Professor Andy Miah

Doping and Public Health (2007, Aug 15-16, Aarhus)

Doping & Public Health
Arhus, Denmark, 15-16 August, 2007.

15 August 2007
10.15 – 10.45
John Bale and Richard Peel (Chairing sections)

Prof. Jens Evald, Chairman of Anti Doping Denmark – Introduction: Anti Doping Denmark’s Action to Protect Public Health

Prof of Legal Philosophy at Arhus.

background
doping and fitness
public health
fitness-doping
anti-doping denmark 3-year project

Background
Anti-doping denmark – independent
Act of Promotion of Doping-Free Sport (2005)
-    ADD is self-governing
-    12 member board
-    7 secretariat
-    ministry of cult = 1/3 of budget

Act 2005
-    doping control
-    info
-    research and development
-    international collaboration on fight against doping
-    provision of advice

Section 9
-    fight against fitness-doping (ie. doping use outside of sport.
-    requires implementation of WADA code in gyms.

Gov argument for fighting doping
-    public health
-    illegal trafficking
-    risk fo drugs spreading to organized sport

Public Health Issue

night-life violence increases by doping

effects of doping:
loss of interest in surroundings
social isolation
suspicion and jealously
new friends with own language
dress code and social code
can’t see anything wrong with own behaviour

big confidence
agrresion
depression
alarm
change in personality
lack of empathy
increase sexual self-orientation

how do users see these changes
- problem is that they do not see the side effects (ME: AS PROBLEMATIC)

ADD a ‘natural born’ protector?
- was never asked to form.
- today, have 70 of 450 centres in system
- working towards new model where commercial centres part of org

ME: is not talking to the political economy of doping (in Denmark). Like the dopers, is unaware of the context of own behaviour.

Is fitness doping a big problem?

Alesandro Donati wrote the WADA report, estimating doping on global scale
- the report mentions 15,000 abusers, the newspaper says 31,000

84% of sold growth hormone is used in sport
ME: but I thought many people believe most athletes are not using hgh, so where is this being used across sport?

also test for doping in prison – the prisoners trust us.

of tests:
0.6% positive in DIF
10% positive in DGI
20% positive in commercial fitness centers

number of positive tests has increased, but could be because of more effective testing.
(testing for steroids/, not social drugs)

some people talk about 60,000 abusers in denmark. we don’t know.

ME: what could improve knowledge. WADA talks about intelligence. it’s interesting for me to hear you throw out the 60,000 figure, given your own estimates. are there formal mechanisms for gathering intelligence and are they different from WADAs? come to think of it, what are WADA’s mechaniss?

Questions:
-    is ADD the right body?
-    Is fitness-doping a real problem to society?
-    which drugs should it test for?
-    can we accept social isolation of doping users?
-    what is lacking the most in fight against doping?

ME: what is worrying about isolationism of dopers? There has got to be at least two more premises to the argument.

ME: the fact that he is asking whether we test for social drugs is v problematic.

Questions and Answers

J: problem is that we cannot register the names of people.

Changes in WADA code allows making separate rules for fitness centres.

10.45 – 11.15

Asst. Prof. Paul Dimeo – The Public Health Origins of Anti-Doping

Key historical moments
- 1948: Dr Christopher Woodward raises concerns about cyclists’ use of drugs
- Late 1940s/early 1950s – returning war verterans and wide availability of amphetamines contribute to rising usage at all levels of American sport
- 1952 – WHO conference
- 1957 – AMAconference
- 1960 – death of Knud Enemark Jensen at Rome Olympics, attributed to amphetamine abuse through later investigations dispute this claim; Avery Brundage raises issue with IOC; British anti-doping expert Arnold Beckett claimed later that IOC knew about t widening use of steroids by 1960
- 1961 – British athlete Gordon Pirie publishers a book ‘Running Wild’ in which he claims some British, many American and many society athletes use doping drugs
- 1963 – CoE meetings
- 1964 – International Congress of Sport Sciences meets during Tokyo Games and prob of doping is raises, also exptl testing conducted on cyclists during Games
- 1967 – British Association of Sports Medicine conf on doping held in London
- 1968 – first testing at Olympics for amphetamines; test for steroids  would arrive in 1076.

