Current anti-doping policy: a critical appraisal

Exploring the scope and applications of anti-doping measures in ultramarathon: an analysis of the positions of ultramarathon race organizers

Introduction

With ultramarathon attracting burgeoning interest, evidence has emerged about doping behaviors. However, currently, research into the anti-doping policy landscape and the adoption of testing and athlete surveillance is limited, including the applicability of rubric from the World Anti-Doping Agency (WADA) and National Anti-Doping Organizations (NADOs). Consequently, it remains unclear if anti-doping provisions have been developed and enforced in ultramarathon, which is a timely consideration given growth in the sport.

Methods

This study gathered perspectives on anti-doping and testing procedures from ultramarathon race organizers (UMROs). To that end, a sample of n = 35 prominent competitions was compiled using web materials and community engagement, encompassing elite and amateur entrants, diverse course designs, and prize money opportunities. Data-gathering was conducted across two phases between November and December 2023, with an initial review of UMRO web resources. Subsequently, UMROs were contacted via email to validate or ascertain their anti-doping and testing policies. Insights from UMRO respondents were reviewed and coded. UMROs who did not reply were excluded from the analysis.

Results

Based on this methodology, the positions of n = 17 UMROs were captured, covering 159 ultramarathon races and approximately 96,500 annual participants. Of these, n = 8 UMROs did not have a self-developed policy and their rubric was pursuant to external authorities like WADA and NADOs. n = 4 had created a specific proprietary policy, which often incorporated WADO or NADO materials. The remaining n = 5 UMROs reported no anti-doping controls were in place at the time of the study. There was also notable heterogeneity in testing and surveillance, ranging from rigorous procedures to an absence of protocols. Interestingly, none of the included UMROs explicitly reported that they had enacted anti-doping measures against athletes.

Discussion

Various determinants could inform these regulatory inconsistencies across UMROs, such as financial constraints, infrastructural and logistical barriers, cultural factors, and the lack of a unifying international federation in ultramarathon. Given the disparate approaches identified in our results, greater cooperation and education may be necessary to enhance understanding about the implications of doping and advance cohesive frameworks. This should involve collaborations with WADA and NADOs to promote best-practices and evidence-based exchanges within the community.

A level playing field in anti-doping disputes? The need to scrutinize procedural fairness at first instance hearings

The WADA Code upholds the virtues of procedural fairness. Minimum procedural guarantees have been strengthened under the 2021 WADA Code and the International Standard for Results Management. However, implementation of these guarantees by National Anti-Doping Organizations (NADOs) and domestic anti-doping panels are critical in ensuring that athletes are afforded procedural fairness. While some countries have enacted reforms in anti-doping dispute resolution infrastructure, other jurisdictions are arguably lagging behind. Since few doping disputes are heard by the Court of Arbitration for Sport (CAS), a strong domestic dispute resolution framework should encourage independence, efficiency and cost-effectiveness, as well as promote consistency and procedural fairness at all levels of hearing. First instance hearings are particularly significant given that CAS is not considered a practical option for many athletes, especially those from developing countries, predominately due to challenges of access to justice and affordability. Irrespective of procedurally unfair decisions at first instance, CAS has the de novo right of review to correct any such irregularities. However, this approach alone is inadequate, especially given that most athletes do not appeal to CAS. CAS, WADA and NADOs all have significant roles to play in ensuring procedural fairness for athletes. WADA and NADOs need to do more to ensure compliance with procedural guarantees at first instance. This paper advances the debate on the importance of procedural fairness and proposes a research agenda to support future reform, arguing that the current anti-doping model needs to reconsider how these important standards are upheld, from first instance until final appeal.

