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Reigning Blood: Thoughts on the Scandal of Blood Doping in Athletics

August 22, 2015

I was asked if I’d write a thing about doping for a website, so I did but the editor never got back to me.  Here is what I wrote:

This year the World Athletics Championships is being held in Beijing. But there is no doubt that this event is clouded by a doping scandal that threatens to seriously damage, if not destroy, the sport’s credibility.  The scandal was the result of two news reports.  The first concerned the allegation that a high proportion of Russian athletes were involved in systematic doping.  The second was the Sunday Times/ARD programme and publication in the first weekend of August which leaked extracts from an historic blood profile database held by the International Amateur Athletics Federation (IAAF). When these profiles were analysed by experts in biological passport analysis, the results suggested that as many as 1 in 7 athletes from 2001 to 2012 had returned “suspicious” values, tainting many major championships, including the 2012 Olympic Games.  Clean athletes have lost medals, failed to make finals, and lost funding because they were out-competed by athletes who were doping.

The reaction to the leak has itself been revealing: the leaders of the IAAF have come out fighting against the findings and denying any wrongdoing; the experts concerned have countered these arguments. Finally, social media platforms have been ablaze with comment and speculation about which athletics star will be implicated next.  This scandal can, I think, be better understood if the scientific basis of the allegations is understood. Furthermore, the reaction of those at the top of sport and anti-doping, as well as the public reaction to the scandal, tells us a lot about how a future scandal such as this might be avoided.

What does “a suspicious profile” actually mean?

The athlete biological passport (ABP) is a method used to detect doping, not by finding a drug in blood or urine samples, but by finding evidence of doping in biomarkers such as haemoglobin concentration.  The ABP works by an individual athlete regularly giving blood samples, from which a profile is generated with individual limits (“probability thresholds”, currently 99%) set to identify abnormally high or low values. A “suspicious” profile is one which exceeds these limits at some point or points, or which contains deviations or fluctuations that are identifiably abnormal (these are known as an “Atypical Passport Findings”). An expert reviews the profile and uses other data (if available) to confirm that it is not likely to be due to pathology or specific circumstances that might affect blood sampling (e.g., illness).  If those other data are not available, the result remains “suspicious” and follow-up data collection and additional testing can be performed.  The “suspicious” profiles noted by the Sunday Times/ARD experts were those exceeding a 99% probability threshold.  This is consistent with the current WADA guidelines.

The reason the “suspicious” profiles are not direct evidence of doping is that the ABP requires further review for this to occur. A suspicious result warrants further review by two independent experts if the first reviewer has ruled out normal physiology and pathology. Only if the three reviewers unanimously agree that the use of a prohibited substance or method is highly likely and illness or other factors are unlikely to account for the results can an “adverse passport finding” result be declared, which then initiates disciplinary procedures against the athlete.

It is worth pausing here briefly to make the point that ABP findings are considered “atypical” and “suspicious” when there is not enough evidence to be certain that things other than doping could explain the finding. Results only become “adverse” (that is, the athlete can be sanctioned) with further evidence and review.  The data on which the scandal is based are atypical, NOT adverse findings.

The rigour with which the ABP is administered and managed makes it sounds perfect, but it isn’t.  As with standard doping control tests, the ABP is designed specifically to avoid false positives (that is, you want to go out of your way to avoid sanctioning a clean athlete).  This means that the false negative rate is high. In other words, cheats can and do avoid sanction (more on this later).

The issue the experts in the Sunday Times/ARD story took with the IAAF was that suspicious findings did not seem to be followed up.  The IAAF did have procedures in place to do so.  The allegation that they did not is, therefore, very serious. I am in no position to say whether this is true or not, but on other points of the story I have some sympathy for the IAAF.  Much of the focus in the original story was on the World Championships in Helsinki in 2005.  But the sanctioning of athletes using the ABP did not come into force in athletics until 2009.  Judging the actions of the IAAF by the standards of today seems a little unfair.  That said, Dr Michael Ashenden, one of the experts consulted and an architect of the ABP itself, makes a compelling argument that the IAAF could and should have done more at the time in any case.

