Medicine and sport science最新文献

In sport, a wide array of substances with established or putative performance-enhancing properties is used. Most substances are fully acceptable, whilst a defined set, revised annually, is prohibited; thus, using any of these prohibited substances is declared as cheating. In the increasingly tolerant culture of pharmacological and technical human enhancements, the traditional normative approach to anti-doping, which involves telling athletes what they cannot do to improve their athletic ability and performance, diverges from the otherwise positive values attached to human improvement and enhancement in society. Today, doping is the epitome of conflicting normative expectations about the goal (performance enhancement) and the means by which the goal is achieved (use of drugs). Owing to this moral-functional duality, addressing motivations for doping avoidance at the community level is necessary, but not sufficient, for effective doping prevention. Relevant and meaningful anti-doping must also recognise and respect the values of those affected, and consolidate them with the values underpinning structural, community level anti-doping. Effective anti-doping efforts are pragmatic, positive, preventive, and proactive. They acknowledge the progressive nature of how a "performance mindset" forms in parallel with the career transition to elite level, encompasses all levels and abilities, and directly addresses the reasons behind doping use with tangible solutions. For genuine integration into sport and society, anti-doping should consistently engage athletes and other stakeholders in developing positive preventive strategies to ensure that anti-doping education not only focuses on the intrinsic values associated with the spirit of sport but also recognises the values attached to performance enhancement, addresses the pressures athletes are under, and meets their needs for practical solutions to avoid doping. Organisations involved in anti- doping should avoid the image of "controlling" but, instead, work in partnerships with all stakeholders to involve and ensure integration of the targeted individuals in global community-based preventive interventions.

The list of prohibited substances and methods (the List) is the international standard that determines what is prohibited in sport both in- and out-of-competition. Since 2004, the official text of the List is produced by the World Anti-Doping Agency (WADA), the international independent organization responsible for promoting, coordinating, and monitoring the fight against doping in sport. Originally based on the prohibited lists established by the International Olympic Committee, the List has evolved to incorporate new doping trends, distinguish permitted from prohibited routes of administration, and adjust to new analytical and pharmacological breakthroughs. In this chapter, the elements that compose the List as well as the updates over the years are presented.

The pillars of anti-doping are detection, deterrence, and prevention. Detection takes the form of testing for banned substances. Deterrence builds on testing and gathering evidence. Athletes who test positive are exposed to penalties. The main tool of prevention is education. Education takes many forms and can be implemented in many ways. This chapter addresses the nature and challenges of current anti-doping education. Firstly, general goals of education and their connection to sport are discussed. Secondly, three normative interpretations of sport are presented, and their implications for anti-doping education are examined. Instrumentalist interpretations and interpretations with emphasis on performance and enhancement challenge the anti-doping campaign. A human excellence interpretation is advocated in which anti-doping is considered a consistent and integral part of sport. Thirdly, future challenges for anti-doping education are reflected upon.

The most important element in achieving athlete compliance with anti-doping rules is the certainty of detection. Thus, scientific research plays a mission critical role in achieving clean competition. Many factors contribute to the advances in detection. Incremental advances in the ability to detect prohibited substances and methods, and identification of long-lived metabolites continue to lengthen detection windows. While the athlete biological passport hematological and steroidal modules hold great promise, experience shows that new research is needed to improve the sensitivity and specificity of the approach for current doping techniques. Indirect detection strategies using biomarkers or transcriptomic techniques have been increasingly investigated. The incorporation of more cost-effective sampling strategies using dried blood and plasma spots, oral fluid, and breath analysis show great promise toward increasing the number of tests while remaining within testing budget constraints. Despite the importance of research to ensuring rule compliance, a major challenge for anti-doping research is achieving and maintaining sufficient funding in the reality of the myriad of new substances introduced for disease treatment but abused for performance enhancement. In addition, obtaining metabolism and population reference range data, particularly for new drugs or designer drugs that have not obtained approval for administration to human subjects, remains a significant problem. Nevertheless, research continues to contribute important data to support anti-doping efforts.

