SII Focus 17th April 2019

PCC: Anti-doping is a self-sustaining bubble resistant to change

Anti-doping governance has become a self-sufficient bubble that is resistant to change, heard delegates on the first day of the fifth Partnership for Clean Competition’s (PCC) biennial conference, which is taking place from April 16-18 in London – its first time to venture outside of the United States. Delegates heard how the voice of athletes is being sidelined; current testing methods are catching few doping cheats; and how new testing methods are not yet being embraced. 

Delegates also heard about current issues, including ‘dark markets’ for unregulated supplements, as well as increasing supplement use in general society. Future risks could include gene and DNA sequence editing, as well as cloning. The complexity of anti-doping regulation was again highlighted as an issue. “Even with my pharmaceutical background, I find it complicated!”, lamented Professor David Cowan, former Director of the Drug Control Centre at King’s College London, about the World Anti-Doping Agency’s (WADA) Prohibited List.

Delegates heard about the advances that have been made in anti-doping science, social science, and legal issues through the conference’s three separate tracks. However, it would appear that these advances are not always being embraced at anti-doping management level.

The athlete voice

Ed Moses, Chair of the WADA Education Committee, expressed his view that current WADA management had lost touch with athletes. He explained that previously, WADA had asked his Committee what athletes might think about various policy areas. “All of that has now stopped”, he said. “The way athletes are spoken to now is like a bad father talking to their child”.

The view was echoed by British Olympic track cycling Champion Callum Skinner and Ali Jawad, a British Paralympic weightlifter who won Silver in the Rio 2016 Olympics, both of whom are part of the Global Athlete movement to increase athlete representation in sports governance. “They are starting to alienate a lot of the athletes”, said Skinner. “Some of the rhetoric they come out with could have that effect. What I feel continually let down by is the governance.”

Detail from RUSADA’s 2018 Annual Report…

“Not only have they lost touch with the athletes, but they’re being less transparent”, said Jawad. WADA has argued that although it is keen to give athletes a voice on its Executive Committee, it cannot do so until athletes can clarify how their representatives are elected. “That’s like the pot calling the kettle black”, said Skinner. Beckie Scott, Chair of the WADA Athlete Committee, said that a Working Group has been set up to examine how athletes might elect representatives to WADA.

Yury Ganus, Director of the Russian Anti-Doping Agency (RUSADA), asked why clean Russian athletes, who haven’t been implicated in State doping, weren’t involved in the Global Athlete movement. “Why do you not involve them?” he asked, pointing out that exclusion makes it harder to effect change in Russia. “Don’t isolate us!”

Science

The ineffectiveness of the testing system was thrown into sharp relief by David Howman, the former WADA CEO who is now Chair of the International Association of Athletics Federations (IAAF) Athletics Integrity Unit (AIU). He pointed out that of the 322,050 samples taken during 2017, just 1.43% returned a positive test (adverse analytical finding – AAF). Because an AAF doesn’t necessarily mean that rules have been broken due to therapeutic use exemptions (TUEs) and longitudinal tests performed on athletes under the Athlete Biological Passport (ABP) programme, just 0.6% of those tests results in an anti-doping rule violation (ADRV).

“To get a less than 1% return on your investment is not something, as a lawyer, you would advise your client to invest in”, said Howman, who has a legal background. “Can we continue to be happy with that investment? Why are we not challenging ourselves to do better?”

Scientists showed that is exactly what they have been doing. Delegates heard about Dried Blood Spot (DBS) testing, which has been used in the Ultimate Fighting Championships (UFC) for over a year and as previously reported, offers a cheaper alternative to blood testing. This is because no phlebotomist is required for sample collection, as they are for venous blood sample collection, and because samples would not need to be stored under optimum conditions during transport to Laboratories for testing. 

Dr. Daniel Eichner of the Sports Medicine Research and Testing Laboratory (SMRTL) in Utah, outlined work analysing the effectiveness of ‘red’ and ‘green’ capillary blood collection devices placed on the arm, which can retrieve enough blood for DBS in about three minutes. These have replaced ‘finger prick’ devices as the preferred method of blood collection for athletes, since many athletes use their hands during competition.

In contrast to pain felt on use of finger prick devices, respondents reported that they felt ‘almost nothing’ using the green device. However the green device left a small circular welt on the arm. Alan Brailsford, Director of the Drug Control Centre at King’s College, said that temperature doesn’t affect samples collected using DBS, but a potential drawbacks were that samples take time to dry. “Application for use as part of the Athlete Biological Passport looks promising”, he said.

In 2016, WADA funded research into the potential application of DBS testing, however it would appear that things have moved on since then. Although delegates at the WADA ABP Symposium in September last year heard a presentation from Dr. Matt Fedoruk, Science Director for the US Anti-Doping Agency (USADA), it has yet to adopt the new technology.