The good, the bad, and the ugly

The reaction the scandal has been an interesting exercise in sports politics and the power of social media.  WADA stated that it was shocked and within a week had announced an investigation into the allegations.  The full scope of this investigation is not clear, but it is likely to focus, in part, on how the data were disclosed rather than how the IAAF responded to the blood profiles pre-2009. Lord Coe, now president of the IAAF, came out fighting, suggesting that war had been declared on athletics, and dismissing the analysis of the “so-called experts”.  This was likely to be part of his successful attempt to get elected to the presidency, but it was also an exercise in how not to manage a crisis.  The experts he maligned really were experts in this particular field.  They have diagnosed that his sport is sick, and he needs to listen to their advice.  More broadly, in the post-Armstrong era, having an international federation “circle its wagons” in this way was bound to lead to accusations of cover-up, whether true or not.

The IAAF’s bullish reaction to the scandal led to commentators on social media in particular savaging the IAAF.  This is understandable, given that these commentators are already extremely hostile to any official narratives in the wake of the Lance Armstrong case and the role the UCI played in it.  They were also primed by a Tour de France in which suspicion of the CG contenders grew exponentially in spite of attempts to prove innocence. It was to be expected that they would turn their guns on athletics, and several high-profile athletes have been the subject of intense speculation as to whether their ABP profiles are suspicious.  Some of that commentary was thoughtful, detailed, and nuanced, but even the most cursory search on Twitter shows many high-profile athletes being very seriously libelled with doping allegations.

Given recent cases, such as McAlpine vs. Bercow, naming names without evidence on social media is extremely ill-advised.  The acid test here is: has an athlete been mentioned by name? Has doping guilt been implied, even indirectly? Does the athlete in question have an adverse ABP finding? If the answer to the first two questions is “yes”, and the answer to last question is “no”, then the athlete has been libelled, in the UK at least.

How should the IAAF deal with this in the future?

It is important to remember that the goal of anti-doping is to protect clean athletes.  This is difficult because proving a negative in systems shrouded in secrecy is almost impossible.  Some form of transparency that federations and athletes can buy into would be a start.  Some athletes have chosen to make their passport data public, whereas others have not given their consent. This is already leading to assumptions that lack of disclosure means that the athletes in question have something to hide.  This might be true, but it may also mean that the athletes possess passport profiles that contain atypical findings that are explicable, but they are concerned that key contextual details may be lost or simply dismissed.  It is also possible that the explanation for atypical contains information of such a personal nature that the athlete does not want any of the information in the public domain.  All that considered, the IAAF and WADA urgently need to build transparency into their systems.  One way would be to periodically, or on request, perform a full three expert review to give an athlete a clean bill of health (or otherwise), and publish the resulting ABP Document Package with the athlete’s consent.

Finally, there is the future of anti-doping per se.  If we have learnt anything from the Armstrong case, it is that analytical anti-doping measures will only go so far.  What did for Armstrong was tenacious investigative journalism and equally tenacious law enforcement input, followed by a forensic investigation by USADA.  In this regard, catching cheats isn’t just about blood.  If anti-doping policy was a pheasant shoot, doping controls and the ABP would be akin to beating the ground and sending in the dogs: to be successful, you still need the people with guns in the end.  WADA and the sports federations covered by the code need to use all necessary means to catch doping cheats, because the current systems are not protecting clean athletes in the way they should.

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One Comment leave one →
  1. Andy Giddings permalink
    August 22, 2015 3:01 pm

    Dr Burnley, thanks for this. Its always interesting to read your articles which I find balanced and practical, which are rare qualities in the social media free for all we live in nowadays. This article in particular covers the pros and cons of each of the parties involved, as well as the dangers of libel. I am always intrigued by the number of casual social commenters who never realize the dangers of making defamatory or libelous statements

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