Biathlon’s Aggressive Testing Led to Starykh Suspension — But Is It Enough?

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SOCHI, Russia – In the leadup to the Olympics, three biathletes produced biological “A” samples which tested positive for a banned substance.

While only one of the three, Irina Starykh of Russia, was set to compete at the Games – she now will not, as the International Biathlon Union (IBU) handed her a provisional suspension – the tests themselves as well as the ensuing revelations about the Russian team have raised uncomfortable questions about just how clean endurance sports are right now.

Cross-country skiing and biathlon had perhaps been lulled into a false sense of security. There had been no publicized doping bans since 2011, when Estonian cross-country skier Andrus Veerpalu tested positive for human growth hormone (HGH) and Ukrainian biathlete Oksana Khvostenko tested positive for ephedrine.

Athlete after athlete said publicly that they believed the sport was clean, or close to it.

“Our system is working and I trust in that system,” U.S. biathlete Susan Dunklee said after placing 14^th in the sprint race at the Olympics. “I trust that they are doing the best that they can.”

There has been no further official communication from the IBU regarding Starykh, whose “B” sample has allegedly been opened; it is unclear whether testing has been completed yet. One of the other athletes under investigation, Karolis Zlatkauskas of Lithuania, has admitted that he used recombinant erythropoietin (EPO), a common blood-doping drug, and waived his right to have his “B” sample analyzed.

But among the questions that have been raised: are biathletes really doping more than their cross-country counterparts, none of whom tested positive for banned substances in the leadup to the Games?

“Biathlon is a unique sport,” said IBU Vice President of Medical Issues Dr. Jim Carrabre. “It’s hard to tell, because it’s not just skiing speed, but we look at things like needle marks. We get information from others that is given to us. We use all of this as background information to decide who should be doing what, and when.”

The World Anti-Doping Agency (WADA) has not released its 2013 data, but in 2012, there were 1,377 in-competition and 1,132 out-of competition tests in the sport. And a whole lot has changed since 2012.

“We’ve almost doubled our anti-doping budget in the last year leading up to the Olympics, because of the concern of what would happen,” Carrabre said.

Some athletes have reported being tested a dozen times between Christmas and the Olympics, including in at least one case on back-to-back days. That may be because national federations, as well as the IBU, are both testing athletes.

“It depends on how often a national federation tests them, and which national federation tests them,” Carrabre said. “Not just the number of tests, number doesn’t mean quality. It also depends on performance.”

As is true in any sport, that doesn’t mean that every athlete in biathlon is clean. There are always drugs for which no test has yet been developed, and teams with large budgets and sophisticated programs can figure out ways to administer drugs at small enough doses that they will not be detected. If the test can’t detect a drug, then having more tests can never solve the doping problem.

But Carrabre believes that the IBU is doing a good job – at the very least, no worse of a job than other endurance sports, like cross-country skiing. He points to the recent positive tests from Starykh, fellow Russian Ekaterina Iourieva, and Zlatkauskas as evidence that the testing efforts have not been for naught.

Passport to Positive

A key centerpiece of the IBU testing program is the blood passport program. These programs, which are supported and encouraged by WADA and used in several sports, measure parameters of an athlete’s blood which may be affected by the use of prohibited substances.

Typically, the parameters include things like red blood cell count, hemoglobin, hematocrit, and reticulocytes (immature red blood cells). Training and other aspects of daily life affect these measures, but in predictable ways. The passport approach allows anti-doping scientists to set thresholds based on an athlete’s own physiology, rather than cutoff values based on population-level data.

“We know the profile,” Carrabre said. “A blood profile is like a wave, and it falls in a very characteristic pattern. If there are ripples in that wave, then we know something is up. We don’t necessarily know what, but we’ll start investigating. Either the ripples go away or we catch somebody.”

It takes a number of blood samples from an athlete to begin to understand their body biology, so the IBU tries to test early and often. One part of that is that for the last ten years, they have begun testing athletes at World Junior Championships so that they have good baseline data for subsequent years of testing.

