The way, then the lack of will: A story of anti-doping and those who might save it

24 Apr 2017 Posted by

About a month ago, the folks from Clean Sport Collective asked me if I would write a piece on anti-doping, which they published on their website.  I’ve reproduced that below, with a few additions and expanded thoughts.  It talks about how the science has provided a better “way” for anti-doping, but that it has also exposed a lack of “will”, a far greater problem to overcome.  Enjoy!

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Enlightenment

My career in sports science is divided into pre- and post-“enlightenment” periods on the doping issues facing elite sport.  That’s not to say I was ignorant of doping – one of my earliest memories of sport was watching the television news in South Africa when Ben Johnson was caught for doping after his Olympic 100m triumph in 1988.  I remember my parents explaining what happened as the news showed footage of Johnson surrounded by photographers in Seoul.  I was in high school for the Festina scandal in cycling’s Tour de France, and when I studied my undergraduate degree, I encountered numerous sporadic cases.

The “enlightenment” I speak of was not an epiphany, then.  It was a gradual process, a realization of the fact that like the iceberg analogy so overused in business, what you’re seeing above the surface represents only a fraction of what actually exists.  Perhaps as I studied exercise physiology as a specific field, and became ever more immersed in the limits of human performance during my PhD research, the dots were joined in a way that brought out the realities, of that time, that doping was pervasive, and so effective that winners were usually synonymous with dopers.

By the time I finished my PhD, there was little doubt in my mind that the sport was straining at the boundary of credibility, though unfortunately, not enough people seemed to care for it to really impact the all important “product”.

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In the beginning, there were poor tools

In the first part of this awareness, the problem with anti-doping was a little different to what it is today, and this is an important concept.  From the early 1990s, up to around 2006, the main issue facing those on the side of clean sport was the power of their tools.  Anti-doping had been set up as a “catch (or test)-and-release” system, until you caught one that had a banned substance in the urine, and then you would pursue the case and seek a ban.

It was smoking gun stuff, in the sense that the presence of a banned substance in the urine or blood sample provided by an athlete was conclusive evidence that the athlete had doped, and the ban would be issued.   Anti-doping needed the smoking gun.

One small problem – there was no test for EPO, there was no test for many of the steroids being used, or for growth hormone, or for blood transfusions.  The culprits were ‘invisible’ to the testers.  The smoke was either invisible to the tests, or it disappeared too soon after the shot was fired to be detected.  Finding it proved impossible. Even those that were visible were detectable only if they were in high enough amounts, because the tests weren’t sensitive enough to detect them in really low concentrations. We had a tool problem.  Like a shed built by a carpenter without a hammer, anti-doping was flimsy and unsubstantial.

What this created was a system too easy to bypass.  EPO could be used with concern only for the athlete’s haematocrit, because the stop-gap at the time was to say that any athlete whose hematocrit was too high (the point of using EPO is to raise the red blood cell count) were forced into a mandatory rest period.  Other hormones were impossible to police, even indirectly.

So in that generation, the old adage that testers were two steps behind the cheaters was largely true.  The effective drugs were easy to use.  A solution had to be sought.

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A better, smarter hammer

That solution fell to science, because in order to improve the tools, advances in science were required.  New tests, for previously undetectable substances, and improved tests, for substances previously detectable only in large amounts, had to be developed.

And sure enough, that happened.  A urine test for EPO was developed, and the sensitivity of various tests improved, which made the margin of error for an athlete increasingly smaller.  That’s not to say this solved the problem – the THG scandal that caught Marion Jones and Tim Montgomery, among others, showed how a designer steroid would still be undetectable, and had it not been for a coaching rivalry provoking an anonymous delivery of that drug to authorities, it may still have been unknown.

Similarly, test sensitivity still falls below a required standard, which is why the retesting that we see six to eight years after big events nabs athletes and forces the clumsy reallocation of medals.  That situation can always improve, but progress is never bad.

And then, in 2006, the biological passport concept was introduced.

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The biological passport and the “squeeze”

In the biological passport, an athlete is tested at multiple points in time, and certain blood parameters are measured.  They included young or immature red blood cells (called reticulocytes), haematocrit and haemoglobin, all indicators of the “health status” of a person’s blood.  The premise here was that any doping, whether it was EPO to boost red blood cells, or the removal of blood for later re-infusion, must change those blood parameters in the short term.

For instance, when you remove blood, the body is clever enough to respond by increasing the production of new blood cells. So for a short time, the reticulocyte count will rise and be elevated, but the haemoglobin will be low, because of the blood removal. The opposite would happen with reinfusion of that blood at some later point, usually midway through a stage race.  EPO, meanwhile would also cause predictable changes in reticulocytes (increase) and red blood cell mass and hemoglobin (increase, but later) over time.