Dr. Fedoruk also presented a study on the use of devices to measure prohibited substances in oral fluid and exhaled breath, which could be used in addition to existing testing methods. He said that urine collection is still the “gold standard”, as it is possible to test for so many substances, however is invasive due to the need for doping control officers to witness collection of the sample to ensure that cheating is not taking place. This is not an issue for devices used to collect oral fluid or exhaled breath, which can be used to detect certain types of substances considered a risk in certain sports (e.g. stimulants). 

Dr. Cowan pointed out a future challenge for anti-doping by referring to the work of He Jiankui, a Chinese biophysicist who has genetically engineered the genes of twin girls so that they cannot contract HIV. He asked if such technology, including cloning, could have a future application in sport.

“We need to rethink the way in which we approach anti-doping”, he argued, pointing out that although for the vast majority of substances on the Prohibited List any amount is considered an ADRV, it is society that decides what is considered doping. Yet excretion of substances differs from person to person, and the human physiology can modify substances. “We cannot show intent”, he highlighted.

Because of this, he suggested that anti-doping should revisit the use of receptor-based bioassays for detecting certain substances. In basic terms, it is understood that an effective receptor within the human physiology is needed for a substance to “deliver its payload”, as Dr. Cowan put it, and the performance and structure of receptors can differ from person to person. So when measuring the potential effect of a substance on the human physiology, it would appear to make sense to examine them, as well as test for the amount of the substance present within the human physiology (click here for research on this).

Another challenge involves supplements, especially those sold over the internet, which Dr. Cowan said often have “chemically impossible” structures in order to get them through customs. The ‘dark market’ for supplements and prohibited substances sold over the dark web was also mentioned as an area of concern.

Both Dr. Cowan and Dr. Christiane Ayotte, Director of the INRS-Institut Armand-Frappier (Montreal Laboratory) highlighted the increasingly difficult task that Laboratories are being asked to perform, in detecting ever-smaller amounts of prohibited substances in samples. The phrase “looking for a needle in a haystack” and “a pinch of salt in an Olympic-size swimming pool” will already be familiar to those that work within anti-doping.

Dr. Ayotte said that anti-doping uses the same tools as forensic science, however when somebody dies of a drug overdose, the amounts are comparatively easy to detect. “We are running after traces”, she said. “We are torturing the fly. Administration is at fault for asking us to get to that level.”

However, Dr. Ayotte highlighted that one of the benefits of increased detection methods is major advances enabling detection of the long term metabolites (LTMs) of various substances. This theme was picked up by Dr. Adam Beharry, USADA’s ABP Manager, who highlighted that between 2008 and 2012, there were just three AAFs for dehydrochloromethyltestosterone (DHCMT – or oral turinabol), whereas there were 82 AAFs in 2013 alone, after the LTM test was introduced in December 2012.

Oral turinabol, or DHCMT, was the substance used in the now infamous ‘Duchess’ cocktail developed by Dr. Grigory Rodchenkov, former Director fo the Moscow Laboratory in order to dope Russian athletes with less risk of them testing positive. In 2011, Dr. Rodchenkov and his assistant, Dr. Tim Sobolevsky, developed the science behind the test for the long term metabolites of DHCMT. 

Dr. Cowan pointed out that the reason that Russia was successful in using DHCMT is that Rodchenkov and Sobolevsky realised that this substance, which wasn’t new to sport, hadn’t undergone modern research methods. Perhaps realising that it was better to air their research before others, they published in 2011. As such, Dr. Cowan pointed out that it is important for anti-doping to continue to fund “mundane” research.

Dr. Ayotte also highlighted that the 31 Laboratories accredited by WADA do not have the same levels of detection, however explained that this is not a major issue, as samples can be transferred between Laboratories. However, what it does mean is that athletes are not being screened for the same amount of prohibited substances in all countries. However, the practicalities of achieving this make it almost impossible.

Other tracks covered research into the battle for resources in anti-doping programmes; effective collaboration in education programmes; a World Anti-Doping Code update and overview of relevant case law at the Court of Arbitration for Sport (CAS); and legal perspectives of new collection and testing methods. A video of the morning presentations is available below, and a live stream of today’s proceedings is available here.

Sea change

Echoing sentiments expressed by many at the WADA Symposium in March, many called for a new approach to anti-doping. David Howman and pointed out the expense of the testing system, which produces few results. He highlighted that investigations are now uncovering major doping scandals, such as police investigations into doping at the Nordic Skiing World Championships in Austria. He highlighted that NADOs don’t have search and seizure powers, but police do, so criminalisation could be a way forward.

Day One of the PCC conference highlighted that those governing anti-doping need to re-engage with athletes. However, many of those involved in anti-doping are now asking questions about whether the current testing system – a staple of the anti-doping system – needs a complete overhaul. Scientists have shown that they are doing all that they can with the tools that they have, but perhaps anti-doping administration needs to redirect their expertise. The playing field in sport is never level, and perhaps it is time to admit that the same is true in anti-doping.

• An update will follow from Day Two of the PCC Conference. Follow @sport_integrity on Twitter for updates. For a timeline of our tweets and retweets from Day One of the event, please click here.

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