The other aspect is to make the process frequent, quick, and minimally invasive.

“We have a really simple screening program,” Carrabre explained. “We only take a little bit of blood. Before each race we’ll take 10 or 20 athletes or something, it takes a minute to do the test. Although it doesn’t qualify as a passport test, we use a blood passport machine so we know our numbers are really accurate. We use that to qualify who we should be testing more and targeting more.”

As a result, the federation has a pretty good idea of who might be doping. Then, it’s just a matter of catching them.

“We didn’t tell anybody what we were doing,” Carrabre said. “We like to play coy, like the cat wagging its tail when the mouse runs in front. It goes by once or twice, and then the third time it gets bitten.”

Bad History, Positive Future?

Biathlon has been rocked by doping scandals in the past. Notably, in 2009, three Russian athletes – Albina Akhatova, Dmitry Yaroshenko, and Iourieva, who is now a repeat offender – tested positive for EPO. Finland’s Kaisa Varis, formerly a cross-country skier who had served a doping ban in that sport, had tested positive for EPO one year earlier. All were high-profile, winning athletes.

That was about the same time that cross-country skiing was also embroiled in doping scandals, with Natalia Matveeva, Yulia Tchepalova, and Nina Rysina of Russia all testing positive for EPO in 2009 and Kornelia Kubinska of Poland and Alina Sidko of Russia in 2010. That year, there was also a bizarre scandal where Niklola Pankratov, another Russian skier, was caught with blood transfusion equipment while crossing a border.

One challenge of pursuing EPO violations is that the drug, which is a synthetic version of naturally-occurring hormone which promotes red-blood cell production, comes in many forms. These forms have subtle structural differences, for example in the carbohydrate side chains of the protein complexes. Although some methods can differentiate forms of recombinant and natural EPO, they are not currently usable in “field” tests such as in anti-doping efforts.

That means that it’s often not possible to tell what specific form of EPO is being used. Current methods focus on distinguishing recombinant from natural EPO within an athlete’s body. Another problem is that injected EPO clears from the body very quickly.

“Our last experience was a bad one,” Carrabre said of late-2000’s biathlon. “It took us three years to find the drug. It was a new drug, and it was biathlon that figured this out.”

Modern methods, however, are beginning to be able to detect very small amounts of rhEPO. Research published in 2013 and 2014 suggests that “microdosing,” the practice of using very small doses that were previously undetectable, will carry a much larger risk in the future.

The bad history in endurance sports is why the IBU is pushing the passport program so aggressively. They believe that it enables them to target the most likely dopers – those who would have gotten away with it in previous years.

“Even if their blood is negative, if their passport shows a difference, and change or a ripple, from what we’ve seen before, we say, why is that so?” Carrabre explained. “What is going on that would cause that?”

Case Study: Kaisa Varis

When Carrabre says that he can tell if someone is doping, he’s often right. One example is Varis, who was on the Finnish cross-country team which was caught in a major scandal at 2001 World Championships for using the blood plasma expander hydroxyethyl starch. Varis herself was not banned then, but she picked up a two-year suspension in 2003 for EPO.

When she returned from the ban, she became a biathlete.

“I sat down with her and tried to talk to her about the culture here,” said Carrabre, who had worked with the IBU since 1998 but took over as chair of the Medical Committee in 2002. “She kind of looked at me funny. The expressions tell you a lot. You develop an intuition as a doctor dealing with patients, and it’s kind of the same with athletes. You can kind of tell if somebody’s telling the truth or not. She said, oh, I’m not involved with that anymore.”

Carrabre was unconvinced. Varis started her first biathlon World Cup race in 2007, placing 70^th. The next season she finished seventh in one of the first races in the fall, then earned her first win in January.

Carrabre tested her, in part because of the results and in part because her blood profile “didn’t look so good.” The “A” sample was positive for EPO.

