WADA’s Grey Areas

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I wrote a blog recently entitled ‘Bumping Up To The Rules’, in it I really only covered blood spinning. The WADA code has several ‘grey areas’ which we can look at in a little more detail.

People don’t really like reading WADA documents unless they really have to (not even the Worlds top female sports person), they’re not exactly exciting. There’s probably only a small percentage of club cyclists who take any interest whatsoever in it, for obvious reasons. While these documents look like just an ordinary list at first glance, looking more closely, they provide some useful insights into the world of anti-doping, what’s currently detectable, what WADA know about & can’t detect, and what they know may be going on but can do little or nothing about. This blog will perhaps explain where there are some major issues & knowledge gaps, which could be (and are) exploited. It’s very rare for the testers to be one step ahead of the dopers, it’s mostly a game of catch-up for the enforcers, unfortunately that’s how it works without reliable, extensive & prohibitively expensive worldwide sporting intelligence.

You can view the WADA prohibited list via this link.

“More Human Than Human”

The whole chemical side of doping may be old news at the top end of some sports in the near future. One of the most frightening issues that WADA will encounter is the advancement of gene doping (listed in section M3 of the list). Renee Ann Shirley (a former chief of Jamaican anti-doping organisations & now an anti doping crusader) brought my attention to an interview with Patrick Arnold (the inventor of designer drug THG, it’s a long interview at 2.5hrs, gets really interesting in last half hour after he’s talked about his past which sounds very ‘Breaking Bad’). He states that there’s a strong possibility the Chinese might have experimented with gene therapy in the 1990s to engineer human embryos (from approx 2h 15m onwards). He says that those superhumans would now be starting to come through into competition. If this is true, the WADA list is going to be obsolete very soon in some areas of the sport & the real issues are going to be way beyond what we currently consider cheating.

It perhaps sounds more like fantasy from sci-fi films like Blade Runner (incidentally set in 2019), where the slogan of the company creating replicants was “More human than human”, the idea being that they were removing the imperfections & creating a better, stronger & smarter species. The developments that have been made in this field are well documented & this Nature article from 2012 lists some genetic anomalies that have been identified & could be utilised, such as a mutation that makes EPO receptors more efficient & the ability to determine the amount of fast & slow twitch muscles fibre. There’s some really important & legitimate uses for gene therapy in medical science, such as eradicating some genetic diseases. As we know from sports history, some legitimate methods find their way into sports to aid performance.

Further reading:

The Grey Areas

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By ‘grey areas’, I’m highlighting areas of the code where cheating could be possible, but it’s either undetectable or there’s not sufficient research to show if a drug or method is performance enhancing. These drugs & methods may be banned in the future, in the mean-time they may be looked at as ways to legally exploit the rules, or use substances in an almost undetectable manner.

The very first section (S0) of the list covers all drugs that could provide performance enhancement, but are unknown to the testers. This covers substances for which there had been no tests developed, such as THG from the Balco affair. A designer drug that athletes like Dwayne Chambers was using, not on the list at the time, but unless a sample had been leaked to the authorities the drug would not have been detected.

“NON-APPROVED SUBSTANCES

Any pharmacological substance which is not addressed by any of the subsequent sections of the List and with no current approval by any governmental regulatory health authority for human therapeutic use (e.g. drugs under pre-clinical or clinical development or discontinued, designer drugs, substances approved only for veterinary use) is prohibited at all times.”

In Section S2, under ‘PEPTIDE HORMONES, GROWTH FACTORS, S2 RELATED SUBSTANCES AND MIMETICS’, we find some familiar substances from the previous blog, which may have raised levels caused by procedures such as blood spinning. Namely growth factors bFGF, IGF-1 & VEGF which can enhance athletic performance. These effects have been found to have elevated levels due to the effect of blood spinning, so if further research proves that be conclusive, we may see further action on blood spinning. I again state, anybody using this procedure is working within the current rules, ethical issues could be raised if they are aware that the procedure raises the levels of banned substances, but it won’t lead to any bans.

“Additional prohibited growth factors:

Fibroblast Growth Factors (FGFs);
Hepatocyte Growth Factor (HGF);
Insulin-like Growth Factor-1 (IGF-1) and its analogues; Mechano Growth Factors (MGFs);
Platelet-Derived Growth Factor (PDGF); Vascular-Endothelial Growth Factor (VEGF)”

 In section M1, we start to get into the possibility of blood manipulation & blood substitutes being used. If athletes are on the biologicial passport program, these may be identified, however if athletes are operating below the level where that kicks in, it’s unlikely that we would see any sanctions. Take Jonathan Tiernan-Locke as an examplehe performed at World Tour level before he was in the World Tour and subject to the full blood passport. There was a sample taken in September of 2012, presumably as he was selected for the Worlds to ride for GB, which didn’t match up to his samples once on Team Sky & under the full biological passport system. This could suggest that riders or athletes looking to step up a level can boost their performance while under the radar & just outside the biological passport system, in the hope of securing a contract in the next rung of their sport. It’s an incredibly expensive, but effective method for catching people, perhaps some more target testing of riders outperforming their previous results could be employed, again, it requires additional funding in a time of worldwide austerity, so it may not happen in the near future.

