18 April 2019

PCC: One size no longer fits all

The World Anti-Doping Agency (WADA) is now 20 years old, and was formed largely as a response to the Festina affair, which brought doping into the public eye. The theory was that a single set of harmonised rules overseen by an international and independent agency would end the inconsistency amongst international federations and countries with regards to policing doping in sport. Today, delegates at the Partnership for Clean Competition (PCC) conference heard that this ‘one size fits all’ approach to anti-doping has served its time. A new, more inclusive approach is needed.

Delegates heard views that included:

• it is more important to fund extra investigative work than more testing;
• that WADA has lessons to learn from the US professional leagues about their approach to including athletes and to sanctioning substances of abuse and/or recreational drugs;
• that team sports require a different approach to anti-doping than individual sports;
• that the complexity of anti-doping leads to abdication of responsibility for fear of getting things wrong;
• that standards are good, but people are arguing over minute points whilst forgetting their purpose;
• that the qualities required for anti-doping leadership point towards athletes.

Engaging with change

One of the consistent themes that carried over from yesterday was that those governing anti-doping need to engage with change rather than attacking it. In the opening session Jonathan Taylor, head of WADA’s Compliance Review Committee (CRC) asked Ben Cohen of the International Testing Agency (ITA) whether there was a perceived conflict of interest, due to its funding by the International Olympic Committee (IOC). “If you are a service provider, are you truly independent of your clients?” asked Taylor. “If they have resolved those perceived conflicts of interest, I suggest that they publish how they have done this on their internet site”.

Some delegates agreed that the same perceived conflict of interest argument could be levelled at WADA. “WADA is partly funded by the IOC, and going into the Olympic Games, you can’t commercialise and police it at the same time”, said Shanna Burnette of the Clean Sport Collective. “That’s where one of the biggest lack of trust exists between brands that are not putting up sponsorship dollars, and athletes as well”.

It was recognised that the ITA has benefits in taking away the responsibility for anti-doping from international federations that may not have the resources to deal with the issue. “I wonder if it is a coincidence that the ITA was created once WADA said that it was going to enforce its compliance rules?” queried Taylor. “Three thousand potholes filled in. I think that is worth writing about.”

However this is part of WADA’s perception issue, argued Michael Ask, the CEO of Anti-Doping Denmark. “From an athlete’s point of view and even from a smaller NADO’s point of view, WADA appears to be a technical body, with lots of papers and bureaucracy, that doesn’t really get down to tackling the problems”.

The US flip

In the past, delegates at anti-doping conferences asked why the US professional sports are not signatories to the World Anti-Doping Code. Today, delegates at the PCC conference asked why WADA is not considering ideas that the US professional sports have implemented, which place athletes at the heart of deciding how testing procedures should be implemented.

US professional sports are not signatories to the Code because they have collective bargaining agreements (CBAs) with the unions that represent their athletes. Under such CBAs, the leagues and unions negotiate anti-doping testing protocol. In contrast, the World Anti-Doping Code requires athletes to surrender many rights – a situation that would not be acceptable to the US player unions and would lead to a lockout. This situation transpired in 2011.

The US professional leagues separate performance enhancing drugs from ‘substances of abuse’, for which treatment is prescribed rather than a ban. “Do you really need to worry about cocaine enhancing performance?” asked Kevin Manara of the National Football League (NFL). Pat Houlihan of Major League Baseball (MLB) pointed out that players are not routinely screened for ‘substances of abuse’ unless an incident – such as an arrest – puts a player “on the radar” of the MLB Players Association Treatment Board.

If a player fails to engage with treatment, a ban can follow. In contrast to this, under the World Anti-Doping Code an athlete who took cocaine in a nightclub can face the same four year ban as an athlete who used erythropoietin (EPO) to cheat in the Tour de France. Such an approach can have unintended consequences. UK footballer Josh Yorweth was sanctioned with a four year ban after refusing a test due to taking cocaine the previous weekend. 

Such situations are likely to be rectified if the ‘Substance of Abuse’ clause in the draft of the 2021 Code (PDF below) is adopted. Article 10.2.4 mandates that when an anti-doping rule violation (ADRV) involves a Substance of Abuse, and the athlete can establish that the use occurred out of competition and was unrelated to sporting performance, then an athlete can reduce a sanction down to one month, if they agree to completion of a substance abuse programme. A ‘Substance of Abuse’ includes prohibited substances that are abused in society outside of the context of sport, and are identified as ‘Substances of Abuse’ on upcoming editions of the Prohibited List.

It was later pointed out that athletes are considered role models by many. If you take this view, as many athletes do, then whether a substance has the potential to enhance performance has little relevance. When asked why athletes assume this role, often without question, distance runner Kara Goucher answered: “Because we just do!”

“Do athletes have adequate support for the demands that sport places on them?” asked Sue Backhouse of Leeds Beckett University. “Self medication shouldn’t be an issue”. Dr. Matthias Kamber, formerly with Anti-Doping Switzerland, argued that a Code of Conduct would be a sensible approach to such substances.

Houlihan also said that MLB provides players with supplements that have been certified as safe by the NSF. “Let’s be realistic about this”, he said, referring to the idea that most elite athletes use some form of supplementation. It was pointed out the US approach of banning athletes for a number of games rather than a period of time suits team sports, as it prevents any ‘gaming’ of the system, whereby bans could be scheduled to begin at the end of the season.

Matthew Graham of the World Players Association (WPA) said that an advantage of the CBA approach is that it is not concluded until athletes accept it. A problem with the current approach under the World Anti-Doping Code is that WADA is “inherently playing catch-up”. This theme was later picked up by Backhouse. “When decisions are made for us, we are not going to feel fully involved”, she argued. “We are not going to own them”.

