Doping: black and white or shades of grey

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In the fall out from the Sharapova Meldonium case much has been made of what is and what isn’t cheating or doping. This is not such a certain area, containing many shades of grey.

People caught doping are often said to have crossed the line. But what is the line and were is it drawn? Is it easy to find? There are a few areas I can think of which confuse the matter somewhat.

The starting point for what is considered doping is the World Anti-Doping Agency list of prohibited substances and methods.  This list, updated annually records all the different drugs that may not be used, as well as methods such as blood doping. To get onto the banned list a drug or substance will have to fail two of the three following tests: it enhances performance; it could be detrimental to the health of an athlete; and it is against the ‘Spirit of Sport’.

Having a specific list should make it clear what is banned and on the flip side it says that if a substance isn’t on the list then it is allowed to be used.  This is the black and white interpretation. Banned or not banned.  However, there are a few things that confuse:

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This was meldonium last year.  The medicine was not on the banned list therefore under the WADA regulations it was acceptable for use in sport.  There are issues around supply and distribution of controlled medicines and that could get you into legal trouble in some countries. Pharmacists can be struck off for selling drugs without prescription. There is black market in many drugs, just a quick internet search will allow you to buy prescription only drugs on line that could enhance your performance.  The other way to get such drugs would be to have a friendly family doctor who may write you a script unecessarily. I’m sure the legal profession frown on such activities.

Another example in this category would be the use of thyroid hormone, Levothyroxine.  Thyroxine was the drug that was supposedly given to many athletes by the coach of Mo Farah, Alberto Salazar. Many of these athletes saw a specialist endocrinologist in the US, Dr Jeffery Brown, who “sees thyroid illness where others see normal thyroid function”. The use of the drug will help to improve recovery between hard training efforts and reduce fatigue in general.

Neither drug mentioned above require disclosure to a governing body or approval before use.  So this mainly comes down to personal morals on the whole – are you willing to get hold of and take an unnecessary medicine to improve your sporting performance?

Use of drugs banned in competition during training

There are some  drugs which are banned in competition only. These are a range of stimulants, narcotic painkillers, cannabis and corticosteroids. These are seen as drugs which give a performance boost but only short term, for instance stimulants give a bit of a boost for a few hours on the day of use. Drugs  banned at all times include anabolic steroids which give a longer term gain (muscle mass isn’t lost quickly).

However some of these in competition only drugs, particularly corticosteroids, have some longer term benefits. Cortico’s are said to help an athlete to lose weight whilst in periods of intense training. They also reduce inflammation so may well help recovery for many sports. You could use these for all your training without fear of failing a test as long as you stop taking them long enough before the competition period to allow it to be flushed from the body. Some corticosteroid creams are available over the counter in the UK, but the stronger versions require a prescription.  Again, do you chose to use to use a drug (often prescribed) with the sole intent to improve your sporting performance rather than improve your health, that isn’t strictly banned during training?

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Sometimes an athlete is required to use a medicine to improve their health. If that medicine is banned then you may be able to get a Therapeutic Use Exemption (TUE) to allow it’s use, if you can show that the banned treatment is more effective than any non banned alternative. Often asthma is cited, as you need a TUE for some types of inhaler. The range of conditions that are covered is much larger though, including ADHD, diabetes and infertility amongst others.  To get a TUE the athlete will have to have supporting documentation with  diagnostic testing results from a medic. Currently there is no requirement to have an independent doctor examine the athlete, the forms require a ‘appropriately qualified physician’ to complete the forms. Again a friendly Doctor might be able to help with this.

Supplements

Almost all athletes use a supplement of some sort. Whether it is a multivitamin or protein powders, most supplements are not banned and are fine at all times in sports. But is taking a pill instead of eating the correct food a line that shouldn’t be crossed?  OK, multivitamins are fine, what about l-cartinine? Cartinine is found in many supplements and energy gels. It is also available in meat and dairy foods. Cartinine is said to help reduce fatigue by allowing the body to help burn fat as a fuel (important in endurance events). So it is a metabolic modulator (on WADA prohibited list, class S4.5, the same category as meldonium) and has potential to enhance performance in sport. Two of the three tests….

Equipment related

A final thought is around equipment that could be used to improve performance in a ‘grey area’ kind of way. A very good example here is an oxygen tent to mimic sleeping at altitude. Tents have been used by athletes for some time, including by Lance Armstrong to increase circulating red blood cells, improving oxygen circulation allowing greater endurance in sports. This technique directly mimics the use of EPO or blood doping, both banned at all times!

So that’s a small run down of some grey areas in sports doping. Where do you personally draw the line? This conundrum is nicely summarized by the journalist Paul Kimmage in a question to a professional cyclist last year: what do you mean by clean?

So where do you draw the line?

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Dr Tom Bassindale

About Dr Tom Bassindale

Dr Tom Bassindale is a forensic scientist, and the founder of We Are Forensic. He's managed hundreds of forensic toxicology cases, and is an experienced court witness. He has specialist expertise in forensic toxicology and drug testing in sport. Dr B is currently a senior lecturer at Sheffield Hallam University. And yes... he watches CSI.