The objective of this course is to encourage a critical understanding of doping. To achieve this goal, this course will rely on a multidisciplinary approach that allow you to see how different disciplines get into a single object, in different perspectives and in often complementary ways. This approach will also allow us to appreciate the complexity of a subject like doping. Doping in sports is a complex practice whose definition and identification is the result of socially and historically constructed norms. This course offers to shed light on the processes that led to the use and prohibition of doping substances. Performance enhancement or physical transformation are two aspects of doping which are seen as problematic, yet even as we speak companies are making fortunes selling body improvement and other forms of “human enhancement” to us. These apparent contradictions will be analysed to show that beyond sanitary questions, doping raises many social, scientific and legal issues. In efforts to control doping, governments and sports authorities have put into place institutions responsible for defining what falls into the category of doping, but also what prevention, repressions and research methods to put into effect. This course will also explore biological control measures such as the biological passport, key legal dimensions, organisations that produce performance, as well as the sociological dimensions of doping. Besides the Professors of University of Lausanne, the best experts of doping are involved in this course: experts from an Anti-doping Laboratory (LAD- Lausanne-Switzerland), from the CAS (Court of Arbitration for Sport), from the UEFA (soccer), and from the WADA (World Anti-Doping Agency). Teaser: https://www.youtube.com/watch?v=20Q3eR_g7rU Main Learning Outcomes At the end of the course the participants will be able to : 1. Identify the “cultural” dimension of doping, that is as a historical practice linked to the transformation of social norms, 2. Go from a binary way of thinking - for or against doping - to an understanding of the complexity of this phenomenon which is biological, psychological and sociological, all at the same time, 3. Recognize the institutions, the actors and the practices of the fight against doping, 4. Explain how the social and organisational context influences individuals decisions and how this influence can be reduced by effective prevention measures, 5. Identify how the fight against doping is led and how testing is carried out.
5- Atypical analysis results and the future of the fight against doping
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Do curso por University of Lausanne
Doping : Sports, Organizations and Sciences
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Module 4 - Bioanalytical and forensic approaches to doping
Module four presents bioanalytical and forensic substance detection and analysis methods. It is made up of 4 interviews carried out with doping experts from the Swiss Laboratory for Doping Analysis (LAD) in Lausanne (Switzerland), that will explain: - how bioanalyses are carried out (Norbert Baume, head scientist at the LAD); - how the biological passport works (Neil Robinson, head scientist at the LAD); - forensic approaches to doping (François Marclay, research scientist at the LAD); - atypical analysis results and the evolution of the future of the fight against doping (Martial Saugy, director of the LAD).
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Fabien OhlProfessor of Sociology of Sports / Professeur en Sociologie du Sport
Faculté des Sciences Sociales et Politiques (SSP)
[MUSIC]
Monsieur, before we talk about the atypical analysis results in
the future of tests, can you tell us a little bit about what you do?
And could you introduce yourself?
>> I am a biologist, I trained at Lausanne University.
And I am currently the Director of the Swiss Laboratory for Doping Analyses,
where my work basically involves examining the results.
>> Could you also
tell us a little bit about the Swiss Laboratory for Doping Analyses?
>> Well, the LAD, as it's known, the Swiss Laboratory for Doping Analyses,
is a laboratory that is accredited by the World Anti-Doping Agency.
There are about 30 laboratories all over the world
which carry out this activity and which have this accreditation.
The laboratory was established about 25 years ago as part of,
The Forensic Medicine Institutes, decision taken by the CHUV,
the University Hospital in Lausanne.
It was decided to put it in this area of forensic medicine because
this anti-doping activity was closest to
the toxicological analyses that were carried out as part of forensic medicine.
So this laboratory is accredited by this World Agency, the WADA.
But also by the Swiss Accreditation Service.
So we are ISO-compliant.
And we have to follow international regulations for anti-doping.
These international standards are subject to the World Anti-Doping Code.
These are universal rules that are implemented and
used in all of these accredited laboratories.
And they are often used, in fact, in the discussions in the courts and tribunals.
Well, it was particularly innovative in the sense that it created this
biological passport, yes.
