Anti-Doping:Anti-Doping:

The Challenge and the OpportunityThe Challenge and the Opportunity

Andrew Pipe, CM, MD, Dip Sport Med, FACSMAndrew Pipe, CM, MD, Dip Sport Med, FACSMUniversity of Ottawa Heart Institute, Ottawa, Ontario, CanadaUniversity of Ottawa Heart Institute, Ottawa, Ontario, Canada

Chair, FINA Doping Control Review BoardChair, FINA Doping Control Review Board

1616thth World FINA Sports Medicine Congress World FINA Sports Medicine Congress

You seem familiar yet somehow strange -- You seem familiar yet somehow strange -- Are you Canadian?Are you Canadian?

The Role of Physicians & ScientistsThe Role of Physicians & Scientists

• Advisor and ConfidanteAdvisor and Confidante

• Advocate for the health of the athlete Advocate for the health of the athlete and the well-being of sportand the well-being of sport

• Responsibility to patient, sport and Responsibility to patient, sport and the communitythe community

• Support the pursuit of excellence by Support the pursuit of excellence by fair and ethical meansfair and ethical means

• Provide distinct leadership…Provide distinct leadership…

““If drug use in sport is a developing If drug use in sport is a developing scandal, then it is a scandal that scandal, then it is a scandal that

involves the medical establishment as involves the medical establishment as well as the sporting one.”well as the sporting one.”

Sports IllustratedSports Illustrated 1969; June 23:66-69 1969; June 23:66-69

Sport Scientists & Sport PhysiciansSport Scientists & Sport Physicians

““Are we to be seen as contributing Are we to be seen as contributing to deliberate, cynical practices to deliberate, cynical practices

which subvert the processes and which subvert the processes and nature of sport ?........or do we nature of sport ?........or do we

demonstrate leadership, guided by demonstrate leadership, guided by principle and an ethical principle and an ethical perspective?”perspective?”

The Physician and the AthleteThe Physician and the Athlete

“ “As in any other area of medical practice, As in any other area of medical practice, sports physicians must care profoundly, sports physicians must care profoundly, and in the broadest sense, for the welfare and in the broadest sense, for the welfare of their patients while understanding the of their patients while understanding the unique dimensions and pressures of the unique dimensions and pressures of the environments in which their patients live, environments in which their patients live,

train and compete.”train and compete.”

““They are our They are our patients first…patients first…

they are athletes they are athletes second!”second!”

Considerations in Anti-DopingConsiderations in Anti-Doping

• AutonomyAutonomy

• StewardshipStewardship

• Safety, Harm MinimizationSafety, Harm Minimization

• BenificenceBenificence

• DehumanizationDehumanization

• PaternalismPaternalism

• CommercialismCommercialism

ChallengesChallenges

• Society Society

• Science vs. pseudoscienceScience vs. pseudoscience

• $$$$$$

• StewardshipStewardship

• ‘‘Synicism’Synicism’

ChallengesChallenges

• CapacitiesCapacities• Competencies Competencies • Costs Costs • ComplexityComplexity• ConsistencyConsistency• Civil Liberties & LitigationCivil Liberties & Litigation

The FINA ExperienceThe FINA Experience2004 - 20072004 - 2007

Testing: In and Out of competitionTesting: In and Out of competition

YearYearFINAFINA WADAWADA NF’sNF’s

TotalTotalICIC OCOC OCOC ICIC OCOC

20042004 992992 1,0601,060 212212 2,1792,179 2,4262,426 6,8696,869

20052005 740740 1,0901,090 260260 1,7831,783 1,2721,272 5,1455,145

20062006 752752 1,1311,131 213213 1,9301,930 2,0422,042 6,0686,068

2007*2007* 691691 873873 165165 353*353* 629*629* 2,711*2,711*

* Incomplete data* Incomplete data

The Costs of Doping ControlThe Costs of Doping Control

YearYear TestsTests Costs**Costs**

20042004 6,8696,869 $1,717,250 $1,717,250

20052005 5,1455,145 1,286,2501,286,250

20062006 6,0686,068 1,517,0001,517,000

2007*2007* 2,7112,711 677,750 677,750

20,79320,793 $$5,198,2505,198,250

** @ $250 per test** @ $250 per test* Incomplete data* Incomplete data

Positive Doping CasesPositive Doping Cases

YearYear TotalTotal (FINA)(FINA) (NF’s)(NF’s) %%

20042004 2121 33 1818 0.3%0.3%

20052005 3232 66 2626 0.6%0.6%

20062006 1717 00 1717 0.2%0.2%

2007*2007* 1717 44 1313 0.6%*0.6%*

* Incomplete data* Incomplete data

Positive Doping CasesPositive Doping Cases

YearYear AASAAS StimsStims GCsGCs ββ-2--2-agonistsagonists DiureticsDiuretics MaskMask Miss/ Miss/

