WADA ... Olympics ...

[Michael Scally MD]

Zachar G, Deshmukh NIK, Petroczi A, et al. Inhibitory Effects of Diclofenac on Steroid Glucuronidation In Vivo Do Not Affect Hair-Based Doping Tests for Stanozolol. Molecules 2017;22(6). Inhibitory Effects of Diclofenac on Steroid Glucuronidation In Vivo Do Not Affect Hair-Based Doping Tests for Stanozolol

In vitro studies show that diclofenac inhibits enzymatic steroid glucuronidation.

This study was designed to investigate the influence of diclofenac on the excretion of stanozolol and 3'-hydroxystanozolol via analyses in hair, blood and urine in vivo in a rat study.

Brown Norway rats were administered with stanozolol (weeks 1-3) and diclofenac (weeks 1-6). Weekly assessment of steroid levels in hair was complemented with spot urine and serum tests.

Levels of both stanozolol and 3'-hydroxystanozolol steadily increased in hair during stanozolol treatment and decreased post-treatment, but remained readily detectable for 6 weeks. In contrast, compared to control rats, diclofenac significantly reduced urinary excretion of 3'-hydroxystanozolol which was undetectable in most samples.

This is the first report of diclofenac altering steroid metabolism in vivo, detrimentally affecting detection in urine, but not in hair, which holds considerable advantages over urinalysis for anti-doping tests.

 

[Millard]

Zachar G, Deshmukh NIK, Petroczi A, et al. Inhibitory Effects of Diclofenac on Steroid Glucuronidation In Vivo Do Not Affect Hair-Based Doping Tests for Stanozolol. Molecules 2017;22(6). Inhibitory Effects of Diclofenac on Steroid Glucuronidation In Vivo Do Not Affect Hair-Based Doping Tests for Stanozolol

NSAID diclofenac as a masking agent? Why did researchers think to investigate this? Yet another trick athletes have been using to avoid detection?

 

[Michael Scally MD]

Anawalt BD. Detection of anabolic androgenic steroid use by elite athletes and by members of the general public. Mol Cell Endocrinol. http://www.sciencedirect.com/science/article/pii/S0303720717305129

Because national and international sports competitions are sources of community pride and financial revenue, there have been great efforts to prevent and detect the use of performance-enhancing drugs such as anabolic androgenic steroids by elite athletes. The World Anti-Doping Agency and its national affiliate anti-doping agencies have created sophisticated monitoring systems and advanced testing techniques to detect the use of banned substances including anabolic androgenic steroids by participants in international and national athletic competitions.

The creation of a longitudinal monitoring program known as the biological passport is a recent, important development in the efforts to prevent and detect the use of banned performance-enhancing drugs and methods. The biological passport program consists of the measurement of urinary and blood markers of anabolic androgenic steroid use (and other banned drugs or methods) at baseline and at random times. A panel of experts reviews the longitudinal data and interprets the likelihood of the use of banned drugs and methods. These advances in anti-doping appear to be highly effective, but some athletes persist in their efforts to cheat the detection process.

In addition, some members of the general public use anabolic androgenic steroids for a variety of reasons including to improve physical appearance or to enhance performance in athletics. Clinicians must depend on clinical acumen and the measurement of serum testosterone and gonadotropins to guide them in making a tentative diagnosis of anabolic androgenic steroid use. Definitive diagnosis requires that the patient disclose the use of the drugs.

Because anabolic androgenic steroids are effective for improving certain aspects of physical performance, some elite athletes (and members of the general public) will continue to use these drugs. Effective efforts to curtail the use of AAS will require decreasing the ease of access to them, continued advancements in laboratory techniques, further research into their effects, and effective education of the general public about the known and potential adverse health effects.

Most importantly, there will need to be a shift from the current societal adulation for athletic performance and muscular appearance.

 

[ergomaniac]

Anawalt BD. Detection of anabolic androgenic steroid use by elite athletes and by members of the general public. Mol Cell Endocrinol. http://www.sciencedirect.com/science/article/pii/S0303720717305129


Most importantly, there will need to be a shift from the current societal adulation for athletic performance and muscular appearance.

