the_sword_july_2015

MEDICAL AND SCIENCEANTI-DOPING EDUCATIONby Dr Clare HalstedThe ‘Clean Sport/Play True’ MinefieldLet me first introduce you to NUF, our notional unethical fencer, who is in the national squad of a top fencingnation and desperate to overtake team mates in the Olympic qualifying race.NUF is vaguely aware that, as fencing is sucha complex sport, involving speed, agility,accuracy, coordination, stamina, mentaltoughness and complex tactical ability,no drug has yet been developed that willdefinitely enhance performance in the meleeof a fencing competition. Disadvantagescounteract benefits so medals are wonthrough hard work and expert coaching.And yet NUF has a feeling that somethingcould help; who cares about any risk to healthor the World Anti-Doping Agency (WADA)concept of upholding the ‘spirit of sport’ –whatever that is, if the reward is success, butwhat?“Hey this is complicated stuff” realisesNUF, “how is a top class athlete without ascience degree supposed to work out how tocheat by doping?” Some help is needed andNUF happens to have a close friend who isa pharmacist. Several innocent chats lateron the subject of protein powders, vitamins,minerals and other supplements, supposedlyuseful for athletes from a variety of sports,and NUF has a much better understandingof most of the available and ‘less-available’substances.Anabolic steroids seem attractive at firstglance – increased strength to wield theweapon? - then the thought of bulky, heaviermuscles and acne – perhaps not. (Must lookgood whipping the mask off after that medalwinning hit!) Gene doping sounds intriguingbut too expensive and not sophisticatedenough yet to produce the perfect fencer;hormones and the like are unlikely to makea difference; increasing the red blood cellcount with that EPO stuff helps in theTour de France but however long a fencingcompetition lasts it doesn’t demand that typeof incredible stamina.“A stimulant though – to keep me hypedup when flagging in the later stages after anearly start and no time or inclination to eat?That’s it and my pharmacist friend will comein useful again”.Has NUF checked the WADA List ofProhibited Substances and Methods? Whoknows?Meanwhile squad mate NEF (notional ethicalfencer) had recently been diagnosed withtype 1 diabetes after feeling very unwell.Now stabilised on insulin and determined tokeep up training and competing she checkson (thanks to her recent anti-dopingeducation session) and discovers that insulinis on THE LIST. Not sure what to do sheconfides in her coach after her next lessonand (thanks to his recent distance learningmodule) he tells her about Therapeutic UseExemptions - TUEs.Off she goes to her doctor to obtain thenecessary medical information, sends off herTUE form to be scrutinised by the relevantTUE committee and promptly receives formalapproval to use insulin.Phew – now to concentrate on building backfitness so to the dietician for advice aboutsupplements (not stimulants, she knowsthose are banned during competitions). Whichones are approved by WADA as safe to use?What none? None at all! Why, when thereare so many available and gyms push themso hard? Her clued up dietician explains that,despite what is written on the tin, in somestudies about 20% of supplements werefound to be contaminated with prohibitedsubstances so unless every batch is analysedthere is no way of knowing what may belurking within. Even vitamin tablets could berisky!However, there is a reliable (UK) laboratorythat analyses a wide range of supplementsand lists the ‘clean’ ones publicly - formanufacturers. BUT if you do use one fromthe list remember - only that specific batch issafe and - keep a small sample back if testingis a possibility. Much better to have the right,balanced diet for the demands of the sport(though in China be wary of the meat).NEF’s coach also remembers to warn herabout checking any medication obtaineddirectly at a pharmacy, although many aresafe to use such as paracetamol, ibuprofen oranti-histamines for allergies. She luckily findsout that a decongestant cold remedy shewas about to try contains pseudoephedrine,which is prohibited in competition (if abovea certain level in a urine specimen) - so notworth risking!Six months later and NUF has made the teamon trial as the 4th fencer. Thanks mainly tothe efforts of the other 3, bronze in the firstteam world cup is theirs, the teams haveshaken hands and the doping control officer(DCO) is approaching. NUF is shocked to bethe selected fencer and protests “but I wasn’tfencing in that match”. The DCO explainsthat any one of the 4 team members can bechosen randomly for testing and off they goto the doping control station. 2 hours later,having finally completed the somewhatdaunting procedure of providing a satisfactoryurine sample under observation, a panickyNUF gets back to the hotel for a sleeplessnight.The dreaded letter arrives soon after, detailingan Adverse Analytical Finding – a levelof a stimulant drug above the permittedthreshold. To cut a sad story short, the formalinvestigation reveals that NUF had taken 2tablets of a prescription-only drug on theday of the event, and despite protestationsof ignorance that this was prohibited, wasfound guilty of a doping offence as no TUEwas in place (and no justification for oneeither). The rest of the team lost their bronzemedals, their world cup points for that eventand their tempers. NUF is still trying to appealthe 4 year ban (increased from 2 years for afirst offence in the revised 2015 WADA code).[NB: this article describes entirelyhypothetical situations but 47 athletes arecurrently sanctioned for doping offences inthe UK]British Fencing’s Anti-Doping Officer - andalways happy to answer queries.Dr Clare HalstedSome other useful linkswww.ukad.org.ukwww.ukad.org.uk/athletes/100percentmewww.ukad.org.uk/coaches/coach-cleanwww.britishfencing.com/governance/medical-anti-doping/JULY 2015 THE SWORD 19