Eliminating doping in Sport: An impossible task ?

Eliminating doping in Sport: An impossible task ? Associate Professor John FitzgeraldSchool of Social and Political Sciences

Outline The year that was Notable new celebrities DefinitionsWADA code / ASADA schedulesDifferent taxonomiesFraming anti-doping controlsTheories of consumption Reasons for testing regimes Preventive approachesThe context of testing So is this about eliminating dopingGusfield / durkheim

The year that was Notable new celebrities Lance ArmstrongGuilty of doping

The weaponGuilty of poor performance

The alchemistNot guilty of anything yet

Hird Guilty of poor governance

The year that was Notable new celebrities AOD-9604A modified fragment (16aa) of human growth hormone developed in 1990s.Weight loss, no effect on muscle mass or growth factorsHexarelinpeptide GH secretagogue, structurally similar to GHRP-6 in the growth factor family which stimulates the release of growth hormone (GH)thymosin beta-4 (TB-4)has a general role in tissue regenerationlowering of the production of pro-inflammatory cytokines.

Source: http://www.abc.net.au/science/articles/2013/07/26/3811053.htm

AOD-9604

Source: http://www.abc.net.au/science/articles/2013/07/26/3811053.htm

WADA/ ASADAUnder the current World Anti-Doping Agency (WADA) Code, a substance or method is prohibited and considered doping if WADA determines it meets any two of the following three criteria:Medical or other scientific evidence, pharmacological effect, or experience that the use of the substance or method represents an actual or potential health risk to the athlete.Medical or other scientific evidence, pharmacological effect, or experience that the substance or method has the potential to enhance or enhances sport performance.Determination by WADA that the use of the substance or method violates the spirit of sport.

Specific criteriaUnder the current World Anti-Doping Agency (WADA) Code, a substance or method is prohibited and considered doping if WADA determines it meets any two of the following three criteria:health risk to the athlete.has the potential to enhance or enhances sport performance.use of the substance or method violates the spirit of sport.

ASADA Amendments 2013Australian Sports Anti-Doping Authority Amendment Bill 2013 is to provide ASADA with the power to issue a disclosure notice compelling persons of interest to assist ASADAs investigations. This will see: individuals required to attend interviews with ASADA investigatorsindividuals required to cooperate with ASADA by answering questions or providing information; however, individuals will not be required to self-incriminate themselvesindividuals required to provide specific documents, materials (including electronic materials and products) and things (such as video cameras, medications and training bags) to ASADA investigators individuals who fail to comply with a disclosure notice face a civil penalty of 30 penalty units per day (currently equivalent of $5,100 per day).

Source: http://www.asada.gov.au/media/ministerial.html

Anti doping testing Rationale

Source: http://www.wada-ama.org/Documents/Resources/Testing-Figures/WADA-2012-Anti-Doping-Testing-Figures-Report-EN.pdf

Anti doping testing Number of tests


Anti doping testing Drug categories (2006)

Anti doping testing Drug categories (2012)


Anti doping testing Drug categories


Anti doping testing Peptides


Anti doping testing Stimulants


Anti doping testing Methylhezaneamine (dimethylpentylamine) (dimethlylamylamine, DMAA)

1944 Eli LillyNasal decongestantDietary supplementNo medical use today2006 geranamine ( with caffeine)single oral dose of about 50-75 mgDose > 100 mg likely adverse outcome


Anti doping testing DimethylamineVFL player Matthew Clark was suspended for two years after the banned substance dimethylamylamine was detected in his system after a game in 2011. Read more: http://www.theage.com.au/afl/afl-news/st-kildas-ahmed-saad-faces-twoyear-drugs-ban-20130730-2qxha.html#ixzz2lwpB7Yo6


Anti doping testing Clark, 22, is serving a two-year suspension handed down by the Australian Sports Anti-Doping Authority (ASADA), after he was found guilty of taking a banned substance whilst playing for Frankston in the VFL in 2011.

He accepted a pre-match drink named 'Hemo Rage'from a teammate and afterwards, tested positive to an ingredient named Dimethylamylamine.

Clark says he was aware that he would be drug tested that day, but was assured by his teammate that the product was within the drug code.

Initially handed a nine-month ban, ASADA appealed the decision, and eventually, Clark was given the maximum two years.

