Sunday, August 9, 2015

What is not prohibited in anti-doping domain

A recent statement by a former international athlete in a newspaper interview that aspirin was one of the banned substances in the Prohibited List issued by the World Anti Doping Agency (WADA) not only showed how inadequate information flow has been in this field in India but also the complexity of the subject of banned drugs.
We have heard of a variety of substances of routine use in ‘over-the-counter medications’, at least in India, being in the Prohibited List.  Ephedrine and pseudoephedrine, available in cold and cough medications, readily come to mind.
But aspirin?
No, aspirin is not prohibited. In combination with another drug it could get among the prohibited substances, say for example oxycodone, an opioid, combined with aspirin. But on its own aspirin is safe for the athlete from an anti-doping perspective.
Aspirin, which belongs to a group of medicines classified non-steroidal anti-inflammatory drugs (NSAIDs), is so commonly used, say for headache and toothache, for cold and flu, for sprains and strains and rheumatic pain and to even manage a heart attack (as an anticoagulant)  in an emergency situation that living without it, even in the sports field, would be unimaginable.
Aspirin (Disprin is a one of the popular brands available in the Indian market that contains aspirin), is commonly used for its anti-inflammatory and analgesic properties. Aspirin is also available in several medicines that are given for the management of coronary artery disease (CAD), say for example Clavix AS which is a combination of Clopidogrel, an anti-platelet drug, and aspirin.

Check it out online

It is interesting to note in this respect that on the website of the Canadian Centre for Ethics in Sports (CCES), Canada’s anti-doping authority, one can check out even the drugs that are not prohibited, not just the ones that are banned.
That is something that should be extremely useful to the athletes since many medicines for routine problems may not be checked out by all through their personal physicians.
 The National Anti Doping Agency (NADA) has a list of brand names of the banned drugs but not of commonly-used drugs that are allowed. Its website needs improvements in several areas.
It is a fact, however, that there has long been a feeling among athletes, coaches, officials, disciplinary panel members, and lawyers that the Prohibited List, issued every year by WADA,  is rather complicated and difficult to understand for the athletes.
Even medical practitioners, especially in India’s hospitals, have found it difficult to exercise caution while prescribing drugs for athletes found to have “some requirement” for steroid use, if one goes by the number of times athletes bring in medical reasons and prescriptions at hearings to explain a ‘positive’ test. This might just be an excuse to avoid sanctions but in the odd case there could well be a lack of understanding of the specific requirement of an athlete and/or the Prohibited List.
True, the list contains an assortment of drugs you might have never heard of (quinbolone, peginesatide, fulvestrant, tuaminoheptane, pindolol etc for example) or even your doctor may have difficulty in recalling some of them except with the aid of that bulky drugs reference book they have. In any case you don't come across these drugs in routine medications that you and I may need.

'Strict liability' principle

It is an athlete’s responsibility, however, to make sure that nothing prohibited enters his/her body. The ‘strict liability’ principle pins the athlete down to such an extent that ‘escape’ from a doping charge becomes almost impossible.
We know of Aparna Popat’s use of D’Cold Total (phenylpropanolamine) and subsequent suspension. It clearly looked an accidental use by the badminton star. (Phenylpropanolamine and phenylephrine are not in the current WADA Prohibited List except under the monitoring programme for 2015).
Athletes failing a test after having ostensibly used cold and cough medications have been aplenty. Discus thrower Seema Antil was in the year 2000 stripped of her gold medal in the World Junior Championships in Chile after she tested positive for pseudoephedrine.
Currently, pseudoephedrine, ephedrine and methylephedrine etc, all used in cold and cough medications, are not banned per se. Concentration levels in urine beyond a prescribed limit will, however, get you a ‘positive’ against your name.

Prescribed thresholds

Medicines of everyday use like ephedrine etc are being regulated in this manner since they are so commonly used but have also been found to be in widespread misuse by sportspersons. The athlete who uses it for therapeutic purposes need not worry thus.
However, athletes do bring in medical reasons and prescriptions to explain the use of even steroids during disciplinary proceedings. And sometimes they do gain some sympathy and leniency, especially if they are from a rural background and might not have had the benefit of the internet etc.
As it happened in the case of a 17-year-old UP athlete in 2012. The distance runner produced a prescription from a health centre in Jaunpur that mentioned Decabolin (nandrolone) among other medicines. He was given the medicine, an injectible steroid, for the “treatment” of typhoid, according to his version.
“The medicines prescribed to the athlete on 26.11.2011 conform to the treatment which is given to patients of Typhoid in such rural dispensaries,” wrote the disciplinary panel in its order while reducing his sanction to one year. There was skepticism but WADA and the IAAF allowed that decision to stand rather than challenge it.