"MOST IMPORTANTLY, there will need to be a shift from the current societal adulation for athletic performance and muscular appearance."

am I reading that right?
we need to stop admiring athletic performance and aesthetic muscular appeal to combat anti-doping.

that would make anti-dopers more useless than they already are.

 

[Michael Scally MD]

Annual Banned-Substance Review-Analytical Approaches in Human Sports Drug Testing

A number of high profile revelations concerning anti-doping rule violations over the past 12 months has outlined the importance of tackling prevailing challenges and reducing the limitations of the current anti-doping system.

At this time, the necessity to enhance, expand and improve analytical test methods in response to the substances outlined in the World Anti-Doping Agency's (WADA) Prohibited List represents an increasingly crucial task for modern sports drug testing programs.

The ability to improve analytical testing methods often relies on the expedient application of novel information regarding superior target analytes for sports drug testing assays, drug elimination profiles, alternative test matrices, together with recent advances in instrumental developments.

This annual banned-substance review evaluates literature published between October 2016 and September 2017 offering an in-depth evaluation of developments in these arenas and their potential application to substances reported in WADA's 2017 Prohibited List.

Thevis M, Kuuranne T, Geyer H. Annual banned-substance review-analytical approaches in human sports drug testing. Drug Testing and Analysis. Annual banned‐substance review‐analytical approaches in human sports drug testing‐

 

[Michael Scally MD]

Kotronoulas A, Gomez-Gómez À, Fabregat A, et al. Evaluation of markers out of the steroid profile for the screening of testosterone misuse. Part I: transdermal administration. Drug Testing and Analysis. Evaluation of markers out of the steroid profile for the screening of testosterone misuse. Part I: transdermal administration

Although the introduction by WADA of the steroid module of the athlete biological passport (ABP) marked an important step forward in the screening of testosterone (T) misuse, it still remains one of the most difficult challenges in doping control analysis. The urinary determination of alternative markers has been recently reported as a promising tool for improving the screening of T oral administration. However, their evaluation for other, commonly used, administration routes is still required.

The main goal of this study is the evaluation of the potential of two groups of metabolites (cysteinyl conjugated and glucuronoconjugated) after transdermal and intramuscular administration of T. Their suitability was evaluated in individuals with both low basal (L-T/E) and medium basal (M-T/E) values of T/E.

In this Part I, we evaluated the urinary excretion profile of these two groups of T metabolites after the administration of three doses of T gel to 12 volunteers (six L-T/E and six M-T/E) for three consecutive days. For this purpose, nine different concentration ratios (five cysteinyl conjugated and four glucuronoconjugated markers) were studied. Both, the intra-individual variability and the detection windows (DW) obtained by each ratio were evaluated.

Cysteinyl conjugates showed a general low intra-individual variability and DWs that were shorter than any other tested marker. Despite the relatively large intra-individual variability, the DWs reached by glucuronoconjugates (2-3 days) were similar to those obtained by markers currently included in the ABP.

Overall; this evaluation advises for the introduction of additional glucuronoconjugated markers in the screening of transdermal T administration.

 

[Michael Scally MD]

Sensitivity of Doping Biomarkers After Administration of a Single Dose Testosterone Gel

Micro-doping with testosterone (T) is challenging to detect with the current doping tests. Today, the methods available to detect T are longitudinally monitoring of urine biomarkers in the Athlete Biological Passport (ABP) and measuring the isotopic composition of excreted biomarkers to distinguish the origin of the molecule.

In this study, we investigated the detectability of a single dose of 100 mg T gel in 8 healthy male subjects. We also studied which biomarkers were most sensitive to T gel administration, including blood biomarkers.

The ABP successfully detected T gel administration in all 8 subjects. The most sensitive ratio was 5αAdiol/E, however, also T/E and 5αAdiol/5βAdiol showed atypical findings. IRMS was performed on 5 subjects and only two met all the criteria for a positive test according to the rules set by WADA. The other three showed inconclusive results.

