23rd August 2018

How to improve anti-doping

There are many problems with anti-doping. That should be obvious to anyone with even a passing interest in what happens beyond the field of play in the world of sports policy, politics, governance, and athlete experience. With changes in the World Anti-Doping Agency’s (WADA) leadership due to coincide with the 2021 World Anti-Doping Code (WADC) review and revision, now is the time for new ideas. 

We would like to propose a new model for anti-doping, and we invite comments from readers of The Sports Integrity Initiative (see link at bottom of page). We would use this feedback to make a detailed submission to the WADC consultation phase, and to garner support beyond WADA. 

The need for change

The main problems we address are related to the ‘pillars’ of anti-doping: 

Education
There is a currently a lack of consistent education across age groups, levels of competition, and sports. Paradoxically, athletes are forced to comply with the Code, but there is no compulsion on any organisation to ensure understanding of the Code and all the Anti-Doping Rule Violations, much less the full details of the Prohibited List. 

Testing
There is currently insufficient testing – it is ineffective, and it is expensive. The one-size-fits-all model means that amateurs are tested for the same substances as professionals, cognitive sports are treated the same as endurance sports. Some sports and countries test more than others. This clearly needs a more nuanced and adaptable strategy. 

Sanctions
Athletes who test positive are mostly given a four year (non-specified substance) or two year (specified substance) ban. This does not take any of the following contexts into account: age, knowledge and awareness, the role of trusted persons, the time the drug was taken and the amount, the potential impact on performance.

Athletes can appeal if it was potentially an inadvertent route of ingestion, but need evidence (which is often hard to obtain), and need to appeal to a National Anti-Doping Organisation (NADO) tribunal and then to the Court of Arbitration for Sport (CAS), both of which adjudicate simply on whether the Code has been applied properly. Arbitration can be time-consuming, expensive, and emotionally draining. As it on a case-by-case basis, outcomes can be inconsistent. Even if exonerated, athletes are left with the stigma of the accusation. 

The challenge, therefore, is to build a new system where these problems can be solved, or least recognised and improved. Our solution requires a much greater input from international sports federations: they need to decide what is best for their sport. They also need to protect their athletes. 

The principles

Central to our idea is that athletes must be educated before they are tested. Different types of athletes will be tested for different substances, and given different sanctions. 

In order to achieve this, anti-doping must be aligned with the talent development pathway of each sport. Anti-doping knowledge must then become part of the athletes’ progression: treated as a skill they must develop as they progress through competitive levels. Much like any other skill, it must be taught it by experts, and the ‘learners’ assessed and accredited. Testing and sanctions are then dovetailed to suit the level of anti-doping knowledge held by athletes. 

An example: football

Let’s imagine that the International Federation of Football Associations (FIFA) is the first to set this in motion. What would be required and what would it look like? 

A starting point would be an expert group to decide which drugs need to be banned at each level of career development, and a talent development group to create ‘levels’ of career progression. Then each national federation would provide clubs with the support for player education, and define sanctions not just according to the substance used, but shorter bans for those less educated.

Hypothetically, such a model could resemble the following:

Level 1
• Amateur clubs that are affiliated with the national federation, that is, they can compete in the national Cup competition.
• Any teams with players under the age of 21 that are not part of a Premier League team academy.
• List of Banned Substances: Anabolic Agents, Narcotics.
• No out-of-competition testing
• Education: Foundational and Values-based; all players required to pass an on-line module; no requirement to attend a workshop.
• Sanctions and appeals: managed by clubs in accordance with general guidelines. These need to be reported to, and approved by, the national federation, and annually collated and reported to the international federation to ensure consistency. 

Level 2
• Semi-professional and lower league clubs (depending on the specific structure in a country).
• All Academy teams.
• List of Banned Substances: Anabolic Agents, Stimulants, Narcotics
• Some out-of-competition testing, but only random and occasional. There is no requirement for a ‘whereabouts’ system.
• Education: Health-based, including good nutrition, also resilience to the temptation for doping, and engaging players in creating a positive environment, including mental health awareness. All players are required to attend two workshops held at their club. They need to pass an on-line module.
• Sanctions and appeals: managed by national federations with support of the NADO. Outcome reported to the international federation, as above. 

