Oscar Pistorius, herbal remedies and doping tests

I won’t be commenting on the murder case, other than to note my sympathy for the victim and her family. But I do have a comment about the alleged “performance enhancing drugs” found in the house. In a statement from the International Paralympic Committee, Oscar Pistorius was revealed to have been drug tested twice in London last year by the IPC, on Aug. 25 and Sept. 8. Both test results were negative of course or we would have heard about it.

Why only two tests? Pistorius won three medals at the Paralympics. Silver on Sept. 2^nd in the 200m T44, gold on Sept. 5^th the 4 x 100m T42/T46 relay and gold again on Sept 8^th the 400m T44. He also came fourth in the T44 100m race on Sept. 6^th.

All top five finishers in an Olympic final are tested immediately afterwards, the assumption being that no more than two will be caught so all the medals can still be awarded [1]. This is not the case in the Paralympics. As can be seen from the above Pistorius was only tested on arrival at the Games and after his 400m win. This is not to cast any aspersions at all, but merely to note that it is easier to avoid testing in the Paralympics than the Olympics. Admittedly there are more medallists at the Paralympics  (at London the discrepancy was 1,522 for the Paralympics against 962 for the Olympics). But the main issue is cost: there is less money in Paralympic sport so less money for testing. I don’t have the details, but I suspect this disparity will be mirrored in a far less effective out-of-competition testing program.

As to what was found in the Pistorius house. The current view seems to be a legal herbal supplement called “Testocompasutium co-enzyme”. I have no idea what this is; perhaps someone can enlighten me? 

Australians doping with designer peptides: do they work as sports drugs?

The news that doping with custom peptides (such as CJC-1295, Sermorelin and Tesamorelin) is widespread in Australian sport has been all over the web recently. So I thought I should add my opinion to a somewhat confused story (at least in terms of how the biochemistry and sports performance is being reported). The first confusion is the use of the word “peptide” as if it is some evil drug. Peptides are just a string of amino acids that make up a protein. If the number of amino acids is small the resultant molecule is called a peptide. If there are lots of amino acids strung together it is called a protein. The distinction between a peptide and a protein is therefore essentially arbitrary. So insulin, human growth hormone and erythropoietin are all peptide hormones. But they could just as easily be called protein hormones. This biochemical distinction is being lost in the current discussions about doping in Australian sport, where peptides are just bad molecules you get from criminal gangs.

So what are these artificial designer peptides? They are drugs that are being used to enhance the release of the body’s own peptide hormones. The synthetic peptides work by mimicking other peptides in the body such as GHRH (growth hormone releasing hormone). So Sermorelin (a synthetic peptide) mimics GHRH (a peptide produced in the body) in activating the release of human growth hormone (also a peptide) from the pituitary gland. This is then supposed to increase muscle mass and power. Confused? Well read my book and there will be a test later (only kidding!).

Worryingly many of the drugs are still in clinical trials, or have been used in such trials and found wanting, and so are not licensed for use in humans. So they have to be obtained by links with organised crime. I can’t help feeling that the most interesting aspects of this story are exactly that: doping is widespread in many sports and very closely linked to criminal elements. As we all knew pro-cycling is not an isolated case

Although we have not got all the details yet, what I am not overly concerned that the drugs themselves will have biased the results of sporting events (though I AM concerned about the health of athletes concerned). Why am I not concerned about the cheating? Well many of the peptides are touted to be an undetectable way of raising your human growth hormone (HGH) levels. This is supposed to increase muscle mass and strength. Yet the experimental evidence for a power increase with HGH administration itself is very weak (M.J. Rennie (2003) Claims for the anabolic effects of growth hormone: a case of the emperor's new clothes?, Br. J. Sports Med. 37 100-105). It is therefore unclear that doping with peptides designed to indirectly increase HGH levels will be any more effective.