Other markers that were affected by T gel administration, not used for this detection today, were serum dihydrotestosterone (DHT) and T as well as reticulocyte count and percentage in whole blood. miRNA-122 was not significantly affected by the single T dose.

A single dose of 100 mg T gel is possible to detect with today's doping tests. Since a single dose of T gel has an impact on some hematological biomarkers, access to both modules of the ABP when evaluating the athletes' profiles will increase the possibility to detect micro-doses of T. In addition, serum DHT and T may be a useful addition to the future endocrine module of the biological passport.

Mullen J, Börjesson A, Hopcraft O, et al. Sensitivity of doping biomarkers after administration of a single dose testosterone gel. Drug Test Anal. 2017. http://onlinelibrary.wiley.com/doi/10.1002/dta.2341/abstract

 

[Michael Scally MD]

Why Do Endocrine Profiles In Elite Athletes Differ Between Sports?

Background: Endocrine profiles have been measured on blood samples obtained immediately post-competition from 693 elite athletes from 15 Olympic Sports competing at National or International level; four were subsequently excluded leaving 689 for the current analysis.

Methods: Body composition was measured by bioimpedance in a sub-set of 234 (146 men and 88 women) and from these data a regression model was constructed that enabled ‘estimated’ lean body mass and fat mass to be calculated on all athletes. One way ANOVA was used to assess the differences in body composition and endocrine profiles between the sports and binary logistical regression to ascertain the characteristic of a given sport compared to the others.

Results: The results confirmed many suppositions such as basketball players being tall, weightlifters short and cross-country skiers light.

The hormone profiles were more surprising with remarkably low testosterone and free T3 (tri-iodothyronine) in male powerlifters and high oestradiol, SHBG (sex hormone binding globulin) and prolactin in male track and field athletes.

Low testosterone concentrations were seen 25.4% of male elite competitors in 12 of the 15 sports and high testosterone concentrations in 4.8% of female elite athletes in 3 of the 8 sports tested.

Interpretation of the results is more difficult; some of the differences between sports are at least partially due to differences in age of the athletes but the apparent differences between sports remain significant after adjusting for age.

The prevalence of ‘hyperandrogenism’ (as defined by the IAAF (International Association of Athletics Federations) and IOC (International Olympic Committee)) amongst this cohort of 231 elite female athletes was the highest so far recorded and the very high prevalence of ‘hypoandrogenism’ in elite male athletes a new finding.

Conclusions: It is unclear whether the differences in hormone profiles between sports is a reason why they become elite athletes in that sport or is a consequence of the arduous processes involved. For components of body composition we know that most have a major genetic component and this may well be true for endocrine profiles.

Sonksen P, Holt RIG, Boehning W, et al. (2017) Why do endocrine profiles in elite athletes differ between sports? Clinical Diabetes and Endocrinology (In Press). Why do endocrine profiles in elite athletes differ between sports? - ePrints Soton

 

[Michael Scally MD]

Evaluation of Markers Out of The Steroid Profile for The Screening of Testosterone Misuse. Part II: Intramuscular Administration

In the fight against doping, the introduction of alternative markers to the steroid profile can be considered as an effective approach to improve the screening capabilities for the detection of testosterone (T) misuse.

The aim of this study was to evaluate the potential of several T metabolites (cysteinyl conjugated and glucuronoconjugated resistant to enzymatic hydrolysis) to detect both the transdermal and the intramuscular administration of T.

In a first part of the study, we studied the potential of these metabolites for the detection of T transdermal administration. Results revealed that resistant glucuronides can be a suitable complement to the current steroid profile.

In this Part II, dedicated to the intramuscular administration, we studied the potential of cysteinyl conjugated, resistant glucuronoconjugated and 1-cyclopentenoylglycine (1-CPG) for the detection of a single intramuscular injection of T cypionate. Possible differences in the excretion profile of all markers were explored between individuals with low basal (n=6) and medium basal (n=6) values of the testosterone/epitestosterone ratio (T/E).

