Erythropoiesis-stimulating agents and other methods to enhance oxygen transport / S. Elliott. - (British Journal of Pharmacology 154 (2008) 3 (June); p. 529-541). - Special Issue: Themed Section: Drugs in Sport: Guest Editors: Professor J.C. McGrath and Professor D.A. Cowan

• PMID: 18362898
• PMCID: PMC2439521
• DOI: 10.1038/bjp.2008.89

Abstract

Oxygen is essential for life, and the body has developed an exquisite method to collect oxygen in the lungs and transport it to the tissues. Hb contained within red blood cells (RBCs), is the key oxygen-carrying component in blood, and levels of RBCs are tightly controlled according to demand for oxygen. The availability of oxygen plays a critical role in athletic performance, and agents that enhance oxygen delivery to tissues increase aerobic power. Early methods to increase oxygen delivery included training at altitude, and later, transfusion of packed RBCs. A breakthrough in understanding how RBC formation is controlled included the discovery of erythropoietin (Epo) and cloning of the EPO gene. Cloning of the EPO gene was followed by commercial development of recombinant human Epo (rHuEpo). Legitimate use of this and other agents that affect oxygen delivery is important in the treatment of anaemia (low Hb levels) in patients with chronic kidney disease or in cancer patients with chemotherapy-induced anaemia. However, competitive sports was affected by illicit use of rHuEpo to enhance performance. Testing methods for these agents resulted in a cat-and-mouse game, with testing labs attempting to detect the use of a drug or blood product to improve athletic performance (doping) and certain athletes developing methods to use the agents without being detected. This article examines the current methods to enhance aerobic performance and the methods to detect illicit use.

Facts
The Fédération Equestre Internationale (FEI) charges Mark Armstrong (athlete) for a violation of the Anti-Doping Rules. On 18 November 2007, the Athlete was selected for in-competition testing. His sample tested positive on salbutamol at a concentration measured as 610 ng/ml. Salbutamol is listed as a prohibited substance on the WADA 2007 prohibited list.

History
The athlete doesn't request an B-sample analysis nor an oral hearing. In a written statement he explains that the source of the contamination is his use of Asthma medication. The Athlete acknowledges that it was his responsibility to obtain a Therapeutic Use Exemption ("TUE") and expresses his deep regret and apology for this omission. He, however, expresses his disappointment that his National Federation ("NF") "did not direct [him] proactively to obtain a TUE as, through [his] involvement in their elite squad, [he is] quite certain they knew [he's] asthmatic and required Ventolin". the Athlete applied for a national TUE with UK Sport and for an international TUE with the FEI. His International TUE was granted on 21 January 2008 by the FEI TUE Committee ("TUEC") with an approval expiry date of 31 December 2009. The Athlete assures that he had no intention to enhance his performance and that his omission to obtain a TUE and his rule violation were unintentional.

Submissions tribunal
The athlete was negligent to ask for a TUE.

Decision
The Tribunal decides to disqualify the Athlete from the Event and that all medals, points and prize money won at the Event must be forfeited, in accordance with ADRHA Article 9.
The Athlete shall be warned and reprimanded.

Costs
The Athlete shall contribute CHF l/OOO.- towards the legal
costs of the judicial procedure.

Systematic review : the effects of growth hormone on athletic performance / Hau Liu, Dena M. Bravata, Ingram Olkin, Anne Friedlander, Vincent Liu, Brian Roberts, Eran Bendavid, Olga Saynina, Shelley R. Salpeter, Alan M. Garber, Andrew R. Hoffman. - (Annals of Internal Medicine 148 (2008) 10 (20 May); p. 747-758)

• PMID: 18347346
• DOI: 10.7326/0003-4819-148-10-200805200-00215

Abstract

Background: Human growth hormone is reportedly used to enhance athletic performance, although its safety and efficacy for this purpose are poorly understood.

Purpose: To evaluate evidence about the effects of growth hormone on athletic performance in physically fit, young individuals.