(Dimeo, P. 2007. A History of Drug Use in Sport, 1876-1976: Beyond Good and Evil (Routledge))

between 1950s and 1960s, change in anti-doping
postwar period public health movement
questions about how sport played a role in public health
by late 1960s as sports orgs took control, tone of anti-doping changed to defensive of sportin culture and assumption of sport ethics. doping not defined as prob of too much intensity, but as a bleamish on utopia of sport. consequently, for public health officials who were more objective on health, had been lost. chance for moderation had been replaced by fanatic approach to the problem.
beginnings of shift from 1952 Februrary.
IOC had announced in 1933 that it did not like doping, but did nothing until early 1960s.
were not many instances at this time.
1948 Woodward
1949 italian ctyclist died allegedly of amphetamine
in US groupwing prob
first major statements on doping came from health not sport – WHO 1952
- 2 speakers talked: Carl Evan – Norway health – oppressive system – said ‘use of dope….popping up here and there in the amateur sports world….will be a disaster for sports’
- American colleague at the conf: Milton Lomer – Social and occupational health secretary for WHO, didn’t like look of sport – athletes pressured into taking health risks for national prestige. he saw sports in critical terms. he thought sports were to blame.  not clear how these speakers reflected view of WHO. no further action was taken.
June 1957 – AMA initited research studies on the subject. beginning of surveillance process. Herbert Berger narcotics expert – claimed dubious success of 4 minutemilers, but also critical of amphetamine use in college and high school in usa – widespread pattern of drug use ‘shocking and visious’ – saw it asa  public health issue. ‘drug addicts might get their start taking amphetamines in high school and college’. also said users displayed violent and criminal behaviour.

anti-doping among officials at this time
AMA projects on use of amphetamines another was a clinical study about effectiveness of amphetamines for performance.

this affected publich health stratgies of surveillance.
clinical studies were sign of honesty – though sports authorities discourages research on doping in 1960s.

in public health cntext, concept of fairness not visible
if anti-doping had remained focused on public health, then nature of antidoping would have been v different.

early 1960s, in UK Austria,
BASM and itlian counterpart established positions
CoE defined doping as an evil, such a view had become routine
like a religious doctrine
eg. IOC anti-doping Arthur Poierot, also Sec of BASM, in 1965: ‘doping is an evil. it is morally wrong…legally indefensible’. – at this time, no evidence to support any of these points
eg. XXXX immoral act of doping  ‘keep the ideal of sports pure for the welfare fo all mankind’

testing in Olympics by 1968.
guardians disliked modernity in sport – eg. training technology.

no interest to dialogue values
problem in their view was fringe element of sport ‘cancer’ on utopia of sport.
IOC wanted elitism, but with amateur values.
constructed a sense of sport that focused on excellence, but values that ddi not reflect reality of elite sports – inspired by indiv and national glory

how ddi early public health experts compare with later sports colleagues

similarities
both disliked drugs in sport, though for different reasons
both thought monitoring important

differences
if about health , not ethics, then must consider broader public
eg. alcohol – all allowed to drink alcohol and excessive can do, but if drive drunk can be prosecuted since affects others health. other crossovers – approach to alcohol has been realistic pragmatic and yet allowed freedom.

if sports doping had been seen purely as public health, would it  have emerged

ME: hmmm, medical intervention of doping might be a difference?

11.15 – 11.45
Prof. Barrie Houlihan – Doping, public health and the generalisation of interests

how politics is changing and how it might change.

theoretical presentation

theory of policy change

generalizing interests – building alliances with sympathetic policy areas

domestic and international policy making is hotly contested – many polic leaders are under constant pressure to give prominence to their issue and to protect it from others

2 questions:
- how can momentum and commitment to resources at domestic and intenational be maintained?
- to what extent can domestic and international sport interest control discoures….

Anthony Downs – policy ‘life cycle’
-    pre-problem stage
-    alarmed discouvery and euphoric enthusiasm
-    realizing cost of signif progress
-    post-problem stage

much of history of anti-doping follows this pattern

first stage
-    death of Tommie Simpson
-    withdrawal from 1983 Pan-American Games
-    1988 ben Johnson
-    1998 tour
-    2007 tour

each began with enthusiasm which rapidly dissipated

look at discourse that surround doping

3 dominant discourses
- fairness, health of the ATHLETE (not public health), image of sport (role model, etc)

these are generally self-serving, inward looking and politically naïve

WADA Code reflects mixed rationale
-    concern limited to athlete’s community

however, wada needs governmental allies
examine how these other orgs discuss doping – they use broader, social terms
eg. CoE – sport important role in protection of health, moral education, international understanding; EU – competence in area of public health; UNESCO Convention – education, health, development and peace
many govs have publich health emphasis on sport – France, Norway, Sweden, Denmark

Dick Pound – ‘unviversal recognitioj…doping serious threat to public health’

whether it’s being exploited, I’m not sure

but not only discourse

competing discourses:
-    constitutional: sport should be self-governing
-    criminal: doping is big criminal business
-    workers rights: right to eran leaving
-    moral/ethical: fairness:
-    medical: health of athletes, treatement
-    public health: doping spills into non-sport

constitutional, moral medical are most promiinant international, others vary between countries

WADA’s response?
-    is WADA aware that it is competing?

public health not exploited by sport

1998 – watershed
- showed weakness of ‘constitutional discourse’
- French gov intervention (and criminal discourse)