The results showed that all tested markers presented low intra-individual stability in basal conditions. Despite this, all glucuronoconjugated markers and 1-CPG, but not the cysteinyl conjugated markers, provided detection windows that were similar or longer than those obtained by markers currently included in the steroid profile.

Based on the results obtained from the two parts of this study and from previously reported data, the potential applicability and the limitations of including these markers in the steroid profile are discussed.

Kotronoulas A, Gomez-Gomez A, Fabregat A, et al. Evaluation of markers out of the steroid profile for the screening of testosterone misuse. Part II: intramuscular administration. Drug Test Anal. http://onlinelibrary.wiley.com/doi/10.1002/dta.2342/abstract

 

[Michael Scally MD]

Polet M, De Wilde L, Van Renterghem P, Van Gansbeke W, Van Eenoo P. Potential of saliva steroid profiling for the detection of endogenous steroid abuse: Reference thresholds for oral fluid steroid concentrations and ratios. Analytica chimica acta 2018;999:1-12. http://www.sciencedirect.com/science/article/pii/S0003267017312783

Highlights
· A method for oral fluid doping controls is proposed.
· Reference thresholds for saliva steroid profile parameters are presented.
· Steroid profile ratios are superior for longitudinal monitoring.
· Saliva outperforms urine for detecting a transdermal testosterone administration.
· Isotope ratio mass spectrometry is no longer required for confirmation.

Urine and blood samples are the primary matrices for the detection of exogenous substances in doping control and toxicology. Although these matrices are, in general, very suitable for a wide range of substances, they do show some issues in particular cases. Here, alternative matrices may provide an answer.

In this work, a quantitative method for steroid profiling (5 endogenous steroids and their ratios) in oral fluid was developed and validated. In total, 826 saliva samples were analyzed, and inter-individual reference population thresholds for saliva steroid profile parameters were set up. Alterations of this steroid profile after administration of naturally occurring anabolic androgenic steroids (e.g. testosterone (T) or dehydroepiandrosterone (DHEA)) were investigated. In addition, intra-individual short and long-term natural fluctuations were investigated. For longitudinal monitoring in oral fluid, steroid profile ratios (e.g., T/DHEA) were superior to absolute concentrations due to lower susceptibility towards the diurnal pattern.

For the detection of a transdermal application of T, the salivary parameter T/DHEA proved to have the highest sensitivity. In contrast with the current screening procedures in urine, there is no need for an additional expensive and time-consuming isotope ratio mass spectrometry confirmation procedure to unequivocally attribute the elevated parameter to an exogenous origin.

 

[Michael Scally MD]

Devriendt T, Chokoshvili D, Favaretto M, Borry P. Do Athletes Have a Right to Access Data in Their Athlete's Biological Passport? Drug Testing and Analysis. http://dx.doi.org/10.1002/dta.2380

The Athlete's Biological Passport (ABP) refers to the collection of data related to an individual athlete. The ABP contains the Haematological Module and the Steroidal Module, which are used for the longitudinal monitoring of variables in blood and urine respectively. Based on changes in these variables, a statistical model detects outliers which indicate doping use and guide further targeted testing of the athlete.

Presently, athletes can access their data of the Haematological Module in ADAMS. However, granting athletes access to this data has been a matter of debate within the anti-doping community. This paper aims to investigate whether an athlete has a right to access the contents of their ABP profile.

We approached this discussion by comparing the nature of ABP data with that of forensic and medical data, and touched upon important concerns with ABP data disclosure to athletes such as: potentially allowing for the development of alternative doping techniques to circumvent detection; and making athletes vulnerable to pressure by the media to publicly release their data.

Furthermore, given that ABP data may contain medically relevant information that can be used to diagnose disease, athletes may over-interpret its medical significance and wrongly see it as a free health check.

We argue that safeguarding the integrity of the ABP system must be seen as the most essential element and thus a departure from immediate data disclosure is necessary. Two different strategies for delayed data disclosure are proposed which diminish the chances that ABP data is misused to refine doping techniques.