Falls into the trap again

The athlete’s story did not end there. Seven months after his scheduled date of return, he tested positive in a reinstatement test. This time again for nandrolone! He did not respond to notices by NADA. He was handed out a suspension of six years for his second offence, in absentia.
In early years of disciplinary hearings in India, panels tended to overlook the necessity for the athletes to have a therapeutic use exemption (TUE) to use banned substances in case they produced a medical prescription. At least they used to be swayed by the arguments about doctors prescribing medicines for apparently genuine ailments. They are stricter these days.
Useful information for the benefit of the athletes is still at a premium in India. NADA is yet to have a Global Drug Reference Online (DRO), as I keep pointing out. The Global DRO has been jointly managed by the US Anti Doping Agency (USADA), the UK Anti-Doping (UKAD) and the CCES, the Canadian agency. The Japanese Anti Doping Agency (JADA) is an official licensee of the DRO.
You can check out a medicine on this online facility in case you have a doubt about a particular drug that your doctor could have prescribed. There could be the odd problem associated with different brand names especially for Indian products if NADA becomes a licensee, but this is something that our athletes will have to live with till NADA creates its own online facility. 

Supplements guide

The USADA can also guide an athlete to a supplements section where he/she can check out a supplement and its safety from an anti-doping perspective. The ultimate responsibility would still lie with the athlete, but at least there is a facility that can give sound advice.
A similar help is also available at the UKAD. The UKAD recently warned that supplements use resulting in a ‘positive’ test would from now on get four-year suspensions. To balance that there is of course a new clause that deals with supplements contamination which could result in a reprieve.
Drug alerts are common on the websites of NADOs. Like this one issued by CCES last May. 
If you are wondering whether there had been any new drug found to have been misused by athletes, yes there has been. This one has not even hit the production line and yet two cyclists got them and have tested positive!
NADA has to keep updating its website with the latest information, not just on rule changes but on new drugs, marketing of substances like methylhexaneamine under new names etc. At least those who want to keep away from accidental use of such drugs would benefit.




Friday, August 7, 2015

The blood test numbers riddle

The news was startling. No, not just the Sunday Times/ARD revelations about ‘abnormal’ blood test results for many of the medal winners in Olympics and World Championships between 2001 and 2012 but also the tally of Indians that figured in the total number of ‘suspicious’ blood test results.
How many samples of Indians figured in the recent “possible doping" revelations based on ‘suspect’ blood values in analysis conducted by two Australian experts on behalf of the Sunday Times, London, and ARD, the German broadcaster?
Six hundred samples, according to one report! That is staggering.
One report said the Australian scientists found more than 1400 tests involving around 800 athletes were ‘suggestive’ of doping.
If the total number of ‘abnormal tests’ was around 1400, as the report suggested, it is impossible that the Indian count would be 600  and not a single Indian would be accounted for in a report the Telegraph, UK, published, sourced independently by the paper.
So, we should forget about five per cent of the 12,000-odd blood samples that returned ‘suspicious’ results having belonged to Indian athletes.
What could be the number then?
Could it be 70 blood samples in the ‘suspect’ list having belonged to the Indians as one paper reported or could it be five per cent of the 70 Indian samples having recorded ‘abnormal’ values as the same paper said in another report?
The latter could be closer to the truth.
And if we accept that the latter could be the truth_say three or four Indian samples that were categorized as ‘abnormal’ that could belong to one or two Indian athletes_ then there should be no undue need for concern. Seventy ‘doubtful’ samples may probably mean all samples collected from India had turned in ‘suspicious’ results. That would be really alarming.

