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Anti-Doping: The Challenge and the Opportunity Andrew Pipe, CM, MD, Dip Sport Med, FACSM University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

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Presentation on theme: "Anti-Doping: The Challenge and the Opportunity Andrew Pipe, CM, MD, Dip Sport Med, FACSM University of Ottawa Heart Institute, Ottawa, Ontario, Canada."— Presentation transcript:

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2 Anti-Doping: The Challenge and the Opportunity Andrew Pipe, CM, MD, Dip Sport Med, FACSM University of Ottawa Heart Institute, Ottawa, Ontario, Canada Chair, FINA Doping Control Review Board 16 th World FINA Sports Medicine Congress

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

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5 The Role of Physicians & Scientists Advisor and ConfidanteAdvisor and Confidante Advocate for the health of the athlete and the well-being of sportAdvocate for the health of the athlete and the well-being of sport Responsibility to patient, sport and the communityResponsibility to patient, sport and the community Support the pursuit of excellence by fair and ethical meansSupport the pursuit of excellence by fair and ethical means Provide distinct leadership…Provide distinct leadership…

6 “If drug use in sport is a developing scandal, then it is a scandal that involves the medical establishment as well as the sporting one.” Sports Illustrated 1969; June 23:66-69

7 Sport Scientists & Sport Physicians “Are we to be seen as contributing to deliberate, cynical practices which subvert the processes and nature of sport ?........or do we demonstrate leadership, guided by principle and an ethical perspective?” “Are we to be seen as contributing to deliberate, cynical practices which subvert the processes and nature of sport ?........or do we demonstrate leadership, guided by principle and an ethical perspective?”

8 The Physician and the Athlete “As in any other area of medical practice, sports physicians must care profoundly, and in the broadest sense, for the welfare of their patients while understanding the unique dimensions and pressures of the environments in which their patients live, train and compete.” “As in any other area of medical practice, sports physicians must care profoundly, and in the broadest sense, for the welfare of their patients while understanding the unique dimensions and pressures of the environments in which their patients live, train and compete.”

9 “They are our patients first… they are athletes second!”

10 Considerations in Anti-Doping AutonomyAutonomy StewardshipStewardship Safety, Harm MinimizationSafety, Harm Minimization BenificenceBenificence DehumanizationDehumanization PaternalismPaternalism CommercialismCommercialism

11 Challenges SocietySociety Science vs. pseudoscienceScience vs. pseudoscience $$$$$$ StewardshipStewardship ‘Synicism’‘Synicism’

12 Challenges CapacitiesCapacities CompetenciesCompetencies CostsCosts ComplexityComplexity ConsistencyConsistency Civil Liberties & LitigationCivil Liberties & Litigation

13 The FINA Experience 2004 - 2007

14 Testing: In and Out of competition Year FINAWADANF’s Total ICOCOCICOC 20049921,0602122,1792,4266,869 20057401,0902601,7831,2725,145 20067521,1312131,9302,0426,068 2007*691 873 873165 353* 353* 629* 629*2,711* * Incomplete data

15 The Costs of Doping Control YearTestsCosts** 20046,869$1,717,250 20055,145 1,286,250 1,286,250 20066,068 1,517,000 1,517,000 2007*2,711 677,750 677,750 20,793 20,793 $5,198,250 ** @ $250 per test * Incomplete data

16 Positive Doping Cases YearTotal(FINA)(NF’s)% 2004213180.3% 2005326260.6% 2006170170.2% 2007* 2007*174130.6%* * Incomplete data

17 Positive Doping Cases YearAASStimsGCs β-2- agonists DiureticsMask Miss/ Refuse CannabisCocaine 2004821271 200510511101 2006332162 200752211141 Total2610275

18 ATUE’s 2007 = 710 Discipline # ATUE’s Percentage Swimming58682.5% Water Polo 73 7310.2% Diving 26 26 3.6% 3.6% Synchronized Swimming 22 22 3.0% 3.0% Open Water Swimming 3 0.004% 0.004%