 

[Michael Scally MD]

The Effect of Athletes` Hyperhydration On the Urinary ‘Steroid Profile' Markers in Doping Control Analysis

The urinary ‘steroid profile' in doping control analysis is a powerful tool aiming to detect intra‐individual deviations related to the abuse of endogenous steroids. Factors altering the ‘steroid profile' include among others the excessive fluid intake leading to low endogenous steroids concentrations compared to an individual`s normal values. Cases report the use of hyperhydration by athletes as a masking method during anti‐doping urine sample collection.

Seven healthy physically active non‐smoking Caucasian males were examined for a 72‐h period using water and a commercial sports drink as hyperhydration agents (20 mL/kg body weight). Urine samples were collected and analyzed according to WADA technical documents.

Although, significant differences were observed on the endogenous steroid concentrations under the studied hyperhydration conditions, specific gravity adjustment based on a reference value of 1.020 can eliminate the dilution induced effect.

Adjustment methods based on creatinine and urinary flow rate were also examined, however, specific gravity was the optimum method in terms of effectiveness to adjust concentrations close to the baseline ‘steroid profile” and practicability.

No significant effect on the urinary steroid ratios was observed with variability values within 30% of the mean for the majority of data. Furthermore, no masking on the detection ability of endogenous steroids was observed due to hyperhydration.

It can be concluded that any deviation on the endogenous steroid concentrations due to excessive fluid intake can be compensated by the specific gravity adjustment and therefore, hyperhydration is not effective as a masking method on the detection of the abuse of endogenous steroids.

Athanasiadou I, Kraiem S, Al‐Sowaidi S, et al. The effect of athletes` hyperhydration on the urinary ‘steroid profile' markers in doping control analysis. Drug Testing and Analysis 2018. https://doi.org/10.1002/dta.2403

 

[Michael Scally MD]

Pielke R. Assessing Doping Prevalence is Possible. So What Are We Waiting For? Sports Medicine 2018;48:207-9. https://doi.org/10.1007/s40279-017-0792-1

How many? This is one of the most important questions to ask and answer in any policy-making setting. How many immigrants live in the UK [1]? How many people have polio [2]? How many Bluefin tuna are caught each year [3]?

Effective management or regulation in any policy setting would not be possible without an ability to answer such questions. “How many?” is easy to ask, but in many cases, it can be fiendishly difficult to answer. Often, empirical research using multiple methods are necessary to determine a useful answer, and even then estimates can be clouded by uncertainties and areas of fundamental ignorance.

The question of how many? is just as important to answer in the context of anti-doping (prohibitions against the taking of certain banned substances) in elite sport [4]. Fortunately, the accurate quantification of the number of athletes who dope presents no more complicated a methodological challenge than counting British immigrants, those afflicted with polio, or the number of fish in the sea. In fact, it’s probably much easier to answer.

However, for reasons both scientific and political, it has proven difficult to develop robust estimates of the number of elite athletes who take banned performance-enhancing substances. In a 2015 review, De Hon et al. [5] observed, “Remarkably, few scientific articles have addressed this subject so far, and the last review dates to 1997. As a consequence, the true prevalence of doping in elite sports is unknown.” There are of course understandable reasons for sports organizations to wish to remain ignorant about the prevalence of doping. As a World Anti-Doping Agency (WADA) Working Group concluded in 2012, “There is no general appetite to undertake the effort and expense of a successful effort to deliver doping-free sport” [6].

In their review, De Hon et al. [5] recommended the use of a survey technique called the “randomized response technique” (RRT), which allows the athlete to maintain both anonymity of his/her identity and his/her answer. Lensvelt-Mulders et al. [7] concluded that “using randomized response questions in surveys on sensitive topics significantly improves the data quality of the surveys. Currently available research has not demonstrated the superiority of any data collection method to RRT.” Despite almost a half-century of the use of RRT methods to elicit data on sensitive topics, until now there has been only one study to apply RRT to doping prevalence [8], which found that 20–39% of German Olympic-level athletes admitted to using banned substances in the previous year.

