Visions,plans and hopes can the doping culture be changed

1
Visions,plans and hopescan the doping culture
be changed?
The FIS experience
2
Structure

• Focus on blood testing
• 1. Some historical remarks
• 2.The EPO era is it still on?
• 3.Altitude training and blood transfusion good
  substitutes?
• 4.Future and Hopes

3
Blood DopingAt the Olympics in Mexico City,1968
there was no blood manipulation other than that
lots of iron and vitamins were given to the
athletes!

4
A new experience training at altitude improved
performance at altitude Altitude training was
introduced
5
2.In the early 1970ties Ekblom et al
Response to exercise after blood loss and
reinfusion Opened for blood transfusions
6
In the 1990ties EPO became available !
7
EPO
Females Males
8
EPO stimulates the production of red
blood cells and thus the hemoglobin level
2.Central circulation Cardiac output Hemoglobin
more oxygen per litre blood oxygen delivery
1.Respiration Ventilation
4.Muscle metabolism Energy stores Mitochondria

3.Regional blood flow Muscle blood flow
02-extraction
9
Aerobic fitness effect of EPO on Hb being
elevated from 15.0 to 16.5-17.0 g/100 ml
Maximal oxygen uptake l / minut
After
Before
EkblomBerglund,1991
10
Effect of Hb elevation(individual start) Hb
g/100 ml Aerobic fitness Performance
ml / kg x min Top skier 14.5 to
17.0 75 to 80 6-8 30
km time 1.21 1.17 placing gt25
top 10 Very 14.5 to 17.0 81 to 85
6-7 Top skier 30 km time 1
.17 1.14 placing top 10 winner
11
Possible other effects of EPO use
Endurance
Muscle factors Metabolism Efficiency
Maximal Oxygen Uptake
Exercise at a high rel. VO2
?
EPO
12
Possible other effects of EPO use
Brain
?
??
Endurance
Muscle factors Metabolism Efficiency
Maximal Oxygen Uptake
Exercise at a high rel. VO2
?
EPO
13
Mean hemoglobin values since the 1980ies
(combined data with Videman et al.)
What happened in cc skiing in the 1990ties?
Hb g/dl
14
Hb values in cc sking at World Championships in
the late 1990tiesindividual values

• 1995 some skiers had 20 g/100 ml with all medal
  winners above 17.5 g /100 ml
• From 1997 upper allowed limit for men 18.5 g/100
  ml
• 1999 some 30 male skiers between 17.0- 18.7 g/100
  ml medal winners gt 17.0 g/100ml
• Altitude training,blood transfusion,EPO ???

15
FIS programBlood profiling combined with urine
Epo tests

• Some trials during the seasons from
  (1997)2000-2001
• A full scheme was planned for 2001-2002 , which
  in essential parts was implemented
• From 2002-2003 the scheme has been in use

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Blood profiling
Reticu locyte
Macro-cyte
RBC

• Hb/Hct
• Reticulocytes
• Macrocytes
• Se-EPO (Epo rhEPO)
• Se-Tfr

Bone marrow Blood
FIS includes 12(4)
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Blood sampling

• The day before the event or in the morning just
  before the event
• No firm control of food/water intake or
  exercise/training
• Blood sample is taken in the sitting position
  without stasis after at least 10 min in this
  position
• Follow up blood sample in some 12 - 20 skiers
  after the race

18
Mean hemoglobin values since the 1980ies
(combined data with Videman et al. at sea
level)cc skiers
Hb g/dl
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Hb-mean14.9 g/100 ml range 14.4 15.5
Variation lt 5
20
Female cc skier
Mean Hb (SD) 14.8 (0.44range 14.1-16.1)
variation 14.2
21
Male cc skier
Mean Hb (SD) 15.8 (0.58)Hb variation
range 14.6-16.9 g/dL variation 17.9
22

