Monday 30 July 2012

Can drug doping improve female swimming times at the London Olympics?

Those of you who read my book or this blog will know that I don’t do exposé; I am all about the science not the gossip. Anyway even if I wanted to I’m no journalist and have no inside information. Still I thought it worth responding to some of the more uninformed outrage at certain events at the Olympics regarding the recent performances of Ye Shiwen1

A young athlete with unusually outsized body features wins a gold medal and world record by a wide margin. This statement could be as true of Ian Thorpe1 in 1999 as Ye Shiwen1 in 2012. In fact Ye Shiwen1 has even been called the teenage torpedo, echoing Thorpe’s1 nickname of the Thorpedo. The statement could also be true of Usain Bolt’s1 unusual physical attributes (his heightand stride), although his really extraordinary times came a little later in life. A policy of keeping quiet in the absence of evidence would seem to be fair to all athletes from whatever country they originate.

China has a lot of people. It also has a lot of money, with the second largest GDP in the world. It has a regime that aims to closely control its population and views success at the Olympics as important for its international prestige. Frankly it would be astonishing if China didn’t dominate the medal table at the Olympics. I personally doubt they have yet got anywhere near sorting out a method to select really efficiently from this large gene pool; there may be more extraordinary athletes to come.

Be that as it may could swimmers go faster if they doped? Swimming is a strange sport for sports scientists used to treadmills and exercise bikes. The absence of artificial flumes in most laboratories, and the difficulty of monitoring athletes in the water, mean there is a much smaller research literature in swimming than in cycling or running. But it seems clear that for nearly all Olympic distances a combination of power and endurance is required. The East Germans showed that female swimmers, at least, benefitted from anabolic steroids. Athletes from other countries have tried EPO and other blood oxygen boosters. There is no reason to think these would not have some effect on enhancing performance. It is not the science we are debating here, but the ethics of “outing” people in the absence of evidence. I agree with Arne Lundqvist, chairman of the IOC’s medical commission in his statements that echo Wittgenstein’s famous phrase “Whereof one cannot speak, thereof one must be silent”.

The athletes caught at the Olympics will be the subset of cheats who are not very good at hiding their handiwork. As stated by many people, surprise out-of-competition testing, currently monitored by individual countries, is the key to catching the clever cheats wherever their country of origin.

As for swimming itself, it seems that it may need to introduce an athlete biological passport, as much to protect the innocent as catch the guilty. However, there may be ethical problems given how young people are when they hit their peak. The passport needs time to work. Taking blood samples from all prospective 13-year old superstars may be problematic.

1  Please note that the mention of any athlete by name should not be taken to imply that I have any reason, or even suspicion, that they have ever been engaged in doping with performance enhancing drugs.

Wednesday 25 July 2012

Positive drug tests at the Olympics: the athlete biological passport comes of age?

It is interesting reading my old blogs in the light of the recent success reported by the IAAF in catching six people doping via the indirect method of analysing blood samples over a number of years: the so-called “biological passport”.

It seems like some of my more earlier views may have been a bit too negative about the success of the scheme. A major new weapon seems to be the “plea bargain”. Admit doping and you get a two-year ban. Don’t and you will get four years if you fail your appeal. I am not sure what the British Olympic Association will feel about this though, given their concern about short bans. But it does avoid the risk of WADA losing a case at the Court of Arbitration for sport. Perhaps more interesting is the use that these admissions could have on the case of those who do not fess up. The passports from those who own up could be compared to those who have admitted doping, hence strengthening the prosecution case. 

Sunday 22 July 2012

NOT doping in the Tour de France: Bradley Wiggins, Chris Froome and Mark Cavendish

So for the 2nd year running the Tour de France is going to be won by a clean cyclist with no taint of a doping history. Of course as a Brit, I am really proud of these guys and Team Sky’s achievements. Not forgetting the mastermind that is Dave Brailsford who managed the whole process from start to finish (on a side note I also think that David Millar’s success on this tour sends a good message that redemption post doping is possible).

I was pondering what to write other than praise for these guys and I thought I could reflect on the words of Dave Brailsford. I remember reading somewhere that he disliked doping because it made people lazy as they could cut corners in preparation. This chimes with some of the ideas I explored in my book. I argued in many cases doping could increase the number of people able to get close to the best times, but it doesn’t necessarily improve those times. You cannot automatically assume to run or cycle the fastest time requires doping.

There are some notable exceptions to this rule. Anabolic steroids enhancing the performance of female athletes in power events is likely to be one of them. And far be it from me to go against Brailsford, but I think if done effectively blood doping would probably have some influence in the Tour de France. The most obvious area is topping up the red blood cells that get lost during the race. Elite athletes turn over their red blood cells much quicker than us mere more mortals. If they exercise continuously the number of red cells will diminish, as will the body’s ability to carry oxygen effectively. On a rest day topping up with a pint of blood would likely enhance performance. And we know from diaries obtained from some dopers that that is exactly what they do.