Risk and enabling environments in sport: Systematic doping as harm reduction

Doping and the use of performance enhancing drugs (PEDs) are often considered and discussed as a separate issue from other types of substance use, by sporting bodies, politicians, the media, and athletes who use drugs themselves. However, perceptions and understandings of substance use in the sport and fitness world are directly related to those of substance use in the non-sport world. One way the gap between sport and non-sport substance use research can be bridged is to consider sport risk and enabling environments. Similar to non-sport contexts and drug use, it is important to analyse the environments in which doping occurs. This approach allows us to examine the dynamic interplay between risk and enabling factors, as the enabling environment shifts in response to changes produced in the risk environment, and vice versa. There are models of sport environments that have proven effective at both enabling doping by athletes and reducing harms to athletes: systematic doping. This article will use secondary literature in order to review and analyse known cases of systematic doping through the risk and enabling environment frameworks. We argue that these systems responded to anti-doping in ways that protected athletes from the risk factors established by anti-doping policy and that athletes suffered most when these systems were revealed, exposing athletes to the full range of doping harms. Further, we argue that risks within these systems (i.e. extortion, bullying) resulted from the broader prohibitive sport environment that forces doping underground and allows such abuses to occur.

Simple Synthesis of 17-β-O-hemisuccinate of Stanozolol for Immunoanalytical Methods

The use of doping in sports is a global problem that affects athletes around the world. Among the different methods developed to detect doping agents in biological samples, there are antibody-based methods that need an appropriate hapten design. Steroids with a hydroxyl group can be converted to the corresponding hemisuccinates. A novel approach to the synthesis of 17β-O-hemisuccinate of the common doping agent stanozolol is described here. Acylation of stanozolol with methyl 4-chloro-4-oxobutyrate/4-dimethylaminopyridine, followed by mild alkaline hydrolysis with methanolic sodium hydroxide at room temperature, gave the simultaneous protection and deprotection of pyrazole-nitrogen atoms. The proposed new synthetic method allows the desired hemisuccinate derivative to be obtained in only two steps, and with a good total yield starting from stanozolol.

Attitudes Toward Cognitive Enhancement: The Role of Metaphor and Context

The widespread use of stimulants among healthy individuals to improve cognition has received growing attention; however, public attitudes toward this practice are not well understood. We determined the effect of framing metaphors and context of use on public opinion toward cognitive enhancement. We recruited 3,727 participants from the United States to complete three surveys using Amazon's Mechanical Turk between April and July 2017. Participants read vignettes describing an individual using cognitive enhancement, varying framing metaphors (fuel versus steroid), and context of use (athletes versus students versus employees). The main outcome measure was the difference in respondent-assigned level of acceptability of the use of cognitive enhancement by others and by themselves between the contrasting vignettes. Participants were more likely to support the use of cognitive enhancement by others than by themselves and more when the use of enhancement by others was framed with a fuel metaphor than with a steroid metaphor. Metaphoric framing did not affect participants' attitudes toward their own use. Participants supported the use of enhancement by employees more than by students or athletes. These results are discussed in relation to existing ethical and policy literature.

Social Policy and Cognitive Enhancement: Lessons from Chess

Should the development of pharmacological cognitive enhancers raise worries about doping in cognitively demanding activities? In this paper, we argue against using current evidence relating to enhancement to justify a ban on cognitive enhancers using the example of chess. It is a mistake to assume that enhanced cognitive functioning on psychometric testing is transferable to chess performance because cognitive expertise is highly complex and in large part not merely a function of the sum specific sub-processes. A deeper reason to doubt that pharmacological cognitive enhancers would be as significant in mind sports is the misleading parallel with physical enhancement. We will make the case that cognitive performance is less mechanical in nature than physical performance. We draw lessons from this case example of chess for the regulation of cognitive enhancement more generally in education and the professions. Premature regulation runs the risk of creating a detrimental culture of suspicion that ascribes unwarranted blame.