Data sources: MEDLINE, EMBASE, SPORTDiscus, and Cochrane Collaboration databases were searched for English-language studies published between January 1966 and October 2007.

Study selection: Randomized, controlled trials that compared growth hormone treatment with no growth hormone treatment in community-dwelling healthy participants between 13 and 45 years of age.

Data extraction: 2 authors independently reviewed articles and abstracted data.

Data synthesis: 44 articles describing 27 study samples met inclusion criteria; 303 participants received growth hormone, representing 13.3 person-years of treatment. Participants were young (mean age, 27 years [SD, 3]), lean (mean body mass index, 24 kg/m2 [SD, 2]), and physically fit (mean maximum oxygen uptake, 51 mL/kg of body weight per minute [SD, 8]). Growth hormone dosage (mean, 36 microg/kg per day [SD, 21]) and treatment duration (mean, 20 days [SD, 18] for studies giving growth hormone for >1 day) varied. Lean body mass increased in growth hormone recipients compared with participants who did not receive growth hormone (increase, 2.1 kg [95% CI, 1.3 to 2.9 kg]), but strength and exercise capacity did not seem to improve. Lactate levels during exercise were statistically significantly higher in 2 of 3 studies that evaluated this outcome. Growth hormone-treated participants more frequently experienced soft tissue edema and fatigue than did those not treated with growth hormone.

Limitations: Few studies evaluated athletic performance. Growth hormone protocols in the studies may not reflect real-world doses and regimens.

Conclusion: Claims that growth hormone enhances physical performance are not supported by the scientific literature. Although the limited available evidence suggests that growth hormone increases lean body mass, it may not improve strength; in addition, it may worsen exercise capacity and increase adverse events. More research is needed to conclusively determine the effects of growth hormone on athletic performance.

Four weeks’ corticosteroid inhalation does not augment maximal power output in endurance athletes / H. Kuipers, G.A.C. van't Hullenaar, B.M. Pluim, S.E. Overbeek, Olivier de Hon, E.J. Van Breda, L.C. Van Loon. - (British Journal of Sports Medicine 42 (2008) 11 (Nov) p. 868-871). - doi: 10.1136/bjsm.2007.042572

Abstract:

Objective: To assess possible ergogenic properties of corticosteroid administration.
Design: A balanced, double-blind, placebo-controlled design was used.
Participants: 28 well-trained cyclists and rowers.
Intervention: 4 weeks’ daily inhalation of 800 mg budesonide or placebo.
Main outcome measurements: The subjects performed three incremental cycle ergometer tests until exhaustion, before and after 2 and 4 weeks of placebo or budesonide administration, to measure maximal power output (Wmax). Once a week they filled in a profile of mood state (POMS) questionnaire.
Results: There was no significant difference in Wmax between the placebo (376 (SD 25) W) and the corticosteroid group (375 (36) W) during the preintervention test, and there were no significant changes in either group after 2 and 4 weeks of intervention. No effect of the intervention on mood state was found.
Conclusion: 4 weeks of corticosteroid or placebo inhalation in healthy, well-trained athletes did not affect maximal power output or mood state. Hence no ergogenic properties of 4 weeks’ corticosteroid administration could be demonstrated, which corroborates previous studies of short-term corticosteroid administration.

Facts
The French Cycling Federation (Fédération Française de Cyclisme, FFC) charges respondent M25 for a violation of the Anti-Doping Rules. During a cycling event on August 26, 2007, respondent didn't attend the doping control.

History
The respondent claims he arrived as the last one at the finish line, far behind the other participants. He went to his car and didn't notice the announcements by microfone. However the panel holds that a designated test person is still responsible to be available for a doping test.

Decision
1. The respondent is acquitted.
2. The decision (acquitttal) dated November 28, 2007, by the disciplinary committee of the FFC doens't need to be modified.
3. The decision starts on the date of notification.
4. The decision will be published and sent to the parties involved.