Continued discuss about criminanlization
need for sport to build a defensive ‘generalisation of interest’?

criminalization – ljunqvist – advocates criminalisation of sports related drugs

strategies for generalisation of interests
-    sectional interests (like elite sport) aim to further interest by linking to public good o
o    ‘one has to hrase one’s argument in impartial terms, as if one were arghing for the public good and not fornes own self interest’ (John Elster)

is linking elite doping with public health going to strengthen elite anti-doping?

back to initial 2 questions

discussions
-    what is existing relationship between antidoping and external interests?
o    what evidence is there of alliance building?
o    the evidence suggests that they are not.
-    are we seeking generalisstion of interests by sport to link with supportive external interests or the incorporation of sport by eternal interests.. – rather public health sees sport as valuable to them.

ME: is this because it would diminish the autonom yof WADA

parallel discourses?
-    internaitonl, still focus on athlete’s health, modest concern on public health and broader pro-social discourse on sport
-    domestically: increasing number of countries a crime/law and order discourse (encouraged by WADA?) but in others an increasing concern with public helaht and sport for al not just elite)

evidence of a changing discourse? sport still claiming tis privileges status (overplaying its hand)
sport/elite soprt has lways been linked with other non-sport interest

ME: how does this function with doping technologies that are not clearly linked to public health issues – e.g. blood doping or hypoxic training? Is there a challenge over boundaries – ie. doping more than drugs. difficult to excite public health policy makers about hypoxia?

ME: would a public health approach require the separation of some doping technologies from others? – ie. some have a clearly larger spill over than others.

what will keep doping on the front burner?
rely on continual succession of crises?
criminalization is easier than public health.
links to either run risk of loss of control by WADA and NADOs.
but criminalization makes more difficult harm minimization.

Verner:
don’t know if prob of doping, but we’ll solve it
in 1960s don’t know if was a big prob, but begin to solve
how politicians trying to solve.
problem generated by political ambition.

ME:mobiilisation fo anti-doping is often

Barrie: different to identify public health dimension of some doping technologies, but for others, it is clearly the case

11.45 – 13.00
Lunch
13.00 – 13.30
Prof. Claudio Tamburrini – Postponing motherhood: an unfair advantage?

follow up project on genetic technology and gender

trying to ascertain how genetics impact on gender equity in elite sports

from time to time here that women give birth after menopause.

none of the techniques to assist this are genetic, but is conceivable.

whether athletes who postpone motherhood gain advantage over those who don’t?
is this adv unfair?

when we speak of motherhood, not suggesting htat elite sports are not compatible with motherhood. some argue that it eventually enhances sports participation. (IRSS 2001).

but still the case that natural difference between mean and women still exists – women bear children and men don’t. so possibilitiy to equalise ability will remedy natural disadvantage.

do not take a stance on whether interventions aimed at delaying menopause should be considered treatement or enhancement.

does postmenopausal….

assume that gender equity is desirable, though this is contested by some.

possible that technology could create more gender equity.
-    eg. resistance to ART – reinforces idea that women should become mothers and limits value of fulfilment without children

Laura Purdy

even if decision makers accept homosexual families, better heterosexual since discrim, but this is not a good argument.

develop a ‘happy child’ criteria – but no reason why could not meet standard

reasonable happiness

postmenopausal motherhood discourse shows resistance.

lets assume many women will do this. impact?

change of family. but no harm in that.

assume that once mothers, will shortly die. need to ensure provision within the community.

no reason to oppose postponing motherhood.

perhaps the children might resent older mother.

sport obvious eg where having children is a disadvantage.
-    those who do not can remain productive during  their peak years.

is genetically postponing motherhood unfair in elite sports?

a substance or method will be considered if 2 of 3 conditions.

assume that the technology will become safe.

is it an unfair competitive adv?

if open to all, then how unfair?

perhaps expensive will create greater unfairness?

not suff reason to label it as unfair, according to anti-doping policy.

trying to underline sport governance of such mattes, when the become a scientific reality.

must search somewhere else to discern whether is unfair or not.

might argue that is unfair adv since put colleagues under tpoo heavy burden – renouncing to motherhood for the same of competitiveness

but all sports persons forfeit plans and put pressure on competitors to do the same.

perhaps the too heavier burden objection could substitute the current criteria, combined with some other form of consideration. eg. ethos of sport – rules out improper manipulation of the body.

ME: What sorts of things are able to become proper manipulations of the body?

hypoxic chamber might be risky if stay in too long, are directly enhancing, but unlike trad doping re ot seen as artificial.

prob is how the competitive adv might be seen by sports bodies.

given that men are fertile for longer than women,

ban on gene doping – what is the non-therapeutic use? possible to treat muscle disorders that might improve muscle strength.? gene encoded epo to boost bone marrow, might also increase for sport.

must be more accuratey specify unapproved aplpictions of genetic technologies.

need increased insight on potential conflicts between socially desirable goals and ethos of sport.

need for open and critical debate on how governing bodies should deal with people who are already modified.

the greater the possibility of other genetic technologies to equalise different, more reason to accept

13.30 – 14.00
Prof. John Hoberman – Is testosterone a supplement or a drug?