The event has completely changed his life.

Source: http://www.afl.com.au/news/2013-07-04/banned-vfl-player-on-road-back

Anti doping testing Anabolic agents


TaxonomiesHow the substance effects the body (e.g. stimulants); Chemical identity (e.g. steroids, caffeine); Based on their outcomes (e.g. performance and image enhancing drugs PIEDS); Legal or social status (licit/ illicit) Role in relation to sport activity (pre-activity, recovery) (Newland et al., 2012). Level of interest a substance may have to performanceWhether they are approved by sport anti-doping regulators.

Eg what is a supplement ?

What is a supplement ?

Under the World Anti-Doping Code strict liability principle, athletes are ultimately responsible for any substance found in their body, regardless of how it got there. http://www.asada.gov.au/substances/supplements.html

Dietary supplement Also called: 1,3-dimethylamylamine 1,3-dimethylpentylamine 2-amino-4-methylhexane 2-hexanamine, 4-methyl- 2-hexanamine, 4-methyl- (9CI) 4-methyl-2-hexanamine 4-Methylhexan-2-amine DMAA Floradrene Forthan Forthane Geranamine Methylhexanamine Methylhexaneamine Pentylamine, 1, 3-dimethyl-Source:http://www.asada.gov.au/substances/supplements.html

Methylhexaneamine is classed as a stimulant on the World Anti-Doping Agencys Prohibited List and it is prohibited in-competition. Generally, stimulants act directly on the central nervous system to speed up parts of the brain and body. They can increase alertness and reduce fatigue.

The prohibited list

Source: http://www.wada-ama.org/en/World-Anti-Doping-Program/Sports-and-Anti-Doping-Organizations/International-Standards/Prohibited-List/

Drug use Theories Cultural beliefs about utility, efficacy and harm associated with drugs can be powerful determinants of their use. Three cultural theories:Edgework supply-driven consumption and healthism.

EdgeworkSensations of being on the edge, Avoiding disaster Improving performance (Lyng, 1990; Hunt et al., 2007). Competing social forces create a tension that enhances the likelihood of edgework practices (Reith, 2005). The social pressure to be natural and drug free A consumerist force to heighten performance through consumption. Consumers are continually perched on the boundary between indulgence and the denial of their impulses and desires (Reith, 2005). There is both a function and a pleasure to pushing the boundaries of performance, and these boundaries may not necessarily just be found in elite sport performance. Risk taking among elite sportspeople has been explored extensively from a psychological perspective (Petroczi and Aidman 2008),

Supply-driven consumption Market supply to increase consumption trends for illicit, legal and therapeutic substances. Supply-induced heroin and amphetamine consumption in Australia and South East Asia (Dietze and Fitzgerald 2002; UNODC, 2013). Alcohol industry and binge drinkingRise in antidepressant use in the 1990s anddisease mongering by the pharmaceutical industry (House of Commons, 2005).Australian Crime Commission (ACC, 2013) - corruption of professional sport through the illicit supply of psychoactive and performance enhancing drugs (ACC, 2013).

Healthism1980 the problem of healthism was identified (Crawford 1980)excessive attention to ones own health and the overmedicalisation of everyday life (Petrie and Wessely, 2001). Inappropriate level of use of a wide range of substances in order to enhance health and performance in the absence of disease (Greenhalgh and Wessely, 2004).Cultural trend for articulate, educated, and health-motivated segments of the population, Prevailing folk models of chronic illness and substance use. tonic, fuel and food, lay people applied to psychotropic drugs (Helman, 1981). Recent unprecedented rise in population consumption:enhancement drugs (memory, sexual drive, strength, performance, attention and image)broader social trends ? (Quintero and Nichter 2011).

