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How to Win the War on Drugs in Sport

How to Win the War on Drugs in Sport

Drug scandals again tarnish the Tour de France. Last week three riders, Spaniards Manuel Beltrain and Moises Duenas and Italian climber Riccardo Ricco, winner of two mountain stages, failed tests for the banned performance enhancer EPO. This year has seen fewer spectacular expulsions, but of course the game is not over.

Does this mean the drug testers are winning the war on drugs? It might. But it might also mean that cyclists and their doctors are getting better at evading testing. A recent BBC investigation supports the latter conclusion. WADA labs have been proven to fail to pick up positive results. There are 80 copy-cat drugs, produced in China, India and Cuba, which are difficult to detect. And labs apparently collude with doctors to “exchange knowledge” on testing procedures. Expert Professor Bengt Saltin, a leading anti-doping expert and a former winner of the IOC Olympic Prize, the highest honour in sports science, said

"I would think that most of the medal winners and many in the finals of endurance events – there is a big risk for them having used EPO."

So despite the numbers of athletes being prosecuted for EPO declining by two-thirds between 2003 and 2006, Professor Saltin concluded this was due to evasion, not a reduction in use.

"The reason that I am still a little bit upset with the whole situation is that I have seen too many suspicious samples that are clearly abnormal. Athletes are getting away with it. Look how many have been caught for EPO misuse recently."

The response is predictable: widen testing critieria. Experts have suggested that urine samples should be tested for any evidence of naturally produced EPO. If there is none, it should be classed as suspicious because the use of artificial EPO for doping causes the body’s own production to shut down. These experts also call for testing of blood profiles as well as the urine. An analysis of the number of young red blood cells can also indicate doping.

Is this a solution? No. It will simply escalate the war to the next level. History has proven the ability of athletes and their doctors to ingeniously evade detection. We will never win the war on doping.

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Should Karadzic be Punished?

Yesterday the world celebrated the arrest of Radovan Karadzic, the ex-Bosnian Serb leader who has twice been indicted by the UN War Crimes Tribunal in the Hague, and is charged with – among other atrocities — ordering his forces to kill at least 7,500 Muslim men and boys in Srebenica in July 1995 as part of a campaign to terrorize and demoralize the population.

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The world’s failure to fulfill its goals

The Guardian reports that the world is not on track for meeting the UN Millennium Development Goal to halt and reverse the increase in Malaria by 2015. While the funding for malaria prevention has increased up to $1 bn per annum, this is not enough to meet the declared goal. Indeed, while the figure sounds high, it is only $1 per person at risk or 0.002% of world GDP, which is not much for one of the UN’s major poverty reduction targets. Scientists at the Kenya Medical Research Institute estimate that 50% to 450% more funding is required to make the target. Sadly this situation with the malaria target is not unusual: the current estimates are that we will fail to meet every single one of the Millennium Development Goals (MDGs).

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Reproductive science: is there something we’re missing?

Thirty
years after the first test-tube baby, Nature
asks various experts for their views on what the next thirty years of
reproductive medicine will bring.
Some of the more startling predictions are:

  • No more infertility, with both children and 100-year-olds able to have children
  • Embryos created from stem cells, increasing the ease of embryo research and genetic engineering of children
  • … with the resulting greater availability of embryos making it easier to create cloned humans
  • Artificial wombs, enabling babies to develop outside the mother’s body
  • … which, some worry, could become compulsory as an alternative to abortion, or to avoid premature birth or fetal alcohol syndrome
  • ‘Genetic cassettes’ implanted in embryos to counteract the effects of inherited diseases
  • Increase in litigation following evidence that IVF babies may later suffer adverse effects from the environment in which they were grown as embryos

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Testing alternative therapies

The journal Science is today reporting on a controversial plan by the US National Institute of Mental Health (NIMH) to test an alternative treatment for autism on children. The treatment, known as chelation therapy, involves the use of drugs that remove heavy metals from the blood. It’s based on a the theory – unsupported by conventional science – that mercury in vaccines triggers autism.

Chelation therapy is widely used, but its benefits and effects are not well understood. The NIMH have therefore argued that there is a "public health imperative" to test the drug. But opponents claim that any such study would be unethical, since the quality of the trial is likely to be poor, and any results – especially negative ones – would be unlikely to alter the behaviour of parents who support the therapy.

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Care for the Dying and Cost-effectiveness

Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.

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Unpopular policy and public rationality

The BBC
reports that the Japanese
town of Kamikatsu
has become the first ‘zero waste’ town. Residents
compost all of their food waste, and must sort the rest of their rubbish into
34 different categories—all of which they must take to public waste centres,
since there are no rubbish collections from people’s homes. It seems that the inhabitants of the town are
generally enthusiastic about the scheme, which offers small financial rewards
for recycling, and has encouraged people to make an effort to reduce the
rubbish they produce.

This is one
of those relatively rare, uplifting stories about a scheme designed to reduce
environmental damage that is not only successful, but supported by the
community. Could something similar work
in the UK? Recently, many UK councils reduced domestic refuse
collections from once-weekly to once-fortnightly, with recyclable waste being
collected in the intervening weeks. Whilst this has boosted the amount of rubbish being recycled,
some news reports
reveal that the new measures are unpopular, and some councils have bowed to
public pressure by re-introducing weekly collections. Given the environmental impact of adding to
landfill waste sites, ought the government to placate the public by relaxing
measures designed to reduce waste, or should unpopular measures be enforced
regardless of public opinion?

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Paying to top up NHS treatment

The BBC has this week published a story on co-payment in the UK’s National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab – a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That’s because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.

Should co-payments be banned?

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