20 years ago. West German scientists Manfred Donicker said steroids should not become a popular nutritional supplement

2 months ago in Las Vegas – Intenrational Society for Sports Nutrition
- middle aged man on testosterone on prescription.
- he said, any man over 50 who is not on a testosterone product is crazy.
- ie. donicker’s fear hass come true.

we are talking about a contest between testosterone status

what is difference?

supplement

assume fewer regulations, since assume fewer risks

I will argue that, in order to understand this, must look at history of synthetic tesosterone and realise that campaign to market to the masses

ME: big deal.

Time Magazine
sept 23, 1935
“german and swiss chemical laboratories are already prepared said Dr Ruzicka [one nobel later] last week, to manufacture from sheep’s wool all the testosterone t world needs to cure homosexuals, revitalize old men”

our society has imagined testosterone being put to public health use from the beginning

Newsweek Sept 25, 1996? ‘ Super-hormone hterapy’ ‘tesosterone’
(Uses same cover as john’s book)

Time Magazine – tesosterone again in Time Magazine

The Early Androgens Market: How testosterone did not become a ‘tonic’

there is no critical distinction

Androgen Ointment for careful dosing (1939)
- testosterone drugs being tested.

[see presentation from September 2006 in Newcastle]

Testosterone for Women: the new era of sex as a lifstyle entitlement

Hormones as ‘antiageing therapy’: the medicalization of the ageing process.

dopers in uniform.
- police officers on steroids
- brain doping by students
Chronicle of Higher Education ‘the other performance-enhancing drugs’(2004, Dec 17.)

Does a lifestyle transform a drug into a stimulant?

“I sincerely believe he didn’t see steroids as a drug, none of these kids do’

Tesosterone magazine
- if there is one, it’s probably a lifestyle, not a drug

NEJM – Aging and foundation-of-0youth hormones, paul m stewart. (Editorial)

new york times 1851

ME: treatment of syllvester stallone’s steroid episode in Australia a stunt?

ME:P If I told you that the Sylvester Stallone steroid story earlier this year was a publicity stunt to promote his film, would that change the way in which you would use it as part of your analysis?

what is medical treatment for?

‘if it gives real happiness, that is the most tha  any sufegon or medicine can giv e Dr Harold Gillies, poionieering British plastic surgeon specializing in the cosmetic repair of burned an maimed soldiers.

line between therapy and enhancement more blurred, but in sports it remains distinct.

outside of sport, enhanceemtn becoming part of acceptable lifestle goals.

Questions and Answers

Barrie: impc of context of supplement use. parallel with alcohol use – not supplement, but ubiquitous except in certain contexts, eg driving. so maintain distinction by defining context in which is seen. Also, bigger problem of maintaining definition of what a drug is – performance enhancement. athletes will not take supplements unless performance enhancing.

John: alcohol comparison important, but works one way but not another. focuses on volume of social harm that arses from use – anti-doping can make some analogies. compare social impact of steroid abuse with alcohol. but does not work in following way: putting police officer on alcohol improves performance, but if look hard enough can reconstruct dialogue of police officers on steroids – legit doping to assist in overpowering physically violent criminals. other trade ofd. chief of police of Miami said: we really should think about whether approp to put police on steroids. he was not saying it was wrong, but should think about it. now is v politically incorrect thing to say. but he identified a real dilemma. more common as something like modafinil becomes acceptable as a productivity stimulant. how are our feelings and values going to deal with this? popular wisdom in us that caffeine runs some industries.

Rob Beamish: enhancement as part of popular culture; postmodernist remaking of self; now, we remake self as part of regular way of lif. but also saw enhancement as violation of ethics. but in high performance sport, not anone who says high performance sport is a character building practice. so, enhancement not violation of ethics, but only certain types. where decide that enhancement is no longer ethical. at what point will we see steroids as non-ethical?

John: in 1990,k WHO said in Lancet that small doses of anabolic steroid were safe. research still being churned out in endocriminology. one part of the dilemma is that still in process of deciding how dangerous the drugs are. we know what anti-doping says. but, these are not the only opinions of relative risks. this remains undecided.

14.00 – 14.30
Prof. Bengt Kayser – Current anti-doping policy: harm induction or harm reduction?

doping-like behaviour

Randall, Zimmerman And Crook
prohibited from Olympic strat

kikkan randall – also natural epo peak

spirit of sport – mal defined concept

ME: deliberately so, like many ethical concepts.

repression vs potential gain

consequences of being caught
- exclusion for life

consequences of a medal
- fame and money for life

difficult to punish much more

does anti-doping work in the sense of their being less doping?
- not clear.

transport of doping drugs easier than cocaine, etc

2006 Blood, false-positive detection of recombinant human ep in urine following strenuous physical exercise
- criticised by different groups.

