Drug Testing - Is It Fair? 40 Years Later!

Drug testing of athletes for performance enhancing substances has been going on now for over four decades... Here are criticisms against drug testing methods and suggestions that could make them better. Get the latest here.

Article Summary:
  • Four decades of drug testing has not had a very good track record.
  • Nandrolone metabolites may be artificially increased during testing.
  • Does drug testing need to scrapped or overhauled?
  • Drug testing of athletes for performance enhancing substances has been going on now for over four decades, starting in earnest over 3 decades ago. And it's been over 3 decades that I've been criticizing the whole operation, especially the assumptions, proprietary research, and theories on which the doping tests are based.

    Drug testing, in small part due to my criticisms over the last 30 years plus, and in large part due to the inherent flaws of the testing, has evolved to a system which has all the appearance of infallibility but is extremely vulnerable to error. In the past four decades drug testing's track record has not been very good.

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    Critiques Of
    Testosterone-Epitestosterone Ratio

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    In the 1970s, as I began building the doping structure for the International Powerlifting Federation (IPF), for which I served as Chairman of the IPF Medical Committee, I criticized the inherent flaws of the testosterone-epitestosterone ratio as a test for the use of exogenous testosterone.

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    Over the years they have refined the testing, as I suggested they should 25 years ago, by doing hormonal profiles and carbon isotope ratios as validations for punative positive tests.1

    While some progress has been made on this front other disturbing news have raised questions about the validity of the testing. Recently it's been shown that the testing process, dependent on analytical processes, is not as bullet proof as we are led to believe and has inherent flaws that as yet have not been fully investigated.

    It's Been Shown That The Testing Process,
    Dependent On Analytical Processes, Is Not As
    Bullet Proof As We Are Led To Believe.

    For example, it's been shown that some athletes are able to use exogenous testosterone, with relative impunity since its use doesn't result in any significant changes in their testosterone:epitestosterone ratio.2

    On the other end of the spectrum it's also been shown that genetic differences may result in naturally elevated testosterone/epitestosterone levels.3 While these athletes show an elevated T/E ratio, it's not because they're using exogenous testosterone but because they may excrete less epitestosterone. As such, these athletes, some of whom in the past have been deemed to have had a positive drug test, should not be or have been found positive for the use of testosterone.

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    Anabolic Steroids
    As Endogenous Compounds

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    In the 1980s and 1990s I wrote about the possibility of various anabolic steroids being endogenous compounds, especially 19-nortestosterone (nandrolone, Deca-Durabolin)4,5,6.

    At that time I was advised by Dr. Donike, the head of the IOC drug testing team, that I was wrong about much of what I said about anything concerning drug testing and that I should stop spreading such misinformation. In fact I was right, on this and most of my other criticisms and claims.

    Recently the IOC/WADA has accepted the endogenous presence of nandrolone metabolites and have set a level above which the test is positive for exogenous nandrolone.7 The endogenous production of other anabolic steroids, as has been found in animals8,9,10 is also a real possibility but these have not been adequately investigated.

    There are also other potential pitfalls inherent in the testing process for nandrolone and possibly for other anabolic steroids. For example, recent research has shown that levels of nandrolone metabolites may be artificially increased during the analytical processes itself.11

    Recent Research Has Shown That Levels
    Of Nandrolone Metabolites May Be Artificially Increased
    During The Analytical Processes.

    Many times in the past three decades I have criticized the proprietary research that has been used to back up their drug testing claims. These studies, in my view, have little scientific validity as they are not published and thus not available to the prevailing scientific principles. As well, the black and white attitude of drug testing goes against the theories and principles on which the scientific method is based.

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    Taking WADA/IOC To Task
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    Two recent commentaries in the August 2008 Nature finally takes the WADA/IOC hierarchy and powers to task.

    One of the commentaries12 states:

      "Detecting cheats is meant to promote fairness, but drug testing should not be exempt from the scientific principles and standards that apply to other biomedical sciences, such as disease diagnostics. The alternative could see the innocent being punished while the guilty escape on the grounds of reasonable doubt."

    Another by Donald A Berry13 presents an argument that "the processes used to charge athletes with cheating are often based on flawed statistics." The commentary outlines the deficiencies in Floyd Landis' positive drug test for exogenous testosterone.

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    In his commentary Dr. Berry states:

      "Whether a substance can be measured directly or not, sports doping laboratories must prospectively define and publicize a standard procedure, including unambiguous criteria for concluding positivity, and they must validate that procedure in blinded experiments. Moreover, these experiments should address factors such as substance used (banned and not), dose of the substance, methods of delivery, timing of its use relative to testing, and heterogeneity of metabolism among individuals."

    In addition to transparency and open discussion of testing procedures, and research, it follows that those responsible for the test results and the subsequent decisions should be held legally and financially accountable for their decisions. So far, for various reasons, this has not been the case.

    Those Responsible For The Test Results
    And The Subsequent Decisions Should Be Held
    Legally And Financially Accountable For Their Decisions.

    But athletes should have that recourse. After all as a consequence of these decisions many athletes over the years have suffered, and continue to suffer, needlessly, permanently marked as cheats with their lives disrupted, sporting careers and reputations ruined, and earnings lost.

