Is Blood Testing the Next Step in Doping Control?

The ethics of blood testing as an element of doping control in sport.

Researchers/Authors:Alister Browne, Victor Lachance, and Andrew Pipe

Division of Health Care Ethics, The University of British Columbia, Vancouver, British Columbia; and the Canadian Center for Ethics in Sport, Ottawa, Ontario; Division of Cardiac Surgery, University of Ottawa Heart Institute & Department of Family Medicine, The Ottawa Hospital, Ontario, CANADA

Source:Medicine and Science in Sports and Exercise (1999) Vol. 31, No. 4, pp. 497-501

Summary/Discussion:This isn’t exactly a “study” per se. It is a commentary that appeared in the April 99 issue of Medicine and Science in Sports and Exercise. I felt it was relevant to this column because it represents the current state of affairs with respect to blood testing for doping control in sports.

The following is the abstract of the article as it appeared in Med. Sci. Sports Exerc. 31(4): 497-501, 1999.

“Sport authorities continue to confront a variety of perplexing issues as they attempt to address effectively and efficiently the problems posed by doping. The emergence of the phenomena of blood doping and the administration of erythropoietin have added to the challenges faced by doping control authorities. Some sport organizations have introduced blood tests in an attempt to deal with these issues despite the absence of any effective test for the detection of the administration of homologous blood products or erythropoietin. A number of ethical issues are raised by such developments. Even in the presence of an effective test it is suggested that the decision to implement a specific testing approach can be reached by considering the wishes of a hypothetical “Fair Competitor” and an analysis of the costs involved. In this respect the Fair Competitor assumes in the sport community the role that the “reasonable person” occupies in law, permitting an analysis of a proposed course of action. In making any decision regarding the implementation of any test, a Fair Competitor would be guided by considerations of the postulated advantage and incidence of a doping technique, the likelihood of false positive and negative results, the risk of unwanted consequences of a testing process, and a concern that a specific test not accelerate the likelihood of the use of other doping methods. This approach is applied to a consideration of the appropriateness of blood testing in sport. It is concluded, using such an analysis, that in their present state of development, blood tests should not be implemented. It is recognized that certain sport authorities currently use blood tests to exclude competitors whose blood values exceed certain predetermined levels on the grounds of concerns regarding health and safety. Screening of this kind is beyond the purview of this discussion.”

Blood sampling has been conducted by several prominent sporting organizations to date including the International Ski Federation which took samples and performed analysis at the Cross-Country Ski World Championships in 1989 as well as at the Lillehammer Olympics in 1994. The International Olympic Committee did not conduct this testing at the Lillehammer games. The International Amateur Athletic Federation also conducted blood testing at a number of Europian Grand Prix meets in 1993 and 1994. Most all other sporting organizations including the IOC refuse to adopt blood testing for doping control until ethical and legal issues are fully explored.

The authors present several advantages of using blood as the matrix for testing procedures. These advantages are as follows:

• The procedure for collecting a sample is relatively rapid.
• It is a minimal requirement for the detection ofhomologous(infusion of whole blood or blood products from another person) blood doping.
• It provides the best medium for detectingautologousblood doping (i.e. the use of erythropoietin “EPO” or ones own blood that was previously withdrawn and stored).
• Blood may be useful to confirm the presence of exogenous testosterone detected in the athletes urine.
• Blood plasma provides advantages in identifying the presence of certain peptide hormones such as rHGH or rIGF-1.
• There are existing population based reference guides for clinical hematological tests.
• It reduces the possibility of manipulation of samples.

The authors also provided the disadvantages to testing blood in sports:

• It is an invasive procedure requiring trained personnel (i.e. a phlebotomist).
• Blood analysis requires the handling of blood which exposes technicians to blood born viruses making the practice much more hazardous than urine analysis.
• It requires preparation and the refrigerated transport of the sample.
• Reference ranges for various peptide hormones are yet to be established.
• The concentrations of certain compounds, in particular anabolic steroids, are much greater in urine than in blood.
• Autologous blood doping or the administration of EPO or ones own blood, cannot be reliably detected.
• Hematological parameters may be altered by altitude and/or intense training.
• Concentrations of drugs with low molecular weights are lower in blood than in urine by a factor of 100 – 1000.
• There are serious ethical and legal questions still remaining: Blood testing is invasive, and there is a significant potential for the invasion of privacy (e.g., other health problems will be detected, and unauthorized testing may be done for other conditions such as HIV).
• Additional complications arise about blood testing of minors, who make up a sizable portion of competitive athletes.

The authors approach the issue of whether we are ready for blood testing or not from the standpoint of a hypothetical “Fair Competitor”. They propose that this fair competitor would need to consider six issues when weighing the cost and benefit of blood testing. Remember that this is from the viewpoint of someonenotusing any illegal substances.

1. Is the doping strategy used by other competitors all that effective?In other words, are the people winning mostly because they are doping? If the doping strategies being used by other competitors makes it virtually impossible for the “fair competitor” to win, blood testing would be desirable even with the risk of false positives.
2. How rampant is doping in a particular sport?If doping is relatively rare, the risk of getting a false positive would not be worth a fair competitor submitting to blood tests.
3. What is the likelihood of false positives?In and of itself a fair competitor would not care about “why” false positives occur but would be very interested in whether other athletes can use various doping techniques and still pass the tests.
4. What is the likelihood of false positives?As with false negatives, the fair competitor would not care why they occur but would be concerned about the chances of he/she getting a false positive. This would ruin a career inmostsports as well as tag you as one to avoid when it comes to lucrative endorsement contracts.
5. How easily can Unfair Competitors adopt other methods of doping that are effective yet undetectable by current testing technologies. This issue is futile for the Fair Competitor to worry about especially if you are not a drug user or not willing to use other doping techniques.
6. The risk to the Fair Competitor that he/she will suffer unfair or unwanted consequences as a result of participating in the testing process(e.g., the risk of public or semi-public revelation that he/she is a carrier of Hepatitis B or C, HIV, or other communicable disease; the potential for the blood sample to be frozen, stored, and used for other purposes without the express permission of the athlete).

One other issue that comes into play isthe cost of the tests. If the financial cost of the test makes it impossible to be widely practiced, what good is it to the Fair Competitor? How much a sporting organization is willing to invest in an expensive testing procedure depends not only on the cost in dollars, but also on the benefit to the Fair Competitor.

Finally the authors offer three recommendations.

1. They recommend That Blood TestingNotBe Conducted as Part of the Protocols for Doping Control Procedures in Sport.
2. They recommend That A Vigorous Educational Program to Articulate and Inculcate the Advantages or Drug-Free Sport Should Go Forward.
3. They recommend That Scientific Research Designed to Facilitate the Development of Valid, Reliable Methods of Detection of Prohibited Performance-Enhancing Substances and Techniques Should Continue and Be Appropriately Supported.

At this point I am tempted to ramble about the improbability of drug testing policies in other athletic organizations to effect professional bodybuilding. After all, pro-bodybuilding is all about who’s body looks best with heavy sustained use of anabolics. On the other hand, we can’t forget those of you who are not bodybuilders but are competitive athletes. This article has everything to do with you and your fellow competitors. Because of the risks, both to reputation and privacy, it is not only the hypothetical cheater that need worry about the future developments in doping control efforts in organized sports.