Doping, Doping Control and Sport: Doping, Doping Control and Sport September 12, 2006


Comment on Presentation: Comment on Presentation In historical comments several national instances of doping are mentioned These are not criticisms or political statements There are several points Doping is worldwide Doping works Military has same concerns Question – if sport exceeds capability of human, should you: Modify human Or modify rules of sport?


Tour de France 1967Tom Simpson: Tour de France 1967 Tom Simpson Had traces of amphetamine and methamphetamine in blood. Allowed Simpson to train beyond his limit of strength and stamina. Televised event caught the world’s and International Olympic Committee’s interest in sport doping.


Los Angeles 1984: Los Angeles 1984 Seoul 1988 Ben Johnson


The East German Doping Story: The East German Doping Story Doping by the East Germany state took place for 25 years More than 10,000 young athletes were doped without their knowledge State Sponsored, doctors and coaches began giving athletes the “blue pills” at a young age Pills were steroid Oral-Turinabol (OT) Athletes were told that they were vitamins Pills were known as a “supportive means” for athletes


The East German Doping Story, cont.: The East German Doping Story, cont. Changes began in female athletes: Weight gain Excess facial and body hair Deepening voices Steroid Acne Doctors would make excuses when athletes would ask questions


Heidi’s Story: Heidi’s Story At age 16, began receiving Oral-Turinabol (OT) By age 18, Heidi weighed 220 pounds, had a deep voice, increased body and facial hair and often mistaken for a man According to uncovered medical research records, Krieger received 2,590 milligrams of OT in 1986, the year she won the European Championship Career ended in 1991 when physical strain overtook her body In 1997, Heidi had a sex change and became legally known as Andreas Krieger


Heidi Krieger: Heidi Krieger 1997 as Andreas Krieger


STATISTICAL RESULTS: STATISTICAL RESULTS WOMEN’S SWIMMING - 1972 OLYMPICS EAST GERMAN RESULTS 2 Individual Silvers 1 Individual Bronze 2 Relay Silvers No Olympic or World Records


STATISTICAL RESULTS: STATISTICAL RESULTS WOMEN’S SWIMMING - 1976 OLYMPICS EAST GERMAN RESULTS 10 of 11 Individual Golds 5 other Silver 1 Team Gold; 1 Team Silver 10 Olympic or World Records Rich Young - 7.31.03


STATISTICAL RESULTS: STATISTICAL RESULTS WOMEN’S SWIMMING - 1992 OLYMPICS UNITED GERMANY RESULTS 1 Gold 2 Silver 4 Bronze 1 Team Silver; 1 Team Bronze No Olympic or World Records Rich Young - 7.31.03


East German Doping Machine: East German Doping Machine Ungerleider, Steven. Faust’s Gold: Inside the East German Doping Machine. 1st Edition. New York: St Martin’s Press, 2001 State sports physician Manfred Hoeppener given 22 month sentence for unlawful use of drugs


The Czechoslovakian Doping Story: The Czechoslovakian Doping Story Recent documents show Communist Czechoslovakia systematically and officially administered steroids and other illegal substances to athletes through the 1980s. Czechoslovakia had some of its greatest sporting successes during this time. Coaches, high-ranking sports officials, and government officials had knowledge of the program. This was a “Cold War” campaign to show supremacy over the West, the documents showed. Drug examples were nandrolone, norandrosterone and stanozolol (from Reuters News August 16, 2006)


Helena Fibingerova: Helena Fibingerova


Slide15: Women's Shot Put Final. Olympic Games 1972 1. Nadezhda CHIZHOVA (SOV) 21.03m. 2. Margitta GUMMEL (GDR) 20.22m. 3. Ivanka HRISTOVA (BUL) 19.35m. 4. Esfir DOLZHENKO (SOV) 19.24m. 5. Marianne ADAM (GDR) 18.94m. 6. Marita LANGE (GDR) 18.85m. 7. Helena FIBINGEROVA (CZE) 18.81m. 8. Yelena STOYANOVA (BUL) 18.34m. Women's Shot Put Final. Olympic Games 1976 1. Ivanka HRISTOVA (BUL) 21.16m. 2. Nadezhda CHIZHOVA (SOV) 20.96m. 3. Helena FIBINGEROVA (CZE) 20.67m. 4. Marianne ADAM (GDR) 20.55m. 5. Ilona SCHOKNECHT (GDR) 20.54m. 6. Margitta DROESE (GDR) 19.79m. 7. Eva WILMS (GER) 19.29m. 8. Yelena STOYANOVA (BUL) 18.89m.


