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

25 OCTOBER 2006

  Q180  Chairman: Sorry, I thought you were arguing for WADA to do that.

  Mr Brewer: No, not necessarily. We would say that we would do it in conjunction with UK Sport or, as I say, led by the industry.

  Q181  Chairman: You would want those tested through WADA approved laboratories?

  Mr Brewer: We would like WADA to retain their accreditation of the laboratories to allow them to test manufacturers' supplements. As I said, it would be a retrograde step to take that away. As a general point, if we think that our athletes across sports are under pressure at the moment, in the build-up to 2012 those pressures are going to be immense. We will come out of 2008 with the Chinese host nation I am sure doing extremely well, so the pressures on our athletes to perform—as we are already seeing today—will be immense as we get to 2009, 2010 and beyond. I think anything that we can do to give them that quality assurance to enable them to enhance their performance will be beneficial.

  Q182  Dr Turner: There is obviously agreement that something needs to be done to avoid the situation, whether by ignorance or by contamination through the manufacturing process of the vitamin supplements, where athletes get into trouble. Anecdotally I think most of the cases that I have read about of athletes getting into trouble have been through this route. We agree we need a process to quality assure these products. Who should take responsibility for it and who is doing something about it? You have all agreed that it is highly desirable but nobody has said that So-and-So should do this.

  Professor McGrath: The EU and the US drug administration have been struggling for years with what is a drug, what is vitamin and what is a food supplement. It is an extremely difficult topic to define what should be in what category. WADA then makes its mind up and puts things in one bin or another. It is an extremely difficult area to operate in. Her Majesty's Government is about to allow homeopathic medicines to be sold as if they did anything. If we are in a world where that happens legislatively—and I hope you are all going to oppose this—we are in a very difficult labelling situation here where all sorts of nonsense can get put on labels by governments, so how on earth are we going to separate these nutritional supplements from drugs? I think it is very difficult.

  Mr Brewer: I think there is also the issue that we have to make sure before we accredit a product and say that it has been tested that it actually works and does what it says on the label. That is why working with good quality scientists is crucial to ensure that we are producing products that will enhance performance. The issue that we have is that in improving performance, if we move away from endurance sports, quite often the magnitude of improvement that you will see from any form of nutritional supplement is less than 1%. In order to prove that statistically to a level that then enables papers to be published to say that these products work is often very, very difficult to do. To give an example, you may have 10 subjects in the study. If six or seven of those subjects improve but three or four them do not improve, that may not allow you to have the level of statistical significance that would enable a paper to be peer reviewed and published.

  Q183  Dr Turner: In practice, you already have half a mechanism; you have a WADA list of banned substances, all you need is a mechanism for ensuring that where products are sold they do not contain any WADA list banned substances and they can be demonstrated and accredited that they do not. However, no-one seems to have any idea as to how or who should take responsibility for doing that. Clearly that would resolve a lot of the problems that happen.

  Mr Brewer: There are colleagues from UK Sport here and others in the industry with whom we work very closely to put that process in place and a lot of work has gone on to ensure that the bar is raised as high as possible and there is a recognised standard for having that labelling put on products. What we would argue is that there should be a standard label and that the bar should be as high as possible.

  Q184  Dr Turner: I just want someone to say who is actually going to take responsibility for putting this in place.

  Dr Casey: It will probably rest at least initially with UK Sport, I would suggest. The problem you would have with this approach is that it would favour the larger companies that can afford to do this. This is a very expensive process and that might be one of the sticking points because smaller companies that produce nutritional supplements may simply not be able to afford to assure the provenance of their products right from the production of raw materials. There are many issues surrounding this but I would suggest that if you wanted a starting point then potentially UK Sport would be that starting point.

  Q185  Dr Turner: Who wants to speculate about what the next challenges in the detection of illegal enhancements are going to be? Is it going to be growth hormones or what? Where are the next big challenges coming from?

