The Need For Scientific Study of Doping

The latest issue of the journal Nature has two articles (an editorial and a perspectives piece) on the topic of drug testing for athletes. Both the editors and Donald Berry (the author of the perspectives article) argue for the need for both more scientific testing to support standards for athletic drug screening and for more openness in the process.

From the editorial:

Nature believes that accepting 'legal limits' of specific metabolites without such rigorous verification goes against the foundational standards of modern science, and results in an arbitrary test for which the rate of false positives and false negatives can never be known. By leaving these rates unknown, and by not publishing and opening to broader scientific scrutiny the methods by which testing labs engage in study, it is Nature's view that the anti-doping authorities have fostered a sporting culture of suspicion, secrecy and fear.

From Berry's article:

Whether a substance can be measured directly or not, sports doping laboratories must prospectively define and publicize a standard testing procedure, including unambiguous criteria for concluding positivity, and they must validate that procedure in blinded experiments. Moreover, these experiments should address factors such as substance used (banned and not), dose of the substance, methods of delivery, timing of use relative to testing, and heterogeneity of metabolism among individuals.

In an ideal world, this is exactly the way things should work. Unfortunately, we don't live in an ideal world. There's a very real problem that will arise if the exact methods and criteria are publicized. As the folks at Nature point out in their editorial, there is an intense ongoing arms race between the people who make the drugs and the people who design tests. If the exact testing criteria are publicized, the drug makers will know exactly what they need to do to beat the tests.

That's a problem, and it's not an insignificant one.

If you provide all the testing details, it will stimulate the development of new methods for evading the testing, and make it much more difficult for the testing to achieve its goal. If you don't provide assurances that the testing methods are objective and reliable, it will continue to inject elements of distrust and paranoia into athletics. It's a delicate problem.

The best approach might be a middle ground, where the procedures are subjected to comprehensive and repeated third party testing. The results of the tests would be publicized, but the procedures used would only be outlined in general terms. This will allow for comparisons between methods and an understanding of the true false positive and negative rates involved with each method, without publicizing enough of the details to aid the development of new methods of doping.

There's some precedent for this within the scientific community. When I worked in a molecular ecology lab, we routinely made use of kits from various manufacturers. The kits were widely used within the community, and had been tested against other techniques. The precise makeup of the reagents and spin column filters wasn't widely publicized, but that had minimal effect on the acceptance of their use within the scientific community. The need to preserve proprietary information was understood, and the results spoke for themselves.

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I was amazed when I read Don Berry's criticisms - if he's right factually, then it's pretty damning.

I'm waiting to see how WADA respond to this - I guess they're not happy.

If I was WADA, I wouldn't be happy either. I'm working on a post right now that addresses Berry's points. The short version is that his failure to take lab procedures into account has led him to enormously overstate the likelyhood of false positives for most tests.

Secrecy does not stop people from evading tests over time. As long as there is a proscription rather than oversight for drug or blood doping, we will ALWAYS have a drug program. We can't rely on some secret test for the next decades, rather they should all be out in the open. With all their warts. WADA lost much credibility over the last 10 years with them sounding like arrogant bureaucrats rather than people trying to mitigate drug and doping use - as the use skyrocketed, with team and doctor complicity. Complete openness would be a step toward regaining some credibility. You could keep things secret for a new drug for a short time perhaps but even then there is an argument.

This issues raised in the Nature article I've commented on in several blogs before, but I'll keep pointing out the use of the prosecutors fallacy in the article doesn't really work well for sports where we know from external reasons (not tests) that, for example, of the 13 people on the podium of the Tour de France from 1995 to 2005. Eight have been sanctioned for PED (physically enhancing drug) use or doping, because of outside evidence. One more was implicated in Puerto but "cleared" after he had retired by the Spanish federation. This means that the ratio between the populations of users and false positives won't be skewed to the false positive for reasonable false positive rates. That is, a positive test will very likely be a true positive. There will be casualties and false positives but with the high rate of known PED and doping done I think that is the price the sports will have to pay.

After watching this years Tour and Giro where -every- ride too good to be true was actually caught as CERA use I personally think the other people of that 13 pretty much had to be doping somehow to have competed. They will of course disagree.

What happened to the principle, turnabout is fair play? All those advocating testing of other people should be themselves tested identically, and with equivalent consequences for false positives. If the IOC can destroy an athlete's career for life with an irrefutable, and unverifiable, accusation, then let them be subject to the same testing and consequences. A false positive would lose them their right to gainful employment for life.

If the testing overlords had to face the risks they force on their subjects, I think they would soon loose their taste for testing.

"As the folks at Nature point out in their editorial, there is an intense ongoing arms race between the people who make the drugs and the people who design tests."

The (vast?) majority of drugs used by doping athletes are not of the designer type (Balco). They are legal, but abused, therapeutic products. The people who make these drugs are not perpetrators of the abuse, and it is unfair to malign them, even if the pharmaceutical giants are less than saintly corporations. Amgen took a lot of heat, unjustifiably I believe, when they sponsored the Tour of California cycling race, just because they manufacture EPO.

Those in the war are those less-than-ethical medical support staff who, in partnership with the doping athletes, come up with programs of drug usage that have both a performance advantage and a high probability of non-detection. You are right to point out that publication of testing regimes will help those unethical practitioners.