Drugs in Sport: December 2011 Update

Introduction

Two months ago an Australian Paralympic cyclist was banned from competition for two years following a positive drug test. The athlete was tested shortly after breaking a world record at the national cycling championships earlier this year.

In Australia, the Australian Sports Anti-Doping Agency (ASADA) is responsible for promoting, co-ordinating and monitoring anti-doping. ASADA conducted 7,090 drug tests in 54 sports in 2010-2011. These tests led to 42 athletes being entered onto the independent Anti-Doping Rule Violation Panel’s formal Register of Findings. 

The World Anti-Doping Agency (WADA) co-ordinates global anti-doping through its World Anti Doping Code. It publishes an annual List of Prohibited Substances that have the potential to enhance performance or to mask the use of substances and methods that are prohibited. WADA’s 2012 List of Prohibited Substances was published three months ago.

Doping is characterised by:

  • Presence of a prohibited substance in an athlete’s drug test sample.
  • Use or attempted use of a prohibited substance or method.
  • Refusal to submit a drug test sample after being notified of a test.
  • Failure of an athlete to notify the anti-doping agency of whereabouts or missed tests.
  • Tampering with any part of the doping control process.
  • Possession of a prohibited substance or method.
  • Trafficking a prohibited substance or method.
  • Administering or attempting to administer a prohibited substance or method to an athlete.

WADA’s 2012 List

The 2012 List specifies nine groups of prohibited substances. Each substance is identified as having a potential to enhance performance in competitions or to mask the use of substances and methods that are prohibited.

These prohibited substances:

  • Increase protein synthesis, augment muscle mass and strength (anabolic agents)
  • Stimulate production of naturally occurring steroids, build up muscle, repair body tissue and improve the body’s ability to carry oxygen (peptide hormones, growth factors and related substances)
  • Relax airways (bronchodilators), enhance anabolic and anti-inflammatory actions (beta-2 antagonists)
  • Inhibit or stimulate specific cellular receptors (hormone antagonists and modulators)
  • Increase urination to flush, dilute or conceal prohibited substances (diuretics and other masking agents)
  • Increase reaction time, reduce pain (stimulants)
  • Provide pain relief and mood alteration (narcotics and cannabinoids)
  • Inhibit inflammation, pain relief, relax respiratory tract (glucocortisosteroids)

The 2012 List has an introductory sentence that emphasizes the status of drugs with no official approval and not covered by the nine generic substances in the List: “Any pharmacological substance which is not addressed by any of the subsequent sections of the List and with no current approval by any governmental regulatory health authority for human therapeutic use (for example, drugs under pre-clinical or clinical development or discontinued, designer drugs, veterinary medicines) is prohibited at all times.”

Three prohibited methods are included in the 2012 List. The enhancement of oxygen transfer increases oxygen delivery to tissues to improve aerobic power.  Chemical and physical manipulations consist of the use of substances and/or methods, which may alter the integrity, and/or validity of urine samples obtained in doping controls. These include, but are not limited to, catheterisation, urine substitution and/or tampering with doping control. Gene doping is considered (but not found at present) to target muscle hypertrophy, oxygen delivery, and changes in muscle phenotype.

Exemptions

There are cases where athletes “would experience a significant impairment to health if the Prohibited Substance or Prohibited Method were to be withheld in the course of treating an acute or chronic medical condition.” An International Standard for Therapeutic Use Exemptions became effective in 2005. WADA permits the Therapeutic Use of the Prohibited Substance or Prohibited Method when such use would not enable “additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition”. The exemption exists in cases where “there is no reasonable therapeutic alternative to the use of the otherwise Prohibited Substance or Prohibited Method”.

London Olympics 2012

The ‘Win Clean: Say No To Doping’ campaign for the London Olympics was launched in October.  The launch took place in a week when there was active discussion of a Court of Arbitration for Sport decision that the International Olympic Committee’s Rule 45 that bans athletes suspended for doping for six months or more from competing at the Olympics was “invalid and unenforceable”.

Photo Credit

Cheating

1948 Olympic Games Poster

 

IOC Rule 45: A Brief Note

I have been researching anti-doping in sport recently.

In September the World Anti-Doping Agency (WADA) published its 2012 List of Prohibited Substances.

In October the Australian Sports Anti-Doping Agency (ASADA) published its 2010-2011 annual results.