70 samples may fit in

Seventy Indian samples or tests_and not 70 suspicious cases_would actually fit into the level of participation Indian athletes have had between 2001 and 2012 in Olympics and World Championships and other international events. It is rare, if at all, that blood samples are taken by international agencies when they collect samples in India on occasional out-of-competition testing ‘missions’.
The two global championships mentioned in the Sunday Times report seem to have provided the maximum number of blood samples to the IAAF for analysis and data collection, especially during the period between 2001 and 2009 when the Athlete Biological Passport (ABP) programme was not in existence.
The World Anti Doping Agency (WADA) approved the ABP in 2009. Then onwards separate blood samples were collected and analyzed and the results stored in ADAMS (anti-doping administration and management system).
The experts who analyzed the data for the Sunday Times also took up samples outside of ABP, that is between 2001 and 2009 and possibly other years as well. The crux of the argument between the IAAF and the media organizations and their experts, Dr Michael Ashenden and Dr. Robin Parisotto, lies in this area, whether it would be prudent to depend on blood tests done prior to ABP programme.
We will not go into the merits of those arguments.  The focus here is on Indian athletes and the point to be noted in the Indian perspective is only 14 Indian athletes (half of them on two occasions each) figured in endurance events in either (or both) of the global championships between 2001 and 2012.

Limited Indian participation in endurance events

There must have been a few others whose samples would have been collected, especially between 2001 and 2009 in other international events as well. There were only a few of the Indians competing in endurance events (including combined events) in international meets during those years. The situation has not changed since. It should be noted that blood sample analysis would have required results of at least two or three samples of an athlete.
The events analyzed, according to one report ranged from 800m to marathon and steeplechase plus walks and combined events.
It is also possible that some of the blood samples that the IAAF took in non-endurance events during the pre-ABP era also got into the batch of 12,000-odd samples the data about which was ‘leaked’ to the media organisations.
After all, the 2011 study by the IAAF into prevalence of blood doping among “elite” athletes also included 1329 samples from non-endurance events out of a total of 7289 samples. And they showed abnormal results in three of the non-endurance samples also.
With all possibilities taken into consideration, however, it is difficult to imagine that the IAAF would have collected large numbers of blood samples from Indian athletes during the period 2001-2012 when the tag of ‘elite’ international athletes among Indians would have fitted only very few, if at all, especially among endurance athletes. Not enough to have 600 'suspicious' samples any way. Quite possibly not even 70 'abnormal' ones.
True, athletes like long jumper Anju George was closely monitored by the anti-doping authorities in 2003 and 2004 and subsequent years. When she started competing in many competitions abroad in 2003 and also won the World Championships bronze, India’s only medal in senior global meets, Anju came into sharp focus of the anti-doping agencies. The others were not in the same bracket and would not have been subjected to as many tests.
It is known that in 2011 (Daegu) and 2013 (Moscow) World Championships, the IAAF collected blood samples of all female contestants, ostensibly for a study on hyperandrogensim. (The 2013 Worlds is not in the purview of current debate generated by the Sunday Times report)

Two EPO cases in India

Those wondering how prevalent EPO testing has been in India during the past few years, it is interesting to note that NADA tested 129 samples for the substance in 2013, getting no ‘positive’ while it did 59 urine tests in 2014 through NDTL,  registering two ‘positive’ results, the first ones for the substance in Indian dope testing.
Both EPO cases are pending to be heard by the disciplinary panel. EPO ‘positive’ is not so common in dope testing since the substance reportedly does not remain in samples for more than 48 hours. Micro-dosing these days has made it all the more difficult for anti-doping authorities to catch the culrpits. The IAAF recently stated that since 2001 it had recorded 141 positive cases for EPO.
NADA is yet to start its Biological Passport programme, though it has been collecting blood samples under the ABP programme and feeding the information into ADAMS. It is expected to start its ABP soon now that the ‘whereabouts’ programme in athletics has been put in place and sample collection has already started. A few more disciplines are due for inclusion in the Registered Testing Pool.
The IAAF and WADA could be expected to monitor all the ABP samples. The IAAF has an expert panel that keeps a watch on the data entered by various agencies in the ADAMS. NADA will have to set up an Athlete Passport Management Unit (APMU) when it joins the ABP Programme. That unit will study the results and suggest follow-up measures. An agency can also delegate the authority to an APMU associated with a WADA-accredited laboratory if such a unit exists in that lab.
The recent revelations plus the two EPO ‘positive’ tests that came out of NDTL testing in 2014 (it could not be immediately confirmed which sport these EPO tests came from) should make the EPO dopers in Indian sports extra cautious in the coming months.







