PROFESSOR IAN MCGRATH, MR JOHN BREWER, DR BRUCE HAMILTON AND DR ANNA CASEY

25 OCTOBER 2006

  Q120  Chairman: Where is the cross-over between SmithKline's main pharmaceutical research and putting out products there which would have a performance enhancement cross-over into athletics and into your nutritional drinks? Does that occur?

  Mr Brewer: Not to that great an extent to be quite honest. GlaxoSmithKline has, as you know, a major pharmaceutical business; we sit within the nutritional healthcare business in the UK and so we have a very much ring-fenced budget for sports science and sports nutrition research. However, it would be wrong to say that we are not in contact with our colleagues within our pharmaceutical business to look at other areas and other opportunities, but by and large there is quite a distinction between the pharmaceutical research that we conduct within a separate arm of the business and the very focussed sports science and applied sports science research that we conduct through our nutritional business side.

  Q121  Chairman: Do some of your general products which I could take contain substances which would be on the WADA banned list?

  Mr Brewer: Absolutely, categorically not. We have invested a huge sum of money in working with HFL (the WADA accredited laboratory in Newmarket) to have a process in place that enables us to say to the highest possible level that all of our products are free of substances on the WADA banned list. We have spent a lot of time and money in working closely with HFL and with colleagues at UK Sport to raise the bar as high as possible on not just the testing of the products but the whole supply chain from the production of the raw materials through to the production of the products themselves, the testing of the products and then the distribution of those products and the supply chain of those products to the athletes. We believe that it is of absolutely fundamental importance that we can provide athletes across a range of sports with a kite mark and quality assurance that enables them to purchase their sport nutrition products in the full knowledge that those products have been tested to the highest possible standards.

  Q122  Chairman: We have that on record.

  Mr Brewer: Thank you.

  Q123  Adam Afriyie: Are you confident that GlaxoSmithKline have not invested in any organisations or are not doing overseas research for another branch of the organisation which may be influencing the development of human enhancement technologies in sport?

  Mr Brewer: I can only speak on behalf of the nutritional business and I know the research that we fund which is very much focussed on legal, performance enhancing products. Obviously the rest of the pharmaceutical business of GlaxoSmithKline is huge and sits outside my remit and obviously that is done more for medical purposes and I would not want to comment on that.

  Q124  Chairman: Dr Hamilton, if you find the nutritional companies are doing something but there is not a great deal of research coming elsewhere, is there a push from individual athletes or coaches or sports clubs or individual sports for more research?

  Dr Hamilton: There is although in my experience athletes are not so much interested in research but outcomes and they will jump on a product or a technique or a strategy that they will perceive to work on the basis of no research at all. One of the issues that we have is that I am pushed into situations and encouraged to use techniques or procedures which are based on very little evidence. The push does not so much come for research, it comes to the utilising techniques. Sports medicine in this country is a relatively new profession and one of the underdone areas at this stage is access of sports medicines, sports physicians and practising clinicians to research and that is a real limitation to our practice at the moment.

  Q125  Chairman: Professor McGrath, what do you think are the main developments in terms of the illegal human enhancement technology at the moment? Where should we be looking as a Committee?

  Professor McGrath: I think pharmacology will always develop; drugs are continuously developing, they have been for the last fifty years and that will carry on. One of the difficulties is that sports people are interested in outcomes and are very susceptible to snake-oil salesmen. People come along with things that they say will help without any substantial scientific background to explain how that was developed and what the consequences are. I think pharmacology will continue to develop and we will have to try to keep one step ahead of that somehow. There are only three things that drugs can do: they can enhance physiological performance (heart, lungs, muscles, et cetera); they can cheat the brain safety devices and they can accelerate healing. Accelerating healing is probably something that is a good thing. The point of training is to make physiology better and it is a question of whether you are going to harm people by the drugs that you develop to speed that up. Probably the most dangerous things are the things that cheat the safety mechanisms of the brain. The drugs themselves might be difficult to detect and the consequences that they have may be difficult to detect. I think we will have to keep one step ahead of the game. We have not been very good at actually understanding what illegal drugs do. We have been quite quick to make them illegal and say that they might do harm, but we are not actually very good at understanding exactly what they do to the body. My thesis would be that if we understood better what they did to the body we would be one step ahead and we would be looking at the consequences of the drugs rather than having to search for unknown chemicals. It is obviously in the interests of governments and sports people all over the world to do whatever they can to enhance performance and if we want Britain to be winning medals what we have to do is find ways of stopping them using illegal techniques. I think probably finding ourselves ways of enhancing our athletes' performance is not where we should be putting the effort in; we should be putting the effort into making sure that we understand the things that people are doing to their athletes so that we can be one step ahead to stop it.

