Doping is a societal problem and is not solved by the present testing system within elite sport, academics outlined on the concluding day of the seventh International Network of Doping Research (INDR) conference in Aarhus yesterday. Research conducted by participants indicated:

• that the current policy of total prohibition is not working in elite sport;
• that the prevalence of doping in elite sport is higher than the testing system reveals;
• that high-performance sport cannot be separated from doping;
• that there is some athlete mistrust in the anti-doping system;
• that society’s promotion of muscular physicality as an ideal has led to doping becoming a societal issue.

Professor Bengt Kayser of the University of Lausanne/Geneva opened by examining whether total prohibition of doping is the best approach, if the aim of anti-doping is to reducing the harm caused to the user, both in elite sport and wider society. He argued that now doping sanctions are so severe, total prohibition results in doping being pushed underground, which results in a greater health risk to the athlete.

Kayser argues that athletes adapt their behaviour to optimise performance anyway in terms of training regimes, nutrition, supplements, psychology and technology – none of which are prohibited. In such an environment, he argues, a potential approach to harm reduction might be a monitored gradual removal of substances from the World Anti-Doping Agency’s (WADA) Prohibited List, using permitted levels based on health risk to the athlete. Kayser envisages that a simplified List with cut-off points based on levels considered harmful to the athlete, with close monitoring of the effects, would be a better approach to harm reduction to the user.

Kayser considered that such an approach might put pressure on athletes to take substances they ordinarily wouldn’t consider, due to the knowledge that their competitors are also taking such substances. However, he argued that this stopped short of coercion. Also, an athlete still has the choice not to take such substances. He also pointed out that under the current system, similar pressures to dope exist, but based on suspicion rather than fact.

“Just say no is not an option”, Kayser concluded. “A partial relaxation of anti-doping rules based on harm reduction seems ethically defensible”.

Professor Ian Ritchie, of Brock University, explained how the idea that doping cannot be separated from the ethos of elite sport is not a new idea. Ritchie has been examining the recommendations made by Bruce Kidd and Rob Beamish in their submission to Charles Dubin’s Commission of Inquiry into the Use of Drugs and Banned Practices, a public inquiry released in 1990 following Ben Johnson’s positive test at the Seoul 1998 Olympics.

Ritchie highlights how the Dubin Inquiry was perhaps the largest inquiry into doping ever conducted, involving 119 witnesses, 295 exhibits, 86 volumes and 15,000 pages. It concluded that the use of drugs cannot be separated from the wider system of high-performance sport in Canada and internationally. It found that to successfully tackle the issue, the symptoms of doping need to be treated rather than the cause, arguing that unless you look at the social conditions behind doping, the practice of doping becomes mystified.

Ritchie also pointed out how the “fundamental rationale” behind the WADA Code was taken from a Canadian ‘Spirit of Sport’ campaign launched by the Canadian Centre for Ethics in Sport (CCES) in the 1990s designed to encourage participation in sport whilst discouraging doping. The CCES campaign ended in 1998, when WADA agreed to adopt the language from the campaign into its own Code. However, Ritchie pointed out that since the turn of the century, almost all government-based programmes in sport have failed to encourage participation in sport, so perhaps these laudable aims should be re-examined.

Marcel Scharf of the University of Cologne has been assessing athlete perception of WADA’s Anti-Doping Administration and Management System (ADAMS) within Germany. He found that there were 2,152 athletes recorded as using ADAMS within Germany in 2016, 523 of which took part in his survey.

Of that sample size, 32.3% answered ‘rather not reply’ when asked if ADAMS kept them from doping. Sixteen percent answered ‘I don’t know if it does’. Scharf also found that the ADAMS user interface is a problem, as well as privacy. “The doping control system decides when privacy is allowed, not the athlete”, he said.