ME: Should WADA institute policies to protect vulnerable perspectives on anti-doping?

mike: people who disagree with your prognosis will agree with our diagnosis. disagree with ethical analysis, but agree with analysis.

14.30 – 15.00
Coffee break
15.00 – 15.30
Privat-Dozent Dr. Giselher Spitzer – Body and mind – biographical and health studies about doping victims in East German elite sport

15 years shift – what you see in doping procedures today was ‘state of the art’ before 1989

when did it start with steroids?
- blue pill oral-turinabol was 14-15yrs median
- half of sample doped before, first estimated 10 yeraas up to 14

why taking bills?
- no true answer
- others: vitamins, help traiing,  therapy

important damage and disease in sample
-    negative developments
-    damae of skeleton and muscle make normal jobs impossible (eg. longer standing, sitting, holding things). typical decision to find work was to find freelance.
-    no control group, so used brothers and sisters and offspring of each. most of the conditions are not present in these relations.

change of genotype – genetic damage
-    virilisation of foets or mandartory abortion because of pregnancy while training or a half year after competition
-    premature death while pregnancy or death birth (6 of 46 died from premature death); 3 parents have death birth
-    risk of premature death of children of doped athletes 32 times higher than normal popn; risk of death birth 10 times
-    important when considering that athletes were strong and medically well controlled
-    even control group did not have these figures

side effects on children born to athlete sing drugs
-    most of 69 surviving children also damaged
-    children of mothers who ere drugged, typically handicapped
o    37 children 54% suffer from 2 illneses
o    17 ids multiple damage
-    Dsisease represented more than 2 times:
o    every fourth child has allerges
o    one of 4 has skin illness
o    one of 4 asthmatic
o    one of 10 crippled
o    nearly one of ten metaboligc
o    1 of 7 psychic
o    1 of 17 mental disability

change of phenotype

1.    side effects: skin
a.    skin disease 12%
b.    allergies 12%

Liver
-    disease 17%

organsof body
-    damage to skeleton 92%
-    operations 67%
-    knee shoulder ankle joint 22%

25% of doped athletes have cancer or had cancer
35% sudden inflammations
17% migraine
15% metabolic
stomach 15%
epilepsy 10%
kidney 6%

disturbance of psyche and behav
-    attempts to suicide  38%
-    psychic illness 62%
-    health nutrition 25%
-    social drug
-    addiction to alcohol 13%
-    addiction to drugs 6%

side effects on male
-    testicle-atrophy or loss ability to produce sperm, 4 athletes
-    operation of testicles 3 athletes
-    enlarged prostate and treament 1 athlete
-    gynacomeastia 3 athletes (11%) (pre-cancer)
-    8 andrological diseases (29%)
o    more often than was thought

side effects on women
-    virilisation in general (breast reduction, facial hair, lowering of voice) 42%
-    injectins after maenorrhoea 4 women
-    hypertrophy of clitoris (not asked!) 0 in literature biggest size is 12cm
-    atrophy of uterus and underveloped 2 women
-    changes to ovaries – 3 women
-    generally
o    12 women gynaecological disease (50%)
o    probs with sexualidentification and identity, resulting from virilisation

no case of transexualism

7 secondary side effects as a result of higher dosese (‘overload)
- new type of damage of connecting tissue
- 7 athletes took drugs against feeling of being hungry or pills to lose water
- german masters or Olympic medallists or candidates were anxious because some gram of body mass. they stopped after reaching goal

The Value of the Results
- what we learn
first: give help to victims of mandatory oping as a humanistic need
second: knowledge to prevent re-emergence of simlar systems based on drugs eg china
third: enhancement of future policy

ME: Why do we have no good answers about what is happening in China?

other values
- value of health motor for anti doping
- boy capital is concrete guide for athletes who have to decide if they want to dope
- beyond ethical arguments, must protect own health.