The Win Clean: Say No To Doping campaign for the London Olympics was launched in October too.  The launch took place in a week when there was active discussion of a Court of Arbitration for Sport decision that the International Olympic Committee’s Rule 45 that bans athletes suspended for doping for six months or more from competing at the Olympics was “invalid and unenforceable”.

Today (17 November) there is news that the British Olympic Association (BOA) Board have discussed testing their by-law (on the exclusion of athletes suspended for doping) in the Court of Arbitration for Sport. The Chair of the BOA Board, Lord Moynihan, is quoted as saying:

We now have a situation where drugs cheats will be able to compete in London 2012. We must decide: is the outcome we want a watered-down, increasingly toothless gesture towards zero tolerance?

In an iSportConnect discussion overnight, Sarah Elison has pointed out that “there are two issues to wrestle with (1) is sport a livelihood? and (2) are such bans ‘regulation’ or ‘punishment’?” Sarah observes that:

On the first, one of the reasons we shy away from lifetime bans for professionals, is because of their right to earn a living. Whilst the regulatory and disciplinary process can temporarily deprive them of this there remains a possibility of remediation and a return to the profession in which they (and we) have invested. At a recent conference we discussed sports bans and noted that even a short (2 year) ban for an athlete such as a young gymnast could in reality be a “lifetime” ban for the time they would be at the top of their sport. Whether athletes could argue such bans deprive them of a right to earn a living is separate discussion and has its own case law.

The second point considers the purpose of sanctions. In professional regulation we regulate to “protect the public”, to “maintain and uphold standards” and to ensure “trust and confidence”. Regulatory sanctions are aimed at this, and any punitive effect is acknowledged to be a by-product. It seems the language of the BOA is about punishment for cheats but when you focus on punishing there is a risk of disproportionate and inflexible sanctions. The sports’ bodies need to be clear about their intentions.

She concludes that:

It seems to me there is scope for bans which potentially last a lifetime but with the option of restoration (not overturning the ban but reviewing it after a minimum period of time). Such a model can maintain integrity and reputation in sport and keep out, for an appropriate period, those deemed unsuitable to compete.

This debate in encouraging me to contemplate whether integrity and reputation are absolute or relative constructs.

Postscript

The Court of Arbitration for Sport (CAS) will hold a hearing on 12 March 2012 to consider the British Olympic Association’s (BOA) bylaw for lifetime bans for drugs cheats. A verdict will be announced in April. The BOA lodged an appeal in December 2011.

The Court of Arbitration for Sport (CAS) has registered the appeal filed by the British Olympic Association (BOA), against the decision by the World Anti-Doping Agency (WADA) to declare the BOA’s selection policy addressing athlete eligibility standards for Team GB to be non-compliant with the World Anti-Doping Code.

The appellant BOA requests that the WADA decision be overturned. The case will be handled in accordance with the procedural rules set out in the Code of Sports-related Arbitration. The parties will first exchange written submissions and will then be heard at a hearing, the date of which will be fixed in 2012. A final ruling is expected in April 2012.

Performance Enhancing Drugs in Sport

Introduction

On Monday 30 August I met Will Grant’s class at the ANU. My topic was Performance Enhancing Drugs in Sport. I wrote this blog post as a point of reference for discussion in the class. There is a Slideshare link too.

Background

In 2007 the Select Committee on  Science and Technology of the UK Parliament reported on Human Enhancement Technologies.

In their discussion of drugs in sport they note that doping “refers to the use of performance-enhancing drugs which have been prohibited by sporting regulatory organisations.” The report observes that:

The prevalence of doping in sport has been attributed to a number of factors. Athletes are often under significant pressure to deliver medal-winning performances. They may also face team pressure where success is dependent on the performance of all. There are often significant financial gains to be made from success in many competitive sporting events. Other factors contributing to doping in sport might include a perception that other sportsmen and women are doping and getting away with it and that competition is imbalanced should an individual athlete choose not to go down the same route. Finally, the ease of availability of many prohibited substances may be an exacerbating factor.

Chapter 2 of the Committee’s report provides a detailed background to the regulation of performance enhancing drugs in sport.

The World Anti-Doping Agency (WADA) promotes, co-ordinates, and monitors  anti-doping in sport in all its forms at the international level. WADA’s key activities include “scientific research, education, development of anti-doping capacities, and monitoring of the World Anti Doping Code – the document harmonizing anti-doping policies in all sports and all countries.”

