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Select Committee on Science and Technology Second Report

4 Prevention and detection of doping

The WADA Code

59. Throughout this inquiry we have heard much support for WADA and the WADA Code in the steps it has taken in the fight against doping. Michele Verroken, from the sports business consultancy Sporting Integrity, told us that "the Code has been a major step forward in harmonising certain aspects of drug misuse management across different sports and countries of the world".[84] Mr Matthew Reader, representing the DCMS, agreed with this view, stating that "the adoption of the code and the establishment of WADA is a huge leap forward in terms of fighting doping in sport".[85] We also heard from Dr Bruce Hamilton of UK Athletics that WADA has "revolutionised" their approach to doping in sport.[86]

60. This level of praise for WADA is impressive, particularly in the light of the stringent conditions sporting bodies must meet in order to become compliant with the requirements of the Code. The sports consultant Michele Verroken believed that "code compliance has significantly occupied the sporting agenda",[87] and during our oral evidence session with John Scott from UK Sport, we heard that it is important not to underestimate the difficulty of being code compliant. Mr Scott told us that underpinning code compliance is a "whole raft of operational challenges" [88] and that "making sure that the rest of the world steps up to the bar is the big challenge".[89] UK Sport later told us, on an informal basis, that such challenges revolve around the professional competence and skill of those operating anti doping programmes, for example in relation to the time, education and support required to enable the national governing bodies to become compliant with the Code. One interpretation of this could be that countries with fewer resources should be excused full compliance with the Code. Dr Budgett of BOA, opposed this line and was categorical that the main challenge for individual countries was the need for "government time … because legislation may have to be changed to be in compliance with the Code … I do not think that it actually needs resources."[90] He pointed out that the Code "does not say how many tests you have to do, it just says the structure you have to have in place and I think it is quite right that compliance is insisted on by WADA and the IOC."[91] We agree with this view.

THE PROHIBITED LIST

61. Whilst there is clear support for WADA and the WADA Code in general, there are specific concerns regarding the Prohibited List. Debate about what should and should not be allowed in respect of performance enhancement is led by WADA which has the final say on what should be added to the Prohibited List. The criteria upon which WADA makes its decisions have been set out earlier in paragraph 27 of this Report.

62. During oral evidence, we heard from Dr Bruce Hamilton of UK Athletics that there is little "transparency" in the decision-making process with regard to items placed on the Prohibited List. He illustrated this by reference to the recent examination by WADA into whether use of artificial hypoxic chambers as a training aid should be on the list or not. Hypoxic chambers are used by athletes to simulate high altitude conditions and the use of chambers is controversial because it artificially raises red blood cell counts and hence the amount of oxygen which can be carried to the body's tissues, including muscles. According to Dr Hamilton, WADA found that use of hypoxic chambers was indeed performance-enhancing and that whilst they were not sure whether or not it was dangerous, they felt that it was "against the spirit of sport".[92] However, in Dr Hamilton's words, "at some point behind closed doors it was not put on the list". He argued that "here is something which WADA have said meets their criteria but for undisclosed reasons has not been put on the list",[93] thereby rendering the decision-making process opaque, to say the least. Similar points were made by Dr Hamilton regarding pseudoephedrine, which is often used as a decongestant in cold and influenza medication. Pseudoephedrine was recently taken off the Prohibited List but has subsequently been shown "to have performance enhancement capabilities".[94] It remains unregulated by WADA.

63. When we discussed the issue of hypoxic chambers with Professor Ljungqvist, he explained that WADA conducted an investigation and wide consultation on whether or not use of hypoxic chambers should be banned and that this "resulted in a clear message from our stakeholders not to include it on the List".[95] However, Professor Ljungqvist did allude to a "difference of opinion" about this outcome and that members of the WADA ethical panel "felt that it was not in accordance with sports ethics", whereas "others" felt it was.[96] On pseudoephedrine, Professor Ljungqvist argued that this was "a minor substance" but that it was now in the process of being reviewed again because "a different scientific argument has come up" regarding the metabolism of pseudoephedrine into cathine, a substance on the banned list.[97] We are grateful for these explanations but we remain disappointed by the lack of transparency at WADA relating to how decisions regarding the inclusion of substances on the Prohibited List are made. We believe that lack of transparency in the Prohibited List sends out a poor signal to athletes and that WADA should justify each decision made within the criteria which it has itself set. We urge DCMS and UK Sport to press WADA for clear reasoning to be given for each substance and method included on the Prohibited List and for its decisions in cases where substances and methods are examined but not banned. As a general rule, we should like to see increased attention paid by WADA to the science behind substances and methods considered for inclusion in the List.