DOPING SURVEY IN THE YOUTH SCHOOL GAMES IN BRAZIL

ABSTRACT Introduction: Doping control is an important means for preventing the use of illegal substances and methods in sports. Objective: This study investigated the self-reported use of illegal substances among young Brazilian students in the Youth School Games, the main sporting event among school-aged athletes in Brazil with almost 2 million students during all the phases. Methods: Cross-sectional study with athletes of the Youth School Games 2006 aged 14-17 years. The subjects were randomly selected and completed an anonymous questionnaire about substances use. Chi-square test was used for comparison of proportions between different variables on self-reported use of substances. Univariate and multivariate analyzes and logistic regression were performed. Results: Among the 402 athletes (aged 14-17) who volunteered to participate, the results showed high prevalence of alcohol (35.8%), nutritional supplements (39.1%), and tobacco (5.4%). Regarding illegal drugs and doping, 1.7% reported the use of stimulants, 2.2% illicit drugs, 0.5% anabolic steroids, and 1.7% hormones and other similar substances. Moreover, a different use of stimulants was found (especially Judo and Table tennis), medications (especially Judo and Chess) and dietary supplements (especially Swimming and Judo, with over 50% reported use). Conclusion: The present study suggests that the use of substances among young athletes is similar to the results found among adult Olympic athletes as per International Olympic Committee and World Anti-Doping Agency, especially regarding the use of dietary supplements, anabolic steroids, and stimulants according to data collected by other studies. We consider that the findings of the present work indicate the need for specific efforts to monitor, prevent, and control use of substances among school athletes in big events and competitions, such as this research on doping in the Youth School Games.

The new front in the war on doping: Amateur athletes

The war on drugs is usually associated with criminal policies aimed at stemming consumption of drugs such as heroin, cocaine, and cannabis, less so with enhancement drugs like those used in sport. As drug use in sport, or doping, has become more visibly widespread, policies aimed at combating the issue have become more restrictive, intrusive, and harsh. In this article we draw new comparisons between the wider war on drugs and recent developments in sports anti-doping. We identify a growing trend towards criminalisation of traffickers and users, and associate that with another growing trend: the testing of amateur athletes. This article reviews the current anti-doping system, including the recent amateur policies, then considers of the results of one such program in amateur cycling. We then shift to consider the possible implications for amateurs of criminal doping laws and the recent debates about allowing medical exemptions for therapeutic use of banned substances. We show that drug use in sport can be understood as a new front in the war on drugs, with some extreme measures and many negative unintended consequences. To remedy this, we argue that amateur athletes require a separate anti-doping policy focused on minimising harms of use.

Geneticizing Ethnicity and Diet: Anti-doping Science and Its Social Impact in the Age of Post-genomics

While gene doping and other technological means of sport enhancement have become a topic of ethical debate, a major outcome from genomic research in sports is often linked to the regulation of doping. In particular, researchers within the field of anti-doping science, a regulatory science that aims to develop scientific solutions for regulating doped athletes, have conducted genomic research on anabolic-androgenic steroids. Genomic knowledge on anabolic-androgenic steroids, a knowledge base that has been produced to improve doping regulation, has caused the ‘geneticization’ of cultural objects such as ethnic identities and dietary habits. Through examining how anti-doping genomic knowledge and its media representation unnecessarily reify cultural objects in terms of genomics, I argue that Ethical, Legal, and Social Implications (ELSI) research programs in human enhancement should include the social impacts of anti-doping science in their discussions. Furthermore, this article will propose that ELSI scholars begin their academic analysis on anti-doping science by engaging with the recent ELSI scholarship on genomics and race and consider the regulatory and political natures of anti-doping research.

The psychology of doping

Doping is increasingly becoming a problem in both elite and recreational sports. It is therefore important to understand the psychological factors which can explain doping behavior in order to prevent it. The present paper briefly presents evidence on the prevalence of doping use in competitive sports and the measurement approaches to assess doping behavior and doping-related variables. Furthermore, the integrative theoretical approaches used to describe the psychological processes underlying doping use are discussed. Finally, the paper provides suggestions for appropriate measurement of doping behavior and doping-related variables, key preventive efforts against doping as well as avenues for future research.

Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription

BACKGROUND

Physical activity (PA) is a key intervention for chronic disease, yet few physicians provide exercise prescription (EP). EP is an important component in larger strategies of reducing non-communicable disease (NCD). Our objective was to assess Family Medicine Residents (FMR) knowledge, competence, and perspectives of EP to help inform future curriculum development.

METHODS

A 49-item cross-sectional survey was administered to 396 University of British Columbia FMR. Residents' EP knowledge, competence, attitudes/beliefs, current practices, personal physical activity levels, and perspectives of training were assessed using, primarily, a 7-point Likert scale.