“She must have thought we were stupid,” Carrabre said.

There were just two weeks until World Championships, but at the time WADA had no provisional ban, the kind that is currently applied to Starykh until her “B” sample is tested. As such, Varis could keep competing until the “B” sample came back positive. She also had a right to be present, and/or have her own expert present, when the “B” sample was opened. That expert, she told Carrabre, would be busy for a little while. Conveniently, that made analysis before World Championships impossible.

“Finally I said, too bad,” Carrabre explained. “The longer you wait your risking degrading that sample. That has happened before. I didn’t want to take that chance. Can you imagine the disaster? Someone who has a positive test races World Championships, medals, and then you pull all that away? What an embarrassment to the sport, but also what a loss to all the athletes who should have been on the podium. That would just be a tragedy.”

The “B” sample came back positive, but Varis appealed to the Court of Arbitration for Sport, since the IBU tested her sample without her expert present. She won the case – rules are rules – but WADA has since instituted the provisional suspension rule for cases just like these.

“We got mud on our face, we lost the battle, but we won the war,” Carrabre said. “Sometimes you have to do that in the fight against doping.”

Fine Line

The message that Carrabre hopes to send to athletes is that if they dope, they will get caught and their medals will get stripped.

“If I do see somebody, I can tell you, they will know that we’re looking at them,” Carrabre said. “We will either catch them or they will go away.”

Another example: the statute of limitations on doping offenses is eight years, and Carrabre said that he plans to open up the entire vault of old samples as soon as new anti-doping tests come out, and retroactively void results for athletes who fail.

In terms of the present, it’s all well and good to be actively searching for cheating athletes – Arne Ljungqvist, the head of the IOC Medical Committee and a WADA board member, is called “the doping hunter” – but there’s a fine line between finding dopers, and inconveniencing innocent athletes.

With the aggressive testing regimen, some would argue that the IBU might be crossing that line. But as Canadian biathlete Megan Imrie recently told FasterSkier, it’s fine to be tested at 11:30 p.m. at the Olympics as long as the system is working.

Carrabre says that the IBU pushes as far as it is allowed by WADA rules, and no further.

“When you disqualify an athlete, you have to be really fair to that athlete,” he said. “I would rather have an athlete race being doped, then have them not start and be clean. I know what goes into their training, and you really have to understand. You have to be patient. If you think there’s something going on, it’s our responsibility to catch them. You can’t presume they are guilty before they are tested. That just is not fair.”

Because of this, for instance, he frowns on no-start rules like that employed by FIS, which revoked racing priveleges if skiers’ hemoglobin tests higher than 16.5 g/dl for women or 18.5 g/dl for men. That might end up penalizing athletes who have not doped, but simply spent time at altitude – or might just have unique physiology. Using the passport concept, Carrabre believes, is better because it does not rely on an absolute cutoff which ignores these factors.

“I think we do a good job,” Carrabre said. “Do we catch everybody? I don’t know … It is hard and probably unfair to comment on FIS as I am not part of their antidoping group. However we do things differently in IBU. I have to say that I find it unusual that biathlon would be the only federation to find positives in the year before the Olympics. I just think that that’s strange.”

He hopes that the aggressive testing will catch the athletes that need to be caught, without disqualifying those that have done nothing wrong. And the Starykh case is an illustration of why he says the system is working.

Starykh was a top junior racer who then did not see much international competition for a few years. Of course, that’s understandable – Russia is a big country with an incredibly deep biathlon field. Making the cut for IBU Cup and World Cup rosters is tough.

Starykh resurfaced last season and won the sprint at Open European Championships. This season, she made her first World Cup podium, and was a favorite to medal at the Olympics. Maybe not a gold medal, but a medal.

“Someone could possibly be good, disappear, show up at the Olympic Games, and medal,” Carrabre said. “That would be a catastrophe.”

In the case of Starykh, catastrophe averted.