RefuseRefuse CannabisCannabis CocaineCocaine

20042004 88 22 11 22 77 11

20052005 1010 55 11 11 1010 11

20062006 33 33 22 11 66 22

20072007 55 22 22 11 11 11 44 11

TotalTotal 2626 1010 2727 55

ATUE’s 2007 = 710ATUE’s 2007 = 710

DisciplineDiscipline # ATUE’s# ATUE’s PercentagePercentage

SwimmingSwimming 586586 82.5%82.5%

Water PoloWater Polo 7373 10.2%10.2%

DivingDiving 2626 3.6%3.6%

Synchronized SwimmingSynchronized Swimming 2222 3.0%3.0%

Open Water SwimmingOpen Water Swimming 33 0.004%0.004%

Mantzouranis E. Mantzouranis E. N Engl J MedN Engl J Med 2008;358:1211-1213 2008;358:1211-1213

Prevalence of Clinical Asthma, by CountryPrevalence of Clinical Asthma, by Country

ATUE’s 2007ATUE’s 2007

RankRank CountryCountry TotalTotal PercentagePercentage

11 Great BritainGreat Britain 104104 14.7%14.7%

22 USAUSA 8383 11.7%11.7%

33 FinlandFinland 7171 10.0%10.0%

44 ItalyItaly 6666 9.3%9.3%

55 AustraliaAustralia 5050 7.1%7.1%

66 NetherlandsNetherlands 3838 5.4%5.4%

77 FranceFrance 3434 4.8%4.8%

88 DenmarkDenmark 2828 3.9%3.9%

99GermanyGermany 2525 3.5%3.5%

JapanJapan 2525 3.5%3.5%

Use of Asthma Medications 2007Use of Asthma Medications 2007

# meds # meds usedused AA BB CC DD EE

33 37%37% 37%37% 23%23% 37%37% 35%35%

22 21%21% 51%51% 48%48% 43%43% 24%24%

11 42%42% 12%12% 29%29% 21%21% 41%41%

IncidenceIncidence ≥ ≥ 10.1%10.1% 7.6-10%7.6-10% ≥ ≥ 10.1%10.1% 2.6-5%2.6-5% ≥ ≥ 10.1%10.1%

Developments in Doping ControlDevelopments in Doping Control

• ClinicalClinical

• ScientificScientific

• EthicalEthical

• PoliticalPolitical

Recombinant TechnologyRecombinant Technology

The introduction of The introduction of recombinant technology recombinant technology

made possible the creation made possible the creation of synthetic hormones:of synthetic hormones:

Erythropoietin (EPO)Erythropoietin (EPO)

Growth Hormone Growth Hormone

NatureNature, 405:635(2000), 405:635(2000) Françoise Lasne, Jacques de Françoise Lasne, Jacques de CeaurrizCeaurrizNational Anti-Doping Laboratory, National Anti-Doping Laboratory, 92290 Châtenay-Malabry, France.92290 Châtenay-Malabry, France.

Recombinant erythropoietin in urineRecombinant erythropoietin in urineAn artificial hormone taken to boost athletic performance can now be detected.An artificial hormone taken to boost athletic performance can now be detected.

brief communications

The Changing Face The Changing Face of of

Doping ControlDoping Control

Lessons LearnedLessons Learned• Sport cannot eradicate deliberate, organized doping by Sport cannot eradicate deliberate, organized doping by

itselfitself• Many major antidoping initiatives have been led by Many major antidoping initiatives have been led by

government agencies…government agencies…

• CANADA CANADA Dubin Commission (judicial inquiry)Dubin Commission (judicial inquiry)• AUSTRALIA Customs Seizures PerthAUSTRALIA Customs Seizures Perth• FRANCE Customs Seizures Tour de FranceFRANCE Customs Seizures Tour de France• FINLAND Police Investigations Lahti FINLAND Police Investigations Lahti • ITALY Police Investigations TorinoITALY Police Investigations Torino• USA Revenue Agencies BALCOUSA Revenue Agencies BALCO

• Sport needs to work with governments who have Sport needs to work with governments who have investigative resources sport does notinvestigative resources sport does not

The new faces of anti-doping…The new faces of anti-doping…

““Doping is a legal concept that Doping is a legal concept that includes whatever is on the doping list. includes whatever is on the doping list. Everything else is up to the personal Everything else is up to the personal

judgment of the physician.”judgment of the physician.”