When we arrived on this anti-doping markets, the overwhelming
majority of the laboratories, especially the European ones,
were analytical chemistry laboratories who were looking for
a particular substance, steroids, for example.
We then arrived at the point where EPO's and
growth hormones started being used at the end of the 80's.
These were synthesized.
And this brought us into the vast field of biology.
We moved away from chemistry and we moved into medicine and biology.
And finally, in 96 we had our first
experience with blood sampling from athletes.
We did this because we were in a hospital environment, rather than a chemistry or
pharmaceutical environment.
And these tests, which were carried out in 1996,
along with the UCI, which agreed to start up these blood tests,
those are the tests which led to the passport.
Because by having numerous blood tests and doing this over and
over again, we saw immediately how it would be a good thing to
have a longitudinal approach to the tracking of an athlete.
So, in fact, it is the fact that we are associated with
the Lausanne University Hospital that actually
encouraged us to develop this biological passport.
>> Now about the results of the testing.
How do you deal with these results that are considered to be abnormal?
>> Well the abnormal results that we used to call positives or
positive results are the subject of very elaborates testing in the laboratory.
I think it's important to note that before we actually state that a result
is abnormal, we are going to carry out a number of different checks.
First there is a check which is an analytical confirmation.
In other words, we'll go back to the original sample, which is in cold storage.
And we will redo the test with a number of checks and
tests which will confirm that the substance that has
been detected during the first analysis, was indeed a prohibited substance.
And that we were able to identify it as such.
After this confirmation, then the abnormal result,
in other words the analysis certificate, will be issued, and
will be sent to the anti-doping authority which was defined at the outset.
Then that anti-doping authority is an international federation.
Or it can be a anti-doping agency that has requested
that a sampling be taken, blood or urine, from an athlete, and
which is awaiting the results of the tests for that particular athlete.
This anti-doping authority will then,
Inform the athlete that there is an abnormal result.
>> Well, you don't have the name of the athlete?
It is the authority, I imagine that?
>> Yes, correct.
We only have a number on the samples.
It's an actual number, Which the athlete knows.
And which the anti-doping authority, or body, knows.
And this number is also, generally speaking,
for most of the international federations at any rate, it is then
put into an international database which is known as ADAMS, A-D-A-M-S.
And this makes it possible for the World, Anti-Doping Agency,
the WADA, as it's known, it makes it possible for them to check the results.
So what's important to remember is that this abnormal result,
this positive result, is sent to the World Anti-Doping Agency.
And they are the ones who are overseeing all of these activities
at the world level.
>> Well when you have suspicious cases, to follow up on these cases,
you can deal with this follow-up in the laboratory?
Is that the way it works?
>> Well once again, we have codes.
We receive a urine sample.
We carry out a test on the urine sample.
And if the result is not abnormal,
But suspicious, in other words it is atypical.
That information is also passed on to the anti-doping authority.
They can carry out the matching function.
In other words, they are going to be able to link it with other Numbers, other
checks or tests that were carried out on the same athletes and all of the athletes
who are being followed by these anti-doping authorities have an ID number.
Identification number which is supplied to us, provided to us so
that we can carry out this follow up function.
This is the work of what we call the APMU,
which is our office that deals with the passport or
the follow up, tracking in other words of the athletes.
So on the basis of the identification number of the athlete they are going to be
able to look at the biological variables
which all of a sudden might be suspicious for a particular athletes.
Well when you have athletes who have TUEs,
the Therapeutic Use Exemptions which have been issued by a medical doctor.
Are you able to integrate this into your analysis, into your test?
Well, the information is not integrated in the analyses.
Is themselves, the analyses are carried out in a blind fashion.
We know the sports in question, but
the issue of the TUE only will come into the picture if you will after the results.
There are TUEs of these therapeutic use exemptions for
specific substances such as cortical steroids or
anti asthmatics, and it is often in those cases.
We also have the case of Ritalin, I should add,
which is something that is under discussion as well, but
basically the anti-doping authority will provide us with the information about
a TUE after an abnormal result on those specific substances that I mentioned.
Corticosteroids, anti-asthmatics, possibly Ritalin.