Of course these statements must be couched with the usual caveats that most studies are not done on elite athletes and, for ethical reasons, err on the low side in dosage. But even a quick trawl through the bodybuilder web sites reveals some dopers who think the claimed benefits of “peptides” are all just a placebo effect. If even bodybuilders are sceptical your product works, you really should doubt its efficacy.

It should also be noted that these drugs were designed for specific clinical problems such as to increase growth in growth hormone deficient patients or to increase fat breakdown in HIV-AIDS patients, in particular to treat a symptom called HIV-associated lipodystrophy (excess abdominal fat). Although they aim to increase lean body mass, this is by reducing fat. They have not been designed to increase muscle mass and power per se. So the clinical data do not directly support their use in athletes. Like HGH the use of these synthetic peptide hormone are touted by what I term “lifestyle clinicians” in the USA to solve all sorts of issues relating to ageing and/or weight problems. This is “off label” prescription i.e. the drugs are not officially approved for this use (which usually means, of course, that there is no supporting data).

So what is the problem if the drugs probably aren’t affecting performance too much? Well some of the drugs are not licensed for use as they have undesirable side effects. Or they may be licensed in sick patients where there have benefits that outweigh the side effects. For example in 2010, the US Food and Drug Administration approved Tesamorelin for treating Lipodystrophy in HIV patients (http://www.medscape.com/viewarticle/732450). But they noted that: “the long-term cardiovascular benefit and safety of tesamorelin have not been studied”, “Tesamorelin increases serum levels of insulin-like growth factor 1 (IGF-1), which has an unknown effect on the development or progression of malignancies” (i.e. cancerous tumors), and “Tesamorelin therapy may also result in glucose intolerance and an increased risk for diabetes mellitus”. It seems from the reports that some of the Australian athletes may have not been told what drugs they were being given. In this case it is not only the supplying gangs that are criminals, but the people who administered the drug as well …..

Jack3d and Claire Squire's death

The coroner has spoken 

http://www.bbc.co.uk/news/uk-england-london-21262717

I completely agree

http://runswimthrowcheat.blogspot.co.uk/2012/05/jack3d-not-worth-risk-in-all-sorts-of.html

My sympathies are with Claire's family and friends at this time. I do note that the new Jack 3D has been launched without the offending DMAA (methylhexanamine) ingredient.  The current ingredients look pretty harmless, but it is interesting they think the brand name is not tarnished and worth reusing.

The new ingredients of Jack 3D "ENOS Super Performance System"are L-citrulline, arginine and nitrate [1]. A weird combination of substrates, precursors and products of the enzyme Endothelial Nitric Oxide Synthase (hence the ENOS). As someone who has written a scientific review on this enzyme with over 2,000 academic citations (http://www.biochemj.org/bj/357/0593/3570593.pdf), I wish supplement companies would just leave my field alone and find somewhere else to go to peddle their non validated concoctions.

A bit more of a rant than usual I'm afraid, but this death was so unnecessary....


 [1]  Nitrate can have a performance effect but you can get it cheaper by eating a lot of vegetables (or drinking beetroot juice).

Lance Armstrong: the science fights back

Michael Ashenden agrees with that that Lance Armstrong is lying about not doping in his comeback Tour in 2009/2010 (or I guess we both agree with Chris Gore).
 See Matt Slater’s story at http://www.bbc.co.uk/sport/0/cycling/21195249 It’s nice to be in such good company. People talk about Oprah not asking the difficult questions. She actually didn’t do too bad. But if the science of doping was in her blood (so to speak) she could have pointed out the anomaly with him supporting the blood passport’s accuracy, whilst seemingly making an exception in his own case. I think a Jeremy Paxman or a John Humphrys might have got this point. 
I think Armstrong still needs to be pressed on this point.

