Medicine and sport science最新文献

In the fight against doping, creating a level playing field across all sports is very challenging from a legal perspective. A harmonized approach presupposes first and foremost a supreme regulatory authority on a global level. This task cannot be attributed to the public sector, because there is no supranational authority of public international law capable of dealing with it. Thus, responsibility has to be assumed by a private law entity. This in turn requires complicated contractual agreements by which duties and responsibilities are transferred from the individual to the national level and from there to the top of the pyramid. In practice, this process is not only difficult and cumbersome, it also leads to an accumulation of power at the top of the sports pyramid that must be contained by organizational checks and balances, such as access to justice and the rule of law, accountability, transparency, and possibilities for the respective stakeholders to partake in the decision-making process. The weighting of all these different aspects is demanding and further complicated by the regulatory reach of the various national lawmakers. Since national laws differ considerably and a harmonized legislative approach is nowhere near in sight, a global approach in the fight against doping must push back national laws and legal concepts as much as possible. The purpose of this chapter is to give an overview on all these legal challenges.

This chapter addresses both the development and substance of the World Anti-Doping Code, which came into effect in 2003, as well as the subsequent Code amendments, which came into effect in 2009 and 2015. Through an extensive process of stakeholder input and collaboration, the World Anti-Doping Code has transformed the hodgepodge of inconsistent and competing pre-2003 anti-doping rules into a harmonized and effective approach to anti-doping. The Code, as amended, is now widely recognized worldwide as the gold standard in anti-doping. The World Anti-Doping Code originally went into effect on January 1, 2004. The first amendments to the Code went into effect on January 1, 2009, and the second amendments on January 1, 2015. The Code and the related international standards are the product of a long and collaborative process designed to make the fight against doping more effective through the adoption and implementation of worldwide harmonized rules and best practices.

The challenges facing modern anti-doping analytical science are increasingly complex given the expansion of target drug substances, as the pharmaceutical industry introduces more novel therapeutic compounds and the internet offers designer drugs to improve performance. The technical challenges are manifold, including, for example, the need for advanced instrumentation for greater speed of analyses and increased sensitivity, specific techniques capable of distinguishing between endogenous and exogenous metabolites, or biological assays for the detection of peptide hormones or their markers, all of which require an important investment from the laboratories and recruitment of highly specialized scientific personnel. The consequences of introducing sophisticated and complex analytical procedures may result in the future in a change in the strategy applied by the Word Anti-Doping Agency in relation to the introduction and performance of new techniques by the network of accredited anti-doping laboratories.

Despite being prohibited by the World Anti-Doping Agency (WADA), blood manipulations such as the use of recombinant human erythropoietin and blood transfusions are a well-known method used by athletes to enhance performance. Direct detection of illicit blood manipulation has been partially successful due to the short detection window of the substances/methods, sample collection timing, and the use of sophisticated masking strategies. In response, WADA introduced the athlete biological passport (ABP) in 2009, which is an individualised longitudinal monitoring approach that tests primarily haematologic biomarkers of doping in order to identify atypical variability in response(s) in athletes, highlighting a potential doping violation. Although the implementation of the ABP has been an encouraging step forward in the quest for clean/drug-free sport, this detection method has some limitations. To reduce the risk of being detected by the ABP method, athletes are now resorting to microdoses of prohibited blood boosting substances to prevent abnormal fluctuations in haematologic biomarkers, thereby reducing the sensitivity of the ABP detection method. Recent studies from numerous laboratories, including our own, have confirmed the potential of transcriptomic microarrays, which can reveal distinct changes in gene expression after blood manipulations, to enhance the ABP. There is, therefore, an urgent need to intensify research efforts that involve transcriptomics and other state-of-the-art molecular methods, collectively known as "omics", e.g., proteomics (proteins) and metabolomics (metabolites), in order to identify new and even more robust molecular signatures of blood manipulation that can be used in combination with the ABP and, intriguingly, even as a stand-alone test.