Monday, August 3, 2015

Athletics takes another huge blow





Leaked blood test data leads to sensational doping allegations
One of the oft-repeated arguments in India whenever someone raises the topic of doping in sports is: “Oh, everyone in the world dopes. What is so different about Indians doping?” This argument could of course be true of a whole lot of countries around the world.
In Indian athletics this has been the norm rather than the exception since the late 1990s. Administrators, coaches, and athletes would always try to hide behind this plea, while vehemently denying that there is any doping going on around them.
Today, after a series of exposes by the media since last winter, beginning with the ‘Russian doping’ report by ARD, the official German broadcaster, and the latest report by the same channel in association with the Sunday Times , London, the credibility of international athletics has hit rock-bottom. In between had come the BBC Panorama programme in which Alberto Salazar was accused of  adopting doubtful, unethical methods, leading to a lot of embarrassment for his star trainee, Olympic champion Mo Farah of Britain. That debate is still on.
One used to say that the plea of “world-wide phenomenon” in doping was just an excuse that countries employed to defend their own athletes when they were caught and that the refrain “everyone dopes” was more an exaggeration rather than truth.
One cannot be sure of such an argument today.
How many times have we heard officials telling us that only a “small percentage” of athletes doped in international athletics?
The previous ARD documentary alleged that up to 99 per cent of Russian Olympic team use doping as a means to enhance performance.

 Dopers regain lost ground 

If we used to hear in the past that the dopers were a step ahead of the ‘cheats’, that philosophy had started changing during the past decade or so. We started believing that the testers were almost catching up if not getting ahead. Gradually, the same philosophy of the ‘cheats’ being a step ahead _even several steps ahead_of the testers is gaining ground.
Today, the whole testing regimen is in doubt, especially testing for erythropoietin (EPO), the favourite of distance runners, cyclists and other endurance athletes. Now, also in grave danger of being viewed suspiciously is the biological passport programme that has taken a huge hit following the Sunday Times/ARD revelations.
Though there were doping suspicions and allegations in the 1990s, Kenyan athletics by and large had escaped scrutiny with almost everyone marveling at the feats of its distance runners. The Nandi hills,  Rift Valley and Eldoret all became synonyms with distance running the world over.
Since 2012, however, the number of prominent Kenyan athletes caught for doping had mounted. Last year, one of the most decorated marathon runners of Kenya, Rita Jeptoo was caught for EPO use and suspended for two years. It shook Kenyan athletics.
The allegations of widespread doping in Kenyan athletics, first made by distance runner Mathew Kisorio after he was charged with a doping offence, and then by an undercover German journalist Hajo Seppelt in 2012, only gained further ground during 2013 and 2014. Both the IAAF and WADA started taking more serious note of the allegations.
In the latest German TV/Sunday Times expose which has alleged that a third of the medalists (146 with 55 gold medals) in endurance events between 2001 and 2012 have recorded suspicious blood tests, Kenya ranks second with 25 such doubtful blood values. The list is topped by Russia with a whopping 58 suspect cases, according to a report published in The Telegraph, U. K.

Russian doping tale

Russia, it may be recalled, has had to suspend almost all its elite racewalkers, most of them Olympic and World champions in recent times. Eventually it announced that it was withdrawing all its walkers from the World Championships beginning in Beijing  from 22 August.
Jamaica, another country that had been relatively off the radar of anti-doping agencies through several years and which had been hit by accusations of lackadaisical testing regimen, is rather low in the latest figures with three. Greece and Spain have 12 each according to the Telegraph while Romania and Ukraine 11 each. A surprise 10 is fixed against Ethiopia. Surprise because that country, the land of Haile Gebrselassie has not been heard of much in the realm of doping.
According to the Sunday Times report, two Australian experts had examined the “leaked” blood test reports and came to the conclusion that results of around 800 of the 5000 athletes in the list containing 12,000 blood tests were highly suggestive of doping or at the least ‘abnormal’. They said ten athletes who won medals in the London Olympics in 2012 had suspicious blood values.
Interpretation of blood values usually have remained a contentious area and may be debated further in the days to come.
Expectedly, both WADA and the International Olympic Committee (IOC) have reacted cautiously to these allegations which do not necessarily mean an athlete was found to have doped.
WADA’s independent commission, headed by its founder president Dick Pound, already looking into the previous charges levelled against Russia by German TV network would probe this latest allegation also, it has been reported.

Star British athlete implicated

British publications have given prominent coverage to the news of one of Britain’s “biggest stars” being in the suspect list. According to a report the athlete has threatened to sue Sunday Times if it published the name.
The Lance Armstrong doping story following the sensational, painstaking efforts of the USADA had shocked the sporting world.
The aftermath of the Armstrong doping saga has been such that almost after every stage of the recent Tour de France, doping suspicions were raised _and continue to be raised_about the leader then and eventual winner Chris Froome or anyone else who won a stage or performed beyond expectations. Froome accepted it philosophically.

