably more difficult

I logged onto the website this morning, and we have this block of ads on the page (kindly provided by the folk at Google) and sure enough, every single one was an advertisement for "Drug Rehab". One promised me "Drug abuse no more", which seems like a nice idea (especially for the UCI...)

I take this as a sign - enough with the doping coverage, at least for a while! I'm developing doping fatigue, and looking into some other topics, maybe a short series as we lead into the running season, where hopefully there's some more interesting analysis to be done!

A bad month for anti-doping. Where to now?

The problem is that doping seems to force its way into the science of sport (and onto The Science of Sport) so frequently. And there is one final doping post, again, for now, that I need to write before I can put the syringes and blood bags and tainted beef to rest for a while, and that is a post on the wider repercussions of what has been a pretty lousy month for doping control.

The high profile case of Contador

The highest profile case was that of Alberto Contador - first offered a one-year ban, then exonerated, his case threatens to spin the historical "strict liability" concept 180 degrees and shift the onus back onto the testing authorities to prove that a banned substance was NOT ingested accidentally. I'm sure I don't need to elaborate on how difficult it will be to prove this particular negative...

We've received a number of very interesting emails on this topic (thank you once again), but my personal thought has always been that as soon as the athlete tests positive, then the burden of proof should shift to them to prove their innocence. This differs from the usual "innocent until proven guilty" concept, but that's how it has always been, for better or for worse (more on this below).

What Contador's case has done has interpreted doping control in the opposite direction, based on what seems to be circumstantial evidence (certainly, the beef is long gone, and that's the only evidence I would say is not circumstantial) and a possibility that Contador ingested the clenbuterol accidentally. Incidentally, Contador's lawyer has been speaking out about the reasons for the exoneration, and you can read some of those views here.

My reading of that article is that not much has emerged that wasn't already known. I still think the key question is what level of evidence did that Spanish committee require in order to conclude that accidental ingestion was a valid excuse, in the absence of the supposed tainted beef? Contador's lawyer has pointed to the fact that only 0.25% of all Spanish beef is tested for clenbuterol, with the resultant low probability that authorities are able to pick up clenbuterol presence.

Quite where this leaves doping control for clenbuterol is difficult to say. Producing positive tests is difficult enough - between undetectable drugs, alleged inside information allowing athletes to evade testers, micro-dosing to stay beneath the radar and the "mundane" problem of limited financial resources in a very, very expensive battle, the authorities appear almost "lucky" when a test comes back positive.

Now, it appears that a positive test may become the START of a complex legal process in which the onus is on those authorities to form a water tight case against the athlete - can they provide evidence to convince committees (who are partisan and conflicted) that the substance was present as a result of doping, rather than the result of (and take your pick here): Contamination, spiking, laboratory error, vanishing twins, vindictive rivals/wives, accidents, unexplained but theoretically plausible physiological 'malfunctions'.

Doping control becomes an order of magnitude more difficult if the positive test is merely an invitation for authorities to then eliminate the innumerable other sources of contamination or ingestion.

Diana Taurasi - positive, banned, then the lab apologises

Then to add to the complexity, along came Diana Taurasi, a US basketball star playing for Fenerbache in Turkey, along with three other athletes in Turkey. A positive test for the stimulant modafinil led to a suspension, the termination of her contract and what she describes as the loss of three months of her career.

The reason it was only 3 months (and not 2 years, which is the normal ban for modafinil) is because last week, the Turkish laboratory that tested Taurasi and three others retracted its own result. All four athletes, including another basketball player and two footballers, have been cleared.

Strict liability requires strict testing accuracy

I'm not 100% sure of the reason for the retraction (if you know, please let me know), but the bottom line is that the whole concept of "strict liability" is 100% dependent on accurate testing and so flawed lab processes further dent this concept.

If the positive drugs test places the burden of proof onto the athlete (as I believe it should - Contador's anti-doping committee took a different view), then that testing had better be 100% certain. It cannot produce false positives, and it cannot produce false negatives.

It transpires that the Turkish lab was suspended by WADA in 2009 and then re-instated last year, so there is clearly a quality control to ensure best practice among all the testing labs. Something fell through the cracks, and the result is that the system loses the confidence of the athletes it is supposed to protect.

A review of the banned list may be necessary?

Now, unlike Taurasi, Contador's result was not even a false positive - he never argued that the clenbuterol was not present. So therefore, the test was reliable and properly conducted, but the result unenforceable legally (from the anti-doping authority's point of view. Contador's lawyers would disagree, clearly).

One then has to ask the question that if this is the case, then should that substance remain on the list of substances? There are two options for how one might deal with this kind of situation (it seems to me that neither is an option for clenbuterol):

One could be to make the substance a threshold drug, one where a positive test is declared only when the level of the drug exceeds a certain threshold. This level would be set based on what authorities establish to be a level that confirms doping rather than contamination. The problem in the case of clenbuterol is that it's not as though contamination produces values 1000-fold lower than deliberate use - rather, there seems to be overlap in the levels. In fact, experts on doping control were quoted as saying that Contador's low levels were typical of clenbuterol doping. Also, this would allow significant doping to occur, with a potentially very effective drug. Not a good solution unless you want to bend the boundaries of allowing doping...