So the analysis is carried out in a blind fashion with respect to the TUEs.
And subsequently, there is a check
to ensure that that the presence of these substances in their biological fluids.
Well this means that you have to re-analyze or re-test?
Well yes, we do have to carry out another test in cases where there isn't a TUE.
In other words, we're going to receive the information
which tells us that this particular corticosteroid present
in the urine sample is attributable to the therapeutic use.
And there, the entire anti-doping agency asked us not to confirm
the presence of this substance, but it does happen in about half of the time
57 of the time that the therapeutic use is not in the proper window of
use when compared with the result that we have been able to detect.
And in that case, both the WADA and the anti-doping authority
asks us to check whether the Implementation of this TUE,
this exemption has been carried out in a normal framework.
Well, once you have the results,
does it happen often that people contest the results?
Who is going to carry out a counter-test?
Well, as I said earlier, the result is sent both to the athlete and
to the athlete's federation in general.
Now the results are contested almost automatically.
In other words, the first thing that happens is that the athlete is asked to
explain the situation and the athlete will almost automatically say no,
this was within the general framework of a TUE.
I never actually or perhaps I never actually took this substance.
And the athlete will ask that sample B be analyzed or tested.
Now sample B arrives at the same time as sample A in the laboratory.
And it is frozen immediately,
because sometimes it is necessary to have a counter analysis.
So the athlete who is contesting the result as we said very often will ask that
test be done on sample B,
which is actually a second independent expert analysis.
It's not systematically in the same laboratory
that's one of the very important rules from the very outset of
the anti-doping fight if you will because we have sample B.
Because it is possible for the athletes to return and
attend the present when there is this counter analysis.
He can come with a lawyer, legal advice and perhaps a scientific expert
who can come in other words he can chose his own experts?
Yes and he checks your procedure in other words they are going to check
the procedure in general before second experiences,
we have to provide all of the documentation.
There is a specific procedure which we call the providing or
producing the package of documentation that in fact confirms our results and
shows the way in which the sample was tracked and followed.
The way it was tested in the laboratory which led to a positive result.
This documentation is provided to the athlete's expert.
It is reviewed, it is examined by the expert and
by their legal counsels before sample B is analyzed.
Now during the analysis or test of sample B, the expert and the athletes in general
we do not allow the lawyers to be present during the entire analytical procedure.
Also for safety reasons and
because the procedure has to be carried out without any interruptions or problems,
the expert is going to check the procedure in vivo and in C2.
In other words they can put questions about all of the elements
of the counter analysis or second expert assessment and
they once again, let's say, for example, we come up with the same result.
In other words, in the counter analysis,
we confirm the positive result which was obtained when sample A was tested.
Well, in that case, we're going to have to produce an analytical file,
very comprehensive, which will be examined by the lawyers and the athletes expert.
But does it happen very often that in sample B you have a difference?
In other words, you find traces of something in sample A,
it would be difficult to imagine that in sample b there are no traces.
Is that what is being contested or is it the procedure itself which
is more often contested or challenged?
Well, it's extremely rare that this happens,
that there is a significant difference.
There may be a difference if on sample A we were
very close to the limits of the quantification powers or ability,
or detection ability of the system.
The laboratory is asked not to put itself within those limitations so
that we don't run into any trouble during the second independence expert analysis.
But in general the challenge is about the procedure.
In other words the chain of custody before the laboratory and within the laboratory.
And it can be challenged on the basis of certain
elements that might be found in the documentation.
In other words, the Follow up documentation of the sample afterwards.
In general do people take it all the way to the Court of Arbitration For Sport?
>> Well, I think it's important to know that most of the tests
are done on very high level athletes.
And these high level athletes, in general, are very professional.
They have contracts.
They have sponsors.
And they owe it to themselves to look good.
And, well, there is some sort
of interaction with communication bodies of the federation, or of the country.
Some countries sent experts to support their athletes
because they were very prominent persons in the country.
And, indeed, very often there is a challenge that goes
all the way to the court of arbitration for sport.
Now, before, the court of arbitration for sports, there is a disciplinary
commission which is something which is internal to a federation or
a national agency, which sometimes can lead to a conflict of interest.
