How long should “drugs cheats” be banned?

The British Olympic Association’s (BOA) attempt to keep its lifetime Olympic ban for athletes – in contradiction to the rules of the World Anti Doping Agency (WADA) – was decisively rejected by the Court of Arbitration for Sport yesterday. The BOA had to pay the costs of arbitration.

As I predicted it ends in the defeat that most expected (see my blog of March 12). I can’t say I am too unhappy about this. One of the best features of the current anti doping system is that we have a worldwide body that everyone signs up to. If one country has a different sentence or interpretation of the rules, whether more or less lenient, then they still have to tow the party line. As I describe in my book, at one time or another, many countries – the UK included – have been accused of being too lenient about the results of positive drug tests. We need a standard body to ensure a level playing field; otherwise there will be anarchy. Of course the correct thing for the BOA to do is to campaign to change WADA’s sentencing rules, as it now seems to be doing. Whether it has any political capital left to succeed in this is a moot point.

But the more interesting question is what should the ban be? Two years, four years, life? In my last blog I made the case for a long ban. But there are pragmatic reasons to go for a shorter term. One is that it might encourage cheats to come forward and give evidence against others in the system. But perhaps a more compelling argument is that two years may be the maximum ban that will stand up in court given our current testing regime. After all a ban prevents someone earning a livelihood in their chosen profession; whatever length it is, this is a pretty severe punishment. So you have to be sure of your conviction. My suspicion is that there would be even more appeals against positive tests if the bans were longer. These appeals might also have more chance of success, forcing WADA to prove how a compound got into an athlete’s system, rather than the athlete having to prove their innocence (as is the case now). The more severe a sentence, the more lawyers get involved. Just think how much more legal expense there is in the USA with a death penalty compared to a life sentence. So a longer ban might, perhaps counter-intuitively, result in fewer cheats getting caught.

I am a scientist, not an athlete, nor a sports administrator. My views on the length of ban matter no more than those of any other fan. But for what it is worth I am a pragmatist as heart. I favour the system that has the best chance of catching the most people, not one that inflicts the largest penalty once they are caught. I think fear of getting caught is a better deterrent than fear of the length of a punishment – both in life and in sport.

Of course the main winners in this story are the lawyers who have hoovered up a fraction of the BOA and WADA’s budgets. But that’s a story for another blog…….

Talking about doping with elite athletes

I was invited to an event at the English Institute of Sport in Sheffield last Thursday. The evening wasn't really about drugs; it was more about the use of technology in sport. I was actually invited to show off the new optical methods we are using to measure oxygen in muscle (for details click here). It was great to try this out on some young elite 400m runners and we saw some potentially interesting differences between the right and left legs as they raced round the tight corners at high speed.

Two of the guest speakers were the multiple medal-winning runners Roger Black and Peter Elliott. Their back-stories were really interesting in today’s days of talent spotting and financial support for elite athletes. Roger Black didn’t start in athletics until he was 18 years old and Peter Elliott plied a trade as a steelworker during his competitive days.

Anyway, I gave them both a copy of my book and it will be really interesting to see what they make of it. Chatting to Roger Black in particular made me rethink the parts of my book where I outline the rationale for the length of bans for doping offences. Currently the debate is between a two-year ban, a four-year ban or a lifetime ban. In fact even a two-year ban is much greater than penalties for apparently more serious non-drug offences. Let me explain. Doping is banned partly because it is cheating and partly because it is bad for an athlete's health.  Let’s look at some penalties outside the doping arena. Blatant cheating - say the deliberate handball by Luis Suarez that knocked Ghana out of the football World Cup - can result in as little as a one match ban. Harming an opponent can invoke a longer ban, but still the rugby player Calum Clarke only got a 32-week sentence for an action that resulted in a broken elbow.

So why is the punishment so severe for doping offences, some of which may have only led to modest, if any, performance enhancements? In my book I focus on two possible reasons. One is the bad press that drugs get in society at large; the use of the moniker  "drug cheats" rather than just "cheats" feeds into society's disdain of these activities. The other is that as it is so difficult to catch people doping, it seems reasonable to have a tough punishment. After all we know from subsequent confessions that most offences that are punished are not the first time an athlete has used drugs.

However, I feel I could have put more emphasis on a third reason. Drug cheating is hidden cheating. By its very nature it not only cheats the athlete who loses out on a medal, it perverts what we are seeing as spectators. The event we are seeing is not the event we have paid to witness. A similar situation arises with match fixing. And here the penalties for cheating DO match those of doping (in fact they are more severe).

Doping also has a perfidious effect on all athletes. This was struck home to me when Roger Black said people accused him of cheating, just because he could run so fast (for the record I think these accusations are completely baseless). The fact that all athletes get accused of cheating because a subset are misbehaving seems to me a good reason for keeping the penalties for doping high. 