  Dr Hamilton: The challenges are everywhere. My personal belief would be that every component of the WADA code will be challenged over the next 10 to fifteen years because all of those areas will be areas where people are looking for enhancement. The challenges for us are developing tests for detection of substances that currently cannot be detected. Growth hormones and derivatives are classic. Those areas are extremely difficult scientifically to confirm or otherwise and then to develop a test that is appropriate is extremely difficult. That is just the stuff we know about at the moment. I am sure, as we were talking a moment ago, there are areas of development going into substances in the same areas of androgenic anabolics and of stimulants that will be being produced with the sole purpose of enhancing performance. WADA are very much trying to think ahead and to put their caps on as if they were the cheats and to think in those directions, but it is a very time consuming and very expensive procedure. I think all of the areas of the WADA code have challenges.

  Q186  Dr Turner: There is the moral and philosophical debate that needs to be heard about what methods of enhancing human performance are acceptable and which are unacceptable and should be illegal. How much serious debate on this is going on through the different sports controlling bodies?

  Dr Hamilton: There is a lot of debate going on. If you take an example—and you can argue whether it is appropriate for WADA to be doing this or not—WADA were recently looking into the use of artificial hypoxic chambers (artificially induced hypoxia) as a training aid and whether that should be on the prohibited list or not. Their findings were that they found that it was performance enhancing; they were not sure whether it was dangerous or not but they felt that it required further research as to whether it was dangerous and that it was against the spirit of sport. That was a long, drawn out process where they asked for submissions from all of their clients world-wide and there was a great deal of input. Essentially they decided that it met two out of three of the criteria which would enable it to be put on the list. At some point behind closed doors it was not put on the list so here is something which WADA have said meets their criteria but for undisclosed reasons has not been put on the list. We would agree with not putting it on the list but there is no transparency in whether it was a commercial interest that stopped them putting it on the list or whether it was the practicalities that stopped them putting it on the list. The sort of moral and scientific high ground that WADA have claimed—and they have claimed that ground—is challenged a little bit by the process which lacks a little bit of transparency.

  Q187  Dr Turner: That sounds rather worrying. Are there any more examples of that?

  Dr Hamilton: I can give you an example close to my heart whereby beta agonist—the salbutamol puffer that you will use for you asthma—the majority of the evidence is that it is not performance enhancing; there is very little clinical risk to someone using low dose inhaled beta agonist. The spirit of sport argument is somewhat weakened. If something is against the rules of a sport it is going to be against the spirit of sport, so while something is on the prohibited list it is very difficult for it not to be against the spirit of sport. For example pseudoephedrine would not be against the spirit of sport now because it is not on the banned list. The point being that because it is on the banned list the majority of people would come in and say that it is against the spirit of sport to use inhaled beta agonist; it is a self-fulfilling prophecy, if you like. That is an example whereby it does not meet the criteria—it is not performance enhancing, it is not dangerous, so it does not meet two out of three criteria—but it continues to be on the list. Not only does it continue to be on the list, but there are very strict criteria required in order to actually use it for legitimate purposes.

  Q188  Dr Turner: Are you saying by inference then that if salbutamol was taken off the banned list there would be a dramatic reduction in the number of asthmatic cyclists?

  Dr Hamilton: We are comfortable that the numbers of people using salbutamol in sport are appropriately using it, so I do not think it would change anything now.

  Q189  Chairman: It is very difficult to explain why there are so many cyclists with asthma.

  Dr Hamilton: The proportion of athletes with asthma corresponds to the proportion of the country with asthma. The highest incidence of asthma in athletes is found in those countries with the highest incidence of asthma in their general population.

  Professor McGrath: There is not enough attention paid to what these drugs actually do. If WADA says that a substance probably causes harm but they do not actually know what it does, then maybe there needs to be more research. It all points to understanding these things better. If you understand what they do you can combat them better both through knowledge of what it will do to the body so that you can pick it up even if the drug is undetectable, and to find "what harm does it do?". We have not heard any discussion—we could probably discuss it all day—about what a beta agonist does to the body. That happens to be very close to my own very specialist interest that you really do not want to start me talking about. We know very little about what it would do to the athlete that would cause any harm. It may be that by doing not all that much research you could find that out, but currently nobody knows. If it is a legitimate for other purposes you really need to know why it would be harmful, not just that it enhances performance.