The second is to develop a test that can detect the source, but because clenbuterol is only present through synthetic means, it can't be treated like testosterone, so this is not an option either. Therefore, the rule has to stay as it is, where an athlete is pardoned if they can provide evidence that it entered their system accidentally. In the case of clenbuterol, it's difficult to see how an athlete will NOT make this case, given the precedent now set in Spain, and so this rule, some would say, may as well be extended to say that clenbuterol is no longer tested for as a banned substance.

The merit of anti-doping? The cost-benefit question

All of this points to one very important question - where is the fight against doping headed? Two things stand out:
  • The absence of a failed dope test is a very poor indication of a clean athlete - Jan Ullrich only ever failed a test for recreational drugs. Ivan Basso and Marion Jones never did. Nor did Tim Montgomery or Dwain Chambers, until a tip-off led to a new drug test. The point is that athletes are tested all the time but elude detection. "World's most tested athlete" is a completely meaningless phrase. Even the introduction of the sophisticated biological passport has not yet "caught" anyone, thanks to equally sophisticated micro-doping, though I would argue that it has been an effective deterrent and in time, will make inroads
  • The presence of a failed dope test is no indication of a dirty athlete - ask Diana Taurasi, who has failed one more drug test in her life than Marion Jones. Jones doped, Taurasi (seemingly) did not.
So why then bother testing? A colleague asked me this today - it's enormously costly, it seems to create more controversy than it is worth, and positive tests mean little to certain committees who either re-interpret the doping regulations or attempt to cover them up (if the Sports Illustrated article is believed, which I think it is).

Two possible solutions - simplify, or shorten?

One solution is to simplify the fight by cutting the list dramatically. Go back to an interview we did with Prof Bengt Kayser of Geneva in 2009. In it, he argues for a reduced list of banned substances. Effectively, the message is "Cut the fat, improve the accuracy of testing so that positive tests actually become meaningful, and then enforce stronger bans on offenders".

Another is to reduce the length of a ban for a first-time offence. At first this may seem paradoxical, but it has some real merit, and was introduced to me by a reader, David Beever. The rationale (in short), is that shorter bans can be enforced in much the same way as the "safety stop" for EPO was enforced using hematocrits in the 1990s. The first time offender then receives an automatic 3-month ban (less likely to be challenged vociferously as unfair), but a second offence carries a much longer ban. After all, if Contador continues eating that contaminated Basque meat...

So the approach, according to David is to "loosen them (doping penalties) up, and those who start collecting strikes/bans will soon be naturally marginalised anyway."

There may very well be merit in these approaches. I would love to see a situation where testing is so reliable and valid that a positive test is a guaranteed four-year ban, so that the penalties are harsh and the risk of being caught is high. Sadly, neither seems likely - avoiding detection seems all too easy, and penalties are lenient or avoidable. And so maybe it is time for compromise.

Why anti-doping? Drugs are not equally effective and the rights of ALL athletes

As for the complete legalization of doping, that is a post or a series all of its own. What I will say is that I'm not fond of the idea of watching sport when the result may be determined pharmacologically. The problem is that drugs don't affect people the same way. Just as some people respond well to sleeping tablets, or pain killers, the effect of doping on performance is likely to be highly variable. Now, if a drug improves performance by 0 to 5%, and the natural/physiological differences between athletes is 1 to 2%, then you have a situation where a drug can make a bigger difference than the normal differences between athletes. It would be much like Formula 1 Motorsport, where the difference between cars is larger than the difference between driver ability. The result is that the best (human, anyway) is often undiscernable.

Then there is the matter of those who don't wish to dope. Ricardo Ricco demonstrated the dangers of doping, as did dozens of young men who died in their sleep in the 1990s as a result of unregulated EPO and blood doping. Christophe Bassons is one such rider, and a clean sport respects his rights (to health and performance) just as much as it does ours to watch it. Anti-doping exists as much for those who don't wish to dope as it does to prevent those who do.

And finally, as we discussed at great length last year, the fight has made steps forward. The performances in the Tour were arguably still "drug-assisted", but gone are the days of the 6.5 W/kg ascents - in fact, as I've pointed out numerous times, Contador and Schleck would have been minutes down on their best climbs. That to me is a sign of a problem that is at least being "reigned in", if not eradicated, and as long as that is happening, it's a campaign worth continuing.

So call me romantic, but I hope that doping can claw back some credibility. It may take some compromise on that list, but it beats the Pharma-Olympics (and call me naive, but we are not quite there yet!). As always, yours views welcome!

Oh, and one last thing - there has to be a central authority to whom federations are accountable. The allegations made against the UCI by the likes of Landis may be only partly true, but as has been said before, if even 10% of them are true, then there is corruption and collaboration at the head of the sport. Yet nothing will come of it, because the people who should act are those who stand accused. Until there is a central body, with teeth and authority to act, the sport will resist change from within. So fix the management structure, before the Feds have to come knocking incidentally...

That's it for doping (I hope). Follow our Twitter feed for updates and links to more stories, but I'll put my mind (and what time I can squeeze out) to another series in the coming week!


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