RESULTS

The response rate was 80.6% (319/396). After eliminating 25 that failed to meet the inclusion criteria, 294 were included in the final analysis. The majority 95.6% of FMR reported EP as important in their future practice, despite having low knowledge of the Canadian PA Guidelines (mean score 1.77/4), low self-reported competence prescribing exercise as prevention (mean score 13.35/21), and rating themselves "somewhat incompetent" prescribing exercise to patients with chronic disease (mean score 11.26/21). FMR believe PA is integral to their patients' health (98.0%), sedentary behaviour is harmful (97.9%), and feel a responsibility to discuss PA with patients (99.7%). Few FMR (14.9%) perceived their training in EP as adequate and 91.0% desire more.

CONCLUSIONS

FMR report EP is important, yet do not perceive they are sufficiently prepared to provide EP. In future curricular development, medical educators should consider residents' low knowledge, competence, perceived program support, and their expressed desire for more training in exercise prescription.

Physicians' Ethical Dilemmas in the Context of Anti-Doping Practices

The World Anti-Doping Code states that, there is an intrinsic value about sports that is the celebration of the human spirit, body and mind, and is reflected in values other than winning or being the first in any sports game. The spirit of sports includes ethics, fair play and honesty. Anti-doping practices are based on this ethical ground and supported all through the world. However, recently with the arguments that there is no substantial definition of the term "spirit of sports", and that the fights against doping is based on questionable ethical grounds consisting of dubious claims about fairness in sports and terms such as "level playing field". Medical ethics is involved in this discussion because of the crucial role of physicians in anti-doping policies and practices as well as developing and administering ergogenic substances or methods for athletes. This role of physicians raises ethical questions regarding physician-patient relationship, principle of non-male ficence, privacy and confidentiality of patient, and fairness and justice in the macro allocation of resources. The aim of this paper is to discuss ethical arguments on anti-doping practices and policies and, to further evaluate current anti-doping practices in the context of medical ethics.

Challenges to promoting health for amateur athletes through anti-doping policy

Anti-doping regulations are intended, at least in part, to promote the health of athletes. While most anti-doping efforts target elite and professional competitors, there have been recent moves by sport governing bodies to expand anti-doping testing to include amateur athletes. Drawing on previous critiques of anti-doping policies and illustrating cases, this article outlines five of the challenges to health promotion of applying the current detect and ban model to the amateur level of sport. I argue that the current approach is not effective and, in some ways, may undermine the goal of health promotion at the amateur level. In order to address these challenges, I propose alternative, health-centred strategies that focus on athlete empowerment and choice through critical awareness of a variety of substances, associated risks and rewards, and the role of expertise in decision-making.

The controversy of sports technology: a systematic review

Changes or introductions of technology or equipment can affect how a sport is played or influence its performances. This article conducted a systematic review of peer-reviewed literature to identify any case studies of controversial events surrounding the implementation or use of sports technology. 56 articles were identified that highlighted 31 different case studies found over a three decade time period. Thematic analysis revealed six distinctive themes when reviewing the articles. Whilst the sport of golf had the highest number of case studies, it was found that a significant level of attention had been recorded in the cases of Oscar Pistorius use of prosthetic legs in athletics and the use of full length swimsuits in swimming. The trend surrounding the number of articles was shown to be initially intermittent but saw a peak period from 2008 to 2010. However, the frequency of such articles since this peak has been more consistent. It is proposed that long periods of time without intervention or resolution by a governing body often increases the peer-reviewed attention paid to such cases in examples such as those identified in this systematic review.

Questions of fairness and anti-doping in US cycling: The contrasting experiences of professionals and amateurs

The focus of researchers, media and policy on doping in cycling is often limited to the professional level of the sport. However, anti-doping test results since 2001 demonstrate that banned substances are also used by US cyclists at lower levels of the sport, necessitating a broader view of the patterns and motivations of substance use within the sport. In this article, we describe and explain the doping culture that has emerged in domestic US cycling among amateur and semi-professionals. Through analysis of records from sports governing bodies and journalistic reports, we assess the range of violation types and discuss the detection and punishing of riders who were not proven to have intended to cheat but became "collateral damage" in the war on doping. We argue that the phenomenon of doping is more complex than what has been shown to occur in elite sport, as it includes a wider variety of behaviours, situations and motivations. We develop fresh insights by examining cases where doping has been accidental, intrinsically motivated, non-performance enhancing or the result of prescribed medical treatments banned by anti-doping authorities. Such trends call into question the fairness of anti-doping measures, and we discuss the possibility of developing localised solutions to testing and sanctioning amateur athletes.