RECREATIONAL OR SOCIAL DRUGS

64. The Prohibited List includes a number of recreational or 'social drugs' currently controlled in the UK under the Misuse of Drugs Act 1971 that do not have obvious performance-enhancing capacity. Cannabis is an example of such a substance where some experts such as Professor Hans Hoppeler from the University of Bern believe that use of this drug "is not doping".[98] There have been a number of cases of athletes taking recreational drugs, for example, footballers Shaun Newton, who was banned from West Ham for seven months, and Adrian Mutu, who was sacked from Chelsea. During oral evidence, the Minister for Sport, the Right Honourable Richard Caborn MP, told us that he would wish to "look very seriously" at the Prohibited List with a view to removing what he believes are "social drugs".[99] The Minister felt that WADA's role was to root out cheats in sport and to stop athletes using drugs which enhance performance, rather than to be in the "business of policing society".[100]

65. There is disagreement on the effect of social drugs upon performance. For example, Dick Pound, head of WADA, has argued "who's to say that by taking cannabis in a sport like gymnastics, where there is a fear element, you are not giving yourself an advantage by being more relaxed?"[101] We are concerned at the approach taken by the Government to the use of recreational drugs in sport where they may be performance-enhancing and against the spirit of sport, and we urge the Government to conduct further research to ascertain the possible performance-enhancing capacity of social drugs in sport.

THERAPEUTIC USE EXEMPTIONS

66. During this inquiry, it became clear that there is a perception that the TUE system is subject to abuse. UK Sport told us that they are concerned "about the international consistency of the application of TUEs".[102]Indeed, there are claims that some sports show an unduly high proportion of TUE registrations, for example, cycling where use of asthma-treating steroids, such as salbutamol, is supposedly widespread. Professor Ivan Waddington (from the Centre for Research into Sport and Society at the University of Leicester) gave a lecture at University College Chester in April 2004 in which he referred to "concern surrounding the fact that, among elite international athletes today, the claimed incidence of asthma is several times higher than that in the general population". He went on argue that "there is no obvious medical reason why this should be the case" and that "the suspicion must be that the widespread diagnosis of asthma among elite level athletes is part of a common strategy to avoid the normal sanctions associated with the use of performance-enhancing drugs of the kind which are used in some forms of anti-asthma medication".[103]

67. This view is by no means universally held. During oral evidence, we heard from both Dr Budgett of the BOA and Professor Ljungqvist of WADA and the IOC that the level of asthma incidence in UK athletes, which is at approximately 20 per cent, is directly comparable with that of the rest of the population.[104] Dr Budgett also gave his personal opinion that since "we in this country are the most efficient at filling out these abbreviated therapeutic use exemption forms in the British team, we have a reputation of having a much higher incidence of asthma than other Olympic teams".[105] However, when asked by the Committee if he was confident that, for elite athletes, every TUE for drugs used in asthma is because exercise-induced asthma is proven, Professor Ljungqvist answered in the negative.[106] Furthermore, Professor Ljungqvist informed us that it was because of such concerns that 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".[107]

68. It is the abbreviated TUE process which has led to most concern. Dr Budgett of the BOA argued that TUEs "should all be considered therapeutic use exemptions, not abbreviated therapeutic use exemptions" and that an abbreviated TUE "is just a rubber stamp and is a complete waste of everybody's time".[108] He believed that "we should get rid of abbreviated therapeutic use exemptions" and "decide whether we really want people to prove that they have whatever the condition is and that they need the medication".[109] Whilst we are not convinced that the TUE system is necessarily subject to widespread or systematic abuse, we are concerned that there is potential for such abuse. We recommend that UK Sport press WADA for abolition of the abbreviated TUE system, and that UK Sport ensure that all TUEs in the UK are awarded on the basis of sufficient evidence that an athlete requires the medication for which the exemption has been awarded.

Testing for use of illegal HETs

INTELLIGENT TESTING

69. UK Sport conducts most of its tests out-of-competition, with allocation increasingly governed through the concept of 'intelligent testing'. We applaud UK Sport for its efforts to identify time-points at which an athlete may be more likely to take illegal HETs. However, there appears to be scope for greater understanding of how banned substances work and when they need to be taken for best efficacy. We have seen little evidence that UK Sport is working with scientists to gain understanding of the effects and pharmacokinetics of banned substances. Such information could include ascertaining when an athlete would need to stop taking a banned substance for it not to be detected during a competitive event, and thus could further enable testing at time-points when an athlete would be most likely to be using it. We recommend that UK Sport further develop its research programme into the science behind doping and that it apply understanding of the effects and pharmacokinetics of banned substances to its testing programme to help further identify optimum testing time-points for doping in sport.