Caston Lundby – rHuEPO treatment in humans: new findings and considerations for anti-doping work in the future

function of rHuEPO on blood

red cell mass ncerase, decrease plasma – total amount remains similliar

function of rHuEPO on performance

invasive studies – 6 catheters

new: epo also works at altitude. if take epo and ex at altitude, have use until 4100m approx.

so epo works for max ex intensively, but since most comps not held at max capacity, wanted to know at more suitable ex level. – how long could cycle of 80% of max to exhaustion
-    VO2max inc, but sub maximal intensities, much greater effect of epo doping.
-    not that using epo will lead to 54% increase, but that, in cycling, if break away from pack, could go for same velocity for 54% more time.

does epo have other functions than increasing oxygen content?
-    we’ve found receptor for epo in skeletal muscle (Lundby et al, AJP.
-    we’ve found no other physiological function with our model.
-    if develop more capabilities, could inc ex capacities.

to determine whether other effects,  gave subjects epo.
-    cycling exercise.
o    removed new blood from epo inducaed athletes. result showed presccie correspondence with pre-induced performance
•    suggests that effects of epo on performance related to arterial oxygen content

conclusion 1
-    rHuEPO increase arterial oxygen content by inc red cel mass decaeasing plasma vol
-    if arterial o2 inc aerobic also increase
-    m

is it dangeros to take rHuEPO.

transgenic mouse – tg6 mouse – born with 80 hematocrit. lives for 12 moths. wild type lives 24 months.
-    dies ofmulti-organ failure.

Mean Arterial Blood Pressure -0 in our substances, increased by 5-6ml of mercury – if you have this throughout your life, it is of course hazardous, but if increase to 50 and inc mercury for a few months per year for a cycling career, my guess is that it’s not so bad.

also investigated heart itself. found no dangers.

detection strategies and other

are the detection methods good?
-    abolish hematocrit level? because easily manipulated (plasma expanded, or blame sauna)
-    so, think about quantifying total haemoglobin mass, since this is constant measure usually

Hb increases with altitude exposure
Hb increases with training
Daily variation in htc
daily variation in plasma epo

so, to know whether is stable, measured in subjects – breath carbon monoxide

not clear that rapid increases in htc is blood doping

wide variation

so, this method is worthless

the on/off model

future (now) ?

epo receptor activating peptides (ERAPs)
-    do job of epo, but are not epo

when not neede, broken down immediately by
-    prolyl hydroxylase inhibitors

group in oxford has made inhibitors (DETECT FOR INHIBITOR?)

Machines to use?
-    Radiometer OSM3

Conclusion 2
-    difficult ot get htc or hb mass measure
-    machines don’t always tell the truth
-    future (and this is now…) is scary with regard to detecting endogenous epo enhancing agents

15.30 – 17.00
INHDR network meeting

19.00
Dinner in Aarhus
4
International Network of Humanistic Doping Research
www.doping.au.dk
16 August 2007
8.45 – 9.15
Coffee
9.15 – 9.45
Asst. Prof. Rob Beamish – The Policy Implications of the Current Social Construction of Steroids as a “Moral Panic”

I try to never use the word doping, since implicit illegality

Umah Bartov ‘Distorted Mirrors’
- perceptions are fundamentally important
- holocaust portrayed through series of mirrors

march 17, 2005 – committee on government reform

social constructionism
- moral panics
- claims makers
- build moral consensus

eg. house committee is one process of claims making

coubertin’s objectives have become the IOC brand

1972 munich – separate GDR
- east german successes embarrassment to west

Wade 1972 raises concern about steroids

‘the first of male steroids to improve performance is said to have been in world war II when….

1988 – 48 strides under 9.8 seconds

Trevor Graham turns in syringe with THG to USADA
BALCO
2004 State of the Union

San Francisco chronicle links Greg Anderson to BALCO who is linked to

bigorexia – young men trying to bulk up. – associated with Viagra, and other enhancements – ‘cult of the body’ within a context where drug/supplement use is widespread.

comic book masculinity

use of steroids part of postmodern world of changing faces.

Questions and Answers

John H: how long did victor conte serve in prison for balco – 3 months. grotesque disproportion of moral panic vs judicial system.

Rob: game of shadows – clear that there are thousands of BALCOs throughout America.

Paul D: mythmaking vs actual fact? how distinguish?

9.45 – 10.15
Dag Vidar Hanstad (Norwegian School of Sport Sciences) – Where on Earth was Michael Rasmussen? Elite Level Athletes and their Whereabouts
dag.vidar.hanstad@nih.no

www.sportsanalyse.com

aim
-    survey of athletes attitudes on doping
-    292 subjects, 80 responses (or was it 80?)

findings
-    80% said they trusted the online system
-    1 out of 4 felt it reduces the joy of being an elite athlete
-    signif percentage felt that 3 warnings in 18months should lead to sanction
-    many athletes felt part of a ‘big brother’ system?
-    few felt that info collected would be misused.

does tracking whereabouts violate self-determination?
need to regulate can get out of control

everyday surveillance is extensive

10.15 – 10.45
Asst. Prof. Andy Miah – Human Enhancement Technologies and Sport: The New Language of Doping?
10.45 – 11.00
Coffee break
11.00 – 11.30
Prof. Mike McNamee – Ethical issues regarding human enhancement technologies: Therapy, Enhancement and the traditional goals of medicine in sport

against doping
- performance enhancement
- allows more training – coercion
- unnatural
- harmful
- unfair advantage
- cheating

idea of enhancement
- valorization of autonomy
- are athletes generally autonomous. if not, cannot make autonomous choices
- athletes are not autonomous, do not understand sports medicine, are passive.