  Q126  Mr Flello: Dr Hamilton, I would like to return to some of the points you were saying about the challenges and the issues and the overlap there. Can I draw out a little bit more about the main challenges to a medic in the sporting world?

  Dr Hamilton: We have to differentiate between the elite sporting world and the mainstream sports because the pressures and the management of athletes is entirely different. My role is one of both trying to maximise the health and wellbeing of the athletes, allow them to recover from training more quickly, allow them to progress and recover from injuries as rapidly as possible. I am also linked in closely with the science side of the sport trying to maximise the performance. Quite often maximising performance will be in direct conflict with the health and wellbeing of the athlete. We can encourage someone to recover quickly and allow them to do more training, but that training may well be having long-term consequences for them in terms of osteoarthritis, in terms of injuries that may come on post the competitive period that they are interested in. There is a conflict there all the time between my role of trying to enhance the performance and trying to manage their injuries, and that is something we deal with on a day to day basis. There are conflicts in the area of medication use. What is illegal and perceived to be inappropriate to use today may well not be tomorrow and athletes are very quick to jump on that. A relevant example would be pseudoephedrine which was prohibited until a couple of years ago when it was taken off the list because—I am uncertain as to exactly why it was taken off—it was presumably so commonly found in over the counter medications that it was difficult to control its use. It was taken off the list but subsequently it has been shown in a research paper with Birmingham University and Asker Jeukendrup to have performance enhancement capabilities. Athletes will want to use that now and I am in no position to say they cannot use it, so we try to control it from a health perspective. Then the athlete will ask the question, "If I can use that, why can't I use this?" and it is very difficult to argue against that when two substances, methods or techniques or whatever it is will actually have the same risk benefit profile.

  Q127  Mr Flello: What are the methods you can use legally to enhance performance in a competitive environment?

  Dr Hamilton: On the day performance enhancement pseudoephedrine is a product that legally people should be using within health limits. Creatines are another product that have been shown to have some performance enhancing benefits for certain events. We use a number of neuro-muscular stimulation techniques—manual techniques—to try to enhance the performance on the day to keep the muscles activated. Appropriate warm-up, appropriate fluid and appropriate diet are areas which are most commonly neglected and are big players.

  Q128  Mr Flello: Is there a tension on you to short cut some of those basics?

  Dr Hamilton: No. There are always challenges to try to maximise everything, but my personal interaction with athletes is that they will not be challenging me to use illegitimate means; they would want me to push the envelope of legal means. Yes, I will be pushed to maximise it but within legal boundaries.

  Q129  Mr Flello: Dr Casey, you mentioned about trying to wean the troops off hamburgers and certainly through the Armed Forces Parliamentary Scheme there seems to be a fairly staple diet at training camps at Pirbright and Sandhurst and the like. It has been commented that trying to get the troops off smoking would have more of an impact than anything else. Is there any research going on in that particular area in terms of looking at the way troops lead their social lives?