So, by testing the athlete at multiple points, and taking advantage of the fact that our blood values don’t bounce up and down like a currency on a volatile Tuesday of trading after a corrupt politician destabilizes the economy, scientists were able to come up with a model that would effectively compress doping, if applied correctly.
Was it perfect?  No, the sensitivity remains an issue, because these physiological outcomes are complex.  They can be affected by multiple factors, and so the ranges that are “allowed” before a passport result is deemed “suspicious” are necessarily wide.  That means that micro-dosing remains viable for athletes, who can use small enough doses to get some benefit, but not so large that they trip up the “alarm” set by these boundaries for what is deemed “normal variation”.

Also, by creating these upper and lower boundaries for variation in blood parameters, the anti-doping procedures had effectively delivered an “instruction manual” to sophisticated dopers, by telling them what magnitude of change they could afford before they’d be flagged as suspicious.

It meant that the right combination of doping methods (EPO vs infusion vs removal vs saline infusion) would allow the doper to navigate the system with a degree of confidence they’d never be caught. If variable X increased because of one method, it could be brought back down with another, and the athlete would always stay in between these “guide lines”.

Further, it’s expensive (multiple time points are required), logistically challenging (more on this later), and it’s vulnerable to legal challenge because hematology is complex and athletes can challenge the assertion that variation is caused by doping as opposed to say, altitude, or sickness, or dehydration.

However, it was a step in the right direction, a tool that looked for the effects of a drug, rather than the drug.  Progress. That gap from tester to cheater was narrowed, maybe to within touching distance, and it is surely better than it used to be where there was no limit, and EPO use was rampant.  It is not a co-incidence, in my opinion, that middle and long distance times have hardly improved since the late 1990s, early 2000s.  The development of the test created a “watershed”, and we’re on the right side of that, with progress needed, admittedly.

But that’s where the story turns for the worse.

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The will, the way, and the problem with anti-doping today

It is often said that where there is a will, there is a way.  The development of more sensitive tests, and new tests, had given anti-doping tools with which to fight the good fight.  Or at least a better one.  They were, with the acknolwedged limitations, a better “way”.

The problem this has revealed, sadly, is the lack of will.  Perhaps that lack of will is a new phenomenon, a product of the growth in commercial value of the sport – who wants to tarnish the golden eggs laid by those athletes?

Or perhaps that will was never there, but it was never required to show itself because the tools didn’t push it into a corner that demanded that the authorities, those people sitting a level above the scientists, take any action.

In any event, the common theme running through doping scandals in the last decade has been a lack of will, rather than a lack of a ‘way’.  And that, frustratingly, is a greater problem to overcome.

It was responsible for the massive cover-ups in Russia.  It was responsible for WADA and sporting body’s initial inaction to the information provided by whistleblowers. It was responsible for the laxity of testing in labs around the world, which makes certain countries doping havens because they are inaccessible to international testers and lack the resources to conduct their own testing.  It’s responsible for the necessary mistrust of the performance from countries like Ethiopia, Kenya and Jamaica, where testing is lax.

Some of this comes from a genuine lack of resources, and that’s something I’m sympathetic towards.  But that lack amplifies, rather than diminishes, the implications of situations we have seen too often, where authorities are alerted to doping, but do little, until a persistent journalist digs and digs to discover a thread that they can pull on in order to expose an anti-doping failure.

I cannot forget how between the IAAF and WADA, there was synchronized and repeated outrage against one doping allegation after another, made because of investigative work by the media, against Russia, only for it to later be confirmed that hundreds of emails had already been sent to them about it.

When authorities talk of “shock” and even go so far as to declare reports of cover-ups as a “declaration of war” (here’s looking at you, Seb), the outside world cannot but wonder whether those tasked with policing the sport have the integrity to do so, or whether they are engaged in a complex “House of cards” game of PR and spin?

When authorities know, and fail to act within their own mandate, that suggests a failed system brought on by a lack of will.  This was highlighted most recently by yet another media-led revelation that retesting of Beijing samples revealed “numerous” cases of athletes with clenbuterol in their urine (this is an example of how the tools improved – that urine had the clenbuterol in 2008, it just could not be detected then).

The IOC, and then WADA, did not pursue a single one of these, because the levels were too low, which they said was indicative of food contamination, not doping. And certainly that may be true, but clenbuterol is what is called a non-threshold drug – any clenbuterol, no matter how tiny in amount, should trigger an adverse finding and subsequent investigation.  Also, low levels don’t have to mean contamination – they could mean small doses of drugs, or a long time between use and testing.