[Discussion of public health and decriminalization of doping]

These reflections aim to increase awareness of the contradictions inherent in the definition of sport and its relation to health and education. Taking the doping issue as a point of departure, we seek to open a general debate regarding the impact of the sports performance industry on public health. Illegal doping practices lead to the health insecurity of many professional and aspiring athletes, and, moreover, to the ethical disorientation of sports amateurs and educators. We therefore consider the necessity of discussing a possible decriminalization of doping in professional sports.

The Experience of Competition Ban Following a Positive Doping Sample of Elite Athletes

World Anti-Doping Association (WADA) is responsible for doping-free sporting contests and is the only sporting body posing relevant competition sanctions. While doping relates to various controversial attitudes and beliefs proposed in the past, the confirmation of a competition ban following a doping violation has many negative connotations for the lives of the athletes. This can elicit multiple significant and far-reaching implications for them and their close ones. Aiming to better understand these implications in an athlete’s life, 5 Greek male and female athletes having recently received a competition ban after a doping violation were interviewed. Qualitative analysis of the data showed that many important psychological, social, and financial implications follow such a sanction. Most importantly, these consequences may even contribute to indications of poor mental and physical health. Discussion of the results provides suggestions for the alleviation of the negative consequences following an involuntary sporting career pause or termination.

Doping in sports: knowledge and attitudes among parents of Austrian junior athletes

Strategies for doping prevention are based on prior identification of opportunities for intervention. There is no current research focusing on the potential role in doping prevention, which might be played by the parents of junior elite athletes. The purpose of this study was to evaluate the knowledge and attitudes toward doping among parents of Austrian junior athletes and to analyze factors potentially influencing these beliefs. In this study, two questionnaires were distributed to 1818 student athletes, each with instructions that these surveys were to be completed by their parents (n(total) = 3636). Parents filled in questionnaires at home without observation. Responses from 883 parents were included in this analysis. Compared to female parents, male parents demonstrated significantly better knowledge about doping and its side effects and were more likely to be influenced by their own sporting careers and amounts of sports activities per week. Parental sex did not demonstrate a significant influence on responses reflecting attitudes toward doping. Additional research is needed to compare these results with young athletes' knowledge and attitudes to determine if and to what degree parental attitudes and beliefs influence the behavior and attitudes of their children.

Religiousness as a factor of hesitation against doping behavior in college-age athletes

Religiousness is rarely studied as protective factor against substance use and misuse in sport. Further, we have found no investigation where college-age athletes were sampled and studied accordingly. The aim of the present study was to identify gender-specific protective effects of the religiousness (measured by Santa Clara Questionnaire) and other social, educational, and sport variables as a potential factors of hesitation against doping behaviors in sport-science-students from Mostar, Bosnia, and Herzegovina (51 women and 111 men; age range, 18-26). The gender differences for the non-parametric variables were established by Kruskall-Wallis test, while for the parametric variables the t-test for independent samples was used. Multiple regression calculations revealed religiousness as the most significant predictor of the social, health, sport and legal factors of hesitation against doping behaviors in both genders. However, the differential influence of the social, educational, sport and religious factors in relation to negative consequences of the doping behaviors is found for men and women. Such differential influence must be emphasized in tailoring the anti-doping policy and interventions.

