DR RICHARD BUDGETT AND DR ARNE LJUNGQVIST

29 NOVEMBER 2006

  Q240  Dr Harris: And 20% of your team, as it were, having it is what you would expect.

  Dr Budgett: Yes.

  Q241  Dr Harris: Therefore, they should be on salbutamol in the interests of their health.

  Dr Budgett: Hopefully on preventers and not needing salbutamol, of course.

  Q242  Dr Harris: What about other countries? Is 20% about the norm?

  Dr Ljungqvist: I would say around that, yes, and, as we all know, asthma and asthmatic conditions are increasing in society. We do not know why but probably because of the introduction of all sorts of environmental elements that were not there before and it is no surprise that asthma or asthmatic conditions, bronchoconstriction, will be revealed during exercise because it is one way to provoke the symptoms whereas those who do not conduct much exercise may not be aware that they are carrying a problem in that respect.

  Q243  Dr Harris: Are you confident that, for elite athletes, every therapeutic use exemption for salbutamol type drugs is because there is shown to be proven exercise induced asthma?

  Dr Ljungqvist: No. That is why the IOC decided as from the Salt Lake City games to conduct their own investigations and not accept therapeutic use exemptions issued by other bodies. We did have laboratory investigations in place in Salt Lake City, Athens and Turino in order to make sure that those who were not able to provide laboratory data confirming the asthmatic condition would be subjected to an investigation on the spot and we have actually rejected the TUEs that have been issued by other bodies because we could not confirm the asthma.

  Q244  Dr Harris: Is that not a little unfair on those countries that cannot afford these sophisticated tests for exercise induced asthma that Dr Budgett described?

  Dr Ljungqvist: I think it is not unfair because we give them the opportunity to have them done on the spot before the games.

  Q245  Dr Harris: We have heard a number of people say that the therapeutic use exemption is a bit of a nonsense, that it is approved drug taking covered by medical certificate of questionable validity. You have been pretty firm in saying that you do not think there is a problem.

  Dr Budgett: Did I say that?

  Q246  Dr Harris: I used the example of asthma which is the one that is most commonly cited, that too many people have it for it to be true therapeutic use. That is what we were told.

  Dr Budgett: The problem is that they should all be considered therapeutic use exemptions, not abbreviated therapeutic use exemptions, and I think that it has actually muddied the water because the IOC in asking for tests to prove asthma are effectively saying, "We want a therapeutic use exemption", not an abbreviated one because an abbreviated one is just a rubber stamp and is a complete waste of everybody's time. I personally think that we should get rid of abbreviated therapeutic use exemptions and actually decide whether we really want people to prove that they have whatever the condition is and that they need the medication and I would applaud the clear requirements of a therapeutic use exemption. It has been a fantastic help for people who suffer anything from attention deficit disorder to ulcerative colitis.

  Q247  Chairman: That has cleared that point up. In terms of cycling, do they have the abbreviated therapeutic exemptions rather than the full test because they seem to be able to just provide a doctor's note.

  Dr Budgett: Yes and it is the same in rowing. It is a note on a form; you do not have to show that you have had a test; you just say what test you have had. No proof of diagnosis is required.

  Dr Ljungqvist: May I add that I know of only one sport that has adopted the IOC principle of asking for laboratory documentation of the diagnosis and that is my own sport, athletics. We do not accept abbreviated therapeutic use exemptions for asthmatic medication.

  Q248  Dr Harris: Are doctors anywhere in the world under pressure from their medical regulators not to do the wrong thing in this respect? We have the General Medical Council here which is increasingly proactive in following up allegations of doctors not doing something that is appropriate therapeutically. There must be a number of doctors in the world who are providing rubber stamps which have been shown not to be correct. Is there any comeback? Do you know of any who are subject to professional sanction in their country?

  Dr Budgett: I have never come across one although I did have a letter from the GMC a few years ago saying, as you say, that they would take appropriate measures if anyone was found to have aided an athlete in breaking the anti-doping rules. They would consider that to be a breach of the regulations.