  Dr Casey: We are not doing any research specifically aimed at smoking. I cannot speak on behalf of the Ministry of Defence, but certainly it is my understanding that there is an on-going discussion about smoking. It has been an on-going issue for many years, as you can imagine. A lot of the studies we do with basic recruits do not just cover the physiological side of training; we also do a lot of profiling in terms of their physiological responses to stress and also their coping mechanisms and that type of thing. In terms of the sort of person they are, that is something that is the subject of on-going research. We do not do a lot of social research within our department with these groups of people, but going back to the question of diet, I do not think it is any secret that certainly in the past the diets have had room for improvement but there has been a major overhaul over the last two years in the whole area of military feeding. When I started working with the military I started very much at the high performance end, ergogenic performance enhancement, and I have taken a step back at every stage and we are right back at the beginning now and we are really trying to address the entire issue of military feeding right from the recruit who walks through the door. That is where the big difference would be. I have mentioned that before and I agree with Bruce Hamilton that the biggest difference to your performance whether it is physical performance or cognitive performance, your mood state, how you train, how you recover, all of those things will be governed by what you are eating on a daily basis, not what supplements you are taking and what drugs you are taking or what you can get hold of. It is your daily diet, it is your training—how good is the training, how progressive is it, are you breaking the recruits in too early—all of which has been addressed over the last couple of years. There has been a major overhaul of the whole of military feeding, from your basic recruit right through to servicewomen—concentrating on pregnant women and also on special forces—and that is on-going at the moment.

  Q130  Mr Flello: Is that an area where the military is benefiting from research that has been done over many years in the sports field?

  Dr Casey: Not necessarily the sports field but certainly in the areas of public health and general nutrition.

  Q131  Mr Flello: In terms of the quality of legal research in this country, how does it compare to the international position? Who are the world leaders in this area? How can the UK be the best compared to them?

  Professor McGrath: I think that Britain is up there with the leaders in this area. Maybe Denmark, Sweden, Canada, Britain, the US, Australia, South Africa tend to be the leaders in this area. There is a big potential for making it better. There is better science out there that could be applied to this area if, as I said, there was some driver to make people do it. In the last research assessment exercise of the universities in Britain there were only five groups that had a five star rating. That, in the whole of Britain, is not what you would be driving towards for an area of academic endeavour. Of these five three were very much technologically oriented groups—Loughborough, Manchester Metropolitan, Liverpool John Moores—and only Birmingham and Glasgow were embedded in biomedical science rather than in sport. There is a big potential there. There are a lot of other places in Britain who could be doing this kind of research if there was some driver. You would expect £500,000 of one MRC grant but there just are not the resources going into this area.

  Q132  Mr Flello: Mr Brewer, perhaps I could ask for your perspective on the same area. Obviously an organisation like yours is a multi-national one, so how would you see the comparison of the UK research in that field?

  Mr Brewer: I guess we are in the fortunate position that we can cherry pick where we have our research done and it would be wrong to say that we do not look overseas to see if there are any opportunities there. The fact that four of the five universities that we currently fund are in the UK I think is testimony to the fact that we do rate very highly the quality of the academic research that can be obtained at key centres of excellence in the United Kingdom. Very important for us is working with academics who have the ability to do firstly high quality science but then work with us to translate that science into meaningful claims and meaningful language that we can then use to develop next generation products and to translate to the athletes and the coaches and the sports science and sports medicine support staff the benefits of those products and the benefits—as Dr Casey has said—of the correct nutritional strategy to support the supplementary parts of their diet that give them that extra half of 1%. I think we are very comfortable with the quality of academic research that we can obtain within the United Kingdom. The outputs that we obtain from that are very good, they have helped us to develop products over the years, they have helped us to develop new claims over the years. I think perhaps the classic claim from us from a business perspective is when we funded research at Loughborough University back in the late 1980s where we were able to show that isotonic drinks can improve performance by 33%. That was something that was generally known within the world of sports nutrition but it enabled us to take our products one stage further and to educate the coaches and athletes accordingly. That is very important to us, that delivery of an education message to support the product development which we can only get by working closely with academics.

  Q133  Dr Iddon: Professor McGrath, when you said in your written evidence to the Committee that "much research in sports related topics is not cutting edge and does not have sufficient scientific depth" were you referring only to UK work or were you referring to global work when you said that?

  Professor McGrath: I think it would be a global phenomenon. It is an area where you can produce certain outcomes in terms of physiological studies of athletes quite cheaply, but to achieve any depth to move the thing forward in terms of science it is much more expensive. It is incontrovertible, that where we are moving forward, in areas such as cardiovascular research, cancer research, the quantities of monies involved are many multiples of the kind of money that goes into sports related research. Because the drivers are not there, the science is not being applied there, but the science could be applied. The science of physiology, biochemistry and molecular biology is all there, but where would you get the money to apply it to sport?

