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Drug testing news for September 2

Testing times ahead

By Jeff Jones, online editor

Over 10,000 athletes will be competing in the 2000 Olympic Games, starting in just over two weeks. 480 of these will be cyclists, spread over the three disciplines of track (180), road (212) and mountain biking (80). Apart from the logistics of organising this many athletes and a like number of support crew, there is also the question of drugs testing, both before and during the Games.

The Australian Sports Drug Agency (ASDA) and the Australian Sports Drug Testing Laboratory (ASDTL) will be carrying out an intensive drug testing program over the coming weeks, in an attempt to make the Sydney Games the "cleanest ever". They received a significant boost in that regard with the recent approval of the combined blood/urine test for Erythropoetin (EPO). There is now no longer any question that EPO is the drug of choice for endurance sports, and cycling leads the way in the area, in more ways than one. For those unfamiliar with it, EPO is a natural hormone that works by increasing the body's rate of production of oxygen carrying red blood cells. The more of these that are in the body relative to their "natural concentration", the greater the amount of oxygen can be used by the muscles. A faster bike rider (in general) is the result.

History

Since its presence in the peloton in the late 80's, EPO has been blamed for several deaths, caused the sport's biggest drugs scandal in its biggest event, the Tour de France (1998), been the subject of 'sporting fraud' and drug trafficking cases, and more generally labeled (by the French in particular) as the reason for 'two speeds' in the peloton. It has been around for over a decade and only now a reliable test has been developed. The primary reason for this is that artificially injected EPO has been extremely difficult to detect in a standard urine test - up till now that is.

The history of developing a reliable test is littered with failures, although all have played their part in the progress. The International Cycling Union (UCI) have been at least vocally supportive of all attempts - sometimes too much, as whenever each apparent solution failed, they and the cycling public were once again disappointed. Eventually there was enough impetus behind the project for several countries to work together in developing a working test.

In the meantime, the UCI introduced a hematocrit 'cap' of 50% for professional riders as a health measure (the average range is 38-46% for this value that represents the percentage of red blood cells in the blood. EPO increases it.). A rider failing the health check was disqualified for two weeks, and had to bear the suspicion of being an EPO user. Values of over 50% are uncommon, certainly amongst endurance athletes who tend to have their hematocrits depleted over the course of a stage race or race season. The most famous case is probably Marco Pantani's 50+ in the 1999 Giro d'Italia that caused his ejection from the race whilst he was in the lead on the penultimate day.

The blood test

In 1998, a significant amount of research was carried out by the Australian Institute of Sport into the effects of EPO on athletes. Although anecdotal evidence was overwhelming at the time that EPO is the wonder drug, it had to be verified scientifically. The ethics of administering EPO to "normal" people were questionable, but it was decided that the need for a reliable EPO test was greater, and that this was an important step in the right direction.

"The bottom line is that EPO works," as David Martin, one of the research scientists at the AIS said of the results. Cyclists who were on 'the program', and who of course were banned from competition for a significant time period, were also surveyed and unequivocally supported that conclusion. However, the results had to be verified at a broader level, taking into account different ethnic and religious backgrounds, as well as a variety of other factors. More tests were conducted in several countries earlier this year in an attempt to provide adequate validation for the research to the powers that be: the UCI and the IOC, in time for the Sydney Games.

Of course, the Australian research wasn't just used to prove that EPO makes faster cyclists - a mathematical model was also developed to detect abnormalities in the blood after taking EPO. It was found that certain parameters in addition to hematocrit (Hct) were important: Hemoglobin (Hb), Erythropoetin (EPO), Soluble Transferrin Receptors (sTfR), % Macrocytic Cells (%Macro), % Hypochromic Cells (%Hypo), Absolute Reticulocyte Number (RET), Reticulocyte Size (MCVr) and mean Reticulocyte Hemoglobin Concentration (CHCMr). It's probably best to leave it there, suffice to say that the model developed worked quite well, with an almost zero chance of a false positive result.

In the past, blood tests for doping were frowned upon by sporting bodies and some athletes, who believed that they were an invasion of privacy and their individual religious beliefs. This led the International Olympic Committee to wait until the 2000 Games before they allowed blood testing amongst Olympic sports. The UCI was a long way ahead in this regard, having introduced the hematocrit test in 1997, and a more sophisticated "health check" in 1999. In addition, hemoglobin values were taken into account in addition to hematocrit in the pre-race tests carried out this year.

