Prestatiebevorderende middelen bij fitnessbeoefenaars / Eindred. Olivier de Hon; J.H. Stubbe, A.M.J. Chorus, L.E. Frank, P. Schermers, P.G.M. van der Heijden. - TNO Kwaliteit van Leven; Universiteit Utrecht; i.o.v.: Dopingautoriteit. - Capelle a/d IJssel : Dopingautoriteit, 2009

In sports, the use of various performance-enhancing drugs is prohibited. These are often called ‘doping’ substances. It is not clear how many people use performance-enhancing drugs in the Netherlands. No recent studies have been conducted on the prevalence of performance-enhancing drugs in unorganized sports.
Therefore, the Anti-Doping Authority of the Netherlands commissioned TNO Quality of Life to investigate the prevalence and determinants of use of performance-enhancing drugs by athletes visiting Dutch fitness centres. In the current study, the concept of ‘doping’ was not strictly defined as substances on the Prohibited List of the World Anti-Doping Agency (WADA). Firstly, not all substances on this list are of primary interest to the commissioners of this study, nor to fitness athletes looking for performance enhancement (for example corticosteroids and cannabinoids). Secondly, some relevant substances are not on the Prohibited List, for example thyroid hormones and oral anti-diabetic medication. Therefore, these substances were included in the current study. Furthermore, use of performance-enhancing drugs was defined as using doping substances at least once in the preceding year.

The research questions of the study were:
1. What is the prevalence of use of performance-enhancing drugs by athletes (15 years and older) visiting Dutch fitness centres?
2. Which determinants are related to the use of performance-enhancing drugs by athletes (15 years and older) in Dutch fitness centres?
3. Are there trends in the determinants of use of performance-enhancing drugs?
4. How can the prevalence be assessed in a reliable and relatively simple manner in future studies?

Questionnaires were conducted among owners and athletes of fitness centres. A total of 500 centres were randomly selected from the trade register of the Dutch Chambers of Commerce (which listed a total of 1839 of such centres). At least three attempts were made to contact the owners of fitness centres by telephone. A total of 188 owners were reached of which 92 agreed to participate in this study (response rate = 49%). Characteristics of fitness centres participating in the current study were compared with characteristics of centres participating in the Dutch National Fitness Monitor. The findings showed that centres participating in the current study were a representative sample of the Dutch fitnessbranch. Participating in research about performance-enhancing drugs can be threatening to athletes visiting Dutch fitness centres. Respondents may be reluctant to reveal sensitive information. To tackle the problem of response errors, two web-based surveys were conducted. The first survey was conducted to compare the prevalence and determinants with earlier studies. This is the classical method. The second survey was conducted to investigate whether there was an underestimation of the true prevalence caused by response errors due to social desirability. This is the randomized response method. This second method will result in a more reliable and valid estimation of the prevalence of use of performance-enhancing drugs, if respondents experience the questions about performance-enhancing drugs as threatening.

A total of 718 athletes from 92 fitness centres completed the questionnaire; 246 respondents completed the first survey (i.e. classical method) and 447 respondents the second survey (i.e. randomized response method). 8.8% of owners of fitness centres answered there was a good chance that athletes visiting their centre used performance-enhancing drugs. One out of ten athletes knew at least one person who used performance enhancing drugs. These drugs were classified into the following categories: anabolic steroids, prohormones, substances to counteract side-effects, growth hormone and/or insulin, stimulants (to reduce weight), and miscellaneous substances. The classical method resulted in prevalences varying between 0.0% and 0.4% for the different types of performance-enhancing drugs with an overall prevalence of 0.4%. The randomized response method resulted in prevalences varying between 0.8% and 4.8% for the different types of performance enhancing drugs with an overall prevalence of 8.2%. The overall prevalence of the two survey methods differed significantly.

