-Point-

The Quest for Clean Competition in Sports: Are We the Dopes?

G.S. Baird

October 2014

www.clinchem.org/content/60/10/1276.full

© Copyright 2014 by the American Association for Clinical Chemistry

© Copyright 2009 by the American Association for Clinical Chemistry

IntroductionIntroduction

Doping is variably prevalent amongst athletes, yet there are high-profile cases of elite athletes who are caught, and some survey data to suggest that the prevalence is quite high in specific cohorts

Undoubtedly there is some deterrent effect from antidoping measures, but getting caught is still unlikely, and the potential benefit from doping appears to be high (although this is admittedly controversial).

Elite athlete dopers have more resources (and highly capable analytical laboratories) at their disposal.

© Copyright 2009 by the American Association for Clinical Chemistry

Questions on Antidoping TestingQuestions on Antidoping Testing

Why do we test athletes for performance-enhancing drugs? Why should we? Safety? Fairness?

Has antidoping testing made sports safer and fairer?

Does the public understand the limitations of the tests that clinical chemists do to detect doping?

Can a deterrence scheme be effective if it misses a high percentage of offenders?

© Copyright 2009 by the American Association for Clinical Chemistry© Copyright 2009 by the American Association for Clinical Chemistry

Figure 1. The pre- and post-test probabilities from laboratory tests given various test specifications (sensitivity/specificity) and results (positive/negative). Posttest probabilities tend towards 0 or 1 for negative and positive results, respectively, across a wide range of pretest probabilities when sensitivity and specificity are both high (blue and green curves); this means that results are often interpretable. When the test is made highly specific but poorly sensitive, as anti-doping tests frequently are (red and purple curves), positive results are interpretable albeit uninformative if pretest probability is already high, and negative results are difficult to interpret because pretest probability is very close to posttest probability.

Test Efficiency from Bayes’ TheoremTest Efficiency from Bayes’ Theorem

© Copyright 2009 by the American Association for Clinical Chemistry

What would happen if we stopped?What would happen if we stopped?

In the absence of any deterrence, rates of doping would be expected to increase, but what if they are already close to 100%?

A playing field that is permissive to doping is not “fair”, but is it “fair” now?

The entire problem comes down to what we expect, as a society, from our athletes, especially the professional ones. This might best be discussed in social studies classrooms, not clinical chemistry journals.

The financial motivations present in sport today may make meaningful changes impossible.

-Counterpoint-The Quest for Clean Competition in Sports: Deterrence and the Role of Detection

L.D. Bowers

October 2014

www.clinchem.org/content/60/10/1279.full

© Copyright 2014 by the American Association for Clinical Chemistry

© Copyright 2009 by the American Association for Clinical Chemistry

What is the objective of an anti-doping What is the objective of an anti-doping program?program? Deter individuals from making the decision to

use performance-enhancing substances

Ensure compliance with rules made to create a level playing field for true competition

Pharmacological anarchy does not result in a level playing field. Imagine two individuals – one with a hematocrit (Hct) of 42 and one with an Hct of 48. If both increase their Hct to 50, the first individual gets more of a performance enhancement.

Athletes could be coerced into participating in unregulated human experimentation.

© Copyright 2009 by the American Association for Clinical Chemistry

Compliance with RulesCompliance with Rules Moral inhibitions are the most important factor in

an individual’s decision to comply with a ruleCompliance with the rule is viewed as a duty (deontological ethics) Moral inhibitions can be re-enforced by a community of

athletes that actively supports an anti-doping creed or statement

Moral inhibitions are weakened by isolation from the community and rationalization

Moral inhibitions do not always correlate with behavior

When moral inhibitions are weak, deterrence strategies can be used to ensure compliance with a rule

© Copyright 2009 by the American Association for Clinical Chemistry

Factors that Impact Deterrence Factors that Impact Deterrence Perceived certainty of being caught

Collection strategies must increase athlete certainty about being caught (“ambiguity avoidance”)− No-advance notice− Out-of-competition vs. in-competition collections

New testing methods and strategies− Testing changes athlete behaviors (e.g., route of

administration), which requires new tests− New therapeutic agents with abuse potential require

research into new tests

© Copyright 2009 by the American Association for Clinical Chemistry

Factors that Impact Deterrence Factors that Impact Deterrence Perceived severity of the penalty

Formal sanctions − Penalties imposed by the governance structure

(e.g., 2 years of ineligibility) Informal sanctions

− “Costs” imposed by significant others (e.g., loss of reputation, etc)

Perception of the “quickness” (celerity) of the imposition of the sanction

Delaying the sanction is perceived as beneficial by the individual breaking the rule

The time required to prepare a reasonable defense must be balanced with importance of the celerity of the sanction

© Copyright 2009 by the American Association for Clinical Chemistry

Strategies increasing certainty of detectionStrategies increasing certainty of detection

Intra-individual reference ranges Sequential blood and urine samples allow prediction of

expected range within which the next result should fall Some values are expected to be “negative”

Alternate sample matrices Oral fluid and dried blood/plasma spots could result in

more cost-effective collections Development of new test methods

Development of tests like LC-MS/MS method for IGF-1 and hCG helps clinical and endocrinology fields as well as anti-doping

Collection of non-analytical data on individual doping practices (e.g., purchase of doping products)

© Copyright 2009 by the American Association for Clinical Chemistry

SummarySummary

The most important factor in rules compliance is moral inhibitions

The principles of perceptual deterrence provide a strategy for maximizing deterrence

Certainty Severity Celerity

Increased certainty of detection requires research into new testing methods and strategies that benefits a range of scientific disciplines, including clinical chemistry

© Copyright 2009 by the American Association for Clinical Chemistry

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