70. WADA has testing agreements in place with, for example, the IOC and recognized International Federations. WADA conducts mainly out-of competition testing, focused on athletes competing at the international level (although it may also test national level athletes). A WADA priority is to test athletes who may not otherwise be subject to testing, for example those living in areas of the world without a national anti-doping programme. Rather than using random selection to pick all athletes to be tested, WADA claims that it has also adopted a scientific approach and selects a significant proportion of athletes based on factors such their recent performance, history of doping, and vulnerability to the temptation to take performance enhancing substances.[110] WADA also participates in a taskforce with the IOC to ensure global testing prior to and during Olympic Games.[111]

71. There is some concern with respect to international testing programmes. John Scott from UK Sport told us that he thinks "it would be fair to say there are a large number of tests internationally that are basically wasted because they are never going to catch someone who is doping in the way they are applied". He added that "one of the agendas that is very much being debated internationally now is that it is not just about doping numbers, the test numbers that you do, it is about the effectiveness of those testing numbers".[112] It is essential that there should be clear consistency between WADA and IOC and national testing programmes. We consider that UK Sport has an important role to play in sharing experience and knowledge of best practice built up through its own 'intelligent testing' programme. We recommend that UK Sport work with WADA to help further develop WADA's testing regime and increase the chance of catching athletes who are guilty of doping.

URINE VERSUS BLOOD SAMPLE

72. Most of the testing undertaken by WADA (individually and on behalf of the IOC) and, on a national basis, by UK Sport is via urine samples. Professor Ljungqvist told us that "urine is by far the best bodily specimen to use for the purpose of anti-doping analysis" because substances that are contained on the Prohibited List are usually eliminated via urine.[113] He was supported in this view by Bruce Hamilton of UK Athletics who pointed out that "there is no point in taking blood if we do not have an appropriate test".[114] Other witnesses disagreed. For example, Professor Ian McGrath of the University of Glasgow told us that "there is an awful lot more in blood than there is in either saliva or urine".[115] With reference to the national testing programme, Michele Verroken of Sporting Integrity argued that the "UK's testing programme must include routine testing of blood which is a basic pre-requisite for detection of certain prohibited substances and methods, such as growth hormone and EPO".[116] Whilst we accept that most testing is satisfactorily carried out through urine, we are of the view that increased research may be needed to determine the most appropriate testing route for different prohibited substances and we urge the Government to consider supporting studies of this nature. In the meantime, we urge UK Sport to increase its programme for testing blood samples since this may facilitate more detailed testing for prohibited substances, either in the present or future (see below).

DETECTING THE UNDETECTABLE

73. In respect of the samples taken for testing, Bruce Hamilton of UK Athletics argued that "the challenges for us are developing tests for detection of substances that currently cannot be detected".[117] Certainly, it is problematic that some illegal HETs are currently undetectable. For example, as detection of erythropoietin, used to increase numbers of red blood cells and hence oxygen carried to body tissue, has become more advanced, athletes have reverted to blood doping to enhance their oxygen-carrying capacity. Increased use of blood doping, e.g. though autotransfusion, the process of drawing blood from an athlete, storing it until they have replenished their natural blood supply and then putting it back in thus increasing the red blood cell count, presents real problems for detection programmes. UK Sport explained that "an athlete growing and using their own blood makes it impossible to detect if the levels are below those reported for an adverse analytical finding".[118]

74. Since 2001 WADA has committed more than US $28 million to scientific research as part of its commitment to increasing the volume of research dedicated to developing new and improved detection methods for performance-enhancing substances and methods. UK Sport has also committed itself to a long-term research programme in which detection of doping is key. These efforts are being co-ordinated through what UK Sport described as a well-established partnership between itself, the WADA-accredited laboratories and universities conducting anti-doping research.[119]

75. We applaud WADA and UK Sport for their support of research into the development of new detection techniques. One improvement that could be made quite easily, however, would be the retention of B samples where a positive result is not found. These are currently destroyed but if they were to be retained pending the development of new detection methods, athletes using a banned but currently undetectable HET could be identified at a future date, thus increasing the detection rate and adding to the deterrent effect. We recommend that UK Sport and WADA increase storing of data and samples to allow re-evaluation and analysis of test samples once more sophisticated detection methodologies have been developed.

76. Whilst on a Committee visit to Australia to investigate some of the issues raised in this inquiry, we learnt that the idea had been mooted that all athletes should compete internationally in the year prior to participation at the Olympics Games in order to be eligible for selection. The argument behind this suggestion is that it would enable determination of athletes' baseline performance, potentially making it easier to detect whether doping has occurred since unusual increases on this performance would raise suspicion. We believe that this policy is worth serious consideration and that adopting it unilaterally in this country would send a clear signal that the UK is 'playing fair' and thus set a good example to the rest of the world, in the important lead-up to the 2012 Olympics. We urge UK Sport to consider the value of implementing a policy in which all UK athletes would be obliged to compete internationally in the 12 months prior to the 2012 Olympics in order to be eligible for participation in the games, with exemption given where appropriate, for example in cases of serious and proven injury.