1998 Tour de France: 1998 Tour de France Masseur for Festina Team stopped at France-Belgium Border – 400 Doping Items including EPO One stage of race annulled due to stoppages Doctors and others investigated Only 14 teams of 21 original and 100 out of 189 riders complete the race. Willy Voet published story “Massacre a la chaine”


Finnish Ski Team 2001 : Finnish Ski Team 2001 World Championships – Nordic Skiing Athletes, head coaches, and team physicians Administered Hydroxy-ethyl starch Doping agent Masking agent Thought HES could not be detected!


BALCO: BALCO Non-medical person purportedly selling supplements (ZMA) Along with VP, trainer, and coach Indicted on 42 counts: Distribution of anabolic steroids Misbranding drugs with intent to defraud Possession of hGH Money laundering Spent some time in prison and house arrest


Conte Comments: Conte Comments Stresses that he isn't in it for money. He is doing a public service, he says -- helping athletes use performance-enhancing substances in a healthy way From: http://www.playboy.com/magazine/big_guy/index.html


Goldman Survey – 1995: Goldman Survey – 1995 198 Elite athletes surveyed You are offered a banned performance enhancing substance and guaranteed You will not be caught You will win 195 athletes said yes would take 3 said no would not


Another Question: Another Question 198 Elite athletes surveyed You are offered a banned performance enhancing substance and guaranteed You will not be caught You will win every competition for five years Then you will die Would you take it?


Answer: Answer More than half said they would take the substance!!!


35 Olympic Sports: 35 Olympic Sports Summer sports Aquatics, Archery, Athletics Badminton, Baseball, Basketball, Boxing Canoe / kayak, Cycling Equestrian; Fencing, Football Gymnastics, Handball, Hockey Judo, Modern Pentathlon, Rowing Sailing, Shooting; Softball Table Tennis; Taekwondo; Tennis; Triathlon Volleyball, Weightlifting; Wrestling Winter Sports Biathlon, Bobsleigh, Curling, Ice Hockey Luge, Skating, Skiing


DEFINITION OF DOPING (FROM WADC)(Note: the numbering system reflects that of the Articles of the WADC, Reference 1.): DEFINITION OF DOPING (FROM WADC) (Note: the numbering system reflects that of the Articles of the WADC, Reference 1.) 2.1 The presence of a Prohibited Substance or its Metabolites or Markers in an Athlete’s bodily Specimen (concept of Strict Liability) 2.1.1 Each Athlete’s must ensure that no Prohibited Substance enters his or her body. 2.1.2 Excepting when a threshold applies, the detected presence of any quantity of a Prohibited Substance shall constitute an anti-doping rule violation. 2.1.3 As an exception to the general rule of Article 2.1, the Prohibited List may establish special criteria for the evaluation of Prohibited Substances that can also be produced endogenously.


DEFINITION OF DOPING: DEFINITION OF DOPING 2.2 Use or Attempted Use of a Prohibited Substance or a Prohibited Method. 2.2.1 The success or failure of the Use is not material. 2.3 Refusing to submit to Sample collection after notification as authorized in applicable anti-doping rules or otherwise evading Sample collection. 2.4 Not being available as prescribed or otherwise missing a test.


DEFINITION OF DOPING: DEFINITION OF DOPING 2.5 Tampering, or attempting to tamper, with any part of Doping Control 2.6 Possession of Prohibited Substances and Methods 2.7 Trafficking in any Prohibited Substance or Prohibited Method 2.8 Administration or Attempted Administration of a Prohibited Substance or Prohibited Method to any Athlete, or assisting, involving an anti-doping rule violation or any Attempted violation


Doping Control: Doping Control Organizations having adopted World Anti-Doping Code International Olympic Committee / International Paralympic Committee International Federations National Olympic Committees (e.g., USOC) National Anti-Doping Organizations (e.g., USADA) Most nations


Doping Control: Doping Control WADA has responsibility for doping control program. Implemented through the World Anti-Doping Code IOC enforces Code at the Olympics IFs enforce Code at International Competitions NADOs enforce at National Competitions WADA receives financial support from donations by nations


