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Hepped up on goofballs

Alexandros Tsathas examines how we keep our athletes on the right track

Art by Amandine Le Bellec Art by Amandine Le Bellec

The world can safely expect its television screens and muesli bar boxes to be consumed by Olympic branding over the coming few months. Watching dedicated and deserving athletes achieve their life-long dreams is a pleasure. But, like any show on television, what the bad guys get up to–and how the authorities try to stop them–is infinitely more interesting.

Sport’s ‘bad guys’ are dopers. The international body responsible for their detection is the World Anti-Doping Agency (WADA). Established in 1999, WADA devised and now maintains the Prohibited List – a list of banned substances which practically all sporting codes around the world (with the notable exception of America’s NBA, NFL and MLB) must comply with to receive government endorsement and funding.

USyd has a connection with WADA in the form of Professor David Handelsman, a senior clinical educator and researcher within USyd’s medical faculty. Professor Handelsman is a cheery, bearded fellow whose knack for simplifying the complicated is testament to his mastery of his field. An expert in male reproductive health, he holds several esteemed positions, including Head of the Department of Andrology at Concord Hospital and Director of the ANZAC Medical Research Institute. He also sits on WADA’s fourteen-member Health, Medical and Research Committee (HMRC) – its research and development arm. The HMRC is responsible for maintaining the List, defining the medical circumstances under which it is acceptable for athletes to use banned drugs and, fascinatingly, overseeing the development of new and improved drug tests.

Sports doping really took off during the Cold War as a shortcut for Eastern bloc countries to prove their society’s physical, and therefore moral, superiority over their dominant Western rivals. This challenge was quickly reciprocated by Western bloc athletes. As Handelsman explains, the drugs an athlete might use depends entirely on the sport they play and its physical demands. Different drugs confer different advantages and work in different ways. Most are hormones (Handelsman’s area of expertise), which are the body’s chemical messengers and trigger useful athletic processes like building muscle and making red blood cells. Some drugs are synthetic copies of natural hormones and ‘directly’ boost hormone levels. Others act ‘indirectly’, causing glands to secrete more hormones than usual.

The general principle of drug detection is to measure the level of substances not native to the body. This process typically involves collecting urine or blood, and then analysing it using advanced laboratory techniques, such as mass spectroscopy. Suspect compounds can then be identified and quantified.

There are two main challenges testers face. First, they have a limited time frame or “window” to collect a positive sample before the body breaks down or excretes the drug. Second, sensitivity: banned substances are often only present in tiny concentrations, making it hard for even the most advanced technologies to detect them. This is where Handelsman and the HMRC come in.

The HMRC’s research continually improves on these two test parameters. Anti-doping labs, universities and laboratories put forward proposals on how they might do so, and the HMRC awards grants to those it deems have the greatest potential for success. Handelsman is impressed by many of the proposals that have passed over his desk – “People think drug cheats are clever, well the scientists who work in this area are very clever”.

Researchers can now even test for androgens (male hormones) by analysing an athlete’s hair or nails. As they grow, they become a “sprouting timeline” of an athlete’s doping history and general health. Another recent development to emerge from WADA-backed research makes it possible to detect blood doping by measuring the level of phthalates in an athlete’s bloodstream. Phthalates, used to soften plastic, leech into blood that has been stored in plastic bags.

With such impressive developments and ongoing test revision, one might reasonably suspect that drug cheats have a waning shadow in which to hide. Handelsman agrees that common, well-known drugs can be fished out pretty easily. Only “ill-advised and desperate” athletes use them. But he likens drug cheats to cyber-criminals who constantly adapt to efforts to thwart them. He says a recent such trend is “designer drugs”, which gives way to an enthralling narrative.

“‘Designer drugs’ is a misleading term”, he says. There is nothing bespoke –or trendy– about them. Their history dates back to the 50s and 60s, which constituted “the golden age of steroids”. During this period, an explosion in steroid research took place, with two great successes: the contraceptive pill and synthetic corticosteroids (skin rash creams and the like). The dream was to create a synthetic drug that had all of testosterone’s benefits without its masculinizing effects (which for women and children, would be undesirable). This quest was ultimately unsuccessful, but spawned thousands of steroids for which patents were filed. Only about 30 of these were successfully tested and commercialised. Today’s “designer drugs” are drawn from the vast pool of those that didn’t make it, some because they were not safe or effective enough. Patents expired decades ago, and now “bathtub organic chemists” are deciphering the old literature and synthesizing these drugs for use in sport.

Designer drugs can’t be detected immediately by mass spectroscopy. This is because for the technology to identify them, it must first be aware of what to search for, i.e. a reference or a known chemical structure.

Another new trick athletes use to circumvent the system is autologous blood transfusions – where athletes train at high altitudes to boost their red blood cell count, extract this blood, and then inject it when they need a boost during competition. Because the red blood cells injects are not strictly foreign, the practice is extremely hard to detect. WADA’s introduction of the Athlete’s Biological Passport has made a big difference. This is a system of tracking of athletes’ blood metrics over time to identify irregularities.  The process is now well established and is continually being refined.

It is an unfortunate truth of doping that only those who fail get caught. So how does WADA become aware of new drugs? “Mostly anonymous tip-offs” according to Handelsman, who cites the example of a rival trainer who handed in a syringe he found in a change room, which ultimately brought down Sydney 2000 gold medal sprinters Marion Jones and Tim Montgomery.

Handelsman reserves little sympathy for dopers, remarking that staying clean is an “occupational expectation”, much like a pilot avoiding flying drunk. WADA has a similarly stringent approach, with changes to its Code in 2015 upping the usual first-time ban from two to four years for those found guilty of doping.

It’s comforting knowing that for every Dank (of Essendon fame) and Ferrari (Armstrong’s doctor), there’s a Handelsman siding with the good guys. Sport is so popular because it promises a gladiatorial battle on an even playing field. To remove this premise is to compromise not only sport’s integrity, but its appeal. It risks morphing into an entertaining farce like the cartoonish World Wrestling Entertainment.

In a chapter on sports doping that Handelsman penned for the respected medical text Endocrinology, he noted “a century ago, deliberate training itself was considered an ungentlemanly breach of fairness”. As values and technology change, and with gene replacement therapy now possible, will even genetic differences be deemed unfair in the future? Only time will tell.

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