Should an athlete advocacy organisation be established to help athletes navigate the minefield of banned and permitted substances in sport? We believe it should be.

Last week’s report by the Australian Crime Commission (ACC) on the impact of doping in professional sport coincided with the introduction of the Australian Sports Anti-Doping Authority Amendment Bill 2013, that would potentially give the Australian Sports Anti-Doping Authority (ASADA) unprecedented power and control over investigations into anti-doping rule violations.

Even without the proposed prosecution powers, ASADA may already not be perceived by athletes as a preferred source for information into supplement use. In research conducted by one of this article’s authors as part of his (yet-to-be-published) thesis, elite and pre-elite athletes were given a list of individuals and organisations and asked who they had previously contacted with regards to clarifying the rules of doping for their sport prior to taking a new medication/supplement.

The three top answers were: athletes' club coaches (87.85%), general practitioner doctors (86.52%), and the internet (83.23%). ASADA was one of the least common sources for that information, at just 23.34%.

As the lead national authority on what is legal or illegal in sport, ASADA is the ultimate source in Australia to confirm whether a substance is banned. But if ASADA is also the prosecutor of athletes for anti-doping violations – as per the proposals in the new bill – that will make it difficult (and even less appealing) for athletes to approach the organisation to clarify the status of supplements. An analogy would be a person asking the police how much cannabis he or she is allowed to legally grow/possess.

Supplements

Many modern-day elite athletes use dietary supplements to help cope with the pressures of being an elite athlete – a practice that also extends to non-elite level athletes.

Supplements include vitamins, minerals, herbal remedies, traditional Asian remedies, amino acids and various other “ergogenic” (performance enhancing) substances.

Such substances may often also be used independently of expert (physicians and dieticians) advice, and many athletes may not know if the supplements used are banned in sports.

Even if athletes have the relevant scientific knowledge and are aware of the legalities of the active ingredients, not all supplements are regulated, and traces of substances that may be banned in sport may be present but not listed on the supplement bottle.

One of the first comprehensive studies to evaluate the doping risk posed by dietary supplements showed about 15% of a total of 634 supplements purchased in various countries in 2000 and 2001 contained varying levels of cross-contamination with prohibited anabolic androgenic steroids (AAS). Studies since 2002 have found further supplement products contaminated with high amounts of undeclared AAS.

Because the manufacturers of these contaminated products also manufacture other nutritional supplements on the same production line, the risk of cross-contamination with such AAS is very high.

Athletes’ ombudsman

An independent athlete advocacy organisation that looks out for the athletes with regards to performance-enhancing substances and methods (PESM) is important, and we believe it should have the following characteristics:

• It should comprise professionals who are knowledgeable in the area of PESM and can tell athletes what are legal or illegal PESM, acting as an “ethics” body to make sure athletes have an informed choice and a neutral second opinion.

• It should not be tasked with also policing the athletes/clubs. After all, it’s not hard to imagine there could be a perceived conflict of interest where an organisation has a duality of policing and advising functions.

• It must be independent from the clubs'/sports' codes. Each club’s sports science staff will continue to do what is necessary to improve athletic performance, but ultimately they work for the interest of the clubs that pay them.

• It should be funded through players' lobby groups that currently help negotiate on behalf of athletes’ matters pertaining to welfare, salaries, insurance, and so forth.

An advocate agency is important especially in the context of inadvertent doping. Research by one of this article’s authors has shown that amateur elite athletes may not know all anti-doping rules and this puts the athletes at risk of inadvertent doping under the strict liability standard.

An informed consent requires that athletes understand both the risks and benefits of any potential treatment or substance they are receiving. The use of waiver/consent forms does not relinquish the responsibility for individuals/organisations providing the potential PESM.

As a protection for athletes, the information for all new treatments would be screened by the athlete’s organisation, acting as a guardian ad litem.

Illegal secretagogues

Let us take the recent ACC report as an example. In that report, one of the alleged violations that are deemed to have been committed is the use of peptides. The report states:

Peptides are classified as a Schedule 2 (S2) prohibited substance on the WADA Prohibited List and are therefore prohibited for use by professional athletes both in and out of competition. Peptides have been a WADA prohibited substance since at least 2008 …

The report then cites the misuse of the following peptides:

• CJC-1295

• GhRP-6

• hexarelin

It is unknown what information was provided to athletes under investigation for doping practices before they were allegedly injected with the peptides. An unscrupulous therapist could have informed the athletes that they were being injected with small proteins. This would be technically correct. So what’s wrong with being treated with proteins?

There are certainly enough protein powders available in health food stores. There are also numerous top athletes promoting the virtues of protein supplements in advertisements.

The issue at hand is that the alleged peptides may act as secretagogues: a substance that, when introduced into the human body, causes another substance to be secreted.

In this case, the substance being secreted by the body is the human growth hormone (HGH).

The peptides do not in themselves cause the effects of HGH. It needs to act through the body’s own gland (pituitary gland) to produce this hormone. The peptides simply maximises the body’s own HGH production.

The WADA Prohibited List states for specific substances under section S2:

S2. PEPTIDE HORMONES, GROWTH FACTORS AND RELATED SUBSTANCES

The following specific substances and their releasing factors are prohibited:

Growth Hormone (GH), Insulin-like Growth Factor-1 (IGF-1), Fibroblast Growth Factors (FGFs), Hepatocyte Growth Factor (HGF), Mechano Growth Factors (MGFs), Platelet-Derived Growth Factor (PDGF), Vascular-Endothelial Growth Factor (VEGF) …

But it also has a “catchall” clause in the section that states:

… as well as any other growth factor affecting muscle ,tendon or ligament protein synthesis/degradation ,vascularisation, energy utilisation, regenerative capacity or fibre type switching and other substances with similar chemical structure or similar biological effect(s) …

An athlete who is diligent and wants to check if, for example, CJC-1295 is listed in the banned list, will not be able to find it, unless he or she knows how the substance acts – its “similar biological effect(s)”.

But – because of the inconsistency of applying the section S2 rule – the issue is also not straightforward for those familiar with the pharmacodynamics of substances and body physiology.

If, as per the rule, “growth factor affecting muscle, tendon or ligament protein synthesis/degradation, vascularisation, energy utilisation, regenerative capacity or fibre type switching and other substances with similar chemical structure or similar biological effect(s)” are to be prohibited, then it would be inconsistent to accept the substance of Actovegin and Platelet-Rich plasma. Neither substance is currently banned in sport.

There are also some amino acids that are legal in sport that may act as secretagogues. Amino acids such as arginine, ornithine, glycine and glutamine are readily available over-the-counter.

These amino acids have the potential to act as growth hormone secretagogues but are not banned under the WADA prohibited list.

As can be seen, even when confined to the matter of specific substances and section S2 of the prohibited list, the issue is not straightforward. Navigating through the problem of supplementation would require some knowledge of the science and the law.

We do not advocate the use of any substance that has not been approved for human use. Nor are we condoning the abuse of illicit substances that put athletes’ health at risk.

We do, however, believe that athletes’ have a right to an informed choice. Something a zero-tolerance policing approach does not provide.