Situating Nutri-Ethics at the Junction of Nutrigenomics and Nutriproteomics in Postgenomics Medicine

Food has societal, economic, medical and ethical implications, being fundamental for life. It plays an important role also in sports medicine, since a healthy diet is an important part of an athlete's training. Nutrigenomics and nutriproteomics are emerging as a result of a convergence of nutritional, genomics and proteomics knowledge strands in the postgenomics era. These fields of inquiry present an opportunity for the design of customized diets potentially able to counterbalance the extant obesity epidemic and remedy metabolic diseases, among others. They are noteworthy for sport medicine as well since they could provide athletes with crucial information for personalized training and nutrition, in order to achieve the best results possible and express one's own potential. But they could also be used as a form of personalized doping, thus constituting an advancement of “classical nutrition-based doping” (i.e., the use of nutraceuticals, stimulants and supplements). However, nutrigenomics (or nutriproteomics)-based nutritional doping is different from the first-generation doping because it is specifically tailored to the genomics and proteomics makeup of the athlete, although their effectiveness remain to be discerned in future systematic studies. Against this scientific background, ethical issues of nutrigenomics and nutriproteomics are discussed in the present paper with emphasis on the current limitations and the dizzying potentials of the omics data-intensive research for science and society. Additionally, I discuss the need to communicate uncertainty as a fundamental construct and intrinsic part of postgenomics personalized medicine, not to forget the gaps regarding the lack of adequate governance, and issues over providing a proper nutritional education to athletes as onus of the international sports organizations.

“Let food be your medicine, and medicine be your food”

Hippocrates

The Olympics and harm reduction?

The current anti-doping policy (‘war on doping’) resembles the ‘war on drugs’ in several aspects, including a zero-tolerance approach, ideology encroaching on human rights and public health principles, high cost using public money for repression and control, and attempts to shape internationally harmonized legal frameworks to attain its aim. Furthermore, even if for different reasons, both wars seem not to be able to attain their objectives, and possibly lead to more harm to society than they can prevent.

The Olympic buzz is mounting and we can expect multiple headlines in the media on doping and anti-doping stories related to this event. In this article we describe current anti-doping policy, reflect on its multiple unplanned consequences, and end with a discussion, if lessons learned from harm reduction experiences in the illicit drugs field could be applied to anti-doping.

Complex interaction of religiousness with other factors in relation to substance use and misuse among female athletes

Strength of religious faith (SRF) is rarely studied as a protective factor against substance use and misuse in sports. Herein, we studied the potential buffering effect of the complex socio-educational, sports, and religiousness factors in the protection against substance use and misuse, including cigarettes, analgesics, appetite suppressants, potential doping behavior, and binge drinking. The sample of subjects included 40 high-class female athletes (22-26 years of age). Using a strictly anonymous questionnaire, we investigated different social, educational, and sports factors (including SRF measured by the Santa Clara Strength of Religious Faith Questionnaire) in relation to substance use and misuse. Following the calculation of simple correlations, multiple regression analysis revealed that in combination with low sports experience, SRF has a significant buffering effect against binge alcohol drinking and consumption of appetite suppressants. The data are discussed in comparison with previous findings and theoretical background. Future studies should study the topic while observing samples of recreational and competitive athletes of both genders.

Bike Racing, Neutralization, and the Social Construction of Performance-Enhancing Drug Use

Drawing from participant observation and interviews, I examine the attitudes and beliefs of elite and former professional cyclists and team personnel regarding performance-enhancing drug (PED) use and the neutralization techniques they employed to excuse and justify PED consumption. Participants most frequently adopted accounts in which they condemned the condemners, viewing as hypocrites those labeling PED use as deviant, and arguing that all manner of PED use is commonplace throughout society. Participants further expressed distrust of sporting federations, law enforcement, and medical professionals, whom they viewed as exaggerating and distorting information about the dangers of PED use. Riders also appealed to higher loyalties and defense of necessity, claiming that PED use was for many professional cyclists nearly an occupational necessity. Members viewed PED use as a rational means to an end while also embodying fundamental tenets of professional cycling culture which prizes risk taking and commitment.

Prioritising health in anti-doping: what Australians think

OBJECTIVES

There is debate concerning whether the guiding paradigm for anti-doping policy should be the current legalistic approach or a "harm minimisation" approach prioritising athlete health. This study sought to determine whether a representative sample of Australians prioritises health above other concerns using the World Anti-Doping Code's Spirit of Sport statement which lists the 11 attributes that define the moral basis for anti-doping.