The minister’s son: was the doping backed up by the science?

The elite rugby playing son of the UK government’s Environment Secretary was recently banned for 21 months for taking a range of substances including human growth hormone and anabolic steroids in order to aid recovery from an injury. In a family statement these were called “widely available”. Even though they are a class C drug no one will be surprised to hear that anabolic steroids are accessible. Human growth hormone (HGH) is a bit more unusual. It is a prescription drug that you need to reconstitute before injecting. The product will likely be labeled as to its primary use; this use is for conditions (mainly in children) that have growth deficiency due to a lack of this hormone. The most famous example of this being a certain footballer called Lionel Messi. The cost of treatment for the young thirteen year old (probably running to thousands of pounds) was funded by Barcelona, who Messi then signed up to play for, arguably the most economically successful drug prescription in history ¹.

How does a drug, banned in sport and only approved for treating extreme growth deficiencies, become available to athletes? There is of course the black market. But it is also possible for any doctor to prescribe any prescription drug “off-label” i.e. for something other than the use that has been approved. Such use is only limited by the individual ethics of the doctor concerned; in their view any benefits to the patient should outweigh any risks. There is minimal evidence that HGH has any benefits in the normal population. However, there are a number of doctors (especially in the USA) who consider it a useful anti-ageing treatment. Consequently they prescribe the drug in this off-label way. Manufacturers are only allowed to advertise its approved use; in the past US government penalties for such illegal marketing have resulted in multi million dollar fines. This marketing has now stopped; nevertheless it is possible that pharmaceutical companies make more money via off label prescription than for the approved use. This “loophole” also results in another route for accessing HGH; internet sites based in the USA even offer prescriptions over the web. Whilst not quite as easy to get hold of as anabolic steroids, the minister’s comments on its availability are valid.

However, the more interesting part of this story is why the drugs were taken, namely to enhance recovery from injury. This is an explanation that has been used before. When his last chance at an Olympic medal seemed to be fading due to a recurrent hamstring injury, the British bobsleigher, Mark Tout, turned to anabolic steroids. He was discovered and banned for life (the penalty was later reduced to four years).

Athletes are desperate to recover from injury and may stoop to using methods they would normally shun. So these accounts are entirely believable, though clearly this is no excuse when you get caught. But do they work? Do anabolic steroids² and human growth hormone aide recovery from injury? Both types of drugs have been available for many years. To my knowledge there is no validated clinical trial supporting their use in repairing damaged nerves and tendons, though HGH may possibly aid recovery from bone fractures. Whilst one observational study showed that people claiming to be on steroids recovered better from injury, some animal studies have shown that steroid treatment can actually make injuries worse.  The field is perhaps summed up by the titles of two recent papers this year looking at nerve and tendon damage in rats; contrast “Growth hormone does not stimulate early healing in rat tendons” with “Growth hormone treatment enhances the functional recovery of sciatic nerves after transection and repair”.

The truth may be out there, but science has not found it yet. If these class C drugs do aid recovery, the effect must be marginal at best. Certainly not worth risking the side effects or the sports ban.

Notes:

1   Thanks to my twelve-year-old son Alex for pointing the Messi story out to me.

2   This article refers only to the use of anabolic steroids; these are distinct from corticosteroids that are available on the NHS to reduce inflammation during recovery and are not banned by WADA if the athlete has a therapeutic use exemption.

Drugs on the Today program

A good chat with Justin Webb on the radio 4 Today program last Saturday.  I was slightly surprised by his first question which seemed to imply that winning was not the only reason elite athletes took performance enhancing drugs. Perhaps it was just a function of their obsessive personality?  I am not quite sure I got the answer (or the question) entirely right. But it got me thinking. Elite athletes don't just compete in competitions where winning is important. Some equally obsessive personalities who are just as fit compete in ultra endurance events* e.g. multi-day continuous marathons or triathlons, often in extreme conditions. These events are as much a competition against yourself as against the other athletes. There are limited financial benefits and the fame of winning is restricted to a small community. In this case taking drugs might seem to be cheating on yourself. Yet on the other hand there are limited drug tests to worry about. It might be interesting to know whether drug use is more or less prevalent in this community than in traditional Olympic sports.

* note that in my book I give reasons, based on evolutionary biology, why drug use may anyway be less effective in enhancing performance in these kind of events. 