  Q249  Adam Afriyie: John Scott of UK Sport came before the committee a little while ago and said that a great deal of the dope testing conducted was pretty much useless or wasted because of the way that the tests were applied and he suggested that athletes might quite easily get around the tests. Other bits of evidence say that rather than urine tests, maybe blood tests would be more appropriate for certain types of doping. My question to Dr Ljungqvist is, what reviews have you undertaken to assess the effectiveness of the current WADA testing programme?

  Dr Ljungqvist: I see in the media and it is probably the general perception amongst the average person that there is an over belief in blood testing as a magic tool for finding doped athletes. Urine is by far the best bodily specimen to use for the purpose of anti-doping analysis because the substances that are on the List and even other substances are usually eliminated, not all but most of them, via urine and they are concentrated in urine to a much higher extent than they are in blood and their metabolites are being analysed, so the blood—

  Q250  Dr Iddon: I would like to challenge you on that because I have another hat, I am Chairman of the Misuse of Drugs All Party Group in this place. We know that in prisons where urine samples are taken regularly for judicial testing, it is very easy to corrupt the urine or even to switch it with a sample that does not contain the substance. Can you be absolutely sure that the sample of urine that you are taking from an athlete is uncorrupted and actually from that athlete?

  Dr Ljungqvist: If I may, I will come back to that because that is a different question. I am talking about the biological science now which makes urine by far the best bodily specimen for the purpose of analysing for doping substances. It is another matter that you can manipulate the system and I may come back to that.

  Q251  Dr Iddon: That is not what we heard in Australia.

  Dr Ljungqvist: No, but that is what you hear from me.

  Q252  Chairman: You are right.

  Dr Ljungqvist: The blood testing serves a particular purpose for the analysis of certain methods and substances. Like HBOCs haemoglobin oxygen carriers, artificial haemoglobin molecules, for the purpose of analysing for growth hormones and for establishing that normal blood parameters of an athlete in order to be able to tell if suddenly on an occasion the parameters deviate from the norm which would make you target the athlete for analysis for Erythropoietin which is made on urine again. That is where the blood analysis comes into play. When it comes to the possibility of manipulating the urine, the WADA Code and most regulations at the domestic level and at the international federations' level try to make sure that the out-of-competition testing system does not give room for manipulating the urine. The out-of-competition system should ideally be that the doping control officers come and knock on the athlete's doors in total surprise in order that the athlete has no chance of making any arrangements. Even one or two hours' notice allows for the athlete to make certain manipulations himself. As you know, the urine is supposed to be collected under close supervision of a doping control officer which is an embarrassing method or procedure but it has to be done. You probably know that, in Athens, we found two Gold Medallists who did not wish to provide urine under those circumstances and they were therefore banned and their gold medals taken away from them because they were obviously trying to do what you were hinting at, namely manipulate or switch the urine or make use of artificial devices and so on.

  Q253  Dr Iddon: In Australia, we came across a case of a Moslem who, for cultural reasons, refused to give a sample. If more and more Moslem athletes are taking part in various games, that provides you with a real dilemma, does it not?

  Dr Ljungqvist: I think that is a very bad excuse because I have taken blood and urine samples from Moslems without any problems.

  Q254  Dr Iddon: Drug testing has been going on for several years now—this is my perception and I may be wrong—and there does not seem to have been a decline in the numbers of positive results. Is that because athletes are not being put off by the fact that drug testing is available or is it the fact that you are testing more samples today than you were in the past?

  Dr Budgett: We do not really know the answer to that but my opinion would be that there are many more samples being tested, there is much more out-of-competition testing, so you are more likely to pick up athletes when they are attempting to cheat. As Dr Ljungqvist said earlier, quite a few of the apparent percentage who are positive are inadvertent or very minor offences because the athletes have taken substances which some of us do not think should be on the List.

  Q255  Dr Iddon: As a chemist, I know that tests can sometimes go wrong for various reasons, either the reagents are not up to standard or the laboratory is not up to standard, and I also know as a chemist that laboratories vary in their professional character right across the world. We also saw in Australia that at the time of their games in Sydney, they had to take on an enormous number of extra people into the testing programme. How can you be sure therefore with all those parameters that can move either way that, at the time of the Olympic Games for example, the laboratories are properly accredited and all the extra people who are going to work in those laboratories are up to standard?