The publication by Ulrich et al. [9] in this journal, presents a second empirical study of doping prevalence using RRT. This is a very important paper for at least three reasons:

• First, it offers addition empirical evidence on the prevalence of doping in elite sport.
• Second, the journey that the paper took from initial commissioning to publication illustrates the challenges of conflicts that sport organizations face in anti-doping.
• And third, the paper provides a clear proof-of-concept for the implementation of an evidence-based approach to documenting the prevalence of doping in elite sport.

Let’s briefly consider each in turn.

 

[Michael Scally MD]

The Confession Dilemma: Doping, Lying, and Narrative Identity

Despite the commonly held view that confessing to doping is morally right, few former elite athletes who have doped confess to doping.

In this paper, I ask whether elite athletes who have doped are morally obliged to confess. I start by observing that the core of the elite athlete’s confession dilemma is located in the dichotomy between lying and veracity.

I argue that lying about doping belongs to a particular kind of lying that, in turn, brings about a particular kind of consequence. More specifically, I consider lying about doping in light of an athlete’s personal narrative identity.

Initially, the narrative identity view seems to strongly support an elite athlete’s moral obligation to confess (i.e. to start telling the truth about who they really are). However, viewing narrative identity not merely as description (responding to the question, Who am I?) but also prescription (responding to the question, Who should I be?) complicates this picture.

The prescriptive perspective of narrative identity is a gateway to understand the significant negative consequences of confessing to doping. In this way, I call into question commonly held views about the moral obligation to confess.

Sandvik MR. The Confession Dilemma: Doping, Lying, and Narrative Identity. Sport, Ethics and Philosophy 2018:1-14. https://doi.org/10.1080/17511321.2018.1465113

 

[Michael Scally MD]

Hopker J, Schumacher YO, Fedoruk M, et al. Athlete Performance Monitoring in Anti-Doping. Frontiers in Physiology 2018;9:232. https://www.frontiersin.org/article/10.3389/fphys.2018.00232

The use of information technology within sport has significantly increased over recent years. These data and information have the potential to make a significant impact on sporting performance, and the nature of its related sciences too.

For example, the retrospective analysis of sporting performance data affords the possibility to identify the impact of various technological advances and rule changes on world record performances in sports such as, javelin throwing (+95% over 76 years), pole vault (+86% in 94 years), and 1-h track cycling (+221% in 111 years; Haake, 2009).

Similarly, such types of longitudinal data analysis may also be useful from an anti-doping perspective. In this regard, it has previously been shown that yearly world best performances increase with the emergence of new potent doping agents, such as anabolic steroids or EPO (Schumacher and Pottgiesser, 2009).

Conversely, when new anti-doping tests are implemented, overall world best performances decrease as the effects of certain performance enhancing drugs become detectable, and are therefore avoided by athletes (Schumacher and Pottgiesser, 2009). These findings raise the possibility that performance monitoring can be useful for anti-doping efforts.

As the aim of any doping regime is to improve sporting performance, it has been suggested performance data, in the form of an Athlete Performance Module (APM), may be useful in strengthening the sensitivity and applicability of the current Athlete Biological Passport (ABP) in the fight against doping in sports (Schumacher and Pottgiesser, 2009).

However, there is a general view that performance biometrics alone are not sufficient evidence to establish doping, and as such, cannot demonstrate the use of a prohibited substance in accordance with the World Anti-Doping Code (Article 2.2).

Even though sudden increases in performance can be caused by reasons other than doping (e.g., improved training or nutritional strategies), such observations may nevertheless provide worthwhile information in order to trigger targeted anti-doping tests of specific athletes (Iljukov et al., 2018).

In addition, whilst not sufficient to convict an athlete for doping, an atypical individual performance profile may also be useful as corroborative evidence in, for example, an ABP case. However, to date, the use of performance data for anti-doping purposes by National Anti-Doping Organizations (NADOs) and International Federations (IFs) remains low.

…

 

[Michael Scally MD]

Drug‐drug interaction and doping: Effect of non‐prohibited drugs on the urinary excretion profile of methandienone.