19 Mantzouranis E. N Engl J Med 2008;358:1211-1213 Prevalence of Clinical Asthma, by Country

20 ATUE’s 2007 RankCountryTotalPercentage 1 Great Britain 10414.7% 2USA 83 8311.7% 3Finland 71 7110.0% 4Italy 66 66 9.3% 9.3% 5Australia 50 50 7.1% 7.1% 6Netherlands 38 38 5.4% 5.4% 7France 34 34 4.8% 4.8% 8Denmark 28 28 3.9% 3.9% 9 Germany 25 25 3.5% 3.5% Japan 25 25 3.5% 3.5%

21 Use of Asthma Medications 2007 # meds used ABCDE 337%37%23%37%35% 221%51%48%43%24% 142%12%29%21%41% Incidence ≥ 10.1% 7.6-10% 2.6-5%

22 Developments in Doping Control ClinicalClinical ScientificScientific EthicalEthical PoliticalPolitical

23 Recombinant Technology The introduction of recombinant technology made possible the creation of synthetic hormones: The introduction of recombinant technology made possible the creation of synthetic hormones: Erythropoietin (EPO) Erythropoietin (EPO) Growth Hormone Growth Hormone

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25 Nature, 405:635(2000) Françoise Lasne, Jacques de Ceaurriz National Anti-Doping Laboratory, 92290 Châtenay-Malabry, France. Recombinant erythropoietin in urine An artificial hormone taken to boost athletic performance can now be detected. brief communications

26 The Changing Face of Doping Control

27 Lessons Learned Sport cannot eradicate deliberate, organized doping by itselfSport cannot eradicate deliberate, organized doping by itself Many major antidoping initiatives have been led by government agencies…Many major antidoping initiatives have been led by government agencies… CANADA Dubin Commission (judicial inquiry)CANADA 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 LahtiFINLAND 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 investigative resources sport does notSport needs to work with governments who have investigative resources sport does not

28 The new faces of anti-doping…

29 “Doping is a legal concept that includes whatever is on the doping list. Everything else is up to the personal judgment of the physician.” Heinz Liesen, 1988 “As a physician, the only thing that concerns me is the health of the athlete and nothing else.” Heinz Liesen, 1999

30 Groups to whom sports doctors report a sense of responsibility Anderson, Gerrard. J Med Ethics 2005;31:88-92

31 Stewardship

32 Sports Medicine – Is There Lack of Control? “Members of the medical profession have long been concerned with the health and welfare of people in sport, but never have the stakes been so high. Evidence continues to grow that some are showing more interest in finding new ways of enhancing the performance of those in their charge than in their physical wellbeing.” “Members of the medical profession have long been concerned with the health and welfare of people in sport, but never have the stakes been so high. Evidence continues to grow that some are showing more interest in finding new ways of enhancing the performance of those in their charge than in their physical wellbeing.” Lancet, 1988

33 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 decision or activity is probably inappropriate. Pipe. Med Sci Sports Exerc 1993;25(8):888-900

34 Changing a Culture: Leadership with An Ethical Perspective

35 Professional Codes of Conduct Defined standards of behaviour regarding doping issuesDefined standards of behaviour regarding doping 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

36 The 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

37 The 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 emphasizing excellence in all domainsAbility to integrate educational programmes emphasizing excellence in all domains Determination to address anti-doping as a priorityDetermination to address anti-doping as a priority Replace “Rhetoric” with “Robust programmes”Replace “Rhetoric” with “Robust programmes”

38 The Spirit of ofSport

39 The Future ? “…an array of scientific developments that will transform the ability of individuals to alter their genomic, and hence their anatomic and physiologic potentials…such developments can only be addressed, ultimately, by an enhanced sense of responsibility toward the practice and the processes of sport” “…an array of scientific developments that will transform the ability of individuals to alter their genomic, and hence their anatomic and physiologic potentials…such developments can only be addressed, ultimately, by an enhanced sense of responsibility toward the practice and the processes of sport”

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

41 New Anti-doping Approaches ? Civil AuthoritiesCivil Authorities Physician, Scientists, OfficialsPhysician, Scientists, Officials Professional Societies Codes of Ethics Disciplinary approaches Licensing ? Sanctions ? Educational ProgrammesEducational Programmes Athlete TestingAthlete Testing

42 Safeguarding Sport for Tomorrow


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