Level 3
• Elite, professional clubs in the highest league.
• List of Banned Substances: Anabolic Agents, Peptide Hormones, Growth Factors, Blood doping, Stimulants, Narcotics.
• Education: Similar themes to Level 2, but with more detail. All players required to attend two workshops at their club and one conference with players from other clubs.
• Sanctions and appeals: managed by NADOs. Any dispute is resolved by the international federation. All decisions are publicly explained in order to build up case law and to help educate athletes against potential violation situations. 

How other sports might differ

Football has specific characteristics. The drugs and methods that are most important are those which improve endurance, even though there little evidence exists of football players using Erythropoietin (EPO) or blood doping, in comparison to cycling or athletics. Footballers might be under pressure to have the ‘cut’ look, so fat-burning products might be attractive. However, the controversial issue in football has been the use of recreational drugs. The authorities might decide that when players test positive they are initially given counselling, rather than an immediate ban. 

What we can say, however, is that football has a clear developmental pathway which links to the status of clubs to being selected for international competition. And there is a longevity to players’ careers, not as much as in golf, but more than in swimming or gymnastics. As such, the timing of education and testing, and the length of any bans, can be planned accordingly. 

Cycling has an even clearer developmental structure, based on performance levels: its Category system. As each rider moves up from Cat. 4, to 3, to 2, their level of compulsory anti-doping can be managed in line with their accreditation. The International Cycling Union (UCI) might also decide to focus on products used for blood doping, peptide hormones, and stimulants. It is not immediately obvious whether anabolic agents are a high risk in cycling – perhaps specific types, which boost testosterone without resulting in mass muscle bulk. 

By contrast, a skill based sport such as golf might not include anabolic agents at all, putting more emphasis on beta-2 agonists. Golf could be an interesting example, because the developmental pathway is linked to earnings, ranking, and meeting entry requirements for the most prestigious events, rather than involving a club system. Thus the ‘levels’ and associated anti-doping education would be planned around those elements. 

Another distinctive feature of golf is the length of the athletes’ career, which might suggest longer bans are appropriate. However, set against that would be the impact of a ban, which is an immediate loss of all earnings, including sponsorship, and a real challenge in moving back up the ranking system upon return to the sport. This raises the issue of athlete protection: those on contracts with teams or who need to gain entry to specific tournaments should have legal employment rights, especially in cases of innocuous or inadvertent doping. 

Early specialisation sports such as gymnastics would need a completely different approach. The education and testing of adolescents presents questions about the nature of ‘consent’, the learning process, the dependence on coaches and parents, and the observation of the urine test, much less the ‘whereabouts’ system and Therapeutic Use Exemptions (TUEs). It might seem more appropriate for sanctions to be accorded to the athletes’ support personnel if they are under the age of 18. 

The compulsory education should be expected of not only the athlete themselves, but of their immediate support network. Testing should be limited to elite athletes, and bans should be shorter to reflect the average career span. However, some specific protections should guarantee athletes access to others coaches and doctors, if their support personnel are banned. 

Purely cognitive sports, such as chess and bridge, might have their entire anti-doping focus on mental stimulants. Lifestyle sports, such as windsurfing and skateboarding, might not be concerned with EPO or anabolic agents. Strength sports such as weightlifting might emphasise muscle building drugs rather than those used for endurance or ‘recreation’. 

Each international federation has the opportunity to use the three WADC criteria in distinct and creative ways suited to their sport. Firstly, they could ask if a drug or method poses a risk or potential risk to the health of athletes. The answer might depend on the nature of the sport: anything which alters perception in Formula 1 could be fatal, a weight gaining product in boxing could put the fighter in a classification with much larger and stronger opponents. 

Secondly, they could ask if a drug or method improves performance, and whether it would made a difference to the outcome close to a competition’s timeframe. Thirdly, WADA’s controversial ‘spirit of sport’ [Article 4.3.1.3 of the WADC mandates that a substance can be prohibited if it is contrary to the ‘spirit of sport’] could be reinvented on a sport-by-sport basis: what values and characteristics are most important? This could in fact be integrated with a broader Code of Conduct that is specific to the nature and culture of the event. Of course, each sports federation could also be given the authority to set these in balance, and one potential approach would be to ditch the ‘spirit of sport’ as it is not easy to apply in practice, and then only ban a drug if it is both a risk to health and is performance enhancing. 

A final overarching element to our proposal is that all sanctioned athletes are given social psychology support in order to reduce the risks of mental health crises and associated financial issues. The sense of isolation can be overwhelming. Sports should take a duty of care approach, be interested in the welfare of athletes, help to manage bad publicity and provide avenues for a return to sport, even if in a non-athlete role. 