Relative no of skiers with variation around the
mean of lt10(s l to 1000m) Females
Males 2001/2 89 87 2002/3 93
91 2003/4 94 93 2004/5 94
93/94 2005/6 94 93
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Skiers with high Hb valuesg/100 ml
Females Males
gt 15.0 gt16.0 gt16.0 gt17.0 2001/2
28 8 48 29 2002/3
14 0 32 6 2003/4 12
0 21 5 2004/5 10
0 24 6 2005/6 14 0
28 6
24
What has been accomplished?1.Quite normal mean
Hb levels,2.Less of variation around the mean
during a season3. Fewer skiers with high Hb
values at special events
Hb g/dl
25
Improved Culture ?
26
A strong voice todayAny Hb level should be
allowed as long as EPO or blood transfusion are
not used!
27
Abandon the upper limits for HbFemales
16.0Males17.0 g/100 ml
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Pragelato2005,(n32) vs 2006/OG,(n215)
Males, Hb,g/100 ml Ret.
mean, gt16.0 gt17.0 lt0.5,gt2.0 2005
15.3 7 0 0 0 2006/OG
15.9 114 10 8 3
29
Pragelato2005(n28) vs 2006/OG(n115)
Females Hb g/100 ml Ret.
mean,gt15.0,gt16.0 lt0.5, gt2.0 2005
14.4 1 0 0 0 2006
15.1 28 2 5 4
30
Altitude and OG
Males Hb g/100ml Ret.
mean, gt16.0, gt17.0 lt
0.5, gt2.0 Sea level,05/06 14.9 6 1
0 0 VdF(1000 m) 15.3 34
3 12 8 Davos(1500 m) 15.4 19
2 14 6 Pragelato(1550m)15.9 114
10 8 3
31
Too high Hb at the OGMales Ten ! All had
lived and trained for at least 3 weeks at
2000-2700 maslFemales Two ! One had lived in
an hypoxia tentat home since early
January.This skier has never been above 15.3
g/100ml(Pragelato 2005) and at sea level her Hb
values are 14.0- 14.5 g/100ml.At the OG she had
16.4 g/100ml.
32
Aclimatization is a prerequesite to perform well
at medium altitude butFIS does not favour
excessive use of altitude training or living in
hypoxia houses or tentsFair???
33
The true reason for some Ski Associations to
propose no upper limit for Hb valuesis to open
up for the use of Blood Transfusion EPO
because it can be used without detection
34
Blood transfusion with the skiers own blood ???
Likely to be used with the the following
scheme 1. One litre of blood is withdrawn and
the red cells stored well ahead of the critical
coompetition 2. Altitude training for 3-5 weeks
ahead of the major competition 3. At competition
the regular Hb test the day before competition 4.
Later the same day in the afternoon/evening the
stored red blood cells are given back 5.
Competition next day
Little can be done to stop it with the
present rules !
35
EPO/NESP in SkiingSkiers with positive urine
EPO/NESP tests

• In the season of 2001/2 we had 5 cases
• In the season of 2002/3 we had 1 case
• From there on no more cases

Why ???
36
rhEPO patternthe old practise
rhEPO injection
rhEPO detection in urine
37
Positive urine EPO test
38
EPO-use without positive urine EPO test the
practise to day
Proper whereabout
Hct()
Hb(g/dl)
No where about
Enlarged plasma volume(albumin)
50
45
EPO
Urine EPO test
75/25 Negative 65/35
Positive
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rhEPO detection
1990-2002/3
2003 - ??
Normal
Old Fashion
New
a) Purified control urine
)
g,h) Urine from two cyclists from Tour de France
1998
d) Urine from a control subject
bc) Patients treated with rhEPO
e,f) Urine from two with some own production
40
Possible cases with micro useage of EPO
1.In the seasons 2002/03 and 2003/04 FIS has no
good data 2.In the season 2004/05 we had 9
likely cases but none ??? just ahead of the World
Championships 3. In the season 2005/06 FIS have
had 3 likely cases ????(4-5) in connection with
the OG
It is time to use various blood variables
suspisious urine EPO tests as evidence for EPO
doping !!!
41
Future

• Bring a case with micro EPO useage to CAS and
  open for indirect evidence to be the basis for a
  doping offense
• Develop a test to detect the use of own blood in
  a blood transfusion
• Minimize urine sampling and upgrade tests on
  blood,especially important for EPO
• Introduce the athletes passport making it
  possible for doping control on the individual
  level

42
Can the culture be futher improvedand can all
cheaters be caught ?

• There are hopes
• CAS has accepted the FIS blood testing program
• WADA has a meeting April 8th to review the value
  of blood profiling
• More interest in developing doping tests based on
  blood
• It is likely that within a couple of years a
  doping offense can be based on indirect
  evidence,i.e. reflections in the body(in a blood
  sample)that a banned substance has been used

43
Why Doping Control

• Fair play
• Protect the individual and the health of the
  athlete
• BiologyElite sport is based on natural talent
  which is developed with proper training and a
  healthy living
• PhilosophyThe soul of sport The spirit of
  sport!
• Against these views stand the right of an
  individual to his/her body and what can be done
  with it
• The pragmatic view There is a strong anti doping
  policy in many European countries as well as in
  Canada and Australia because of the economical
  basis for sport in these countries(billions of
  tax money cannot be given to the sporting
  community if doping was free, it may also relate
  to sponsors)