The urine test

To circumvent some of the problems associated with blood testing, researchers were also looking for a urinary based analysis method to check for EPO. Earlier this year, the French anti-doping laboratory of Châatenay-Malabry publicly announced that they had a procedure that would do just that. It was based on an electrophoretic technique that could detect minute changes in the pH of urine, depending on whether natural or artificial EPO was present. After they had developed the procedure, they tested it on samples collected from the infamous 1998 Tour de France. The results were interesting to say the least.

Their work was published in in June this year in Volume 405 of "Nature", the popular mainstream Scientific Journal, as a brief communication. They tested 102 samples, and found that 28 were above the normal range of 0-3.7 IU per litre, and the remainder below their minimum detectable concentration of 0.6 IU per litre. Of the 28 'high' samples, 14 of them gave a clear indication that there was exogenous recombinant EPO present. It is also interesting to consider the fact that there were so many non-detectable values: EPO is like other hormones e.g. testosterone, in that the body reduces its own production if it is artificially administered. When you stop taking it, your levels drop quite low for a while before normal production ensues. However, such a generalisation could not be made from this paper.

One final note about the urine test is that it was effective up to three days of taking EPO, as opposed to the blood test which could work up to three weeks.

Vive le Tour...

Despite it occupying a mere half a page in a scientific journal, albeit a well known one, some members of the UCI and the Societe du Tour de France deemed that the urine test was sufficiently developed to use in the Tour de France in July. However, at the last moment an independent panel appointed by the UCI declared that it was insufficiently validated, and more work would need to be carried out. "A minute scientific risk remains that currently prevents the total validation of this process," said Dr. Patrick Schamasch, the director of the panel.

Although it would have been an important step in the fight against EPO abuse, the test as it stood left too many legal holes for potential guilty athletes to step through, and they would certainly try. In recent months, further validation has been carried out on both the urinary and blood tests with the result that the IOC medical committee approved them on August 2 and more recently an IOC legal panel on August 29. So, at last we are going to have EPO testing in endurance sports, beginning with the biggest event of them all, the Olympic Games.

A small word of caution before we celebrate the "end" of EPO: for an athlete to be positive in Sydney, they will have to fail both blood test and subsequently the urine test, remembering that the latter's efficacy is only 3 days maximum. EPO works on a much longer term, and this combination test could be quite useful in a three week tour, as EPO users will typically "top themselves up" just prior to the race in order to get them through that last week. Still it is a positive move forward, pardon the pun.

Drug testing in Sydney

Recently the Australian Sports Drug Agency gave a press conference detailing their drug testing plan for the Olympics. ASDA have been extremely busy in the past 14 months in the leadup to the games, conducting 6,636 tests in Australia both in and out of competition. This is in addition to the World Anti-Drug Agency, who have carried out 2,500 out of competition tests across all Olympic sports. ASDA plans a further 400 urine tests and 300 EPO tests in the coming weeks prior to the Games, many of which will be in training and competition centres outside Sydney.

Although normal analysis is between 4-6 weeks, the nature of the Games means that a 72 hour turnaround will be necessary so that athletes can be quickly notified and appropriate measures taken. To do this, they have received $AU1 million from the Federal Government, in addition to IOC funding. The tests cost money and one reason that the blood test is being used as a screen is that it is far cheaper than the urine test, with the latter costing some $AU2000 per sample, while the former is only $AU600-800.

When asked about the efficacy of the combined test, ASDA's chief executive Natalie Howson told cyclingnews.com that although it's limited to three days, it still should be quite effective in preventing drug use: "I think that athletes would not take the risk...you're playing Russian Roulette with your chances [of giving a positive result]," she said.

"It's the best step we've had in the fight against EPO, and we want to avoid legal problems," said Howson of the IOC's approved protocol. Importantly, she added that if the blood test did yield an abnormal value, it "would be investigated further" although there would probably be no follow up if the urine test was below the detectable limit, as noted above.

The blood tests require 8-14 millilitres of blood and will be sensitive to the athlete's preparation. The overall testing regime is significantly more comprehensive than at Atlanta, meaning that Sydney should at least be "cleaner" and certainly an interesting test case for the blood/urine EPO test.