We shouldn't forget that Armstrong pulled out, ostensibly for legal and financial reasons, of Don Caitlin's widely publicised personalised anti doping program that was scheduled for his comeback Tour. It would have been very interesting to compare Caitlin’s proposed every three day testing regime with the more limited data from USADA and UCI that seem to damn him.
 http://www.nytimes.com/2009/02/12/sports/othersports/12cycling.html?_r=0

Swansea City ball boys

OK - this is not about drugs in sport, but I couldn't resist it:

In 1973 Swansea City  became the first team in football's lower leagues to have ball boys.

In the first batch was a certain Chris Cooper

I have two main memories:

1 We were ordered to all go to the side of the pitch nearest the tunnel for the last 10 minutes of the match so we didn't get run over when the skinheads invaded the pitch at the end of every game (this was the 70s after all). 

Oh and 

2 We were told to give the ball back quickly if Swansea were losing and very slowly if we were winning. And to try and avoid getting beaten up by frustrated opposition players in the latter case.

I was born 40 years too early - or I could have been famous ……  (or at least kicked by somebody famous) 

http://www.mirror.co.uk/sport/football/news/eden-hazard-sent-off-for-kicking-ball-1552195

Was Lance Armstrong lying to Oprah Winfrey?

To quote Gordon Farquhar at the BBC:

http://www.bbc.co.uk/sport/0/cycling/21085940

“Armstrong is an accomplished liar. Serious questions remain over the analysis of blood tests taken from Armstrong in 2009 and 2010 following his comeback. Usada says the tests "built a compelling argument consistent with blood doping. Armstrong has not yet admitted to doping on his return to the sport in 2009. Wada president John Fahey doesn't buy Armstrong's assertion that he was clean during his comeback. Tests were carried out on 38 of his blood samples from that time by the Australian Institute of Sport, which concluded that the chances of the blood values recorded occurring naturally were one in a million. The tests were not part of the recognised anti-doping programme, but Fahey wants Armstrong under oath again on this”.

I couldn’t agree more. In his Oprah interview Armstrong makes the case that the sport is cleaner and it is harder to cheat because of out-of-competition testing and the athlete biological passport. Yet as I have said on this blog before, his blood samples in 2009 and 2010 were highly suspicious. The data that makes them suspicious (plasma volume, reticulocyte count) are the same that would raise warnings on the passport. This is the basis for the “one in a million” comment from Prof. Chris Gore mentioned in the above quote.

If Lance Armstrong was not lying to Oprah and he was in fact clean in 2009 and 2010, it calls into question the whole biological passport system. The only resolution is for Armstrong to work with UCI, WADA and Chris Gore to explore how such anomalous blood results could have occurred by chance. As some have suggested on my blog (step forward “anonymous”) perhaps he used hypoxic tents in Italy? If we don’t know how this happened there could be a whole lot of “false positive” passport results and athletes could be accused unnecessarily.

Or perhaps Armstrong was just lying? It has been known

Lance Armstrong on the Oprah Winfrey Show

I can’t wait to hear the 112 questions Oprah tried to ask Lance Armstrong. None of them I think are likely to be the ones scientists want to know (or at least this scientist). So here are my alternative questions?

1               Who designed his doping program (though we can all guess this)?

2               Was his program more sophisticated than his rivals?

3               How was it evidence-based? For example was the performance titrated individually versus body haemoglobin or was there just an optimum hemoglobin concentration that the all the climbers in the team aimed for?

4               We know how blood doping worked. But what benefit did he feel he get from steroids (both corticoid and anabolic)? How was this evidence-based?

5               Did some people get doped and still not perform better?

6               Was the Armstrong phenomenon in part that he was ideally suited to being doped i.e. was blood oxygen content more rate limiting for his performance than his rivals?

Oprah won’t ask these of course (and to be fair they are not really prime time TV questions)

But she might ask these two

1                                 Would he still have win seven Tours if nobody was doping?

2                                 Would he still have win seven Tours if everyone had the same doping team?

On a non-science level I hope he doesn’t leave any grey areas about his moral standing. He should come as clean as Landis and Hamilton. I won’t hold my breath, however.