  Q134  Dr Iddon: In your written evidence you have said that the whole science base is there, so can you perhaps tell the Committee what Britain needs to do to change this position if we are to be a world leader in our athletics with a view to the 2012 Olympics?

  Professor McGrath: I could say you are too late for the 2012 Olympics, but the fact is that you could do things now if you put significantly more money into the system. I do not know where you would get it, but I would say that, would I not? If you put more money into the area of physiological research you would get some outcome, but I really do think that in terms of understanding the physiology behind these various forms of enhancement, if we did understand that better we would be able to set better limits. One of the difficulties in defining what should be illegal is often that you have achieved something that is way outside the norm, but we are not very good at defining the norm so we get into legal struggles about whether something is 30% more than anybody else would ever have, or is it 300 times. We really do not understand those kinds of things. We are quite good at measuring oxygen consumption and heart rates but we are not very good at the fundamental science that underlies it. What are the genes that are expressed when you take these drugs? Rather than looking for the drugs, we should look at the physiological effects of them. This is all possible; this is not science fiction. If more resources were going into this area we could be one step ahead of the dopers because we would be picking up the things that they are making the body do rather than picking up the things that go into the body.

  Q135  Dr Iddon: With respect, that is all very negative. What we are looking for from our witnesses is to be able to make recommendations to government on the way forward. In an ideal world where do you think the money should be coming from if it were available, and who do you think should be responsible for allocating it?

  Professor McGrath: I think it is quite a good thing to look at the different research councils for different purposes. You could persuade the Medical Research Council to be involved if you saw this as a continuum of improving human performance/health with athletic performance being at one end of that spectrum and illness being at the other end of that spectrum. They would debate it quite strongly with you perhaps. I think the Medical Research Council could be involved there but the Biological Research Council could also be involved in terms of applying the best of modern biology to these sports related and health related issues.

  Q136  Dr Iddon: The BBSRC?

  Professor McGrath: Yes, the BBSRC. I looked at their website in vain for sports and exercise related topics. They actually had an acronym "sport" but it was nothing to do with sport. I do not think you could persuade them to use part of their existing budget to do it. Money would need to come in from outside and it would need to be a substantial amount of money, £20 million or something like that. A project costs half a million pounds and you would probably need to have consortia working on this. You mentioned Britain versus the rest of the world. Any of these projects that we are involved in—whether it is looking at East African runners or some other aspect of physiology—nearly always involve an international consortium of scientists because in order to get enough good groups who are the best in the area you have to work in that way.

  Q137  Dr Iddon: If you were Colin Blakemore tomorrow where would you invest your money in this particular area? In other words, what would be your top three priorities?

  Professor McGrath: My top priority would be looking at the gene expression consequences of some of the enhancement technologies. EPO would be a place to start. What are the gene expression consequences of technologies which enhance the oxygen carrying capacity of the blood. I think that would be one area that I would look at. I would also want to go for a couple of the most common types of drugs that are used illegally and I would try to look at the gene expression consequences of giving these drugs and the physiological consequences. It would not be cheap because there is no point in doing a study with half a dozen people here; you are talking about doing it with different populations: elite athletes, normal plodding athletes, normal members of the public.

  Q138  Chairman: You cannot do it on elite athletes.

  Professor McGrath: You can do it on sub-elite athletes if they are out of competition. That is the way these projects are planned. You cannot do the illegal doping with the elite athletes, but you can do the difference between them being at altitude and not being at altitude, those kinds of things, and you can compare it with other groups who are only a little bit off them in terms of percentage performance. You can do those things; they are ethically possible. However, nobody is doing them because why would you?

  Q139  Dr Iddon: The Australians are doing it; we saw that in Australia and they do not believe that this altitude stuff makes more than half a per cent difference (that is what they told us). Do the other three witnesses before us this morning agree with Professor McGrath's analysis about who should be directing the money and where the priorities lie?

  Dr Casey: Yes. We obviously have a slightly different experience. The Ministry of Defence do not tend to fund research directed at sport so that is not a major issue.