The potential consequences of drug‐drug interactions on the excretion profile of the anabolic androgenic steroid methandienone (17β‐hydroxy‐17α‐methylandrosta‐1,4‐dien‐3‐one) are discussed here. More specifically, we have evaluated by in vitro and in vivo experiments the effects of seven non‐prohibited drugs (fluconazole, ketoconazole, itraconazole, miconazole, fluoxetine, paroxetine and nefazodone) on the main metabolic pathways of methandienone. These are selected among those most commonly used by the athletes.

The in vitro assays were based on the use of human liver microsomes, specific recombinant enzyme isoforms of cytochrome P450 and uridine 5’‐diphospho‐glucuronosyl‐transferase. The in vivo study was performed by analyzing urines collected after the oral administration of methandienone with and without the co‐administration of ketoconazole.

Methandienone and its metabolites were determined by liquid chromatography‐mass spectrometry‐based techniques after sample pre‐treatment including an enzymatic hydrolysis step (performed only for the investigation on phase II metabolism) and liquid/liquid extraction with t‐butyl methyl‐ether.

The results from the in vitro experiments showed that the formation of the hydroxylated and dehydrogenated metabolites was significantly reduced in the presence of itraconazole, ketoconazole, miconazole and nefazodone, whereas the production of the 18‐nor‐hydroxylated metabolites and glucuronidation reactions was reduced significantly only in the presence of ketoconazole and miconazole.

The analysis of the post‐administration samples confirmed the in vitro observations, validating the hypothesis that drug‐drug interaction may cause significant alterations in the metabolic profile of banned drugs, making their detection during doping control tests more challenging.

Mazzarino M, Khevenhüller‐Metsch Franziska L, Fiacco I, Parr Maria K, Torre X, Botrè F. Drug‐drug interaction and doping: Effect of non‐prohibited drugs on the urinary excretion profile of methandienone. Drug Testing and Analysis 2018. https://doi.org/10.1002/dta.2406

 

[Michael Scally MD]

Athanasiadou I, Kraiem S, Al‐Sowaidi S, et al. The effect of athletes` hyperhydration on the urinary ‘steroid profile' markers in doping control analysis. Drug Testing and Analysis 2018;0. https://doi.org/10.1002/dta.2403

The urinary ‘steroid profile’ in doping control analysis is a powerful tool aimed at detecting intra‐individual deviations related to the abuse of endogenous steroids. Factors altering the steroid profile include, among others, the excessive fluid intake leading to low endogenous steroids concentrations compared to an individual's normal values. Cases report the use of hyperhydration by athletes as a masking method during anti‐doping urine sample collection.

Seven healthy physically active non‐smoking Caucasian males were examined for a 72‐hour period using water and a commercial sports drink as hyperhydration agents (20 mL/kg body weight). Urine samples were collected and analyzed according to World Anti‐Doping Agency (WADA) technical documents. Although, significant differences were observed on the endogenous steroid concentrations under the studied hyperhydration conditions, specific gravity adjustment based on a reference value of 1.020 can eliminate the dilution induced effect.

Adjustment methods based on creatinine and urinary flow rate were also examined; however, specific gravity was the optimum method in terms of effectiveness to adjust concentrations close to the baseline steroid profile and practicability. No significant effect on the urinary steroid ratios was observed with variability values within 30% of the mean for the majority of data.

Furthermore, no masking on the detection ability of endogenous steroids was observed due to hyperhydration. It can be concluded that any deviation on the endogenous steroid concentrations due to excessive fluid intake can be compensated by the specific gravity adjustment and therefore, hyperhydration is not effective as a masking method on the detection of the abuse of endogenous steroids.

 

[Michael Scally MD]

 

[Michael Scally MD]

Negotiating Privacy. Athletes’ Assessment and Knowledge of the ADAMS

Elite athletes must comply with a complex system of controls in order to participate in international sports and competitions. The Anti-Doping Analysis Management System (ADAMS) is one of the control devices that subject athletes to a regime of control and surveillance.