Heinz Liesen, 1988Heinz Liesen, 1988

“As a physician, the only thing that “As a physician, the only thing that concerns me is the health of the concerns me is the health of the

athlete and nothing else.”athlete and nothing else.”

Heinz Liesen, 1999Heinz Liesen, 1999

Groups to whom sports doctorsreport a sense of responsibility

Anderson, Gerrard. Anderson, Gerrard. J Med Ethics J Med Ethics 2005;31:88-922005;31:88-92

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StewardshipStewardship

Sports Medicine – Is There Lack of Control?Sports Medicine – Is There Lack of Control?

“ “Members of the medical profession have long Members of the medical profession have long been concerned with the health and welfare of been concerned with the health and welfare of

people in sport, but never have the stakes been people in sport, but never have the stakes been so high. Evidence continues to grow that some so high. Evidence continues to grow that some are showing more interest in finding new ways are showing more interest in finding new ways of enhancing the performance of those in their of enhancing the performance of those in their

charge than in their physical wellbeing.”charge than in their physical wellbeing.”

Lancet, 1988

Will my decision or activity be . . .Will my decision or activity be . . .

• to the credit or benefit of the athlete?to the credit or benefit of the athlete?• to the credit or benefit of sport?to the credit or benefit of sport?• to the credit or benefit of my profession?to the credit or benefit of my profession?

If the answer to any of these questions is “No”, the If the answer to any of these questions is “No”, the decision or activity is probably inappropriate.decision or activity is probably inappropriate.

Pipe. Pipe. Med Sci Sports Exerc Med Sci Sports Exerc 1993;25(8):888-9001993;25(8):888-900

Changing a Culture:Changing a Culture:

Leadership withLeadership withAn Ethical PerspectiveAn Ethical Perspective

Professional Codes of ConductProfessional Codes of Conduct

• Defined standards of behaviour regarding Defined standards of behaviour regarding doping issuesdoping issues

• An international consensusAn international consensus

• A condition of membershipA condition of membership

• A condition of participationA condition of participation

• Provisions for disciplinary actionProvisions for disciplinary action

The Sport Physician & ScientistThe Sport Physician & Scientist

• Provide Care of Highest StandardProvide Care of Highest Standard• Informed Policy DevelopmentInformed Policy Development• Expertise in Administrative MattersExpertise in Administrative Matters• Strength of Professional AssociationsStrength of Professional Associations• Capacity for Strategic LeadershipCapacity for Strategic Leadership• Community EducationCommunity Education• An Obligation to the Well-being of SportAn Obligation to the Well-being of Sport

The OpportunitiesThe Opportunities

• Highly motivated athletesHighly motivated athletes• Highly organized club structures/systemHighly organized club structures/system• Highly trained coaching communityHighly trained coaching community• Commitment of sport leadersCommitment of sport leaders• Ability to integrate educational programmes Ability to integrate educational programmes

emphasizing excellence in all domainsemphasizing excellence in all domains• Determination to address anti-doping as a priorityDetermination to address anti-doping as a priority• Replace Replace “Rhetoric”“Rhetoric” with with “Robust programmes”“Robust programmes”

The SpiritThe Spirit

of of

SportSport

The Future ?The Future ?

“… “…an array of scientific developments an array of scientific developments that will transform the ability of that will transform the ability of

individuals to alter their genomic, and individuals to alter their genomic, and hence their anatomic and physiologic hence their anatomic and physiologic potentials…such developments can potentials…such developments can only be addressed, ultimately, by an only be addressed, ultimately, by an

enhanced sense of responsibility enhanced sense of responsibility toward the practice and the processes toward the practice and the processes

of sport”of sport”

The Future IIThe Future II

“…“…a new generation of a new generation of doping-free, ethical doping-free, ethical athletes who compete athletes who compete in a manner consistent in a manner consistent with the best traditions with the best traditions of sport…”of sport…”

New Anti-doping Approaches ?New Anti-doping Approaches ?

• Civil AuthoritiesCivil Authorities• Physician, Scientists, OfficialsPhysician, Scientists, Officials

Professional Societies Professional Societies

Codes of EthicsCodes of Ethics

Disciplinary approachesDisciplinary approaches

Licensing ? Sanctions ?Licensing ? Sanctions ?

• Educational ProgrammesEducational Programmes• Athlete TestingAthlete Testing

Safeguarding Safeguarding Sport for Sport for TomorrowTomorrow