Anti-Doping: The Challenge and the Opportunity

2. Anti-Doping: The Challenge and the Opportunity 16th World FINA Sports Medicine Congress Andrew Pipe, CM, MD, Dip Sport Med, FACSM University of Ottawa Heart Institute, Ottawa, Ontario, Canada Chair, FINA Doping Control Review Board

3. You seem familiar yet somehow strange -- Are you Canadian?

5. The Role of Physicians & Scientists • Advisor and Confidante • Advocate for the health of the athlete and the well-being of sport • Responsibility to patient, sport and the community • Support the pursuit of excellence by fair and ethical means • Provide distinct leadership…

6. “If drug use in sport is a developing scandal, then it is a scandal that involves the medical establishment as well as the sporting one.”Sports Illustrated 1969; June 23:66-69

7. Sport Scientists & Sport Physicians “Are we to be seen as contributing to deliberate, cynical practices which subvert the processes and nature of sport ?........or do we demonstrate leadership, guided by principle and an ethical perspective?”

8. The Physician and the Athlete “As in any other area of medical practice, sports physicians must care profoundly, and in the broadest sense, for the welfare of their patients while understanding the unique dimensions and pressures of the environments in which their patients live, train and compete.”

9. “They are our patients first…they are athletes second!”

10. Considerations in Anti-Doping • Autonomy • Stewardship • Safety, Harm Minimization • Benificence • Dehumanization • Paternalism • Commercialism

11. Challenges • Society • Science vs. pseudoscience • $$$ • Stewardship • ‘Synicism’

12. Challenges • Capacities • Competencies • Costs • Complexity • Consistency • Civil Liberties & Litigation

13. The FINA Experience2004 - 2007

14. Testing: In and Out of competition * Incomplete data

15. The Costs of Doping Control * Incomplete data ** @ $250 per test

16. Positive Doping Cases * Incomplete data

17. Positive Doping Cases

18. ATUE’s 2007 = 710

19. Prevalence of Clinical Asthma, by Country Mantzouranis E. N Engl J Med 2008;358:1211-1213

20. ATUE’s 2007

21. Use of Asthma Medications 2007

22. Developments in Doping Control • Clinical • Scientific • Ethical • Political

23. The introduction of recombinant technology made possible the creation of synthetic hormones: Erythropoietin (EPO) Growth Hormone Recombinant Technology

25. Recombinant erythropoietin in urine An artificial hormone taken to boost athletic performance can now be detected. brief communications Françoise Lasne, Jacques de Ceaurriz National Anti-Doping Laboratory, 92290 Châtenay-Malabry, France. Nature, 405:635(2000)

26. The Changing Face of Doping Control

27. Lessons Learned • Sport cannot eradicate deliberate, organized doping by itself • Many major antidoping initiatives have been led by government agencies… • CANADA Dubin Commission (judicial inquiry) • AUSTRALIA Customs Seizures Perth • FRANCE Customs Seizures Tour de France • FINLAND Police Investigations Lahti • ITALY Police Investigations Torino • USA Revenue Agencies BALCO • Sport needs to work with governments who have investigative resources sport does not

28. The new faces of anti-doping…

29. “Doping is a legal concept that includes whatever is on the doping list. Everything else is up to the personal judgment of the physician.”Heinz Liesen, 1988“As a physician, the only thing that concerns me is the health of the athlete and nothing else.”Heinz Liesen, 1999

30. Groups to whom sports doctorsreport a sense of responsibility Anderson, Gerrard. J Med Ethics 2005;31:88-92

31. Stewardship

32. Sports Medicine – Is There Lack of Control? “Members of the medical profession have long been concerned with the health and welfare of people in sport, but never have the stakes been so high. Evidence continues to grow that some are showing more interest in finding new ways of enhancing the performance of those in their charge than in their physical wellbeing.” Lancet, 1988

33. Will my decision or activity be . . . • to the credit or benefit of the athlete? • to the credit or benefit of sport? • to the credit or benefit of my profession? If the answer to any of these questions is “No”, the decision or activity is probably inappropriate. Pipe. Med Sci Sports Exerc 1993;25(8):888-900

34. Changing a Culture: Leadership with An Ethical Perspective

35. Professional Codes of Conduct • Defined standards of behaviour regarding doping issues • An international consensus • A condition of membership • A condition of participation • Provisions for disciplinary action

36. The Sport Physician & Scientist • Provide Care of Highest Standard • Informed Policy Development • Expertise in Administrative Matters • Strength of Professional Associations • Capacity for Strategic Leadership • Community Education • An Obligation to the Well-being of Sport

37. The Opportunities • Highly motivated athletes • Highly organized club structures/system • Highly trained coaching community • Commitment of sport leaders • Ability to integrate educational programmes emphasizing excellence in all domains • Determination to address anti-doping as a priority • Replace “Rhetoric” with “Robust programmes”

38. The Spirit of Sport

39. The Future ? “…an array of scientific developments that will transform the ability of individuals to alter their genomic, and hence their anatomic and physiologic potentials…such developments can only be addressed, ultimately, by an enhanced sense of responsibility toward the practice and the processes of sport”

40. The Future II “…a new generation of doping-free, ethical athletes who compete in a manner consistent with the best traditions of sport…”

41. New Anti-doping Approaches ? • Civil Authorities • Physician, Scientists, Officials Professional Societies Codes of Ethics Disciplinary approaches Licensing ? Sanctions ? • Educational Programmes • Athlete Testing

42. Safeguarding Sport for Tomorrow