Anti-doping organisations (ADOs) and national and international sports federations, for example, make use of their whereabouts data for test planning and decision-making regarding test routines. Athletes’ participation is mandatory, otherwise they cannot take part in competitive sports. This, in return, means that they agree to have their privacy and that of others compromised.

Thus, a tension exists between the fight against doping and the integrity of privacy. Through a qualitative study on doping, controls and control practices we have learned that athletes view ADAMS as a necessary nuisance, but we do not know what they actually know about the system.

We conducted a survey among German elite athletes (summer and fall 2016) to further explore the usage routines of ADAMS, the athletes’ knowledge of the tool and their assessment of possible privacy infringements. A total of 523 German athletes registered in the Registered Testing Pool and National Testing Pool (N = 2,152) of the National Anti-Doping Agency of Germany, who provided us with a representative sample, took part.

We found from the survey that athletes have rather contradictory views concerning ADAMS, and often little knowledge of the system as such and would (or know how to) engage in playing the system to avoid controls. Athletes generally voice strong feelings about privacy, while simultaneously accepting ADAMS despite the concerns raised. However, they want more transparency regarding the system and the fight against doping.

We conclude our analysis with a discussion of ADAMS as a surveillance system that, by storing, processing and using data for the purpose of anti-doping measures, engages in social sorting among athletes and creates what we call spillover effects and apparent power asymmetries that have been established throughout the system.

We argue for a new balance within the system of controls, in which athletes are to be treated as actors, i.e. equal stakeholders who take part in decision-making regarding the system, rather than simply users and clients of a control interface. It seems that ADAMS threatens athletes’ privacy and that of their social environment rather than guaranteeing fairness for them.

Scharf M, Zurawski N, Ruthenberg T. Negotiating privacy. Athletes’ assessment and knowledge of the ADAMS. Performance Enhancement & Health 2018. Negotiating privacy. Athletes’ assessment and knowledge of the ADAMS - ScienceDirect

 

[Michael Scally MD]

There are many problems with anti-doping. That should be obvious to anyone with even a passing interest in what happens beyond the field of play in the world of sports policy, politics, governance, and athlete experience. With changes in the World Anti-Doping Agency’s (WADA) leadership due to coincide with the 2021 World Anti-Doping Code (WADC) review and revision, now is the time for new ideas.

We would like to propose a new model for anti-doping, and we invite comments from readers of The Sports Integrity Initiative (see link at bottom of page). We would use this feedback to make a detailed submission to the WADC consultation phase, and to garner support beyond WADA.

The need for change - The main problems we address are related to the ‘pillars’ of anti-doping:

Education
There is a currently a lack of consistent education across age groups, levels of competition, and sports. Paradoxically, athletes are forced to comply with the Code, but there is no compulsion on any organisation to ensure understanding of the Code and all the Anti-Doping Rule Violations, much less the full details of the Prohibited List.

Testing
There is currently insufficient testing – it is ineffective, and it is expensive. The one-size-fits-all model means that amateurs are tested for the same substances as professionals, cognitive sports are treated the same as endurance sports. Some sports and countries test more than others. This clearly needs a more nuanced and adaptable strategy.

Sanctions
Athletes who test positive are mostly given a four year (non-specified substance) or two year (specified substance) ban. This does not take any of the following contexts into account: age, knowledge and awareness, the role of trusted persons, the time the drug was taken and the amount, the potential impact on performance.

Athletes can appeal if it was potentially an inadvertent route of ingestion, but need evidence (which is often hard to obtain), and need to appeal to a National Anti-Doping Organisation (NADO) tribunal and then to the Court of Arbitration for Sport (CAS), both of which adjudicate simply on whether the Code has been applied properly. Arbitration can be time-consuming, expensive, and emotionally draining. As it on a case-by-case basis, outcomes can be inconsistent. Even if exonerated, athletes are left with the stigma of the accusation.

The challenge, therefore, is to build a new system where these problems can be solved, or least recognised and improved. Our solution requires a much greater input from international sports federations: they need to decide what is best for their sport. They also need to protect their athletes.

...