Therefore, it can be concluded that the randomized response method resulted in a more reliable and valid estimation of the prevalence of use of performance-enhancing drugs. The overall prevalence of performance-enhancing drugs was low and therefore it was not possible to carry out an analysis of determinants. As a result, the third question about trends in determinants of performance enhancing drugs could not be answered. A literature research was carried out to investigate which determinants were related to use of performance-enhancing drugs in earlier European studies. The literature search showed that the following determinants were related to performance-enhancing drugs use: gender, educational level, use of various substances (legally prohibited drugs, tobacco, alcohol, coffee, dietary supplements, intention to use performance-enhancing drugs), exercise behaviour (participating in exercise, number of training hours per week, participating in body building), body image (desire to lose weight, self esteem, mental health, and trait anxiety) and social network (knowing people who use performance-enhancing drugs, having a friend who uses doping, and choice of education). The last research question addressed the question how this prevalence can be assessed in a reliable and relatively simple manner in future studies. The current study showed that the classical method led to an underestimation of the prevalence. Therefore, the randomized response method is more suitable for estimating the prevalence of use of performance-enhancing drugs in the future. Studies on the determinants of performance-enhancing drugs should be separately conducted from studies on the prevalence. To enable an analysis of determinants of performance-enhancing drugs, it is important to have a lot of respondents using performance-enhancing drugs. This can be accomplished by including fitness centres that are suspected to have many athletes using performance-enhancing drugs. However, for prevalence studies a representative sample of respondents is essential. Therefore, selecting centres with a high prevalence of performance-enhancing drugs is not the correct strategy, because the results of this selected group of athletes cannot be generalized to the population at large.

Related Cases:
- NBB 2008 NBB Decision Disciplinary Committee 2008063 T
April 7, 2009
- Dutch District Court 2008 Athlete 2008063 vs NBB
March 10, 2010

Defendant appeals against the decision of the disciplinary committee of the Netherlands Badminton Association (Nederlandse Badminton Bond, NBB). Also the Board of the NBB appeals against the decision of the disciplinary committee.

Defendant was unaware, nor had any suspicion, that the ecstasy pills contained the prohibited substances. Also defendant claims that the NBB failed to give sufficient information about the Anti-Doping Code (ADC) rules.

The board of the NBB in her view thinks that period of ineligibility should be 2 years, there are no conditions to reduce the period.

The appeal commission findings are that the defendant has violated the Anti-Doping code rules for testing positive on the prohibited substances MDMA, MDA and 11-nor-∆9-tetrahydrocannabinol-9-carboxylic acid. These substances belong to the non-specific substances for which a reduction can be applicable.
The is no lack of information that the NBB gave toward the ABC rules.
Reduction of the period of ineligibility should be given with great consideration. The lapsed time, usage or intention for taken ecstasy is not important. The appeal committee doesn't agree with the disciplinary committee to reduce the period of ineligibility because this was the first case in badminton.

The appeal committee declines the appeal of the defendant and grants the appeal of the board of the NBB, the decision is a period of ineligibility of two years.

In April 2009 the Hellenic Swimming Federation reported an anti-doping rule violation against the Athlete Dimitrios Xynadas for refusing or failing without compelling justification to submit to sample collection after notification.

The Athlete underwent a Doping Control on 15 April 2009 at the National Swimming Pool of Thessaloniki. During the Doping Control the Athlete left the swimming pool in a hurry leaving all his personal belongings behind after he had received phone calls from his family.

The Athlete stated that he was informed by his family that his father was found in a critical medical condition and he went immediately to the Mpodosakeio Hospital of Ptolemaida where his father was admitted.
In support of his statement the Athlete produced official medical documents and witness statements about his father medical condition and the Athlete’s presence in the Hospital of Ptolemaida.

The Board of the Hellenic Swimming Federation accepted the Athlete’s explanation and evidence and concluded that the Athlete’s failure to submit was without intention or negligence considering the circumstances in this case.
Therefore the Board of the Hellenic Swimming Fedeation decided in June 2009 to drop the charges against the Athlete.

Related cases:
- Dutch District Court 2009 Athlete 2009064 vs NWWB
July 24, 2009
- ISR 2009 NWWB Decision Appeal Committee 2009064 B
January 29, 2010

In April 2009 the Netherlands Water Ski & Wakeboard Federation (NWWB) has reported an anti-doping rule violation against the Person after his A and B samples tested positive for the prohibited substance nandrolone. After notification the Person filed a statement with medical evidence in his defence and he was heard for the NWWB Disciplinary Committee.

The Person stated that he used several prescribed medications and he was under treatment for a physical injury. He also mentioned the medication and treatment on the Doping Control Form.
The Person’s medical history showed that he used prescribed nandrolone as treatment for a serious condition he suffered. This treatment with nandrolone ended in 2006 due to his sport career and the prohibition in sport for the use of nandrolone. Later and previously before he provided a sample he also used another medication. The Person asserted that shortly before he was tested he administered nandrolone and not his medication by mistake as explanation for the positive doping test.

