Thursday 20 August 2015

Doping at the World Athletics Championships – part 1

My title indicates that I think these championships might take up more than one of my blogs! Indeed the Sunday Times/IAAF doping story has already messed up my holiday. I was pestered by well meaning journalists while visiting Yorkshire. Fortunately I was for the most past saved by dodgy mobile phone signals and an absence of Wifi. I did, however, make an exception to talk to Radio 5 live Drive and Radio 4 pm in the BBC radio car parked in the local pub car park. What could be more surreal?

It has been hard commenting on the leaks given the fact that the various protagonists (IAAF and the Sunday Times/ ARD/WDR) have access to the data but have released only a very limited amount into the public domain. The IAAF has indicated they will eventually publish a “prevalence study” sometime in the future. Whether this will go so far as to make comparisons between countries and whether it will also be possible to compare individual sporting events remains to be seen. These of course are the highlights of the leaks, but realistically might be excluded in an academic type report.

So what can be said and how does it relate to the upcoming World Athletics Championships in Beijing? Well, starting with a selfish note, I am pleased that the 1500m final in the women’s 2005 World Athletics championships is finally getting the “recognition” it deserves [1]. In the opening pages of my book I note that, far more than Ben Johnson’s 100m run in the Seoul Olympics, this race deserved the moniker of the dirtiest race in history [2]. My comment that the first five athletes to cross the line were alter found guilty of doping (admittedly in later tests) has now been backed up by anomalous blood readings taken at the time of the events.

It is worth noting that the winning time in this infamous race was over a second slower slower than when the clean athlete, Kelly Holmes, won the 1500m Olympics title a year earlier. This brings me to my first substantive point. An anomalous blood reading does not mean someone is necessarily doping. And even if they are doping it does not mean that they won the race because they were doping. Although there is good evidence in the scientific literature that increasing your total haemoglobin levels increases athletic performance, there are sparingly few results in elite athletes (where performance effects of ergogenic aids naturally become smaller in size). Even the studies that have been done rarely use a proper randomised placebo controlled design. There is no control for the placebo effect. The importance of this cannot be underestimated; a placebo effect is likely to be doubly powerful when taking a banned substance as these are assumed to be especially powerful. Interestingly a recent randomised blind trial on elite cyclists surprisingly showed no effect of altitude training and suggested previous positive results might be mostly down to placebo [3].  “Unfortunately” it will be almost impossible to do a similar study using EPO or blood doping due to ethical constraints surrounding giving people potentially harmful drugs. Worse still the definitive study would involve giving someone the drug and actively telling them they are getting a placebo [4]; even using microdoses of EPO this would be a real ethical minefield.

My second substantive point relates to the success, or not, of the blood passport program introduced in athletics by the IAAF in 2009. Clearly this has resulted in a significant number of suspensions. But has it affected the number of people doping? In cycling there seems to be a clear effect [5]. This was shown by the drop in the number of cyclists showing abnormally high or low levels of young red blood cells called reticulocytes (a recent blood transfusion will likely give a low number and an injection of a high dose of EPO a high number). The blood doping expert Michael Ashenden was reported in the Sunday Times as saying that “despite the introduction of the biological passport, analysis of the data shows nearly 70 athletes with suspicious blood test results still escaped censure” [6]. This my be so, but it would be very interesting to see his detailed analysis of whether there was any change at all from 2009-2012.

The relevant data outlining the effect of blood doping on the performance of elite athletes is hidden from the average scientist in the secret files of doping athletes and their coaches. Still my “not too controversial” personal view is that blood transfusions and high dose EPO genuinely provide a performance benefit in elite athletes. I am currently less convinced that micro dosing of EPO, of the type designed to fool the biological passport, is as effective. It is unlikely to create a situation where a clean athlete cannot win a race against a doper. It is also possible that just by forcing the athletes to change doping strategies to avoid detection, you make that doping less effective.

In the worst-case scenario portrayed by the Sunday Times 30% of successful athletes had anomalous blood readings and so might have been doping; but this still means that 70% of athletes with “normal” blood readings managed to beat these dopers. Doping is best seen as one part of a complex set of factors that lead to a gold medal. It is only occasionally in sport that we see situations where it is inconceivable that a clean athlete could beat a doper – the most notable being the period in the 1970s and 1980s when female athletes were dosing with large amounts of anabolic steroids. The Tour de France in the Armstrong years may well be another example.

My final point relates to one I was questioned by on BBC radio recently. Should athletes reveal their own passport data? Even the athletes themselves are divided on this [7, 8]. But I feel the cat is out of the bag now. Anyone with a normal score is going to shout it from the rooftops. Those with anomalies will be shamed for not revealing them – unless they have a really clear explanation to hand. Anyone not revealing their scores will be assumed to be hiding their data because they are doping. My major concern is that the internet will fill up with well-meaning and not so well-meaning amateurs who will be able to “prove” that someone is doping from their passport score.

We have seen this effect with performance data in cycling for a number of years now. The most recent example was the accusations of doping against Chris Froome in the Tour de France in the complete absence of any analytical doping data [9] or any intelligence about dodgy practices garnered from fellow team members [10]. Another example: the UK 400m runner Roger Black is one of those now calling for athletes to reveal their passport data [7]. Yet I remember him telling me he was once confronted by a member of the public who said he could tell he was cheating just by looking at some of the times he had posted. As Paula Radcliffe [8] said you can never prove you are not doping.

I suspect blood passport scores such as reticulocyte count, red cell volume and haemoglobin concentration will soon become as well known to the world of online sport comment as performance measures such as peak power, VO2 max and lactate threshold are now. In the conclusion of my book I said “When it comes to making practical and ethical policy there is a devil in the scientific detail that is absolutely required if we are to make informed moral and political choices.” In athletics and doping the time of science is upon us now.