International Military Sports Council: International Military Sports Council Military Sports Aeronautic pentathlon, military pentathlon, naval pentathlon Other Sports Basketball, boxing, cycling, cross-country, equestrian, fencing, football, golf, handball, judo, modern pentathlon, parachuting, orienteering, sailing, shooting, ski (nordic and alpine), swimming (including diving, life-saving and water polo), taekwondo, track and field, triathlon, volleyball and wrestling


Formation of WADA: Formation of WADA November 1999, the IOC convened the World Conference on Doping in Sport WADA was created based on IOC’s proposal - IOC wanted to take the burden of testing athletes off of the sport federations There is a perceived conflict of interest - sports bodies advocating sport are also performing doping controls.


WADA’s Mission: WADA’s Mission Seeks to foster a doping free culture in sport Educates athletes about the harm of doping Reinforces the ideal of fair play Sanction those who cheat


World Anti-Doping Program: World Anti-Doping Program Cornerstone – World Anti-Doping Code (WADC) Policy, Rights and Responsibilities International Standards Therapeutic Use Exemptions The Prohibited List Laboratories Testing Sanctions Model Practices for IFs


Slide33: Therapeutic Use Exemption (TUE): What is it? Athletes like all others, may have illnesses or conditions that require them to take particular medications. The medication an athlete is prescribed to treat an illness or condition may fall under the Prohibited List. If so, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take the needed medication. Two types of TUEs Standard (long) Form Abbreviated Form


WADCTherapeutic Use Exemptions: WADC Therapeutic Use Exemptions Allows an athlete to use an otherwise prohibited medication: If no performance enhancement above return to normal health No allowed medication is available or appropriate Health of athlete would suffer If need is due to abuse of prohibited medication the TUE is not approved


WADCTherapeutic Use Exemptions: WADC Therapeutic Use Exemptions WADC requires IFs to handle International athletes USADA to handle national level athletes WADA may review and reverse TUE’s approved by USADA


Therapeutic Use Exemptions: Required for use of any prohibited Method or Substance Standard Form requires the submission of a complete medical file with the request Decision is by a 3 member TUE committee This process requires pre-approval by TUE committee Includes insulin Therapeutic Use Exemptions


Abbreviated TUE: Abbreviated TUE Abbreviated TUE applies only to: certain beta-2 agonists Corticosteroids by local or intra-articular injection, iontophoresis, or inhalation. Notification of use – does not require pre-approval. In most cases no medical file is required Abbreviated form is available www.usantidoping.org United States Anti-Doping Agency


Supplements: Supplements All taken at athlete’s own risk WADA laboratory - Cologne Germany Found 94 of 634 samples contained a substance not listed on the label that conceivably could lead to a positive test 45 of 240 USA supplements (18.8) Using supplements is playing roulette with your sport career.


Basis for Prohibited List: Basis for Prohibited List Must meet 2 of 3 criteria Enhances or has potential to enhance performance Risk or potential risk to health of athlete Violates the spirit of sport Or be masking agent for above


2006 Prohibited SubstancesIn- and Out-of-Competition: 2006 Prohibited Substances In- and Out-of-Competition Anabolic Agents Hormones and related substances Peptide Hormones a. Erythropoietin (EPO) b. Growth Hormone and Insulin-like Growth Factor c. Gonadotrophins (males only) d. Insulin - Permitted only to treat Insulin-dependent diabetes with the approval from a Full TUE Submission e. Corticotrophins


2006 Prohibited SubstancesIn- and Out-of-Competition, cont.: 2006 Prohibited Substances In- and Out-of-Competition, cont. 1. Beta-2 Agonists - Formoterol, Salbutamol, Salmeterol, and Terbutaline permitted by inhalation as determined by physician with ATUE 2. Agents with Anti-Estrogenic Activity 3. Diuretics and Masking Agents – includes propecia (finasteride). TUE is not valid if an athlete’s urine contains a diuretic in association with Threshold or sub threshold levels of a prohibited substance.


