EPO makes its Indian debut

Fifteen years after the International Olympic Committee (IOC) introduced a test for the detection of erythropoietin (EPO) India has opened its account for an anti-doping rule violation for the red-blood-cell boosting drug.

Distance runner Hari Shankar Sharma, who tested positive for EPO at the All-India Police athletics championships at Madhuban, Haryana, in November last year, has been suspended for two years by the National Anti-Doping Disciplinary Panel (NADDP).

That this case, dating back to 28 November, 2014 could be decided only on 5 November, 2015 was due to a combination of reasons.

The New Delhi Dope Testing Laboratory (NDTL), a WADA-accredited laboratory, is shown to have tested the ‘A’ urine sample on 10 March, 2015. But apparently confirmatory evaluation was by then done by another WADA-accredited laboratory in Seibersdorf, Austria and that explained the first delay. The Austrian laboratory is the Athlete Passport Management Unit (APMU) for tests done by the National Anti-Doping Agency (NADA).

Delays

By the time the ‘B’ sample test was done and presence of EPO confirmed it was May. There was a further time lag since the hearing panels had ended their term in February this year and were not reconstituted by the Government till July.  Actually the old panels were re-nominated then and a further reconstitution done only last month. Sharma’s case got delayed in the backlog and was taken up on 20 October.

Sharma did not put up a credible defence, going by the order issued by a panel headed by Mr. Ramnath and including international shooter Moraad Ali Khan and DrL. K. Gupta. The Rajasthan runner who took the gold in the 10,000 metres (30:07.48, ranked 7th in India in 2014) and the silver in the 5000 metres (14:35.38, ranked 12th) at Madhuban, argued that he had undergone treatment for an elbow injury in 2014 and was prescribed some medicines. There was no prescription to back up that claim. He also said he had consumed calcium and vitamin tablets.

Sharma was lucky that his case came under the old Code (2009) and not 2015 since the minimum sanction under the new rules would have been for four years unless unintentional ingestion was established.

What is EPO?

EPO is a hormone produced by the kidneys. An increase in EPO will mean extra red blood cells which in turn will mean supply of more oxygen to the muscles. Artificially it is prepared through recombinant DNA technology. It is used to treat anaemia in the medical field but it also happens to be favourite among endurance athletes for doping purposes. The Tour de France has been notorious for EPO misuse. American Lance Armstrong, stripped of his seven Tour de France titles for doping and banned for life, admitted that he had benefited from the use of EPO.

Just as Armstrong pointed out in the documentary the ‘Armstrong Lie’, EPO detection is difficult since its half life (period during which it could be detected in blood) is around four to five hours. Initially the IOC accepted a method of blood test and urine test to confirm EPO ‘positive’ just in time for the Sydney Olympics. Not many were caught in the initial years.

Subsequently, as science and detection methods evolved, the World Anti Doping Agency (WADA) was able to approve a stand-alone urine test, though it is costly to conduct. Many anti-doping agencies including international federations even now use a combination of blood and urine tests; many use blood tests for screening purposes.

By 2008 the dopers were onto CERA (Continuous Erythropoiesis Receptor Activator), a new form of EPO that was used to help dialysis patients or people with kidney problems.

Biological Passport

Since 2009, WADA has introduced the Athlete Biological Passport (ABP) programme by which an athlete’s blood sample is tested and variables recorded during different stages in order to assess misuse of erythropoiesis stimulating agents (ESA). Suspect cases are followed up for target testing or else brought up as an anti-doping rule violation charge if sufficient evidence is gathered.

The recent uproar over ‘leaked data’ published by German TV ADR in collaboration with the Sunday Times of U. K. related to EPO misuse and blood doping by elite athletes including medal winners in Olympics and World Championships from several countries, Russia topping that list.

The International Association of Athletics Federations (IAAF) is still looking into that issue while a second report by WADA Independent Commission that could be expected to deal with the blood doping allegation among others could be out by December-January.

Recent studies have shown that micro-dosing in EPO is extremely difficult to catch. Athletes can continue to dope and not get detected through micro-dosing, a BBC journalist proved 

The NADA is yet to begin haematological ABP programme though blood samples from India are taken and international agencies could be expected to keep a watch on the data generated over a period of time in order to carry out target testing at least.

NADA has however started steroidal ABP (urine sample) by which an athlete’s steroidal pattern is kept track of. WADA started the ABP (blood) programme in 2009 and the steroidal module in January 2014.

EPO is costly. Its testing is costlier than routine testing of urine samples, making agencies do tests only on a very limited number of samples for the drug. EPO is available in the Indian market. How athletes, cyclists etc could be misusing it in India could be assessed better once the ABP programme is set in motion.

Quite interestingly, a second EPO ‘positive’ reported in India in 2014 also came from the Police championships at Madhuban. It is another distance runner who ran alongside Sharma. His case is expected to be completed soon.

Just because only two athletes have been caught so far in India for EPO should not mean others were not using it. The detection window being small the others might have been lucky to escape.  We should also remember that NADA came into being only in 2009 and the New Delhi laboratory was accredited less than a year earlier. The ‘passport’ as and when introduced should nail many EPO users in future.

Meanwhile, K. M. Rachna, hammer thrower from UP, who stood second in the National Games in Kerala last February, has been suspended for four years by the NADDP. She was one of the 16 to have tested positive at the games. Rachna had tested positive for steroid metenolone.  
(amended 27 Nov 2015)