The purpose of this chapter is to provide an overview of the philosophical and ethical underpinnings of anti-doping policy. The nature of sport and its gratuitous logic is explored. The doping rules in sport, such as the Prohibited List, are ways of drawing a line to facilitate a certain sort of competition. Sports can be understood as a means of testing the natural physical abilities of the athlete, combined with the hard work they put into improving their performance. A test promoted by the anti-doping laws. Permitting certain forms of performance enhancement would threaten the special nature of such a test. Doping can be seen as a threat to the integrity of sport, not just because of the rule breaking doping currently entails. The chapter explores the ethical issues that arise with such forms of enhancement, such as fairness, harms to health, and indeed a refusal to accept human limitations. Finally, the criteria upon which a substance or method may be prohibited by the World Anti-Doping Agency (WADA) is addressed. The 3-part criteria, concerning (1) enhancement, (2) health, and (3) the spirit of sport are described, and literature that takes a critical line is addressed. Particular reference is made to the public health agenda explicit within anti-doping policy.

Traditionally, research in anti-doping has been stimulated by the need for technological improvements to accommodate the expansion of the list of prohibited substances and methods. Nevertheless, in recent years, anti-doping found itself at a crossroads due to the increasing complexity and constant refinement of doping methods. As illustrated by the 2012 USADA (United States Anti-Doping Agency) versus Lance Armstrong case, a change in paradigm was necessary. The exploration of new scientific avenues to understand the mechanisms of doping and pinpoint its practice was most needed to allow designing more efficient preventive or disruptive strategies. In this context, and at the time of writing in 2017, transposing the concept of forensic intelligence to anti-doping was identified as a promising approach to address the different aspects of doping, from the individual athlete to organized doping and trafficking of substances in a proactive rather than a reactive way. Indeed, collection, structuring, and logical processing of multiple sources of information, and not strictly results of bioanalytical testing of urinary and blood samples, can bring additional value to detect and describe potential, emerging, or existing doping issues. This anti-doping intelligence can provide anti-doping authorities and relevant stakeholders with timely, accurate, and usable information for decision making to solve, reduce, and/or prevent doping-related activities. The integration of intelligence to complement other anti-doping approaches is a potentially major step forward in the development of more effective and robust anti-doping strategies.

Prior to the formation of the World Anti-Doping Agency (WADA), the fight against doping in sport was not unified; instead, it relied on individual approaches established by various stakeholders to make it effective. The scandal of the Festina Affair, during the Tour de France 1998, and other drug doping scandals revealed the ineffectiveness and inadequacy of such an approach. The resulting media scandal raised public authorities' awareness about the necessity to deal with doping in sport with a harmonized and a more effective approach. The International Olympic Committee interceded and convened a World Conference on Doping, bringing together all parties involved in the fight against doping. As a result, WADA was established on November 10, 1999, in Lausanne to promote and coordinate the fight against doping in sport internationally. In this regard, the World Anti-Doping Code (WADC or the Code) is the core document harmonizing anti-doping rules and regulations within sport organizations and public authorities. The Code was instrumental in introducing the concept of "nonanalytical" rule violations, which are emphasized within the revised 2015 Code. Nonanalytical rule violations allow anti-doping organizations (ADOs) to apply sanctions in cases where there is no positive doping sample, but where there may still be evidence that a doping violation has occurred. This recognition of "nonanalytical" rule violations by WADA is the concrete result of taking into account lessons learned from prior infamous doping scandals. Thus, intelligence gathering, particularly through cooperation with global law enforcement agencies, is a key tool in the fight against doping. The 2015 Code and the international standards on testing and investigations establish and implement intelligence gathering as part of ADOs' routine activities in the fight against doping in sport.

Clarity about the ethical justification of anti-doping is essential. In its absence, critics multiply and confusion abounds. Three broad reasons are typically offered in anti-doping's defense: to protect athletes' health; to promote fairness; and to preserve meaning and values in sport - what the World Anti-Doping Agency (WADA) Code refers to as the spirit of sport. Protecting health is itself an important value, but many sports encourage athletes to take significant risks. The case against doping is buttressed by concern for athletes' health, but it cannot be the sole foundation. Promoting fairness is vital in all sports as the metaphor of the level playing field attests. But playing fields can be leveled by providing performance-enhancing drugs to all competitors. When doping is prohibited, fairness is aided by effective anti-doping. But the fundamental justification for anti-doping is found in the meanings and values we pursue in and through sport.