DESIGN

A Best-Worst Scaling (BWS) Balanced Incomplete Block Design experiment using 11 choice sets of five Spirit attributes from the set of 11, with the attributes within each choice set in a random order.

METHODS

A representative sample of n=168 Australians responded to an on-line survey. The BWS scores defined the relative ranking of each attribute to define an aggregate model and demographically defined models (gender, education, sports participation and sports following).

RESULTS

Health was ranked as 7/11 in the aggregate model. Only those who did not follow sport prioritised health (2/11), with other demographic models failing to show a meaningful departure from the aggregate model.

CONCLUSIONS

Australians ranked health below other attributes in the Spirit of Sport, appearing to prioritise "rule following" consistent with the legalistic approach. This challenges the harm minimisation approach to managing the role of drugs in sport and suggests that rule-following and legalistic approaches to drug use should take precedence over health messages.

Doping awareness, views, and experience: a comparison between general practitioners and pharmacists

PURPOSE

Information about doping awareness among medical professionals is scarce. We evaluated the attitudes, level of knowledge and experience among general practitioners (GPs) and pharmacists (Ps) with regard to doping.

METHODS

In a cross-sectional national survey a 59-item self-administered questionnaire was sent to a representative random sample of 645 GPs and 330 Ps.

RESULTS

Overall, 204/975 (133 GPs, 71 Ps) questionnaires were returned and available for analysis. Fewer than half (39% GPs vs. 48% Ps, P = 0.702) of respondents were familiar with the formal definition of doping. The abbreviation WADA was correctly interpreted by 42% (33% vs. 59%, P = 0.003), and 65% knew that the European Commission has the legislation to fight against doping. More GPs (69% vs. 31%, P = 0.005) agreed to have a role to play in doping prevention, similar proportions considering themselves to have sufficient knowledge of prevention initiatives (65% vs. 35%, P = 0.369). Overall, 12% of respondents (8.7% GPs, 19.3% Ps) reported being directly confronted with a request for prescription of doping agents in the previous 12 months (mainly stimulants, anabolic agents, hormones, corticosteroids).

CONCLUSIONS

GPs and Ps are frequently exposed to questions about and requests for doping agents. They have acceptable level of general knowledge but are in need for more specific information on prohibited substances and legislature.

Blood doping and its detection

Hemoglobin mass is a key factor for maximal exercise capacity. Some athletes apply prohibited techniques and substances with intent to increase hemoglobin mass and physical performance, and this is often difficult to prove directly. Autologous red blood cell transfusion cannot be traced on reinfusion, and also recombinant erythropoietic proteins are detectable only within a certain timeframe. Novel erythropoietic substances, such as mimetics of erythropoietin (Epo) and activators of the Epo gene, may soon enter the sports scene. In addition, Epo gene transfer maneuvers are imaginable. Effective since December 2009, the World Anti-Doping Agency has therefore implemented “Athlete Biologic Passport Operating Guidelines,” which are based on the monitoring of several parameters for mature red blood cells and reticulocytes. Blood doping may be assumed, when these parameters change in a nonphysiologic way. Hematologists should be familiar with blood doping practices as they may play an important role in evaluating blood profiles of athletes with respect to manipulations, as contrasted with the established diagnosis of clinical disorders and genetic variations.

The development of doping use in high-level cycling: from team-organized doping to advances in the fight against doping

In 1998, the Festina scandal at the Tour de France provided the first proof of widespread doping in professional cycling. This doping scandal marked the end of team-organized doping in professional cycling and ushered in a new period marked by the increasing implementation of anti-doping measures. This article evaluates the impact of the anti-doping rules and tests instituted since the Festina scandal. We adopt a psychosocial approach to analyze the organization of doping and the development of doping attitudes and practices in high-level cycling. Sixteen cyclists were interviewed, of which eight were young, current cyclists and eight were former cyclists who became professionals before the Festina scandal. Our results show that although the fight against doping in the last decade has reduced doping use in high-level cycling, anti-doping measures have also had unexpected effects. The fight against doping in cycling is not over.