Considering the evidence and without mitigating circumstances the Committee did not accept the Person's statement and concludes that he acted with negligence and failed in his responsibility that no prohibited substance enters his body.
Therefore on 29 June 2009 the NWWB Disciplinary Committee decides to impose a 2 year period on the Person starting on the date of the decision.
Fees and expenses for this Committee shall be borne by the Person.

Interpretation of urinary concentrations of pseudoephedrine and its metabolite cathine in relation to doping control / K. Deventer, P. Van Eenoo, G. Baele, O.J. Pozo, W. Van Thuyne, F.T. Delbeke. - (Drug Testing and Analysis 1 (2009) 5 (May); p. 209-213)

• PMID: 20355197
• DOI: 10.1002/dta.31

Abstract

Until the end of 2003 a urinary concentration of pseudoephedrine exceeding 25 microg/mL was regarded as a doping violation by the World Anti-Doping Agency. Since its removal from the prohibited list in 2004 the number of urine samples in which pseudoephedrine was detected in our laboratory increased substantially. Analysis of 116 in-competition samples containing pseudoephedrine in 2007 and 2008, revealed that 66% of these samples had a concentration of pseudoephedrine above 25 microg/mL. This corresponded to 1.4% of all tested in competition samples in that period. In the period 2001-2003 only 0.18% of all analysed in competition samples contained more than 25 microg/mL. Statistical comparison of the two periods showed that after the removal of pseudoephedrine from the list its use increased significantly. Of the individual sports compared between the two periods, only cycling is shown to yield a significant increase.Analysis of excretion urine samples after administration of a therapeutic daily dose (240 mg pseudoephedrine) in one administration showed that the threshold of 25 microg/mL can be exceeded. The same samples were also analysed for cathine, which has currently a threshold of 5 microg/mL on the prohibited list. The maximum urinary concentration of cathine also exceeded the threshold for some volunteers. Comparison of the measured cathine and pseudoephedrine concentrations only indicated a poor correlation between them. Hence, cathine is not a good indicator to control pseudopehedrine intake. To control the (ab)use of ephedrines in sports it is recommended that WADA reintroduce a threshold for pseudoephedrine.

Facts
The French Mountaineering and Climbing Federation (Fédération Française de la Montagne et de l'Escalade, FFME) charges respondent M16 for a violation of the Anti-Doping Rules. During a doping control at the French climbing championship on October 12, 2008, a sample was taken from the respondent. The sample tested positive on benzoylecgonine a metabolite of cocaine. Cocaine is a prohibited substance on the World Anti-Doping Agency (WADA) prohibited list.

History
The respondent questions the testing procedure because in the report she was regarded as a male while she was a female. For this reason she doubts that the tested sample was hers.

Decision
1. The respondent is acquitted and petition or manifestation organized or authorized by the FFME.
2. The decision starts on the date of notification.
3. The decision will be published and sent to the parties involved.

CAS 2008/A/1738 WADA v/DEB & Busch
CAS 2008/A/1738 WADA vs DEB & Florian Busch

Related cases:

• CAS 2008/A/1564 WADA vs IIHF & Florian Busch
  June 23, 2009
• Swiss Federal Court 4A_358/2009 Florian Busch vs WADA
  November 6, 2009

On 7 March 2008 the German National Anti-Doping Agency (NADA) reported to the German Ice Hockey Federation (DEB), an anti-doping rule violation against the ice hockey player Florian Busch after he refused to provide a sample for doping control.

Nevertheless on 15 April 2008 the DEB decided to imposed only a reprimand of the Athlete and fined him EUR 5,000.00 and 56 hours community service. Also the International Ice Hockey Federation (IIHF) adopted this DEB decision and granted the Athlete to play in the Ice Hockey World Championship in Canada in May 2008.

In April 2008 NADA had notified the World Anti-Doping Agency (WADA) about this case. On 6 Mei 2008 WADA requested the IIHF to order a provisional suspension and to sanction the Athlete for 2 years.

However the IIHF Board submitted to WADA on 7 May 2008 that it could not open proceedings against the Athlete because it determinded that at national level the period had not lapsed to file an appeal against the DEB decision.

Accordingly on 9 May 2008 at national level WADA appealed the DEB decision of 15 April 2008 with the Ad-hoc Arbitral Tribunal of the German Olympic Sports Confederation (DOSB). On 3 December 2008 WADA's appeal was dismissed by the DOSB Tribunal due to lack of jurisdiction since the DEB had not implemented the German NADA Code in this matter.