This is why fairly systematically, in fact.
It goes to the CAS, the Court Arbitration for Sport.
We're talking about strong substances, not light substances.
Light substances are specific substances such as cannabis, for example.
Such light substances do not wind up at
the Court of Arbitration for Sport but EPO growth hormones.
Strong substances almost automatically will
go all the way to the Court of Arbitration for Sport.
>> Now, some people might challenge
the results by saying they are false positives.
Does this happen?
Are there false positives in other words?
>> Well, it depends on the substances we're talking about.
It's important to know that for some substances, it is actually fairly complex,
fairly complicated to arrive at a result which is absolutely 100% certain.
We're talking about a very special scientific area.
This is where in biology sometimes there are exceptions and
we should acknowledge this.
However, we're familiar with those exceptions and, in fact,
we're always working in a general area where we exclude metabolic exceptions.
In other words, we put ourselves in a situation
whereby when we produce an abnormal result, and
when we transmitted to the disciplinary body,
we're quite certain we've excluded these metabolic exceptions.
>> Now, we know that there are new substances,
new ways of distribution of these substances.
Things are moving and changing, what is the future of this, the anti-doping?
>> Well, to talk about the future of anti-doping
is to talk about the future of doping, actually.
Now, the future of doping, well, it is true that we are already in
a situation where there are a number of
changes that have occurred in the population of cheaters, if you will.
Our methods are increasingly sophisticated to be sure.
And have, I think, responded fairly swiftly
to the increased sophistication of doping.
This sophistication is especially attributable to the use of
microdoses cocktails or combinations of increasingly specific substances.
In other words, substances that are going to have a very specific
effect on the metabolism of the athlete, in order to make it possible for
them to increase their performance.
And especially, their ability to recover from efforts between the competitions.
But the substances that are used are used differently from
the way they were used in the beginning, a few years back.
They're used in cocktail form, there is fine-tuning.
Let me just take an example.
They might choose a testosterone cocktail, taken as a microdose,
a patch along with EPO, which will also be taken in small doses.
>> Is that what is known as fine-tuning?
>> Yes, fine tuning indeed, that's what we call it.
We know that this is used.
And then some athletes, in fact, have admitted this.
And when we observe, there is specific research.
We can look at the forms, for example, working in the field.
And we know that these are the techniques that are being used.
>> Now, whether it's better in terms of ethics or health, that's questionable.
>> Well, in terms of the health of an athlete, we have to say that it is better.
These professional athletes, in fact,
this is something that they've understood recently.
It is no use for them at all to ruin their health as was done in the 80s.
In the 80s they were taking massive doses of steroids, for example.
In the 80s and the 90s, massive doses of EPOs
to put themselves in situations that were absolutely exceptional for
the human body that were taking risks, and they were burned out fairly quickly.
Now, we are in an area where fine-tuning is the watch word.
And this makes it possible for them to not ruin their health.
And from an ethical point of view, or regulatory point of view, they are doping,
definitely.
So in other words, they're preserving their health.
Yes, compared to earlier times,
it is certain that they're preserving the health.
But it's very difficult to know what the future of the health of these athletes
will look like because they're playing around.
They're manipulating hormones.
And for some of them,
taking these in certain quantities over the long term has a toxic effect.
But there are effects that we do not know if they're reversible or
not on their hormone systems, in general.
So of course, in the future, fine-tuning is a part of it but
we also talk a lot about genetic-doping rather gene-doping.
A gene-doping can take on several different forms.
There's talk about introducing genes.
And those genes will turn the human body into a hormone
factory if you will, a mini-factory.
In other words, a gene that will simulate the production of EPO,
or endogenous steroids, such as testosterone.
But there are intermediate methods we're, in fact, introducing which involves
introducing molecules that have been perfected by the pharmaceutical industry,
which has a very targeted affect on enzyme systems, for example.
Systems in the metabolism which also allow for fine-tuning.
And we think that the future of doping, and
the future of the anti-doping fight will be to go and find.
These are not large proteins.
These are very small vectors, if you will.
That are used in different ways that are administered differently.
They can be injections, they can be taken orally or through patches and
these vectors will have an effect on the metabolism.
