Michael J. Joyner
Thursday November 12th, 2015

The big news in sports doping and track and field is last week’s WADA report on systematic state-sponsored doping by Russia, especially in track and field. The report describes a program reminiscent of what went on in East Germany in the 1970s and ’80s. The report also raises questions about the leadership of the IAAF, whose past president is alleged to have accepted bribes from the Russians to conceal positive tests. The current president, Olympic champion Sebastian Coe of Great Britain, is also under fire for what he might or might not have known, or what he should have known about all of this during his rise to the top of the organization.

So what is the role of drug testing in all of this and why isn’t it possible to simply catch and suspend cheaters with better testing? The Russian story points to the human element and role of corruption in all of this, and the short answer is that testing will only get you so far. Why?

The first problem with testing is defining what is abnormal. Like most things in life there is a normal range and the trick with any sort of medical testing is to decide what is in or out of the normal range. This requires judgment calls on how many false positives or false negatives the people doing the testing are willing to accept. If you set the cut off value too low a lot of people will have false positives, if you set it too high you will get a lot of false negatives. In clinical medicine the risk of missing a case (false negative) is weighed against the risk of over diagnosing things (false positive) and depending on how serious and treatable the condition is a consensus about what is normal tends to emerge.

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In sports doping the goal has been to avoid false positives at all costs, which means there are a lot of false negatives. This is made worse by the fact that dopers currently use tiny doses of short-acting drugs that are either identical or very similar to natural hormones released by the body. So to catch a doper the test has to occur within a narrow time window. All of this is highlighted by the fact that only 1-2% of tests are positive at big events like the Olympics, but it is estimated that 14-39% of elite athletes do or have doped. It is also important to remember that a whole lot of high-profile doping cases, such as those of Lance Armstrong and Marion Jones, were the result of investigations and not positive tests.

The biological passport addresses some of these issues by looking at longer-term trends in blood variables that respond to doping over time, but again with careful use of micro doses of the right drugs it is possible for people to dope and stay in bounds. From my perspective, and in talking with my medical and research colleagues who follow these things, most people believe that better testing, including the passport, has stopped what might be called industrial strength doping. For example, the Russian women implicated in the current doping scandal don’t look like the old school East German women. However, it is important to remember that margins of victory in most events are less than 1%, so it does not take much. The financial rewards for winning an Olympic gold are huge and as 1968 Boston Marathon champion Amby Burfoot has pointed out, the temptations are great.

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The Russian problem also highlights the many human and non-technical problems in doping control. First, in many cases the federations and leagues are basically policing themselves. There is no central testing organization that is truly independent, and while the World Anti-Doping Agency (WADA) certifies labs, it does not run the labs in various countries, a fact that leaves all sorts of room for local interference. Second, in places like Kenya and Jamaica doping control efforts are underfunded and lack the logistical infrastructure to do the job correctly. Third, once a WADA lab comes up with results, the sanctions are generally left to governing federations. Finally, in many pro leagues, including major professional sports in the U.S., WADA standards have not been adopted and the bans associated with positive tests are typically for parts of seasons, as opposed to years.

Run through that list and all sorts of conflicts and temptations exist. Think of the steroid-fueled home run derby in the U.S. that happened after the baseball strike of the middle 1990s. Is it possible that MLB, sponsors, and major TV networks all basically turned a blind eye while attendance and viewership rebounded? Could similar motivations be keeping big time track and field and even the Olympics from really cracking down? Ban too many people and have too many slow times and who watches?

So, given the limitations of testing, how can doping control be improved? Here are some suggestions, notes and points of contention:

  1. WADA should run the labs and adjudicate the sanctions independent of the countries, federations and leagues. Independence, as Olympic marathon champion Frank Shorter has noted, is the key. This would require real funding and real international cooperation. It would also require collaboration with law enforcement. However, it would only cost a tiny fraction of the TV and sponsorship revenue generated by big-time sports.
  2. How many missed tests and ‘dog ate my homework’ excuses should athletes have during testing. Is three missed tests in 18 months too many?
  3. For how long should cheaters be banned? Sanctions vary by sport but the recent controversy surrounding the comeback of sprinter Justin Gatlin after two strikes makes you wonder. If he did not deserve a lifetime ban who does?
  4. As the Russian case highlights, should whole teams or countries be banned?

In the final analysis human biology is too variable and there are too many clever innovators and underground chemists out there to solve this problem solely by testing and technical means. The four suggestions above will improve things and are a start towards cleaner competition, assuming the powers that be are really interested in cleaner competition.

Michael Joyner, is an expert in human performance at the Mayo Clinic, these views are his own. You can follow him on twitter @DrMJoyner

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