Counter-arguments

Our proposal is a de-centralised model, which overturns nearly two decades of global centralisation and monopoly of power through WADA. The benefits of the current approach are, potentially, standardisation (clear rules for all), harmonisation (all sports in all countries are compliant), and thus consistent and apparent equity. 

Changing this would mean accepting that international federations have more authority, and thus there may be a need for an oversight body (made up of former athletes, sports leaders and ‘lay’ or non-sports experts). The federations can then define ‘clean sport’ in relationship to their specific needs. 

We would no longer talk about ‘doping’ in a singular sense, but in a way that is contingent and diversified. This means that the underpinning vague sense of ‘drug free sport’ has to be abandoned, and the world of sport needs to accept that it cannot control all athletes in all countries at all times. 

Sport also needs to accept that athletes are normal human beings: they occasionally turn to a pill or an injection to resolve a health or performance issue. It might be difficult for a short period of time to persuade the wider public that this is acceptable: we have all been culturally conditioned by the myths of ‘clean sport’, the ‘level playing field’ and that sport is always healthy. 

However, there are many ‘shocks’ in political and civil life to which societies must become accustomed, and adapt to, and this is much less of a revolution than other dramatic turns of events in other areas. Not least because it simply accepts both the humanity of athletes, and that their career ambitions are about enhancing their own performance – in other words, being the best they can. 

Implementation might still be as varied, as with the current system. Many countries lack the resources or the political will to support anti-doping. The new de-centralised model means that international federations take responsibility for global sport-specific education, working with national federations and NADOs in each country. Potentially, testing could be ordered and paid for via the new Independent Testing Authority (ITA) by the international federation, in order to ensure parity and consistency. The auditing body mentioned above would ensure the partnerships are operating successfully for each sport, and would compare across sports to ensure that some federations do not lag behind the others.  

Another potential criticism concerns complexity. Every sport would need a system of performance level classifications, tailored and compulsory anti-doping education, medical guidelines for athletes and their support personnel, several lists of banned substances, and a more sophisticated approach to testing. 

However, we only need to look at para-sport classifications to find a system which differentiates between types of athletes; or the UK Coaching Certificate, which sets levels of achievement for each coach and is tailored to specific sports. We would need anti-doping laboratories to become more flexible: they would need to offer a range of sport-specific testing packages according the level which an athlete has reached. However, this should allow for more testing, as the lower level testing is based on fewer substances and therefore would be cheaper. 

Perhaps the harder question is whether international federations can be trusted to set anti-doping standards high enough, or if they would lower the bar in order to avoid scandals. We would need a system of auditing to ensure that does not happen. 

There is also the question of what is a fair and proportionate ban and, relatedly, how do we ensure consistency? The important point is that we achieve consistency within sports, not across them, so that makes life easier. 

Transparency and case law would help. For example, if an elite marathon runner in Canada is given a nine month ban for cocaine use, the international federation has to agree that all elite marathons runners are treated the same; and that the tiered system means that non-elite athletes might get a 3 month ban for the same offence. Many of the violations can be predicted and therefore decided in advance, and those which are not predictable can be decided contingently by precedence. 

Mechanisms for reform

We can refine this model and submit suggestions to the WADC Consultation. However, it is unlikely to be accepted by WADA because it would undermine their authority. Consequently, we suggest that a partnership arrangement is developed with international sports federations, athlete representative organisations, business sponsors, and Governments to push forward new ways of thinking about anti-doping. 

WADA was created in a time of crisis and needed to quickly come up with global-level strategies. We are now almost 20 years further on and many problems remain that are not being openly addressed, much less resolved. The past few years have witnessed one scandal after another, increasingly tough punishments for minor or inadvertent cases, and more investigative journalists asking critical questions about WADA. 

The detection rate has remained much the same (1-2%), education has not improved much, and athletes’ rights have been ignored. It is unquestionably time for a new approach. Our idea might not be perfect, and we welcome the opportunity to refine it and to present it to sports leaders. We can do research on how athletes would respond, what sports fans would think; we could work on the details on what should be banned in each sport at each level. 

In the first instance, feedback would be appreciated, and we will regularly update readers on any progress we make. 

• To offer your feedback and suggestions on the proposals made in this article, please click here.

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