So maybe we should make it legal for ALL cyclists to have a one pint top up on the rest day. No more, no less. Maybe this would level the playing field; even fewer people would attempt to dope as it would give much less additional benefit. Thinking about what this idea look like in practice goes to the heart of why doping is banned. How would you feel if all the Tour de France athletes lined up at a medical centre to have a blood transfusion on their rest day? Would you feel this demeaned sport and set a bad example? Or would you just think, given the extreme requirements for training and competition anyway, this was nothing really to worry about?

I have to say that I personally feel uncomfortable with athletes refueling at blood transfusion stations on a rest day in the same way that racing cars refuel with petrol/gas during a pit stop. It just feels wrong somehow. I can’t make a particularly reasoned argument as to why I have this feeling. But maybe this is fine. The rules of sport are arbitrary; we are allowed to make them as a consequence of an emotional feeling. Most people don’t feel uneasy about some using the drug caffeine to enhance performance. So it is not banned. The same does not hold for anabolic steroids. Hence they are banned. 

Saturday 21 July 2012

Enzo Maccarinelli and another boxing positive test

Enzo Maccarinelli takes a "fat burner" and got banned from boxing for six months.  Yet the supplement claimed to be athlete safe. I am sure this was an accident as Enzo says -  he is even seeking to sue the magazine that advertised the product. But it raises some questions about the whole supplement industry.

The banned stimulant found in the supplement in question was methylhexaneamine; as I show in my book this is rapidly becoming the new "nandrolone", at least in so much as many athletes are getting caught by taking nutritional supplements laced with this compound and hence suffering a positive doping test. 

So what was this boxer thinking about? Very few drugs can burn fat. If a supplement works as a fat burner, it is almost certainly going to contain a banned substance. Or it will be very dangerous. More likely the fat buying moniker is just industry hype aiming to sell a product.

So to summarise: the pill probably doesn't work; if it does work it will be dangerous and/or get you banned. Not a clever idea for an experienced boxer to get involved here, especially one who also trains 40 young boxers.

For the purposes of being balanced to the supplement industry I should take 5 minutes to give their side of the argument. "Fat burners" are popular with body builders. They claim to contain compounds that activate uncoupling proteins.  Uncoupling proteins can indeed burn fat with no gain in energy to the body. But we should be cautious. The slimming industry is a much larger market than the body building world. Not surprisingly a high amount of pharmaceutical and medical research money has gone into trying to produce a safe compound that activates uncoupling proteins. No one has succeeded.

What about Maccarinelli? Dexaprine is the compound he claimed to have taken. It contains “iiodo-thyronines”. This is a word meant to sound like "iodothyronines", which are thyroid hormones. Thyroid hormones do indeed increase the body's metabolic rate, possibly by activating uncoupling proteins. So the manufacturers use a plausible argument. But there is one fatal flaw. Thyronines are proteins. They readily get digested in the gut. Taking iodothyroanine in a pill form is like taking EPO or human growth hormone in a pill, rather than injecting it. It just won't work.

There is only one way to "burn fat" in a pill form. It is called dinitrophenol, a compound that is used effectively by bodybuilders. As I explain in the book this was a very successful slimming drug given by doctors in the easy part of the 20th century. But some patients had an unfortunate side-effect: DEATH. Dinitrophenol became the very first drug ever to be banned by the US Food and Drug administration. Do not try this at home!

When I read all this hype in the supplement industry, it almost makes me feel sympathy with those who dope. At least they are using stuff that actually has a chance of working .........

Tuesday 17 July 2012

Frank Schleck’s Tour de France drug test – what is xipamide anyway?

In one sense there is not much to say about Frank Schleck’s positive drug test (of his A sample only at the time of writing). Xipamide is not likely to enhance performance in its own right; it is banned as it could “mask” the use of other substances that are effective. Xipamide is a diuretic; it makes you urinate more. It therefore has the potential to affect the metabolism of another banned substance. You pee more and so all the drugs in your body are expelled faster.

Xipemide is a drug in current clinical use and so there could be medical reasons for taking it. Hence it does NOT lead to an immediate outright ban with no questions asked. But an athlete does need to explain why it is in his/her body in order to get away with just a slap on the wrists. If Schlek’s B sample does turns out positive it would be nice to know what really happened here. Though I doubt anyone will tell.

I am always somewhat surprised about why these sort of compounds are used. Drug metabolism rates are so individual that it is possible you are just adding to your chances of being caught by taking two banned substances. Were I to be a doper-in-chief I would want to measure the metabolism of both the performance enhancing drug and the masking agent, before deciding whether to risk this. Fortunately this sort of precision is only possible with the connivance of a testing lab. This used to happen in the bad old days of the East German state-sponsored doping; then the while team was pre-tested to ensure that the anabolic steroids they had taken were undetectable prior to competing at the Olympics. But I think it is an unlikely occurrence now.

As for xipamide? It will now return into obscurity. Apart from one footnote: every patient who searches the internet in order to find out about the drug used to treat their fluid retention will now have to wade through a mass of cycling stories at the same time…..

Friday 6 July 2012

Drug cheating at the Olympics: who, what, and why?

I've written a "state of the union" article about where I feel drugs in sport are at these Olympics.

It is in the premier medical journal "The Lancet" and can be downloaded here