Hereafter in December 2008 WADA appealed the Decision of 3 December 2008 of the DOSB Tribunal with the Court of Arbitration for Sport (CAS). Yet, the CAS Panel decided on 23 June 2009 that it could not settle this case on the grounds of lack of jurisdiction. The Panel established that the Decision of the DOSB Ad-hoc Arbitral Tribunal was not appealable due to it was declared final and binding.

Previously in May 2008 WADA had filed an appeal with CAS (case CAS 2008/A/1564) against the IIHF. In this separate proceeding WADA requested the Panel to impose a 2 year sanction on the Athlete. Following assessment the CAS Panel declared itself to be competent and took the e-mail sent by the IIHV on 7 May 2008 as an appealable decision.

Ultimately on 23 June 2009 the Panel decided to annul the IIHF decision and to impose a 2 year period of ineligibility on the Athlete.

CAS 2008/A/1564 World Anti-doping Agency (WADA) v. International Ice Hockey Federation (IIHF) & Florian Busch

Related cases:

• CAS 2008/A/1738 WADA vs DEB & Florian Busch
  June 23, 2009
• Swiss Federal Court 4A_358/2009 Florian Busch vs WADA
  November 6, 2009

• Ice hockey
• Doping (refusal to submit to a sample collection)
• Interpretation of the rules of an IF in conformity with the WADC
• Interpretation of unclear or contradictory arbitration agreements according to the principle of confidence
• Basic requirements for a valid arbitration clause or arbitration agreement

1. International Federations (IFs) that have signed the World Anti-doping Code (WADC) are required, inter alia, to adopt and implement anti-doping policies and rules which conform with the WADC and to require as a condition of membership that the policies, rules and programs of National Federations are in compliance with the WADC; in this respect, International Federations have to adjust their legal order in accordance with the above commitments towards WADA. Where no such adjustments have taken place, the rules of an International Federation must be interpreted in such a manner that their application finds the Federation in conformity with the WADC.

2. Pursuant to Swiss law, arbitration agreements which contain provisions with regard to the essential elements of an arbitration agreement which are unclear or contradictory (so called “pathological clauses”) are to be interpreted in an objective manner which provides for neutrality with regard to the results of the interpretation. If a party argues having understood a clause in a different manner, the principle of confidence is to be applied. This means that the respective will of the parties is to be established as it could be and must have been understood bona fide by the respective addressee of a declaration.

3. The players sign to abide and observe the IF’s Statutes, By-laws and Regulations, and, in particular, decisions by the IF including disciplinary measures in general. They subject themselves to exclusive jurisdiction of IF appeal procedures and, after their exhaustion, to the jurisdiction of the CAS.

4. For an arbitration clause or arbitration agreement to be valid, it has to make clear the parties’ consent to arbitration, to define the scope and limit of that consent, to cover precisely the subject matter the parties intend be submitted to arbitration and to provide for the designated dispute resolution method and for exclusivity. Moreover, by reference to the Code of Sports-related Arbitration, the recommended elements of an international arbitration clause are fulfilled: this is the place of arbitration, the method of selection and number of arbitrators and the language of the arbitration.

In March 2008 the German National Anti-Doping Agency (NADA) has reported to the German Ice Hockey Federation (DEB) an anti-doping rule violation against the ice hockey player Florian Busch for his refusal to provide a sample for doping control.

Thereupon the DEB informed NADA that the proposed sanction would be excessive and that a public warning would be sufficient, considering the circumstances of the actual case. Accordingly on 15 April 2008 the DEB imposed a fine and a reprimand on the Athlete including 56 hours community service.

Through the media NADA was informed about the DEB decision and it was informed that the International Ice Hockey Federation (IIHF) supported this decision and allowed the Athlete to play in the next Ice Hockey World Championship in Canada in May 2008. NADA notified WADA in April 2008 to consider launching proceedings.

After deliberations between WADA the DEB and the IIHF about sanctioning the Athlete WADA appealed in May 2008 the DEB decision with the DEB Ad-hoc Arbitral Tribunal of the German Olympic Sports Association.

Also in May 2008 WADA filed an appeal with the Court of Arbitration for Sport (CAS) against the IIHF and requested for the imposition of a two-year suspension (Proceedings CAS 2008/A/1564).

WADA filed the request for arbitration with CAS to ensure its right to appeal in the situation that the appeal with the German ad-hoc Arbitral Tribunal is rejected. Subsequently, the proceedings before CAS were suspended pending a decision from the German Arbitral Tribunal about the WADA appeal.