UK anti-doping programme

77. UK Sport considers that, with the support of DCMS, it has implemented "a world class anti-doping programme of prevention, deterrence and detection".[120] We sought evidence to support this claim. DCMS support for UK Sport takes the form of monitoring its performance on a formal basis and regular contact with UK Sport about a range of issues in the drug-free sport area.[121] However, the resource offered in-house at DCMS for anti-doping is extremely limited. Matthew Reader, representing the Department, told us: "effectively I have one member of staff working on anti-doping in sport".[122] Although he accepted that it would be "foolish" of him to say that more staff would not be helpful, he felt that if a broad look was taken over what the UK is achieving, and given UK Sport's 'world-class' delivery of the anti-doping policy, he could not "think of anything" in terms of additional work that the DCMS could do with additional staff.[123] This may be the case but we are concerned at the lack of resource given to anti-doping within Government. Whilst limited staffing may not be a problem in the current situation, there may be increased requirement for Government involvement in the lead up to, and during the London 2012 Olympics. We recommend DCMS evaluate whether the resources allocated to anti-doping within its own department are sufficient, and whether they will be so by 2012.

78. UK Sport boasts that it "is one of the world's leading national anti-doping organisations" and that in comparison with its peers, it is "one of the best".[124] When asked on what basis this declaration was made, its director, John Scott, told us that it related to the speed at which UK Sport had been able to respond to the WADA Code in its early days and to receive WADA's endorsement for the UK's approach to the application of the Code. UK Sport had been "one of the first NADOs to receive that".[125] Pushed further to provide evidence that UK Sport is 'world-class', UK Sport then told us that the Committee should not underestimate the difficulties with being compliant with the WADA Code and that UK Sport was "one of the few" National Anti-Doping Organisations with ISO accreditation for its processes. We also heard, again from UK Sport, that it has "one of the best" accredited processes for training its doping control officers who are responsible for taking test samples from athletes.[126]

79. Dr Budgett of BOA supported the claims made by UK Sport for its own effectiveness, stating that it was not "perfect" but it was "getting better" and was "definitely one of the world's leading anti-doping organisations".[127] On the other hand, the evidence received from Michele Verroken of Sporting Integrity expressed concern about UK Sport organisation and certain of its activities, for example, the quality and nature of its testing programmes.[128] There is also the question of how UK Sport collects information and analyses testing data. In its report, Drugs and role models in sport, the Culture, Media and Sport Select Committee commented that the information collection and analysis relating to drugs in elite sport was, at that time, "unsatisfactory".[129] The Government responded that "UK Sport, in recognising the need to improve collection and manipulation of the data to undertake more sophisticated analysis, is developing a new computer system to help achieve this".[130] However, Ms Verroken told us that "much of the data published is incomplete, indicating only tests collected and analysed". She went on to say that "improvements to the accuracy and adequacy of test data would give greater public assurance that a sufficient testing programmes are being delivered".[131]

80. Whilst we accept that UK Sport has made progress in the fight against doping, we found their attitude towards their own performance rather complacent, particularly with regard to apparently unsupported claims that they are "one of the best". We recommend that, rather than arrogate to itself a world-wide leading position, UK Sport operate a continuous review process to ensure current and future success of the UK anti-doping programme. This review process should include monitoring whether the rules are understood and applied consistently across all sports in the UK.

EDUCATION

81. In 2005 UK Sport launched the 100% Me programme, designed to promote the clean sporting success of athletes. UK Sport told us that 100% Me provides a platform for current British athletes to demonstrate that there is no need to use drugs in sport to be successful; ensures that members of the sporting community can access the information and advice necessary to make well informed choices about anti-doping; and minimises the risk of inadvertent doping (through better education of what is and isn't banned).[132] UK Sport claims that 100% Me is "widely recognised, by WADA among others, as a world leader in terms of athlete education".[133]

82. Despite the efforts of UK Sport, it has been suggested that more could and should be done to educate about potential harm from using HETs. During a seminar held to launch this inquiry, we heard from the Olympic gold medal winner Linford Christie OBE that the UK Government should be doing more to educate about the harm HETs could do. For example, he wondered whether information on this area could be included in sports science degree studies and also thought that school education should feature more information on illegal HETs.[134] In response to the suggestion that the National Curriculum could have a role to play in educating about HETs, Allison Holloway from UK Sport told us that "there is quite a lot in the current curriculum at the moment that focuses on education around the misuse of drugs" and that within GCSE Physical Education there is a focus on anti-doping.[135] However, we also heard from Ms Holloway that the "real problem" that lies in schools at the moment is that the "teachers do not necessarily know how to deliver on this subject".[136] We believe that anti-doping education should be targeted at all athletes from an early age and that UK Sport has an important role to play in delivering this agenda. We recommend that UK Sport work with schools to develop an effective mechanism for educating about the harm which doping in sport can cause.

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