  Dr Ljungqvist: Being responsible for the medical organisation at the Olympic Games, I hope I can give you an answer. As you know, there is a very sophisticated accreditation system in addition to the ISO system. This was established, actually, by my own federation back in the 1980s. The IAAF (International Athletics Association) established those procedures and handed over the accreditation procedures to the IOC in 1983—to be used by other sports as well, not just track and field or athletics. Once WADA was created, the accreditation system was further developed, of course, and moved to WADA. This is an annual re-accreditation system of all laboratories. It is not just that the laboratory becomes accredited once and for all; they are re-accredited every year by control samples, et cetera, et cetera. During the games, not just the staff but also the supervision of the staff is increased. To take the fairly small games in Torino, for instance, there were 10 heads of laboratories from accredited laboratories around the world which supervised the work in Torino, together with the chief of the Torino laboratory—you know, the laboratory moved from Rome to Torino. It is a very carefully structured system to make as sure as we can that this is being handled in accordance with the laboratory standards as laid down by the board.

  Q256  Dr Iddon: You have never had an opportunity to criticise a given laboratory or any analyst working in those laboratories by looking at a batch of results that appeared to be suspicious.

  Dr Ljungqvist: No, we have not had an incident. Not during the games, no.

  Q257  Dr Iddon: That is good news.

  Dr Ljungqvist: Yes.

  Chairman: That is good news.

  Q258  Dr Turner: Professor Ljungqvist, we are obviously thinking of 2012. Are there any specific issues the UK should be concerned about in preparation for the 2012 Olympics? What guidance will WADA and the IOC be giving to the issue of doping?

  Dr Ljungqvist: We hope to be able to keep our local organising committees very well informed about any progress that is being made by us in the anti-doping fight and any new methods or new dangers that may come up. I understand that one of the problems that we may face—and you have certainly been thinking about this—is the possible arrival of the misuse of gene transfer technologies for the purpose of doping. I am very pleased to be able to tell, and have been so over and over again, that we have the top expertise in the WADA Medical and Health Research Committee to help us out with modern developments in genetic transfer technology. You have people reading newspapers, that once "gene doping", as it is labelled, comes into sport, there will be no way of finding the cheats. We now have experts in our Committee—and they are established. We have staged two scientific conferences at the highest level, one in the Cold Spring Harbor Laboratory in New York and one at the Karolinska Institute last December. The conclusion today from those meetings is that it is not a question of whether or not gene doping will be possible to detect—it will be possible to detect—it is more a question of how and when. That is a very optimistic message that we get from the expertise in the field. This is an area where for once we can say that we are a little ahead of those who may be tempted to use that method for the purpose of doping. By the time gene doping may be there, we hope and we believe that we have a method in place to detect them and therefore to act as a deterrent. The other piece of advice, since you asked for that—if I may suggest it, and it is a bit tough to say, possibly—is that I am very pleased with the law that we have in place against doping in my country. We have a law specifically directed to the possession, distribution and even use/consumption of doping substances. We have had a law in place since 1991. It was amended in 1998. It has been very helpful to our sports organisations to have that law in place because it makes it possible for the police authorities to make searches on suspicion. It is a very efficient deterrent and also gives you very much information as to what is going on in society. Last year, we had some 1,200 occasions on which doping substances have been seized by the police or the customs in our country, in a country where I would say doping substance is very little used in sport but it is used by other people to a very large extent.

  Q259  Dr Turner: You would recommend that we look at our law at the moment.

  Dr Ljungqvist: Yes. There are two examples: it gives the possibility for police and customs to intervene and it is helpful to sport. We had an example of how it can work the other way around. We had the European championships in track and field in Gothenburg a few months ago and, when the games were about to close, substances and drugs and empty bottles were found in the wastepaper basket in a large container outside the location of the domicile of certain groups of athletes from certain countries. Based on the suspicion, and with the support of the law in our country, the police made an investigation and a serious cloud was hanging over the games. The newspaper reported on "Doping substances found" and "These are doping games" et cetera. The police investigation resulted in the conclusion that it was nothing: they were totally innocent substances.