Facts
The French Cycling Federation (Fédération Française de Cyclisme, FFC) charges respondent M24 for a violation of the Anti-Doping Rules. During a cycling event on July 7, 2007, a sample was taken for doping test purposes. The analysis of the sample showed the presence of a metabolite of cannabis. Cannabis is a prohibited substance according the World Anti-Doping Agency (WADA) prohibited list and is regarded as a specified substance.

History
The respondent had used cannabis in a recreational setting.

Decision
1. The sanction is a period of ineligibility of three months in which respondent can't take part in competition or manifestations organized by the FFC.
2. The decision (a warning) dated November 28, 2007, by the disciplinary committee of the FFC should be modified.
3. The decision starts on the date of notification.
4. The decision will be published and sent to the parties involved.

Facts
The French Swimming Federation (Fédération Française de Natation, FFN) charges respondent M23 for a violation of the Anti-Doping Rules. During a water polo match on November 3, 2007, a sample was taken for doping test purposes. The analysis of the sample showed the presence of a metabolite of cannabis. Cannabis is a prohibited substance according the World Anti-Doping Agency (WADA) prohibited list and is regarded as a specified substance.

History
The respondent claims that the positive test was caused by passive smoking. However the athlete stays responsible for prohibited substances entering his body.

Decision
1. The sanction is a period of ineligibility of three months in which respondent can't take part in competition or manifestations organized by the FFN.
2. The decision (a warning), dated May 29, 2009, by the disciplinary committee of the FFN should be modified.
4. The decision start on the date of notification.
5. The decision will be published and sent to the parties involved.

Facts
The International Rugby Board (IRB) charges Alireza Iraj for a violation of the Anti-Doping Rules. Following the Iran vs Pakistan rugby match the Asian Rugby Championships 2007 during in-competition testing, the player provided an urine sample. The sample tested positive on 19-norandrosterone with a concentration greater than the threshold level of 2ng/ml.

History
The player stated that quite by accident the 19-norandrosterone was given to him by the doctor.

Decision
The sanction imposed for this antidoping rule violation is a period of ineligibility of two years commencing from the 12th December 2007 (the date upon which the player's provisional suspension commenced) and concluding (but Inclusive of) the 12th December 2009.

CAS 2007/A/1356 Tomaž Nose v/ Slovenian Cycling Federation (Kolesarska Zveza Slovenije)

In October 2006 the International Cycling Union (UCI) has reported an anti-doping rule violation against the Slovenian cyclist Tomaž Nose after his sample tested positive for his elevated T/E ratio (testosterone / epitestosterone) above the WADA threshold. The Athlete did not test positive for Testosterone while he used prescribed Testosterone therapy due to his diagnosed low hormone levels.

In this matter the Athlete had a valid TUE issued by the Slovenian Olympic Committee for the use of the prescribed Testoviron. However the Athlete was unaware that he should have obtained a TUE from the UCI for international cycling events. 

Consequently on 10 August 2007 the Anti-Doping Commission (ADC) of the Slovenian Cycling Federation (KZS) decided to impose a 20 month period of ineligibility on the Athlete starting back dated on 6 November 2006. 

Hereafter in August 2007 the Athlete appealed the KZS decision with the Court of Arbitration for Sport (CAS). 

The Athlete admitted the use of Testosterone therapy and denied that the violation was intentional since he had a valid TUE and there was not positive test. He argued that he was unaware that his TUE was not valid for international races.

He had relied on experts to obtain a valid TUE and all assurances had been given by those experts as to the validity of the TUE. Also the response of WADA gave him sufficient reasons to believe that his current TUE was valid for international competitions. 

Furthermore the Athlete asserted that the ADC Decision of 10 August 2007 was based on erroneous and incomplete determination of the circumstances, erroneous application of material law and material breaches of procedure that impacted on the correctness and legality of the Decision. 

The Panel agrees that in First Instance certain material breaches of procedure occurred which impacted on the correctness an quality of the ruling. For that reason the Panel decided to deal with the merits of the case to decide de novo. It therefore does not have to deal with the procedural irregularities which occurred according to the Athlete. 