  Chairman: The whole issue of the ethical question that Des raised is very, very pertinent. If you have hypoxic chambers which are legal, why should you not be using an EPO drug to have the same effect which is readily or cheaply available? I think there are very big questions which hopefully we will try to address as we go through this inquiry.

  Q190  Margaret Moran: Bruce, you have made it very clear that you think that the WADA prohibited list has some significant flaws in it. Do you think that there are particular substances—you mentioned one there—that you would like to see added or removed?

  Dr Hamilton: The WADA prohibited list is a huge step forward from where we were prior to 2000 so it is a good thing in general. They are in the process of flux all the time so any comment I may make may well be something they are looking at changing in the future anyway. For example, they have taken pseudoephedrine off which, in some ways, was entirely appropriate but in other ways challenges the whole process. They have taken caffeine off; again the same principles apply. In some ways it has been trimmed but the problem is that while the categories may have been trimmed the number of substances within that category will expand. For example 10 years ago there might have been four or five stimulants listed, now there is a massive list of stimulants on there and it is very difficult to say that any particular one of those may or may not be performance enhancing or dangerous to use so it is hard to make a comment on those. The inhaled beta agonist is an area that for all sports physicians working in elite sport, is the single biggest factor that causes us concerns and anxieties within the list in terms of a failed drug test for legitimate use. That causes us a great deal of concern. The other area which is, in my opinion, weak in the WADA code is the use of glucocorticoids. Glucocorticoids, for example a corticoid steroid injection for a joint inflammation, have definitely been abused in different sports in the past. The majority, however, are used for quite benign conditions. To give examples of the inconsistencies, you can use a glucocorticoid nasally—so you can use a nasal spray glucocorticoid—without requiring a therapeutic use exemptionary notification at all, but if you use exactly the same substance but inhale it through your mouth you are required to fill in the paperwork. If you are shown to have taken it through your mouth and test positive for it—which is, I admit, extremely unlikely—you can actually end up with a sanction. Those are subtle things and for a physician working with a team of perhaps eighty athletes, half of which he may not have come across before, trying to sort out all those things on all those athletes can be quite stressful. Also, the paperwork associated with it actually takes you away from the role you are trying to do so instead of doing educational talks or whatever you end up doing just paperwork on substances that are really quite irrelevant. It does not really matter if someone is using inhaled beta agonist because it does not work anyway; it is not very dangerous for them. All of my time leading up to the Commonwealth Games for example was spent filling out paperwork for inhaled beta agonists.

  Q191  Margaret Moran: Here UK Sport both tests and prosecutes for doping offences; the Australian system is very different. Which do you think is better?

  Dr Hamilton: I think it is difficult to have your educational supporting body being your prosecuting body. UK Athletics has exactly the same problem. Our anti-doping department will one day be the person who is ringing you up to make sure everything is okay and that you have filled out all the paper work and everything is good; the next day they will be shutting all the doors up and letting you know that you are under a sanction. It is extremely difficult.

  Q192  Chairman: You would support separating the two functions.

  Dr Hamilton: Absolutely.

  Q193  Dr Iddon: A number of people have been critical about the way we tackle this doping problem, particularly blood doping. We have received some evidence, for example, from Michelle Verroken of Sporting Integrity. She believes there is an over-reliance on urine testing rather than more reliance on blood testing. She reckons that if we are serious about detecting the use of growth hormones and EPOs we really ought to concentrate on blood testing rather than urine testing. Would you agree with that, Dr Hamilton?

  Dr Hamilton: I am not certain of the science behind that statement. In principle there was a debate some time ago about the ethics behind blood testing and I think in general most athletes are supportive of it so the ethical argument has been put aside. The real question is, is there an appropriate test? There is no point in taking blood if we do not have an appropriate test. If there is an appropriate test developed for the substance we are looking for then I would support the use of more blood. However, if, for example, you could get just as good a test from saliva then I would equally support saliva.