Werner Pitsch of Saarland University is something of a pioneer in using the randomised response technique (RRT) to assess the prevalence of doping. This uses statistical survey techniques to allow respondents to admit to sensitive issues whilst maintaining confidentiality, removing concern that admitting doping in a survey will implicate the athlete. He presented data from six such studies, which showed the overall prevalence of doping is between 10% and 35%. This percentage is only slightly lower amongst amateur athletes, but is highest amongst the second tier in elite sport, Pitsch outlined.

Pitsch has been using mathematical modelling techniques utilising data from doping prevalence studies. Although conventional research on the prevalence of doping in amateur sport shows that about 5% of participants use prohibited substances or methods to improve their performance, the determinants of doping in amateur sport are similar to that for elite sport, however the context differs in terms of cost/benefit analysis. This dilemma presents a challenge for social scientists, which Pitsch’s model explains.

Anna Efverström and Åsa Bäckström of the University of Gälve have interviewed 13 elite athletes from their country’s Registered Testing Pool (RTP) about their perception of the legitimacy of the anti-doping system. They found certain issues faced by athletes regarding the ‘whereabouts’ system within ADAMS, which requires athletes within the RTP to file where they will be available for testing for one hour each day.

One athlete faced filing difficulties due to his home address not being featured on maps, and therefore not having a conventional address. An Asian athlete complained that they are not a doctor, and it is difficult to know what is permitted. Whilst the Asian athlete was part of the Athlete Biological Passport (ABP) programme, they abstained from all drugs, including headache pills.

Efverström and Bäckström found there was a marked difference between how athletes perceived the anti-doping system, dependent on whether they have received anti-doping education. An athlete from a developed country had to take an online anti-doping course before receiving funding each year, whilst an athlete from a developed country complained about a complete lack of education.

Perhaps understandably, this led to some distrust of the system amongst the sample athletes. Some said they were confident that the anti-doping system was the same everywhere, whilst others said they distrusted the idea that that it was applied equally. This echoed issued raised in Scharf’s earlier presentation on ADAMS.

Professor John Gleaves of California State University, Fullteron, examined whether interventions to improve physical performance in older adults qualified as ‘enhancements’ rather than ‘treatment’. Gleaves examined the relationship between muscle mass loss and ageing, exploring the question of whether interventions are deemed medically necessary under the philosophical idea of ‘growing older better’, rather than an attempt to extend life.

Malene Johannison of Anti-Doping Denmark (ADD) explained how doping outside of sport is now recognised as a public health issue. Since 2005, ADD has been required by law to seek collaborative relationships with gyms to prevent the use of steroids and other performance and image enhancing drugs (PIEDS).

During 2016, ADD conducted 1,234 visits to gyms, and carried out 308 doping controls. In 154 cases, those selected refused a doping test, and for the other 154, 83 (27% of total selected) tested positive and 71 (23% of total selected) did not. In a progressive approach, ADD has realised thatdoping outside of sport can be a symptom of insecurity based on societal pressure to perform well on all levels. Doping can be a coping strategy for this, argued Johannison.

Conclusion

It appears that we have reached an impasse, to borrow phrasing used by Kayser. Academics and anti-doping experts realise that the current anti-doping system is ineffective at preventing doping in elite sport, which has now also permeated into society. The focus on improved performance put forward as an ethos of elite sport actively pushes athletes towards doping. Yet athletes often also mistrust that the anti-doping system is fair.

Academics at the INDR conference generally agreed that a reformed approach to anti-doping is needed, however debated what form a new approach should take. Also discussed as problematic was the strong anti-doping rhetoric perpetrated through the media, which makes any debate on a reformed approach politically difficult for anti-doping organisations. It is perhaps time for science and theory to take the place of moralistic vitriol.

• You can read a Review of Day One of the INDR Conference, ‘Doping in Sport, Doping in Society: Lessons, Themes and Connections’ by clicking here. A Twitter timeline of the day is also available here. To read about the 2015 INDR Conference, please click here.