WADA points out that:

The Code is the core document that provides the framework for harmonized anti-doping policies, rules and regulations within sport organizations and among public authorities. It works in conjunction with five International Standards aimed at bringing harmonization among anti-doping organizations in various areas: testing, laboratories, Therapeutic Use Exemptions (TUEs), the List of Prohibited Substances and Methods, and for the protection of privacy and personal information.

The current code in use took effect on 1 January 2009. WADA publishes a list of prohibited substances each year. WADA asserts that:

  • The List is a cornerstone of the Code and a key component of harmonization.
  • It is an International Standard identifying substances and methods prohibited in-competition, out-of-competition and in particular sports.
  • Substances and methods are classified by categories (e.g., steroids, stimulants, gene doping).
  • The use of any prohibited substance by an athlete for medical reasons is possible by virtue of a Therapeutic Use Exemption (TUE).

The 2010 List specifies the following prohibited substances:

  • Anabolic Agents
  • Peptide Hormones, Growth Factors and Related Substances
  • Beta-2 Antagonists
  • Hormone Antagonists and Modulators
  • Diuretics and Other Masking Agents
  • Stimulants
  • Narcotics
  • Cannabinoids
  • Glucocorticosteroids

The 2010 List specifies the following prohibited methods:

  • Enhancement of Oxygen Transfer
  • Chemical and Physical Manipulation
  • Gene Doping

An example of the detail of the Prohibited List can be found in the changes made to the 2010 List WADA_Summary_of_Modifications_2010_EN. For example:

The issue of growth factors enhancing certain functions was addressed in more detail. Additional examples of growth factors affecting muscle, tendon or ligament protein synthesis/degradation, vascularisation, energy utilization, regenerative capacity or fibre type switching [e.g. Platelet-derived Growth Factor (PDGF), Fibroblast Growth Factors (FGFs), Vascular-Endothelial Growth Factor (VEGF), Hepatocyte Growth Factor (HGF)] were included.

The Australian Sports Anti-Doping Authority (ASADA) is “a government statutory authority that is Australia’s driving force for pure performance in sport. It is the organisation with prime responsibility for implementation of the World Anti-Doping Code (the Code) in Australia.”

Amongst other duties ASADA is responsible for Athlete Wherabouts AW Policy:

As a result, the Code, the ASADA Act 2006 and ASADA Regulations, which contain the National Anti-Doping (NAD) scheme, requires certain Athletes to provide current and accurate Whereabouts Filing to enable Athletes to be located for Out of Competition Sample collection.

ASADA’s mission is to ensure that:

  • every member of Australia’s sporting community has the opportunity to access quality anti-doping education
  • a blend of flexible teaching and learning approaches that cater to a diverse range of needs
  • efficient participant and program management, with meaningful and timely reporting to enable continuous monitoring, evaluation and accountability.

Ryan Napoleon

An Australian swimmer, Ryan Napoleon, provides a current example of the issues and responsibilities raised by WADA’s role in anti-doping and ASADA’s delivery of national anti-doping implementation practice.

The world governing body for swimming (FINA) announced that:

The Australian swimmer Ryan Napoleon was tested positive to the substance Formoterol (Class S.3 Beta-2 Agonists) on 16 November 2009. According to DC 10.4, during the hearing of the Doping Panel it has been sufficiently established how the substance Formoterol entered the body of the athlete due to the use of an inhaler wrongly labelled by a pharmacist. It is clear that the swimmer had no intention of enhancing his sports performances. The Doping Panel underlines the responsibility of the athlete to check his medicine (in this case for asthma). The Doping Panel took into consideration the degree of negligence and decided to apply a 3 months period of ineligibility starting from 20 august 2010.

This is a Swimming Times post on Ryan’s case. This is a post in Pharmacy News about the case.

The national body for swimming in Australia (Swimming Australia) stated that:

Swimming Australia has been informed by FINA’s anti-doping agency that Queenslander Ryan Napoleon has been suspended from swimming for three months. An asthmatic for 20 years, Napoleon took medication from an asthma inhaler which was incorrectly labelled and subsequently tested positive to Formoterol, a common asthma medication, which is also a banned substance on the WADA list. Napoleon has taken the asthma medication Pulmicort for the majority of his life, however on this occasion a Pulmicort inhaler was incorrectly labelled, and was actually Symbicort – which consists of the banned substance Formoterol. In the FINA hearing which was held via teleconference last Wednesday, the panel accepted that Napoleon was not at fault due to the mistake of the pharmacist incorrectly labelling the medication, and that there was no intent to use the banned substance, which he could have applied for a TUE for, if he knew he was actually taking it. FINA did however find that as an elite athlete Napoleon had a ‘reduced responsibility’ in this matter, and should have been fully aware of the medication he was taking, and subsequently applied the three month suspension.

