Sunday 27 April 2014

The new World Anti-Doping (WADA) Code 2015

A special issue of the British Journal of Sports Medicine has just been published on sports doping [1] linked, in part, to the new WADA code coming out in 2015. Some articles are freely available so can be read not just by those of us fortunate to have university subscriptions to the journal (wouldn’t it have been nice if WADA had funded all the articles to be open access so everyone could take a look at the science and ethical discussions?).

I haven’t had time to read everything yet, but two papers caught my eye [2, 3]. The first is called “Time to change” and it is a road map to guide the implementation of the World Anti-Doping Code 2015 [2]. This jibes with many of the ideas presented in my book. For example anti-doping testing alone is doomed to limited success without active government investigation, preferable by police and the judiciary. Having different strategies for different sports, and making this explicit, seems a genuinely new idea. Why test for anabolic steroids and EPO in football (soccer) when the evidence is very limited that these are being abused? Instead focus limited resources on areas where the abuse is taking place. Of course one problem is that the report, quite rightly, favours transparency.  But if athletes know that a type of drug is less likely to be tested, that might in itself encourage use of that drug to increase (we know this happened when caffeine and pseuodoephedrine were removed from the banned list). So WADA might be hitting a moving target.

One beneficial move is the idea that samples should be stored for ten years. Previously lengthy storage was only mandatory for Olympic Games samples. This allows for later checking of samples as new analytical tests are developed. I think this is a genuine deterrent, as athletes who cheat will always worry that they have left a “smoking gun” in a laboratory somewhere.

Another interesting idea is the expansion of the biological passport system. This is a little over hyped; it really only works currently for limited aspects of blood doping. However, a paper in the same issue by Yannis Pitsalidis is promising in this respect [3]. It shows that gene expression is changed for up to four weeks following EPO administration. So-called “omics” approaches might provide a genuinely new tool in the anti doping armoury, especially if they could be expanded to other hormone drugs. A note of caution is advised. It is unlikely that there will be a single passport profile that will apply to whole classes of drugs. My gut feeling is that gene and metabolite profiling will need to be separately validated for every drug or drug sub class. This would be a very expensive process but it is necessary if a passport anomaly alone were to be used to ban an athlete. However, a more general profile could still be an invaluable tool to aid investigation and target further testing.

These changes, whilst laudable on the surface, need to be treated with some caution. The biggest barrier to fair sport is the widespread inconsistencies in out-of-competition testing in different countries. WADA is not a world policeman. It is only as good as the local anti-doping agencies. Concerns about how effective the testing regimes are in Kenya and Jamaica come to mind. It does not matter how sophisticated your testing regime if no one is tested [the Jamaican anti doping agency conducted only one out-of-competition test in the six months leading up to the 2012 Olympic Games in London].

Tuesday 15 April 2014

Xenon and sports doping – does it work?

I have taken a while to write this promised blog about the performance effects of xenon and doping. The reason being that I really could not find anything relevant. As I said in my previous blog on the matter [1], animal studies suggest xenon can activate hypoxia inducible factor. This, in principle, can increase EPO levels, which in turn can increase red blood cell number, which in turn can increase aerobic sports performance. 

The animal papers suggest xenon might be more effective than low oxygen (or altitude training) in raising EPO. Presumably people doping with xenon have access to secret human performance data; this would help them to optimise the treatment. But there are no human studies I could find, or at least none that I could readily access in the scientific literature. Still, given its use as an anaesthetic, I suspect there must be some xenon EPO data hidden in the results section of a paper looking at something else (or even in some hospital records of blood samples following xenon administration) - I just haven’t found it yet!

Anyway I asked my old collaborator, the neonatologist Dr. Nikki Robertson, what she thought of this. Dr. Robertson is looking at the effect of xenon at protecting newborn babies at risk of brain damage. She didn’t know of any studies looking at the long lasting effects of xenon on hematocrit. However, she is currently managing a UK Medical Research Council neuroprotection trial using xenon [2] so she will take a look at her data and see if she can see an effect (although it has to be said that sick babies are about as far removed as you can get from elite athletes, the principle may be the same).

Interestingly another noble gas, argon, is potentially even better than xenon at neuroprotection. If this works via EPO activation it would be even more interesting to athletes as argon is a lot cheaper to buy than xenon!

Saturday 12 April 2014

Asafa Powell: the defence of his doping ban

Just a follow up to my last blog, Asafa Powell claims [1] that he was a victim of a contaminated supplement i.e. the oxilofrene he tested positive for was not a listed ingredient in Ephinany D1.  I think this is true; he therefore has a case that, in this regard, the 18-month ban is longer than some that have been handed down for similar offences. He may well win an appeal at the Court of Arbitration for Sport.

However, I would contend that the unbanned “stimulants” that are listed on the Epiphany D1 label are not that different to oxilofrene if taken in high doses. Aniracetam in particular is a prescription drug used to treat central nervous system disorders, such as Alzheimer’s Disease. If Powell was taking it in a pure pill form as a patient, he would surely have declared it on a therapeutic exemption certificate. I am assuming that Epiphany D1 was not listed on any form as athletes, and their coaches, try to keep their supplement regimes as secret as their training regime. In any case I don’t see much difference between taking a cognitive enhancer such as aniracetam versus a banned stimulant like modafinil which has resulted in any number of doping bans (see my book for details).

As an aside it does seem to me that Powell has a case to sue the manufacturers of Epiphany D1, Dynamic Life Nutrition, LLC for loss of earnings and reputation. They even have a GMP (or “Good Manufacturing Practice”) label on their web page after all - though it is rather fuzzy and difficult to read. However, a quick read of their terms and conditions [2], suggests otherwise:


And even better:

“Company neither endorses nor is responsible for the accuracy or reliability of any opinion, advice or statement on the Company Websites”

and again:

“It is your responsibility to evaluate the accuracy, completeness or usefulness of any information, opinion, advice or other content available through the Company Websites. Please seek the advice of professionals, as appropriate, regarding the evaluation of any specific information, opinion, advice or other content, including but not limited to financial, health, or lifestyle information, opinion, advice or other content.”

Caveat emptor