  Professor McGrath: There is an awful lot more in blood than there is in either saliva or urine and sometimes even if you do not know what you are testing for if you have that in the deep freeze you can test later. I think there is a big case for what has been referred to as the athlete's passport where you have a profile of the blood samples over a period of time. In a sense what is important is if there is big spike in something that changes rather than what the base line levels are. I think if you wanted to get really serious about how to tackle these types of problems it would be to monitor the athletes, keep samples from the athletes throughout their career at regular intervals, particularly around performance but also in between. Even years later, even if they have been using something that is not detectable, later we may have a way of detecting what it did. I think that is the only way you are going to get enough serious material because you have the science of looking at proteins, looking at small molecules, DNA, RNA; all of that can be done in blood.

  Q194  Dr Iddon: The idea of an elite athlete's anti-doping passport came over very strongly when we were in Australia. The lady I have just mentioned has proposed that that is the way forward, to have such a passport. Because people's biochemistry—as you rightly point out—changes with time and it is even so different between one person and another, the only way to detect alterations in a person's biochemistry due to doping technologies is to regularly monitor their biochemistry. Michelle Verroken also suggests that there should be more in the passport than that, not just the analytical data from biochemistry but the prizes that people are winning as well should be recorded. Do you agree with that and is there anything else that you would add to the profile?

  Professor McGrath: I do not think it would be all that difficult to make up a kind of CV for an athlete of what they are doing at any particular time: where they are, what they were doing, whether they are performing, whether they are winning, whether they are not winning. That is the kind of information that is going to be collected anyway by the coach. I would have thought that it was not a very big step to move in that direction.

  Dr Hamilton: Using indirect markers which you are going to propose as a cheating mechanism is difficult because variables will change for reasons other than cheating. It is the distinction between a cheat and a non-cheat through indirect markers which is very difficult and is something you would have to get to a point where you were actually testing for something and you were very confident about it otherwise, as we have seen, it will not hold up in a court of law.

  Q195  Dr Iddon: The final point I want to make—this is a point that Michelle Verroken has made as well but we picked it up in Australia too—is that where an athlete is performing at the very highest levels of international competition and winning huge prize money (which happens, of course) the penalties on those athletes when they are caught with a strange substance in their blood or urine are not great enough. They are earning large amounts of money but really if they are caught doping, since they are such serious role models in international sport, they really ought to be paying a large percentage of their prize money back if they are caught. She believes, and other people believe, that the penalties are not great enough when people are actually caught with illegal substances in their body fluids. Would you agree with that?

  Dr Hamilton: I would agree with that but again I do not believe you can apply it across the board because there are different gradations of cheating.

  Q196  Chairman: Let us take Dwain Chambers, for example. Should he have to pay everything back?

  Dr Hamilton: Speaking generically when you admit to using a performance enhancing substance of that nature for that duration when money is made, I think it would be more than reasonable for an athlete to pay it back. I support what Michelle is saying; I just think it is not always black and white when someone is cheating.

  Mr Brewer: I think there should also be a commonality across not just the Olympic sports but the professional sports as well and we have to recognise that there are a huge raft of sports that sit outside of the Olympic movement—both professional and non-professional—and we do need a common standard of punishment across all sports and not just allow individual governing bodies or associations to decide their own level of punishment for their particular sport.

  Q197  Chairman: Dr Hamilton, in terms of WADA there seems to be a great deal of satisfaction in the way in which WADA is working. Are there any serious weaknesses to the WADA organisation that we should be aware of?

  Dr Hamilton: I think WADA has revolutionised our approach to doping in sport and as a general rule I think the approach they are taking is very strong. I think their consultation process is difficult because of the number of interested parties that they have and that will always slow things down and make it difficult for them to be transparent. I certainly support the approach they have taken.

  Chairman: On that note can I thank you all, John Brewer, Dr Bruce Hamilton, Professor McGrath and Dr Anna Casey, for your responses this morning. I also thank my colleagues and members of the public.