The ban means that Ryan will not compete at the Commonwealth Games in Delhi. In a very impressive statement about responsibility, Ryan observed that “A mistake was made, and the FINA panel accepted that a mistake was made in the hearing, but as an athlete I still understand that I have a responsibility to check all my medication thoroughly.” See my Postscript 2 below for an update.

I am interested to discuss with Will’s class what students the same age as Ryan think about the decision at a personal level and at a governance level.

Conclusion

An Australian Academy of  Science (2004) discussion of drugs in sport concludes that:

Historians point out that drugs have probably been used to enhance sporting performance for more than 2000 years, so it’s unlikely the problem will ever go away. Some commentators are even calling for the legalisation of such drugs so they can be dispensed, administered and monitored more closely. Others say the only way to ensure the health of our athletes is to stamp out drugs altogether. For now, performance-enhancing drugs are illegal, so athletes who use them are cheats. And, given the health risks associated with drug abuse, we can safely say that the race to beat the drug tests is a race nobody wins.

I think this quote contains the essence of the discussion for Monday.

  • Play and display
  • Regulation and deviance
  • Ethical behaviour
  • Governance

In a recent study (2010), Matthew Dunn et al report the findings of a study of 974 elite Australian athletes. They found that:

The athletes surveyed endorsed testing for banned substances as an effective way of deterring drug use; believed that the current punishments for being caught using a banned substance was of the appropriate severity; and indicated that there should be separate policies regarding illicit drug and performance-enhancing drug use.

James Connor and Jason Mazanov (2009) have explored some of the Faustian issues (taking a drug that guaranteed sporting success but would result in their death in 5 years’ time) for those who choose to take performance enhancing drugs. They note that “athletes differ markedly from the general population in response to the dilemma”.

Some Literature

In addition to the hyperlinks in this post, I think the following are interesting contributions to the discussion of performance enhancing drugs.

John Hoberman’s Testosterone Dreams (2006) and Mortal Engines (1992)

Andy Miah’s Website

Ivan Waddington and Andy Smith (2009) An Introduction to drugs in sport: addicted to winning? Abingdon: Routledge.

Postscript 1

Shortly after discussing performance enhancing drugs with Will and his group news broke about Travis Tuck and his appearance at the AFL Tribunal in relation to illicit drugs. Amongst other issues raised by Travis’s case is the role a sporting organisation plays in the sanctions against those who fail drug tests. The AFL policy has raised significant debate about duty of care in relation to players who are at risk.

Postscript 2

Lausanne, 14 September 2010 – The Court of Arbitration for Sport (CAS) has issued its decision in the arbitration between the Australian swimmer Ryan Napoleon and the International Swimming Federation (FINA).
The decision reads as follows:
1.    The appeal filed by Ryan Napoleon on 2 September 2010 against the decision of the FINA Doping Panel of 20 August 2010, decision 03/10, is partially upheld.
2.    The decision of the FINA Doping Panel of 20 August 2010, decision 03/10, is partially set aside.
3.    Ryan Napoleon is sanctioned with a three-month period of ineligibility commencing on 15 June 2010.
4.    All competitive results obtained by Ryan Napoleon from 16 November 2009 up to and including 28 January 2010 shall be disqualified, with all of the resulting consequences including forfeiture of any medals, points and prizes.
On 2 September 2010, Ryan Napoleon filed an appeal with the CAS against the decision issued by the FINA Anti-doping Panel imposing a three-month period of ineligibility following a positive doping test for the substance Formoterol (Beta-2 agonist/specified substance) on 16 November 2009. The CAS conducted an expedited procedure in light of the fact that Ryan Napoleon was selected to represent Australia at the upcoming Commonwealth Games in New Delhi/India. The parties were heard by a CAS Panel composed of Mr Stuart McInnes (United Kingdom), President, Mr Malcolm Holmes (Australia) and Mr Olivier Carrard (Switzerland) by video conference on 10 September 2010. The full award with the grounds will be issued at a later date.

Photo Credits

Olympic Spirit

Olympic Natatorium

Olympic Flame