How do we frame anti-doping Role: battle of perspectivesPerspective FocusTheme Policy options

The U-curve

Level of sporting participationAlcohol consumptionlowhighlowhighPeretti-Watel et al., 2002, Addiction, 97: 707-716

The U-curve Not for all sportsNot for both genders Male contact sportsTeam sports Not for tobacco Different for age sub-groups

Peretti-Watel et al., 2002, Addiction, 97: 707-716

Illicit drug use: Professional sportspeopleSource: Dunn et al., (2011)

Illicit drug use: Professional sportspeopleSource: Dunn et al., (2011) Drug and Alcohol Review, 30, 6368Predictors of recent illicit drug use (past year) among elite sportspeopleHaving been offered/had the opportunity to use illicit drugs in the past year (14x more likely than not) Identifying as a full-time athlete (4x more likely than not ) Knowing other athletes who use drugs (3x more likely)

Supplements

Where young UK athletes get their informationSources of information about supplements Spource: Petrczi et al., 2008 J. Intern. Soc. Sports Nutrition 2008, 5:22

SupplementsAge and Gender likelihood for supplement use

Reasons for supplement useSource: UK Sport: Drug-free sport survey. London: UK Sport; 2005

Perceived problem

Continuum of supplement use ?Petroczi et al., 2008supplementsIllicit drugsalcohol

Continuum of supplement use ?Anabolic ergogenic substances provide a gateway for the use of general illicit drugs (Arvary and Pope, 2000),High school student athletes were four times more likely to dope if they used legal supplements or engaged in risky behaviors Papadopoulos et al. (2006)Nutritional supplement use may be a gateway to doping Backhouse et al (2013) Online sample of competitive sportspeople doping use is 3.5 times more prevalent in nutritional supplement users compared with non users. Athletes who engage in legal performance enhancement practices appear to embody an at-risk group for transition toward doping. Study has significant limitations.

Information sourcesSource: Dunn et al., (2011) Drug and Alcohol Review, 30, 6368Key points Where athletes get their information/advice from is essentialType/quality of informationContext of the information Establish the most appropriate conduits to the right informationContinuum to supplements useEach type of supplement will have a role/function (Strength, weight loss, recovery, performance, emotion management, fun)Be realistic about drug - alcohol - supplement use Encourage players to see the links between the use of different substances

Frameworks Public HealthOrganisationIndividualCommunitySociety

Context body surveillanceBiological passport The quantified self

Athlete Biological Passport Discussed at WADA 2002, now NRL, ITF, ATP, WTA Looking at the effects of dopingMonitoring of selected parameters over time that indirectly reveal the effect of doping, as opposed to the traditional direct detection of doping by analytical means.ABP focused on Australias elite athletesComplements testing regimeMay include:To identify and target athlete for specific analytical testing; andTo pursue possible anti-doping rule violationsBaseline 4 tests4 - 10 tests per year Shift from absolute certainty and perfection to a more defensible empirical and probabilistic foundation (Sottas et al., 2010)

The quantified selfSelf environment - monitoringPersonalized preventive medicine Continuous Wearable Sensor PatchesContinuous Monitoring (smart devices)Biomarkers - risk wellbeingMonitoring the bioeme Sensordrone / Air quality eggOnline platforms for personal data streamsunified self-tracking, several mobile applications such asDaily Tracker (http://www.thedailytracker.com/) Track and Share (http://www.trackandshareapps.com )Crowdsensing

Influencing environmentsBeyond behaviour change: (Social Practice theory) ConsumptionFocus on Health

Source: http://www.rmit.edu.au/cfd/beyondbehaviour

How do we create behaviour changeby changing the environmentRulesAnti-dopingMaterial infrastructuresSupplement programs / mentor programs Common understandingsPerformance / balance / healthPractical knowledgesTraining schedules, recovery schedules

Do we test in order to stop drug use ?We must not say that a criminal action shocks the common conscience because it is criminal. But rather it is criminal because it shocks the common conscience. We do not reprove it because it is a crime, but it is a crime because we reprove it - Durkheim

But what do we reprove in doping?

Principles for approaching alcohol and drugs in sporting contexts Make your frameworks explicitPerformance/ financial/ health/education/welfareMake your framework trustedShepherd with influential peopleTake your time /get it rightGet good evidence/ precedence / storiesMake your framework feasible People need to see that it is reasonable / do-ableEnsure people own it Make sure everyone is involvedNot just players

References Sottas PE, Robinson N, Saugy M. (2010) The athlete's biological passport and indirect markers of blood doping Handb Exp Pharmacol.;(195):305-26. ..

****************************************VicHealth works at a number of different levels, acknowledging that the majority of work happens at the organisational, community and societal level.

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