The Panel holds that the TUE issued by the Slovenian Olympic Committee was not valid for international events. As a result the Panel finds that under the UCI Rules the Athlete committed an anti-doping rule violation by using a Prohibited Substance with a valid TUE.

However the Panel finds that the circumstances in this case have been very exceptional and must be seen as a chain of unfortunate circumstances which may not easily be found in another case.

The Panel established that the Athlete was aware of his duty to obtain a TUE for the use of his medication, he consulted the best qualified expert on anti-doping matters in Slovenia and fully relied on his advice. Unfortunately the Slovenian expert was unfamiliar with the international TUE-procedure and the contacted WADA expert did not notify the Slovenian expert about his erroneous TUE application but rather provided confusing information. 

On that account the Panel deems that the Athlete cannot be blamed for relying on the offical’s advice regarding his TUE application. It concludes that the Athlete’s violaton was not intentional and that he bears No Significant Fault or Negligence. 

Therefore the Court of Arbitration for Sport decides on 11 March 2008: 

1. The Appeal filed by Tomaž Nose is partially admitted.
2. The decision issued by the Anti-doping Commission of the Slovenian Cycling Federation is amended as follows: The period of Ineligibility is set to 12 months and the commencement date of the period of Ineligibility is fixed on 11 September 2006 instead of 6 November 2006. The period of ineligibility thus ended on 10 September 2007.
3. Tomaž Nose is disqualified from the Tour of Slovenia race, which took place between 8 and11 June 2006, and his results obtained at this Tour are annulled.
4. All other motions or prayers for relief are dismissed.
5. This award is pronounced without costs, except for the court office fee of CHF 500 (five hundred Swiss francs) paid by Tomaž Nose, which is retained by CAS.
6. Slovenian Cycling Federation shall pay to Tomaž Nose the amount of CBF 5,000 (five thousand Swiss Francs) as a contribution towards the expenses incurred by Tomaž Nose inconnection with these arbitration proceedings.

Psychological drivers in doping: the life-cycle model of performance enhancement / Andrea Petróczi, Eugene Aidman. - (Substance Abuse Treatment, Prevention, and Policy 3 (2008); 7)

• PMID: 18331645
• PMCID: PMC2315642
• DOI: 10.1186/1747-597X-3-7

Abstract

Background: Performance enhancement (PE) is a natural and essential ingredient of competitive sport. Except for nutritional supplement contamination, accidental use of doping is highly unlikely. It requires deliberation, planning and commitment; and is influenced by a host of protective and risk factors.

Hypothesis: In the course of their career, athletes constantly set goals and make choices regarding the way these goals can be achieved. The cycle of choice - goal commitment - execution - feedback on goal attainment - goal evaluation/adjustment has numerous exit points, each providing an opportunity for behaviour change, which may or may not be related to the use of prohibited methods. The interplay between facilitating and inhibiting systemic and personality factors, constantly influenced by situational factors could result in an outcome vector of 'doping attitudes', which combines with subjective norms to influence intentions to choose prohibited PE methods. These influences also vary from one stage of athlete development to the next, making some athletes more vulnerable to engaging in doping practices than others, and more vulnerable at certain time periods - and not others.

Testing the hypothesis: Model-testing requires a series of carefully planned and coordinated studies. Correlational studies can establish relationships where the directionality is not-known or not important. Experimental studies with the manipulation of doping expectancies and risk factors can be used to demonstrate causality and evaluate potential intervention strategies. The final model can be tested via a behavioural simulation, with outcomes compared to those expected from literature precedence or used as a simulated computer game for empirical data collection.

Implications: A hypothesized life-cycle model of PE identifies vulnerability factors across the stages of athlete development with the view of informing the design of anti-doping assessment and intervention. The model suggests that, instead of focusing on the actual engagement in prohibited PE practices, deterrence strategies are likely to be more effective if they target the influencing factors at the appropriate stage and identify groups of athletes and their respective career stages, which pose particular risks of engagement in doping practices. This enables a more effective intervention approach by targeting specific risk factors and expectancies.