2006 Prohibited Methods: 2006 Prohibited Methods Enhancement of Oxygen Transfer Chemical and Physical Manipulation Tampering IV infusions Gene Doping


2006 Prohibited SubstancesIn-Competition, Only: 2006 Prohibited Substances In-Competition, Only Stimulants Narcotics Cannabinoids Glucocorticosteroids Also in certain sports alcohol and beta-blockers


Laboratories: Laboratories UCLA Olympic Laboratory is only lab in US at this time University of Utah is in process of certification of a second US laboratory – should be done very soon 33 labs worldwide Accredited to WADA International Standard and ISO 17025


Testing: Testing Collection of specimens out of competition – no advance notice in competition – based on selection criteria from event Completed to WADA International Standard USADA completed 8175 tests last year (national & international)


Sanctions: Sanctions Are adjudicated by arbitration Can be appealed to CAS WADA is working to harmonize the Sanctions provided for by IFs and National Anti-doping Organizations


United States Anti-Doping Agency(USADA): United States Anti-Doping Agency (USADA) Independent Agency created as a result of recommendations by the USOC’s select task force on Externalization Has full authority for testing, education, research and adjudication for US Olympic, Pan Am, and Paralympic Athletes. Works with National Governing Bodies (NGBs) and International Federations (IFs) to implement and enforce rules created by WADA


Legal Status of USADA: Legal Status of USADA The Senate Committee on Commerce, Science and Transportation oversees matters relating to Olympic Sports in the U.S. The Ted Stevens Amateur Sports Act governs the Olympic Movement in the United States Public Law 107-67 (section 639) recognizes USADA as the official independent anti-doping agency of the Olympic, Pan American and Paralympic Sport in the United States.


The Mission of USADA: The Mission of USADA


Slide50: USADA’s Role With CISM USADA reviews and accepts Abbreviated TUEs for the US Military members training for or competing in CISM Sanctioned events. Forms must be: Complete Legible Signed by athlete and physician These forms are notifications and do not require pre-approval Abbreviated forms are available on the USADA website: www.usantidoping.org


Slide51: USADA receives ATUE notification ATUE is reviewed Certificate is issued Original document sent to athlete CISM Receives notification via fax/e-mails Copy of notification is retained by USADA


Slide52: USADA’s Role With CISM USADA reviews Standard TUEs for the US Military members training for or competing in CISM Sanctioned events. Forms must be: Complete, including medical file related to request Legible Signed by athlete and physician These forms are for the use of prohibited medications and must be pre-approved or for an emergency treatment. The emergency treatment must be for a diagnosis that would threaten the health and well being of the athlete if the prohibited medication was withheld. Standard TUE forms are available on the USADA website: www.usantidoping.org


Slide53: USADA convenes a Therapeutic Use Exemption Committee (TUEC) comprised of 3 physicians. TUEC approves or denies request Letter and/or certificate issued to athlete. Original sent to athlete CISM receives notification via fax/e-mail Copy of letter/certificate gets attached to athlete’s TUE and is filed by year & sport.


Supplements: Supplements All taken at athlete’s own risk WADA laboratory - Cologne Germany Found 94 of 634 samples contained a substance not listed on the label that conceivably could lead to a positive test 45 of 240 USA supplements (18.8) Using supplements is playing roulette with your sport career.


Slide55: Substances that are converted in the body into steroids which have an anabolic effect Being marketed as “dietary supplements” that promise to build muscle Manufacturers are not required to perform safety tests What are Steroid Precursors?


Doping Challenges: Doping Challenges Human Growth Hormone - approaches Detect hGH Isoforms directly Detect Biomarkers of hGH administration Designer Steroids Exogenous Testosterone


Designer Steroids: Designer Steroids Trenbolone


Physicians, Coaches, and Trainers: Physicians, Coaches, and Trainers “Those who are involved in doping athletes or covering up doping should be subject to sanctions which are more severe than the athletes who test positive.” World Anti-doping Code comment: Version 3, dated 20 February, 2003, Page 25


Drugs, Sports, and Medical Practice: Drugs, Sports, and Medical Practice “The conscious decision of all sport physicians and scientists to play no role in doping practices would offer new hope that sport might continue to represent competition between humans, not laboratory preparations or the products of genetic engineering or polypharmacy.” From: Andrew Pipe, MD and Thomas Best, MD, PhD; Clin Journ Sport Med, 12:201-202 2002


Thanks!! : Thanks!! Questions????