    As well, if those making the decisions were to be held accountable there would be a shift to letting some cheats get away with doping so that someone innocent is not found gof doping rather than the present scenario where both cheats and those innocent of doping are found guilty.

    Until the deficiencies inherent in drug testing of athletes are acknowledged and dealt with drug testing is not fair either in detecting those that use banned drugs or in false positives in those that do not. As such, in this year's Olympic Games in Beijing some athletes using banned drugs and methods won't be caught (including the handful of gene doping athletes who represent the vanguard of a new paradigm in doping), while some who aren't using banned drugs will likely be falsely accused.

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    What's The Answer
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    So what's the answer? Should we scrap drug testing and adopt a Laissez Faire attitude? In my opinion allowing athletes free rein on doping, as suggested by some,14 is a mistake. If we take the example of professional bodybuilders who are not drug tested and are in the forefront of drug use, including almost every drug known to man that may affect muscle size and body composition, then such an attitude would be unthinkable. These athletes, because of their drug use and extremism are among the unhealthiest people on this planet.

    RELATED POLL
    Should drug testing be dropped altogether from sports?

    Yes.
    No.
    No, but the system does need fixing.
    Not sure.

    Do we really want our athletes, for the sake of political and financial gains, to suffer health consequences of unbridled drug use and gene doping? I don't think so. And because of the complexity involved, allowing a limited use of drugs, as suggested in a recent paper,15 wouldn't work.

    Athletes will almost always take more, and be even more adventurous in their drug use than they are today in hopes of beating the system. As well monitoring this drug use so that it's within acceptable limits would be a hopeless task.

    The alternative is to continue drug testing and research, but to open up the procedure to others in the field and to scientific scrutiny and be open to reasonable criticisms made against drug testing protocols and analysis. It's important that everyone involved not wear blinders and realize that while drug testing may be an effective deterrent most of the time, it's not infallible.

    As well, rather than the present hearings and arbitration methods presently used, in which the panel members have very little knowledge or expertise about drug testing, controversial punative positive drug tests should be heard and decided on by a panel made up of a diverse number of experts in the drug testing field who are not financially or otherwise tied in to the sporting federations, the IOC, WADA, or the World Association of Anti-Doping Scientists (WAADS).

    References:

    1. Piper T, Mareck U, Geyer H, Flenker U, Thevis M, Platen P, Sch?nzer W. Determination of (13)C/(12)C ratios of endogenous urinary steroids: method validation, reference population and application to doping control purposes. Rapid Commun Mass Spectrom. 2008 Jul;22(14):2161-75.
    2. Schulze JJ, Lundmark J, Garle M, Skilving I, Ekstr?m L, Rane A. Doping test results dependent on genotype of uridine diphospho-glucuronosyl transferase 2B17, the major enzyme for testosterone glucuronidation. J Clin Endocrinol. 2008 Jul;93(7):2500-6.
    3. Schulze JJ, Lorentzon M, Ohlsson C, Lundmark J, Roh HK, Rane A, Ekstr?m L. Genetic aspects of epitestosterone formation and androgen disposition: influence of polymorphisms in CYP17 and UGT2B enzymes. Pharmacogenet Genomics. 2008 Jun;18(6):477-85.
    4. Di Pasquate MG. Updates four to drug use and detection in amateur sports. Warkworth. Ontario, Canada: MGD Press, 1985-1988.
    5. Di Pasquate MG. Drugs in Sports, 1992-1995. Decker Periodicals New York.
    6. Di Pasquate MG. Anabolic Research Review. Published 1995- 1996 Iron Man Publishing, Oxnard, California.
    7. http://www.wada-ama.org/rtecontent/document/2008_List_En.pdf.
    8. Gavinelli M, Arioli F, Fracchiolla ML, Casati A, Pompa G. Simultaneous measurement of boldenone (alpha and beta), ADD, testosterone, epitestosterone and AED in bovine faeces. Vet Res Commun. 2008 Aug 8. [Epub ahead of print]
    9. Blokland MH, van Rossum HJ, Sterk SS, van Ginkel LA, STephany WE. Development of a method which discriminates between endogenous and exogenous beta-boldenone. Anal Chim Acta. 2007 Mar 14;586(1-2):147-53.
    10. Poelmans S, De Wasch K, Noppe H, Van Hoof N, Van Cruchten S, Le Bizec B, Deceuninck Y, Sterk S, Van Rossum HJ, Hoffman MK, De Brabander HF. Endogenous occurrence of some anabolic steroids in swine matrices. Food Addit Contam. 2005 Sep;22(9):808-15.
    11. Grosse J, Anielski P, Hemmersbach P, Lund H, Mueller RK, Tautenber C, Thieme D. Formation of 19-norsteroids by in situ demethylation of endogenous steroids in stored urine samples. Steroids. 2005 Jul;70(8):499-506.
    12. [No authors listed] A level playing field? Nature. 2008 Aug 7;454(7205):667.
    13. Berry DA. The science of doping. Nature. 2008 Aug 7;454(7205):692-3.
    14. Kayser B, Mauron A, Miah A. Viewpoint: Legalisation of performance-enhancing drugs. Lancet. 2005 Dec;366 Suppl 1:S21.
    15. Kayser B, Smith AC. Globalisation of anti-doping: the reverse side of the medal. BMJ. 2008 Jul 4;337:a584. doi: 10.1136/bmj.a584.