ME: their reliance on expert knowledge is no different from your own knowledge of medicine.

medicine is essentially therapeutic

ME: but a wide range of therapies are context driven. imagine a 70 year old man who can no longer enjoy a sex life. is the prescription of Viagra therapy or enhancement? Alternatively, an individual who has a known late onset genetic condition for which there is an ongoing treatment – you are likely to get Parkinson’s, we should start treating you now’ your characterisaton of these as peripheral to your concerns is mistaken. they are the business of all medicine.

doesn’t follow that what happens within a hospital is all therapy

night and day, cannot tell you when one begins. – ME: yes you can mike, it’s when you wake up

‘there will be cases which are not therapy/enhancement, I don’t have a problem with that’
- ME: that’s precisely the problem you have

demarcate unacceptable enhancement
use of prosthetics in elite disability sport

how desirable is the fact that the performance is dependent on technology? (Loland)
prob is surrending level of control athlete has over daily life
-    ME: so, an athlete that wants to stay at home with family, cannot afford to take them to mountain, her quality of life is diminished by not using hypobaric

will what is left be recognisably human?

Questions for Mike:
1.    if your claim is that athletes are passive – ie. not autonomous – then I also doubt my own understanding of . there is no legal basis for supporting the claim that athletes lack autonomy. In 1985, the case of Gillick vs West Norfolk established what’s called ‘Gillick Competence’. it indicated conditions where minors could obtain abortion without requiring parental consent. it has become a critical part of how we think legally about autonomy and consent. there is no way imaginable that you could argue legally that athletes are not autonomous to such an extent that you could step in for them to decide on the basis of some ‘substituted judgement’. Over the last year, my doctor has quadrupled my preventative prescription for asthma. I’m not sure I understand the medical science too well. I feel like I might be building an unhealthy resistance, but there is no doubt that I have autonomously acceded to this treatment.
2.    Medicine makes us well ‘for something’ it is never free from the lifestyles we want to lead.

11.30 – 12.00

Director Michele Verroken – Anabolic Steroid Use – what is the size of the problem for sport and society?

reliability of data = credibility of information

test date from 1993-2003

no of samples increased from 89166 to 151210

no of anabolic steroid findings inc from 940 to 1169 (872+297 – includes beta 2 agonists)

question – is an approx 2% problem, a problem?

in 2002-3, Australia reported only .59% positive test.

we don’t know about the problem

survey of athletes 1998

54% believe that up to 30% of competitors in their sport were using performance enhancing drugs

4% said 60% were doing so

3% (none from weightlifting or rugby league) believed sport was clean

(from the Indenendent)

new york times 2003
‘how many athletes in us use steroids’
results do not reflect testing data?

also asked whether it bothered people – 30-40% said no.

realibility of testing, random, missed test scenarios

many athletes say random testing is actually targeted.

positive test over the years not significant percentage.

ME: ou mention Beijing. what do we know?

are we helping ourselves by identifying the size of the problem.

better to miss a test than fail a test.

more than 70 British athletes have missed at least one out of competition drug test. 4 of them have missed 2.

IAAF regs say a missed test is for five years, not just 18 months.]

testosterone reporting

testosterone-epitestosterone ratio
- upto 2004: 6:1
- post 2004:

Autologous blood injections in soft tissues complaint

alice in wonderland
‘I don’t think they play fairly…’

£2000 to treat abscess from steroid injectors – if teach to inject properly, lower the cost.

future social problems?
- France BJSM research – 1/100 of eleven year olds use drugs to enhance performance (could be salbutamol)

we know there are inconsistencies between sport and society use of steroids

to WADA
- tighten up testing – not government targets
- promote health consequences of using steroids and opportunities of needle exchange.

12.00 – 13.00
Lunch
13.00 – 13.30
Prof. Alessandro Donati – Connections between doping and narcotic drugs

Australian anti-doping agency – image vs performance enhancing drugs

Schwarzenegger was paid by mafia directly for his films

combination of doping and training knowl
- day of athlete now is full of training – cannot do other things.
- e.g. many cannot read more than 10 books a year
- rogge now interested in youth – fight obesity and sedentary – so, youth Olympic games
- no connection between doping and obesity/sedentary.
- clear that athletes use undetectable drugs, not the others
- anti-doping tests died.
- dick pound says they’ve improved, which is true, but prob is that anyone can modify and disguise drugs.
- we need anti-doping, but not only.

source of proof
- in sport – only test
- in judicial system – searches, seizure, wire ttapping, expert reports, test biology, documents

what is hidden behind high number of negative tests?
- suffer from asthma, high testosterne or hmb
- hides anomalous levels – pathologies behind results
- interest in lives or appearance – I think only appearance
egs.
- upward trend of cholestorol levels through t years. why?
- unexplained fluctuations of haematocrit and haemoglobin levels (more than 20%)
- critical fluctuations of liver transaminase..also azotemia, bilirubin and several other parameters

negative anti-doping hides emerging disease conditions.

electronic health passport is a good idea.

why do we need state laws against doping?
-    every country should pass criminal laws against doping or update existing laws concenring addictive and pharmaceutical substances that would allow effiecient action to contrast t diffusion of doping among amateur athletes and in gymnasia.

mistake in Italian law is that specifies for elite athletes, it should be everywhere.