And will make the human body produce the hormones,
which are necessary to stimulate performance.
Now, in terms of strategy now, if we just look at this for a minute.
Is it sufficient, or is the approach more longitudinal over time?
Yes, the approach is more longitudinal.
Currently we know that there is a biological passport that has been,
that is being used that allow for this sort of tracking.
But this biological passport is just at its beginning stages.
The idea is to have mapping of the athlete.
It's the same type of research that we do in medicine,
carry out in medicine for the health of people.
We have to have a general mapping of the status of the state of the athletes,
of the individual in order to know whether there is a variability or a variation
on certain parameters that will indicate that there's an illness for example.
Or that there is some sort of manipulation that is going on such as doping.
Now, this will have to be over time, longitudinal.
The goal is to have numerous
parameters that we can then find, look for in this biological cascade.
We have to have many parameters so
that we don't have to take dozens of samples every year.
We're also thinking of the athletes, in fact,
especially the clean athletes who have to undergo all of these tests
in spite of the fact that they are not taking any illegal substances.
The goal of the fight is to respect the clean athletes and
not be too intrusive in their lives as athletes.
And to try at the same time to be able to catch with the maximum number of
indications those who are manipulating,
those who are playing around with the biology.
Well, a lot is being said currently about a multidisciplinary approach.
Is this something that can be seen concretely in the work of a laboratory?
Well, it's actually starting to happen.
The multidisciplinary strategy or approach basically
involves observing non analytical facts about an athlete.
We're talking about the environment of the athlete.
We're talking about the doping networks,
which an athlete might be linked to.
Basically, it is the anti-doping authorities who will be collecting all of
these data.
And who will be able of course by discussing these matters with these
scientists who are looking or tracking the biological aspects of
an athlete that their going to be able to do this in an intelligent way.
I think it's important to acknowledge that it is still currently
a laboratory that gives indications that there is manipulation
to be able to have a better anti-doping strategy.
But increasingly these factors, these can involve the performance, for example.
If there's an abnormal performance peak compared to the training of an athlete,
for example.
But it could also be forensic in nature.
In other words, the fact that there is a link to a network of doping substances.
I saw this recently when I discussed this with professional
leagues in the United States on this subject.
It's something that works extremely well in the context of intelligence testing.
They've already set up this network and it has been possible already.
For them to carry out tests on athletes
which in the laboratory actually led to abnormal tests.
Because there was a specific request for a specific test.
Which was linked up to a doping network very close to the athlete.
Now if you have an athlete who increases his performance,
progresses extremely swiftly, would there be a link for example between a trainer?
Who might be in touch with a laboratory or something of that nature?
Well, the laboratory in this case, in general we have
barriers in place in terms of the activity of the laboratory.
We have a code of ethics which is extremely vigorous on this score.
And it will only refer to an anti-doping
authority which has been very well established and identified and so on.
We can discuss these problems with the anti-doping authority, but
it is quite clear I think, that we will never be able to accept having
information from a coach, from an athlete.
We will always ask these individuals to approach
the disciplinary authority of the federation or
the world anti-doping agency.
Which are very happy to receive this information and
who then can carry out appropriate tests.
Now what about the future?
The future in terms of the tests or forensic approach, analyses, and so on.
Will all of this have an effect on the re-analysis?
And we're talking about IOCs and so on.
Well, re-analysis is a subject that a lot is being said about it.
It is extremely interesting.
Indeed, there is an improvement in the analytic technologies.
But there is also improvement, progress in the way in
which one targets the proper testing.
And it is true that in the major events the control paradigm or
strategy for the major events.
Up until now I think we have not been extremely intelligent.
We took the mentalist and we had some random samplings systematically but
this did not actually allow us to target the proper substances,
the right substances, the right athletes to be tested.
Now in the re-analysis concept, we're discussing this with the IOC for
example or the major athletic events.
We're going to introduce these elements to go and
test a number of the urine samples or
blood samples that have been stored over the long term.
And to test them for doping substances or
methods that are extremely specific, extremely targeted.
And linking this up with research that has been done prior to this.
Well, thank you.
[MUSIC]
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