On 3 December 2008 the DEB Ad-hoc Arbitral Tribunal decided to dismiss the WADA appeal because the requested sanction was unfounded. Hereafter WADA appealed this Decision with CAS (Proceedings CAS 2008/A/1738). However on 23 June 2008 CAS rejected this appeal because it lacked jurisdiction.

The CAS Panel determines in this case (CAS 2008/A/1564) that the Athlete has not served any period of ineligibility in accordance with the WADC. The Panel determines, however, that the Athlete has served two sanctions of different kind (fine and community work) and was de facto sanctioned for 1 year ineligibility from international competitions.

The Panel, taking into consideration the preparatory and evaluating hours needed in addition to the 56 hours community work, served by the Athlete, holds justified to equalize fine and community work served altogether to one month of ineligibility in the understanding of art. 10.9 of the 2003 WADC.

The de facto sanction of 1 year for international ineligibility, given the loss of market value, income and reputation attached thereto is held equal by the Panel to 1 further month. Thus, the Panel holds that 2 months from altogether two years of ineligibility have already been served.

Therefore the Court of Arbitration for Sport decides on 23 June 2009:

1.) The appeal of WADA against the IIHF decision of 7 May 2008 is declared admissible and upheld.

2.) The decision of IIHF rendered on 7 May 2008 in the matter of Mr Florian Busch is set aside.

3.) Mr Florian Busch is sanctioned with a two-year period of ineligibility starting on 22 April 2009, two months of which are considered as having already been served and shall be credited against the total period of ineligibility to be served.

4. (…)

5. (…)

6. All other motions or prayers for relief are dismissed.

Detection of testosterone administration based on the carbon isotope ratio profiling of endogenous steroids : international reference populations of professional soccer players / E. Strahm, C. Emery, M. Saugy, J. Dvorak, C. Saudan. - (International Journal of Sports Medicine 25 (2004) 13 (December); p. 528-543)

• PMID: 19549614
• PMCID: PMC2784500
• DOI: 10.1136/bjsm.2009.058669

Abstract

Background and objectives: The determination of the carbon isotope ratio in androgen metabolites has been previously shown to be a reliable, direct method to detect testosterone misuse in the context of antidoping testing. Here, the variability in the 13C/12C ratios in urinary steroids in a widely heterogeneous cohort of professional soccer players residing in different countries (Argentina, Italy, Japan, South Africa, Switzerland and Uganda) is examined.

Methods: Carbon isotope ratios of selected androgens in urine specimens were determined using gas chromatography/combustion/isotope ratio mass spectrometry (GC-C-IRMS).

Results: Urinary steroids in Italian and Swiss populations were found to be enriched in 13C relative to other groups, reflecting higher consumption of C3 plants in these two countries. Importantly, detection criteria based on the difference in the carbon isotope ratio of androsterone and pregnanediol for each population were found to be well below the established threshold value for positive cases.

Conclusions: The results obtained with the tested diet groups highlight the importance of adapting the criteria if one wishes to increase the sensitivity of exogenous testosterone detection. In addition, confirmatory tests might be rendered more efficient by combining isotope ratio mass spectrometry with refined interpretation criteria for positivity and subject-based profiling of steroids.

The benefits and risks of testosterone replacement therapy: a review / Nazem Bassil, Saad Alkaade, John E. Morley. - (Therapeutics and clinical risk management 5 (2009) 3 (11 June); p. 427-448)

• PMID: 19707253
• PMCID: PMC2701485
• DOI: 10.2147/tcrm.s3025

Abstract

Increased longevity and population aging will increase the number of men with late onset hypogonadism. It is a common condition, but often underdiagnosed and undertreated. The indication of testosterone-replacement therapy (TRT) treatment requires the presence of low testosterone level, and symptoms and signs of hypogonadism. Although controversy remains regarding indications for testosterone supplementation in aging men due to lack of large-scale, long-term studies assessing the benefits and risks of testosterone-replacement therapy in men, reports indicate that TRT may produce a wide range of benefits for men with hypogonadism that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially possible stimulation of prostate cancer by testosterone, even though no evidence to support this risk exists. Other possible risks include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea or severe heart failure. Despite this controversy, testosterone supplementation in the United States has increased substantially over the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. The purpose of this review is to discuss what is known and not known regarding the benefits and risks of TRT.