Finally, some good news in the fight against doping

Sport has a doping crisis. It has been tainted with drugs scandals for as long as I can remember, from Ben Johnson being stripped of the 100m Olympic Gold in 1988, to the more recent issues surrounding more or less the whole of Russia in the lead up to the Olympics. Among the way, we have mini-scandals – Mo Farah’s doorbell, Alberto Salazar’s cream, British Cycling’s package in a brown bag – which, whilst not direct evidence of wrong doing, further erode public confidence in the cleanliness of sport.

Public perception vs. reality

As I’ve written about before, some of this is down to a mis-match between public perception of what elite sport “should” be like, and the reality. To a person who has never been on the anti-doping testing pool, it seems easy to never miss a test, whereas the reality is quite different. Similarly, to a normal person who occasionally does some exercise, understanding the therapeutic use exemption (TUE) process appears straight forward, when in reality it appears to be all shades of grey. As always, whenever sides are taken on social media, nuance and context are the first casualties. The result is that we are now at a time when most of the public seem to be of the opinion that most athletes take drugs (they don’t), and that many things which, to the person involved in sport look innocuous, are taken as proof of wrongdoing.

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In essence, we are in a time where the finger is pointed very quickly, but evidence isn’t always offered.  This has happened repeatedly over the last few years; there was a huge furor over Paula Radcliffe’s blood values, which had since gone away until revived this week. Numerous times newspapers have reported that they have seen the names of certain athletes on lists of doping violations, but proof is never forthcoming. This culminates in a two-directional lack of trust; the public don’t trust the athletes, and many athletes don’t trust the public to fully understand the nuance of a given situation.

History tells us that it’s possible to pass multiple drugs tests whilst still doping, down to a combination of ineffective analytical methods, the use of fast metabolizing substances, and corruption from the governing bodies. As such, it’s impossible to say whether or not an athlete isn’t doping with certainty, because passing a drugs test is no longer indicative of being clean (thanks Lance Armstrong).

Good news from genetic research

What we need is some good news, and maybe we’ve got it. Thanks to recent developments in a number of molecular methods, collectively termed “omics”, we can now better understand the expression of genes following exposure to a number of stimuli. For example, one adaptation an endurance athlete is interested in is an increase in red blood cells; these allow for the greater transport of oxygen from the lungs to the working muscle, allowing for exercise to continue at both a greater intensity, and for longer. One method athletes utilize in order to increase their red blood cell number is training. This process leads to an increase in the expression of genes that encode for proteins that drive these increases in red blood cells, which in turn often lead to an increase in athletic performance. Endurance training, therefore, leads to the specific activation of a variety of gene pathways, which lead to improvements.

Of course, we know that some athletes like to enhance these improvements through pharmacological means. EPO, a natural hormone produced by the kidneys, increases the production of red blood cells. But it is possible to source a synthetic form of EPO, rhEPO (the rh stands for recombinant human), which has the same effects. So, if an athlete sees an increase in red blood cell count, this could be down to training, rhEPO administration, or a combination of the two. It’s hard to tell the difference between naturally occurring EPO, and the synthetic rhEPO, which is one of the reasons it took a long time to develop a test for this drug. The search for a reliable test culminated in the athlete biological passport (ABP), the method that WADA uses to monitor various blood parameters in order to detect the use of banned performance enhancing drugs. Here, the thought process is that irregular findings outside of a “normal” range are indicate of an increased likelihood of doping; but, as I mentioned in the introduction, it doesn’t necessarily illustrate proof of doping.

And this is where the “omics” revolution comes in. Whilst exercise-induced EPO production has a particular pattern of gene expression, the use of rhEPO has a different one. Being able to see which genes are being expressed then allows us to differentiate between doper and clean athlete, finally removing the question marks associated with passing a more standard anti-doping test. In this case, it becomes much more binary; if the athlete has a gene expression profile matching that seen when rhEPO is used, then they have been using the drug; if they don’t have the same gene expression profile, then they haven’t.

Finally some clear lines on doping

Such clarity represents a huge breakthrough in the fight against drugs in sport, which is why WADA are funding the studies into this method. Further research is, of course, still needed – it’s not entirely clear what effect differences in gender and ethnicity have on these results – but the early research is certainly hugely promising. Being able to apply this wider, to anabolic steroids and exogenous testosterone, for example, is also a research aim. Whilst there is further work to be done, this represents a huge step forward in the fight against doping, which given the recent erosion of confidence in both the current system and the integrity of athletes, is hugely important.