Drugs in Scotland

Another Physiology Society event on “Designer Athletes”, this time at the Edinburgh Science Festival. The BBC’s David Eades chaired a really interesting debate on the past, present and future of drugs and technology in sport. I seemed to be playing the unusual role for me of the balanced middle-man, my views straddling the anti- doper Michelle Verroken from Sporting Integrity and the more open views of the University of the West of Scotland ethicist Andy Miah. Andy's view is that as technological, surgical and drug enhancements become common in everyday life it is going to be strange to restrict them artificially in sport. Maybe he's on to something. Only two people in the audience (one of them me) thought athletes should not use caffeine. Yet drinking coffee fulfils two of the three requirements for being possibly banned by WADA. It is performance enhancing and could be bad for health (a possible carcinogen according to the World Health Organisation*). Actually my vote for banning it was more about rules consistency than a passionate view that it should not be used. It seems to me to make no sense to ban other stimulants with the same performance and health profile just because in society they are classed as medicines and not beverages. Ban the lot or leave them alone.

Like Julian Savulescu from Oxford, Andy thinks the "health" of the athlete should be the only reason for controlling a product (whether drug or other enhancement). To be fair he realises that the "everything goes as long as it is not unhealthy argument" won't do away with the need to regulate how athletes treat their bodies. We may need to spend as much to safeguard their health as we currently do to test for doping. Even so, I am pretty sceptical that this approach will be practical. It will also change the nature of sports like athletics into a Formula One- like activity where the bioengineers and biochemists are more important than the athlete themselves. Crucially for the spectators, these benefits will be hidden – we won’t know why someone is better than someone else. I think this is what makes Formula One so boring - you can't really see why one car is better. At least in running we have the illusion that success is mostly down to the athletes themselves. Of course except for the Olympics, Formula One viewing is more popular than athletics so my argument may not be as strong as I think it is!

Still I did end the debate with the amusement of being accused by Michele Verroken of being a lackey of US corporate sport. My left wing teenage self was not impressed. My fault was to praise the "socialism" of Indycars versus the rampant consumer capitalism of Formula One; my point being that in Indycars all the cars are pretty much the same so the drivers have equal opportunities to win, whereas in Formula One the test is far more of the commercial car manufacturers and less of the drivers’ skills.

At both of these physiology society events the idea has been mooted to have Formula One in the Olympics. The argument is that chariot racing evolved out of the original Olympic games as man acquired new technology. Surely Formula One is today’s equivalent of chariot racing? Personally I’d rather go back to the future and have chariot racing itself in the Olympics. Now that’s a sport I would pay to watch. It would also be a great legacy for the Olympic stadium (sorry West Ham and Orient!).

* note I don’t view coffee drinking as remotely likely to give you cancer – it is just that it is classified that way by WHO. 

How not to do an anti-doping survey

Just been to a great display at the Museum of Scotland run by the Edinburgh Science Festival. The InMotion exhibition gave kids (and adults) a chance to explore the science of movement. As usual for the festival, the staff were well-trained, knowledgeable and enthusiastic. There were also great profiles of real scientists working in the exercise area, some famous and some not-so-famous (including a dodgy biochemist from Essex called Cooper).

The exhibition was interactive with lots of opportunities for the festival goers to measure the body’s performance and physiology. There were also pop quizzes in topical areas. The attendees were asked to put a yellow disc into a slot to say YES, NO or MAYBE to a range of questions. One asked should athletes be allowed to dope? I was naturally interested in the answer. However, the bright yellow discs proved too much of an attraction. The kids treated the event as a scientific penny push arcade game, clambering up on a step and enthusiastically filling up all the slots they could with as many discs as they could cram in their hands. Perhaps best not to report the results to UK anti-doping? 

Resignation of key anti-doping scientist!

Dr. Michael Ashenden has just resigned from the athlete's passport program designed to detect blood doping.

See his interview to the BBC at:

http://www.bbc.co.uk/news/science-environment-17586597

A key article is probably the one he wrote that says that athlete's can avoid the biological passport - the new ray of hope for anti blood doping.

European Journal of Applied Physiology  (2011) 111(9):2307-14. 

"Current markers of the Athlete Blood Passport do not flag microdose EPO doping". 

Ashenden M, Gough CE, Garnham A, Gore CJ, Sharpe K.

It looks like Ashenden thinks the anti doping agencies are not comfortable with these sort of articles being written - in fact they are proposing that exports must stay silent now and for eight years after they have served on a panel. This is a pretty impossible position for an academic scientist to be put in.

As I say in my book about the passport:

"If the system is going to work in the future and not be continually mired in the courts it seems to me that complete transparency and openness is necessary for the passports, even at the risk of allowing the dopers to have a better idea of how to avoid suspicion. Why are the cycling authorities wary of such openness? Well there is evidence from the confessions of the cyclist Floyd Landis that cyclists have modified their EPO doping regime in response to the introduction of passports. The trick to fool the current biological passport seems to be to dope little and often, rather than in the one large dose that leads to suspicious spikes in blood parameters. The war continues."

As a scientist my sympathy is with Ashenden (whose paper I should have cited in my book by the way - apologies!). If we are not going to go the police state route and have undercover cops infiltrating athlete training camps, we are going to have to succeed by openness so the court decisions are not only effective, but seen by everyone to be fair.