ME: if the law should be for everyone where else do you want to police usage? schools, gymnasia,

sport system is scarely efficient as regards acquistion of proof but decisions on sanctions are taken swiftly, but process much longer

dishonest officials stay in the environment, while athlete is out.

the old ioc was a disaster. now we hope wada, but we are late

connections between doping substances and social drugs

common ground – cocaine, stimulants, amphetamines heroin, opiates narcotics cannabis, ghb, alcohol.

sport system

difficult to accept sport system.
athlete positive for cocaine. he never went to disco. when is he going to use cocaine for social?

antidoping lasws in eujrope

legal systems on dupong
- in June 2006, Italian minister for social affairs appointed me fconsultant

doping substances are assimilated to addictive drugs so that the judicial instruments and the anti drugs criminal las…

se of doping substances not criminal offence for common practiconers but only for professional athletes….because doping gives them an illicit advantage and damages their opponents
- create indiv health smart card for all practioners of sport federation.
- not important to disqualify, but to stop
- inverstigations coordinated by special police squad
- contrast traffic of doping substance via the internet

Article 28, item 4, establishes internet acess providers….

Slovenia
- websites in several countries
-

ME:

13.30 – 14.00
Asst. Prof. Ask Vest Christiansen – The use of anabolic-androgenic steroids among non-competitive strength training athletes – cultural, social, and psychological explanations

campaigns against non-competitive strength trainers has failed, why?
portrait of a person who took a lot of steroids and loved it
presentation of types of questions received by Anti-doping denmark

1999 national household survey on drug abuse – estmate 3m users of steroids in US
ADD estimates between 10,000-60,000 in Denmark
inexactness reveals how little we know
4 of 5 steroid users are non-athletes
in Denmark: 9/10 users non-athletes
steroid users larger doses today than previously reported
widespread misconception that trainin for improving appearance can only succeed with combined drugs and training

have tried to change things by imposing fear

a paradigmatic change – not just a medical prob but a cultural phenonmenon

take into account cultural norms and values of drug inflicted subcultures

campaigns have been based on bourgeious values, v different from cultures of body-builders

focus of campaigns have focused on side effects and consequences – impotence, acne, damage to vital organs.

subjective experience of drugs vary
- inc stength, virtality, libido, social status

a Danish bodybuilder
- said how use of drugs gave 2 fantastic years of building, but ultimately spiralled out of control.
- from compettive football, but disillusioned. realised potential for muscle building. was well proportioned. but after progress, muscle development levelled off. decided to continue development with steroids. began with anabolic, to nanobolic – injecting 150-250 mg per week – more effective and no side effect of subcut fat, as pills did. achieved high recognition in his milieu. strict diet. other things mattered less. when met a girl, made clear should not complain about his use. experienced none of the side effects, never violent. but lost control of medicine. intervals between treatments completely disappeared. did not bother him at first, but became ill. 3 weeks before contest, body broke down. hospitalized. in recovery, realized seriousness, before moving depression. he felt something was taken from him. – injustice that had not been able to finish project. now recovered and teaching in small village school.
- what can be learned?
- male status of muscles is crucial to understanding doping of weight training
- promise of transformation.

Alan Klein ‘little big men’ – promise of change, from vulnerable to heroic and opposing.

14.00 – 14.30
Coffee
14.30 – 15.00

Prof. Verner Møller – Is the current anti-doping strategy satisfactory, and can it be improved?

doping is what wada assesses it to be

prob not that you dope, but how you dope

eg. caffeine – taken off list, despite being a stimulant
why not oppose vanity dopng?

tamburrini – what is wrong with doping?

fact that doping rules are arbitrary does not mean they are mistaken.
second claim by tamburrini, is that open access would be discovery of actual risks.
-    other areas suggest restrictive use leads to

in spite of these reasons, threre is support for anti-doping

so what is wrong with doping? nothing if ultra-liberalistic perspective

Questions and Answers

Claudio: is the reason for so few doping injuries evidence of underground doping research?

15.00 – 15.30
Final discussions
15.30 – 16.00
Epilogue
17.15
Visit and buffet at City Hall