Graham said that of the 85,000 athletes that fall under the WPA’s remit, 80,000 are subject to the World Anti-Doping Code, which is why it has asked for reform of WADA’s Executive Committee so that one third of members are made up of athletes; one third from sports governing bodies; and one third comprise government representatives. He pointed out that an independent Executive Committee might be considered good governance, as would provisions to protect the fundamental rights of athletes, an independent judiciary, and recognition of the specific issues applicable to team sports. 

However, US professional sports also face specific challenges, due to the wide area from which they attract players. MLB highlighted specific challenges it faced in the Dominican Republic, partly due to the fact that anabolic steroids are not illegal and are easily accessible. MLB has also faced a number of clenbuterol positives in players from the Dominican Republic, due to use of Subrox-C, a cough and cold medication that contains clenbuterol. Subrox-D, a similar medication that does the same job, doesn’t contain the substance.

‘Operating in that kind of an environment, where banned substances can be so easily obtained, has been proven to be a challenge’, wrote Michael Teevan of MLB in an email. ‘We have a high number of players who hail from the Dominican Republic (more than 11% of players on 2019 Opening Day rosters), and that level of concentration is a primary reason why we have focused significant resources and efforts to respond to these issues. In recent years we have reduced the incidence rate of positive tests for players from the Dominican Republic, and we are committed to continuing educational and programmatic initiatives to continue that progress.’

Investigations are more important than tests

In their presentation, the US sports were keen to focus on the huge number of tests they perform on players. Bob Lenaghan of the MLB Players Association said over 11,500 tests were performed on MLB athletes during 2018. Manara of the NFL said it had carried out 19,000 blood and urine tests last year. However in sports subject to the Code, the focus appears to be moving away from testing and towards investigations.

“Intelligence is more important than doping tests”, said Trevor Pearce, Chair of UK Anti-Doping (UKAD), referring to use of intelligence to build investigations into doping networks. Pearce advocated partnerships with many organisations that might have a more effective remit than a national anti-doping organisation (NADO) in order to bring down such networks. 

Pearce also highlighted the importance on focussing on criminality in anti-doping, naming the process of following ‘dirty money’ generated by the trade in illicit substances “dopenomics”. He pointed out that “it is easy” to sanction a 17 year old rugby league academy player, but “much harder” to get at those facilitating such behaviour, which is why UKAD views partnerships with police, the Medicines and Healthcare Products Regulatory Authority (MHRA), and the General Medical Council (GMC) as vital.

Trevor Pearce, Chair of UKAD, highlighted “dopenomics”…

“If you have a kilo of steroids, it will cost you roughly £800”, he highlighted. “You can convert that into 380 ten millilitre bottles. You can sell those at £30 each, which gives you, broadly, a profit of £10,000. So if you can move 5,000 bottles a month, you’ve generated £150,000. There are costs along that supply chain, but in broad terms this is illustrative of the profit that can be made.”

Pearce explained that the illicit money from such operations then either has to be reinvested or laundered. “This is where dopenomics become important, because you have to move the money around the system”. Pearce pointed to the success of Operation Grayskull, which took out an illegal steroid laboratory located in Wales, which was producing Anavarex 10 (oxandrolone) tablets. It is understood that this is connected to the shut down of another Laboratory in Sittingbourne, Kent, last year.

Brett Clothier of the AIU highlighting the ‘investigations matrix’…

Brett Clothier of the Athletics Integrity Unit (AIU) of the International Association of Athletics Federations (IAAF), pointed out that small changes can make a big difference in garnering useful intelligence. He said that the 20 AIU staff (eight permanent) have an open plan office, to “ensure that intelligence becomes part of our everyday work”. 

However, he outlined that there is still a reluctance to come forward with information. “I’ve been working in this area for 16 years now, and it is surprising how few people within sport are willing to give information”, he said. This is in contrast to WADA, which reports an abundance of people coming forward with information.

Pirates of the Caribbean 

The comments of Taylor, highlighting the amendments that have been made as a result of WADA’s Compliance Programme, show an adherence to the documentation, rules and regulations that have been created in order to administrate anti-doping. Such adherence has its benefits in the form of unified standards that can be applied anywhere. However, as illustrated by the US professional sports, such guidelines are not applicable to all situations – a situation that many who fall under the Code’s jurisdiction, such as team sports, are starting to realise. Perhaps the Code should be more of what we might call ‘guidelines’ rather than actual rules…

The final discussion of the day bridged this difficult subject, by asking experts what anti-doping might look like in the future. What emerged was a frustration with the complexity of the anti-doping regulatory system that has been created, which is difficult for anyone other than scientists, academics and lawyers to understand. The irony is that the Code is not applicable to them.

Many referred back to a phrase used by David Howman on the first day of the conference: “keep it simple, stupid!” Dr. Peter van Eenoo of Ghent University’s DoCoLab argued that although unified standards are important, the impact of anti-doping case law is over-complication of the rules. “To get cases through, lawyers are arguing every minute point”, he said. “This results in footnote upon footnote upon footnote. People are mis-using the rules.”

He pointed out that lack of funding is a major issue for many of those that work in anti-doping. He said that his NADO does not receive funding, but generates money from the testing programmes that it carries out for sport. Many anti-doping organisations agreed that they are in a similar situation.

Panellists also appeared to make the case that the qualities one might seek in a leader for anti-doping are similar to the qualities held by athletes. “People within anti-doping need to show the same ethical standards as the athletes”, argued Van Eenoo. This has major significance, given the Athlete Voice movement. Unless anti-doping management gets to grips with the above issues, its ship is sunk.

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