Promoting functional foods as acceptable alternatives to doping: potential for information-based social marketing approach

Background

Substances with performance enhancing properties appear on a continuum, ranging from prohibited performance enhancing drugs (PED) through dietary supplements to functional foods (FF). Anti-doping messages designed to dissuade athletes from using PEDs have been typically based on moralising sport competition and/or employing scare campaigns with focus on the negative consequences. Campaigns offering comparable and acceptable alternatives are nonexistent, nor are athletes helped in finding these for themselves. It is timely that social marketing strategies for anti-doping prevention and intervention incorporate media messages that complement the existing approaches by promoting comparable and acceptable alternatives to doping. To facilitate this process, the aim of this study was to ascertain whether a single exposure knowledge-based information intervention led to increased knowledge and subsequently result in changes in beliefs and automatic associations regarding performance enhancements.

Methods

In a repeated measure design, 115 male recreational gym users were recruited and provided with a brief information pamphlet on nitrite/nitrate and erythropoietin as a comparison. Measures of knowledge, beliefs and automatic associations were taken before and after the intervention with at least 24 hours between the two assessments. The psychological tests included explicit measures of beliefs and cognitive attitudes toward FF and PED using a self-reported questionnaire and computerised assessments of automatic associations using the modified and shortened version of the Implicit Association Test.

Results

The information based intervention significantly increased knowledge (p < 0.001), changed explicit beliefs in specific FF (p < 0.001) and shifted the automatic association of FF with health to performance (p < 0.001). Explicitly expressed beliefs and automatic associations appear to be independent.

Conclusion

Evidence was found that even a single exposure to a persuasive positive message can lead to belief change and can create new or alter existing associations - but only in the specific domain. Interventions to change outcome expectations in a positive way could be a rewarding avenue for anti-doping. Effective social marketing campaigns for drug free sport should follow appropriate market segmentation and use targeted messages via promoting the natural form as opposed to the purified form of the main active ingredient.

Potentially harmful advantage to athletes: a putative connection between UGT2B17 gene deletion polymorphism and renal disorders with prolonged use of anabolic androgenic steroids

Background and objective

With prolonged use of anabolic androgenic steroids (AAS), occasional incidents of renal disorders have been observed. Independently, it has also been established that there are considerable inter-individual and inter-ethnic differences, in particular with reference to the uridine diphosphate-glucuronosyltransferase 2B17 (UGT2B17) gene, in metabolising these compounds. This report postulates the association of deletion polymorphism in the UGT2B17 gene with the occurrence of renal disorders on chronic exposure to AAS.

Presentation of the hypothesis

The major deactivation and elimination pathway of AASs is through glucuronide conjugation, chiefly catalyzed by the UGT2B17 enzyme, followed by excretion in urine. Excretion of steroids is affected in individuals with a deletion mutation in the UGT2B17 gene. We hypothesize that UGT2B17 deficient individuals are more vulnerable to developing renal disorders with prolonged use of AAS owing to increases in body mass index and possible direct toxic effects of steroids on the kidneys. Elevated serum levels of biologically active steroids due to inadequate elimination can lead to prolonged muscle build up. An increase in body mass index may cause renal injuries due to sustained elevated glomerular pressure and flow rate.

Testing the hypothesis

In the absence of controlled clinical trials in humans, observational studies can be carried out. Real time PCR with allelic discrimination should be employed to examine the prevalence of different UGT2B17 genotypes in patients with impaired renal function and AAS abuse. In individuals with the UGT2B17 deletion polymorphism, blood tests, biofluid analyses, urinalysis, and hair analyses following the administration of an anabolic steroid can be used to determine the fate of the substance once in the body.

Implications of the hypothesis

If the hypothesis is upheld, anabolic steroid users with a deletion mutation in the UGT2B17 gene may be exposed to an increased risk of developing renal disorders. In the current detecting - sanctioning anti-doping system, athletes motivated by the potential to evade detection owing to their unique genetic make-up could subject themselves to a serious health consequence. More research on AAS metabolism in the presence of UGT2B17 gene deletion is required. Benefit - harm evaluations in therapeutic use of anabolic steroids should also consider this potential link between UGT2B17 gene deletion polymorphism and renal disorders.