Legal Highs

Alongside the sections WADA uses to cover their backs, and rule out unknown drugs & methods, or drugs & methods that have no valid test, we can also see that an athlete could theoretically have a performance advantage but work within the WADA code. It’s up to you how you see that. There are limits on certain substances for very good reasons, some may be naturally occurring to a certain level, where the limit is set at a point that excludes natural occurrence. Others are for legitimate treatment of medical conditions that would otherwise reduce an athlete’s ability to compete on a level playing field.

In Section S3 of the WADA list relating to Beta-2 Agonists, we start to see allowable levels appear. To give an idea of what it would take to break the rule for Salbutamol, WADA allow 1600 micrograms over 24 hours (which then relates to a salbutamol concentration of 1000ng/mL in a urine test) . A normal dose from an inhaler is listed as 100 micrograms, so you’d need 16 puffs over 24 hours to break this rule. For those with asthma, you’ve probably been in the position to take that quantity at some point during a bad asthma attack, although I’m very sure that you’d not be in a position to even consider riding your bike, let along race, it would probably be a struggle getting to the shops. Studies show that 400 micrograms of inhaled salbutamol don’t have any performance enhancing effects on non-asthmatics, although levels above 800 micrograms may have an effect on those without asthma. So the allowable level looks about right, although it may give a performance benefit to those looking to increase the concentration of certain substances in their blood, without reaching the level required to break a rule. Even though I’m asthmatic, this does make me think that making a TUE required for Salbutamol may be the position WADA should use in the future to avoid some abuse. Diego Ulissi was banned for 9 months for testing approximately double the blood concentration allowed in the 2014 Giro d’Italia, claiming that he had taken only 2 puffs, which seems unlikely.

In that section we also see another asthma treatment, Formoterol having a limit of 54 micrograms over 24 hours, where one puff of an inhaler contains 12 micrograms. Theoretically, an athlete could take 15 puffs of a salbutamol inhaler, 4 puffs of a fomoterol inhaler & not break any rules, irrespective of whether they have been diagnosed with asthma as there’s to TUE required. This should give a performance improvement in the case of salbutamol, so far reports on formoterol are inconclusive, so you could assume illegitimate performance gains are small, if any.

Section S6 covers stimulants, there are limits on several of these, which also opens up the possibility of abuse. We have a number that are part of the 2016 monitoring program, as meldonium was in 2015 & subsequently banned. These are bupropion, caffeine, nicotine, phenylephrine, phenylpropanolamine, pipradrol, and synephrine, you may be cutting down on your espresso in 2017. The stimulants that have limits are cathine (5 micrograms per ml of urine), ephedrine and methylephedrine (10 micrograms/ml) & pseudoephedrine (150 micrograms/ml).

You could assume that if you had a good doctor & lots of analysis of what levels you excrete in your urine, you could take up the limit of each stimulant listed above & 15 puffs of a salbutamol inhaler & you’d not be cheating. These are the rules, they have to be placed somewhere, so moving the limits is simply going to change the level people may choose to bump up to the rules. We’re always going to have this problem.

The Gist Of It

We have two differing perceptions of cheating existing alongside each other. In one, the rules of the sport are blatantly broken, banned substances & methods are used to improve performance, with the reward far outweighing the risk of getting caught. As we have seen in recent information from Scottish football, only 8 tests were carried out in 9 months & not one of them was out of competition. The SFA’s policy is not to test out of competition, which is where we know that huge gains can be made. In this scenario there’s virtually no chance of getting caught doping, the only surprise here is that the players are not performing at a higher level, it seems like a free-for-all, why wouldn’t some cheat?

The other perception of cheating exists within the fans & observers of sport, where no rules have been broken but ethical questions may quite legitimately be asked. We can also add therapeutic use exemptions to this area of perception, I’m sure the vast majority are absolutely genuine, I’m also sure there’s an element of bending the rules to allow use of substances that provide a performance advantage without having the condition that leads to the treatment. By the measure we’re basing cheating on (the WADA rules), which are agreed by all nations & the athletes sign up to, there’s no cheating going on in these circumstances. You yourself, if you have a racing licence have signed up to the WADA rules (although you may not have read them up to now, you ticked the box), you’ve also agreed to out of competition testing, which I know does happen in cycling, as I’ve had one myself, in Scotland. Nobody has signed up to ethical standards, this would be irrelevant anyway, so the rules placed by WADA are the guidelines we have to work to, morals are up to individuals.

Rules & ethics are very different things, the WADA list attempts to define ethics based on a set of rules, as do almost all sets of rules in society. Currently that’s the best way we have of attempting to deal with doping in sport, as more research becomes available this list will continue to grow, and the people determined to cheat will use that list as a means of outperforming others. The vast majority are going to avoid the substances & methods listed by WADA, so in those cases its doing it’s job, the problem isn’t caused by a poor set of rules, it’s caused by human nature.

I’m on twitter @spokedoke

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