So the IOC and WADA, however you view it, failed to act in accordance with good science, and their own procedures, instead making an arbitrary decision based on risk of contamination in China and low levels.

Again, they may be correct in concluding that it was food contamination, but there would be data to support that – for instance, if these “numerous cases” came from the full spectrum of sports, in many countries, it would strengthen a food argument.  If the cases come from specific sports and countries, it would not.  Transparency and integrity of anti-doping would disclose this, not deflect after being exposed by a journalist.

It is the latest in a series of events that undermine anti-doping, and hence explain why elite sport is struggling for credibility.  It’s not solely the fault of science, not anymore.  It’s a failure of management, strategy, and ultimately, will.

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Changing the incentive balance

So what is the solution?  A lack of a “way” is solvable with better tools, and that’s happening, and needs to continue happening to make things like the passport better.  Just because it is not yet perfect, it shouldn’t be discarded. As I’ve said before in various contexts, if you start out blind, and someone offers you half your vision, you shouldn’t reject it just because it is not 20/20.  So acknowledge the progress.

It needs to be supported by better legal backing, and more effective sanctions when dopers are caught.  False positives undermine it, as do grey cases where science cannot provide answers that meet an acceptable legal standard, so they must be dealt with.  As a result, progress on the “way” will come from the same steps, in the same direction, as were taken to develop the passport and more sensitive tests.  These advances are what you’d call advances in scale, not concept.  Although, that said, a concept shift might come from the -omics approach to anti-doping, but that may yet take some time to refine.

I honestly believe that many, if not most, of the people actually using the tools within anti-doping are sincere and committed to eradicating doping.  I know many, and I believe them to be good people using the tools they have as well as their resources allow.  But the consistent thread in the sport’s biggest scandals points to something above them, at both the national and international level.

That something is “will”, and it is much more difficult to create.  It requires a revision of the entire system.  Why is will lacking? At the risk of oversimplifying, it is absent because pursuing and sanctioning dopers is at odds with selling the sport for commercial gain.  It’s a negative message, it “spits in the soup”, to borrow a phrase from cycling, referring to people who spoke out about doping.

Until the incentives of those responsible for anti-doping are changed, I do not see how the will to enforce anti-doping can be created.  When authorities are tasked with simultaneously promoting the sport and catching its cheats, the balance will always tilt to one side.  In this world, a whistleblower will always be viewed as a threat who cannot possibly be welcomed.  Retests that threaten the positive veneer of historic events cannot be fully acknowledged (“Quick, blame the meat!”) or indeed done.  Until such whistleblowers can be welcomed as an opportunity, and until authorities win back lost trust, progress will remain stalled.

So anti-doping has to be taken away from sports, and potentially, even WADA’s structure must be changed.  It has been called a “PR arm” of the IOC, because there is something counterproductive in the too-close relationship they have, as well as the funding structure.

Athletes and sponsors, ultimately, may hold the key.  Realistically, it must begin with the athletes, and sponsors may then follow.  If you step back, and look at the sports system, athletes are the ones most incentivized to stand up for clean sport.  Yes, I realize they’re also the ones most incentivized to dope to win, but this becomes a volume balance, an issue of ‘mass’ on one side against the other.  Athletes who wish to be clean have the purest incentives in the sport to press an anti-doping agenda.  They also have the most to lose when doping is prevalent (compare this to the regulatory bodies, who have most to lose when doping is revealed).

Sponsors, too, suffer from the latter problem – they gain more from the spectacular performances doping enables, and stand to lose when it happens.  However, if that particular balance can be changed, then sponsors with integrity may drive the commercial incentives to clean sport up.  I am reminded that cycling was assisted when team sponsors said “no more” and some media refused to cover race results.

However, I maintain it should begin with athletes, and so whatever structure is created, it is athletes who must be given the most important, loudest voice in it.  If the commercial interests can be aligned to this voice, it would help enormously. If sponsors and media pulled in the same direction, then even the commercial drivers for cover-ups might start to erode. It is those three – athletes, supportive sponsors, and media invested in the truth, that may save sport from a doping black hole.

I would argue for the creation of a body whose incentive is to catch cheats, athlete-led and supported by independent scientists. A contract that allocates a portion of TV rights money to anti-doping should be entered into, with no option to change for the foreseeable future, so that money can never become a tool for leverage, bargaining or outright bribery.  The police cannot be made vulnerable to a bribe or pressure from the criminals.

Whether that happens, unfortunately, is down to existing organizations, who would have to change themselves.  That of course, brings us to the need for a “will”, and puts us into a perpetual cycle. Breaking that is going to be the next phase of the enlightenment.

Ross

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