The fight against doping in sport as we know it today commenced by the creation of the International Olympic Committee (IOC) Medical Commission in 1961 following the death of a Danish cyclist during the Rome Olympic Games the year before. After a slow start, the fight got under way as from the early 1970s under the leadership of the IOC and of the International Association of Athletics Federations. Despite a lack of understanding and weak support even from the sports community, a series of measures were taken during the 1970s and 1980s which still form cornerstones of today's anti-doping strategy. In addition to information and education campaigns, the most important examples are the introduction of procedural rules for doping controls, the establishment and follow-up of a list of prohibited substances and methods, the accreditation of doping control laboratories, the introduction of in- and out-of-competition testing, rules for therapeutic use exemption, and the introduction of blood sampling. During the 1990s, the anti-doping fight gained increasing support both inside and outside the sport community. In order to harmonize the wide variety of rules that had developed both in sport organizations and at the domestic level and to promote anti-doping activities, the World Anti-Doping Agency (WADA) was jointly created by the Olympic movement and the public authorities in 1999. WADA is today carrying on the fight supported by the universally accepted WADA Code and an International Anti-Doping Convention under UNESCO.

The introduction, in 2004, of the World Anti-Doping Code and a standardized "prohibited list" of substances and methods proscribed in sport represented a consistent, international response to the escalating challenge of drug misuse in contemporary sport. Simultaneously, it was recognized that athletes experiencing illness or injury might legitimately require the use of "prohibited" medications or procedures, and the concept of the "therapeutic use exemption" (TUE) was introduced. The mechanisms of the TUE process are carefully defined and described in a specific WADA "international standard" (IS). As a consequence, anti-doping organizations (ADOs) were empowered to establish "Therapeutic Use Exemption Committees" (TUECs) whose membership and responsibilities were clearly delineated in the IS, and to whom an athlete and treating physician(s) could make appropriate application for a TUE. A careful review of such an application by a TUEC panel of physicians might allow permission for an otherwise prohibited course of treatment, provided that appropriate criteria had been met. Sport physicians have a clear responsibility to ensure accurate and complete documentation of the clinical circumstances requiring a TUE when completing such applications. Typically, applications for consideration by TUECs are forwarded to a national ADO, but depending on an applicant's level of competition, it may become necessary to involve an international federation or major event organization (e.g., International Olympic Committee, or Commonwealth Games Federation). Such organizations may receive, review, and grant TUEs specific to the competitions over which they preside. Increasingly, there is recognition of TUEs granted by other ADOs. However, this is not always the case; in certain circumstances, the decisions of other TUECs to grant or deny an application may be appealed. The advent of the TUE process ensures that an athlete with a genuine medical condition that necessitates the use of a prohibited substance or procedure can apply for permission to use such treatments and is not denied access to competition or training.

The advent of gene transfer technologies in clinical studies aroused concerns that these technologies will be misused for performance-enhancing purposes in sports. However, during the last 2 decades, the field of gene therapy has taken a long and winding road with just a few gene therapeutic drugs demonstrating clinical benefits in humans. The current state of gene therapy is that viral vector-mediated gene transfer shows the now long-awaited initial success for safe, and in some cases efficient, gene transfer in clinical trials. Additionally, the use of small interfering RNA promises an efficient therapy through gene silencing, even though a number of safety concerns remain. More recently, the development of the molecular biological CRISPR/Cas9 system opened new possibilities for efficient and highly targeted genome editing. This chapter aims to define and consequently demystify the term "gene doping" and discuss the current reality concerning gene- and cell-based physical enhancement strategies. The technological progress in the field of gene therapy will be illustrated, and the recent clinical progress as well as technological difficulties will be highlighted. Comparing the attractiveness of these technologies with conventional doping practices reveals that current gene therapy technologies remain unattractive for doping purposes and unlikely to outperform conventional doping. However, future technological advances may raise the attractiveness of gene doping, thus making it easier to develop detection strategies. Currently available detection strategies are introduced in this chapter showing that many forms of genetic manipulation can already be detected in principle.

Despite numerous attempts to discover genetic variants associated with elite athletic performance, an individual's trainability and injury predisposition, there has been limited progress to date. Past reliance on candidate gene studies focusing predominantly on genotyping a limited number of genetic variants in small, often heterogeneous cohorts has not generated results of practical significance. Hypothesis-free genome-wide approaches will in the future provide more comprehensive coverage and in-depth understanding of the biology underlying sports-related traits and related genetic mechanisms. Large, collaborative projects with sound experimental designs (e.g. clearly defined phenotypes, considerations and controls for sources of variability, and necessary replications) are required to produce meaningful results, especially when a hypothesis-free approach is used. It remains to be determined whether the novel approaches under current implementation will result in findings with real practical significance. This review will briefly summarize current and future directions in exercise genetics and genomics.