"Athletics in the same position as cycling"

One of the doctors who examined the blood values in the latest expose, Michael Ashenden was quoted as saying that the files showed the same “diabolical position” as cycling during the Armstrong era. He was critical of the IAAF and so were many others.
The IAAF, which reports said had dropped a planned injunction against the story, was guarded in its immediate response, stating that it would give a detailed reply in due course.

Drastic action needed

Many commentators opined that this was coming all along and athletics was already headed cycling’s way. Cycling seemed to have improved though from last year’s testing statistics, with 220 adverse analytical findings compared to athletics’ 261. In terms of percentages both were the same at one per cent since athletics had more number of samples tested.
Apart from the predictable response from all concerned, athletics fans would be looking forward to some drastic action should even one per cent of the suspect results turn out to be what they have been alleged to be.
Sebastian Coe and Sergey Bubka, presidential candidates in the IAAF elections scheduled  for Aug 19 have both talked tough about doping scandals that threaten to plunge the sport into an all-time ‘low’ in the coming weeks.
 Coe has said he would set up an independent anti-doping agency for athletics. That would be good not only for the top-level athletes but also for lower rung ones like those in India. More out-of-competition testing by the IAAF under its own agency in future would result in better control all over the world, especially in areas notorious for drug abuse.
Doping has been rampant in Indian athletics with the sport once again topping the charts last year with 36 cases reported and sanctioned by the NADA. Two of them were for eight years, one for six years and another for four years. Most others went for two years.
The AFI has repeatedly claimed that most of these dope offenders were “lower rung” athletes or those who were caught in departmental meets. This could be partially true. Also true is NADA has not been able to put together a “whereabouts” list until May this year and even by July it was yet to fully implement the programme.

WADA may need to step in

This is a serious matter and the sooner NADA starts cracking with its registered testing pool (RTP) based testing the better it would be for Indian athletics. The WADA may have to issue warnings to all concerned that ‘whereabouts’ information when sought by an authority that has the right to seek such information should be made available quickly and without fuss. There should be no room for leniency.
The ‘whereabouts’ information is not about where the athletes are training or what is their residential address, as seems to have been mistakenly interpreted by some quarters. It is about an athlete being available for at least one hour a day at a pre-designated place 365 days a year. The information could be filed on a quarterly basis and updated from time to time.
“Whereabouts”-based testing is crucial to any anti-doping exercise, especially in India, since there have been reports about athletes being unavailable in training camps when testers go looking for them.
With reports of some top female 400m runners evading testers from the IAAF at a camp in Thiruvananthapuram last April, there is a need for the IAAF to turn its attention towards lesser-rated countries like India even as it grapples with the escalating number of scandals in international athletics.
The financial constraints regarding EPO testing, as mentioned in a previous piece here, also is of relevance in the wake of the latest expose. The negligible numbers of samples tested for EPO world-wide in 2014 do suggest that endurance athletes are getting away more easily than could have been imagined.

More EPO testing need of the hour

In India there has not been a single case brought forward by NADA on abnormal biological passport values. Mercifully there is no mention of India in the latest figures. ***This may also mean that data related only to top-level middle distance and long distance runners were scrutinised. Last year NADA conducted just 59 tests for EPO and other related substances. More EPO tests are obviously required to catch the middle distance and 'distance cheats' as the latest revelations have confirmed. Can WADA and the rest of the anti-doping authorities afford to test all samples for EPO in future, at least all samples in endurance events?
A feeling has long been gaining ground among commentators, officials and experts, and would get further intensified following the latest revelations, that anti-doping exercise is a waste of time and money.  Millions of dollars are sunk into this task every year by several agencies but invariably some scandal or the other erupts and the feeling persists that the 'big fish' quite often eludes the net.
For those athletes who might yet be believing in competing ‘clean’ and expecting the authorities to catch the dopers, anti-doping measures remain the only hope in what had long been an "unequal contest". A few more revelations like this and even they might just give up, accepting the futility. That will be a tragedy.

Post-script
The IAAF today (Aug 4, 2015) rejected the allegations made by the Sunday Times/ARD report. The full statement can be accessed here.
***PTI reported on Aug 4 that five per cent of 12,000 samples belonged to Indian athletes. The figures looked highly misleading.
On Aug 5, the two Australian scientists, Michael Ashenden and Robin Parisotto, who analysed the blood samples data for Sunday Times and ARD, rebutted the IAAF claims and charges in a detailed response.