Canadian Anti-Doping Efforts Move Forward with Blood Passport Program

Between April 2010 and March 2011, the Canadian Center for Ethics in Sport (CCES) administered 3,708 urine tests and 436 blood tests in its efforts to curb doping by Canadian athletes.

In the last quarter of that year, skiers and biathletes faced 75 urine and 51 blood tests – all of which came back clean. 34 Canadian athletes in various sports are currently banned from competition due to doping violations, and not a single skier or biathlete is among them.

But like the rest of their countrymen, these athletes are being enrolled in a new CCES testing regimen, called the Athlete Biological Passport program or ABP.

When athletes are tested their numbers will be logged in a “passport”, allowing future investigators to track measurements like blood hemoglobin over time. Even without a positive test for a controlled substance, uncharacteristic spikes in these markers could be used to prosecute doping cases.

The passport system will be added as athletes submit to traditional tests, so it shouldn’t prove to be any more inconvenient than the current system, and some coaches even hope that it will lead to less-frequent testing for clean, low-risk athletes.

First: Why For, WADA? Because of FIS…

The concept of a biological passport has been discussed for years, in part because doping strategies evolve quickly and testers don’t always know what they are looking for. With passport programs, the idea is that anti-doping agencies can look at patterns in blood markers – like red blood cell count or hemoglobin – which indicate that an athlete is doing something to change the oxygen-carrying capacity of their blood. Even if they can’t detect a banned substance, this is often enough evidence to prove a rules violation.

The World Anti-Doping Agency (WADA) approved guidelines for passport programs in December 2009.

“The passport concept is based on the knowledge of drug effects or side effects in medical practice,” WADA wrote in its guidelines. “From this perspective, the substance itself is not detected but rather its effects on the body become apparent. Typically, the effect of the drug remains perceptible and detectable longer in the body than the substance itself.”

WADA itself generally does not perform doping control tests. Instead, they assist and monitor two classes of anti-doping efforts. The first is by the international governing bodies for each sport, and the second is by the national anti-doping agencies in each country.

Skiing was one of the first sports to adopt the passport program, and in fact did so long before WADA.

“FIS has had an athletes biological passport programme implemented since 2001,” FIS Anti-Doping Administrator Sarah Fussek wrote in an e-mail to FasterSkier.

Why? Endurance sports have a high incidence of blood doping and erythropoietin (EPO) use, but such violations are hard to detect analytically.

“When I took on the role as FIS Anti-Doping Expert, the EPO test only recognized two certified pharmaceutically produced EPOs,” Rasmus Damsgaard said in a 2010 interview with FIS. “However, it was common knowledge that 100 not registered EPO’s were available on the black market.”

Even if he was sure that an athlete was doping, Damsgaard couldn’t necessarily do much about it. After looking at samples, he could see unusual blood profiles and sometimes even detect a black-market EPO. But only an analytical finding of one of those two varieties of EPO could lead to a sanction through WADA.

“Over recent years, doping regimes have become much more scientifically planned and have taken full advantage of the weaknesses in traditional protocols with all available pharmaceutical resources,” WADA noted in its 2009 guidelines.

WADA knew that it had a problem on its hands, and when Damsgaard urged the international agency to change its guidelines, it did. EPO sanctions are now easier to hand out for a variety of reasons, including more sophisticated tests. But an increasing number of doping cases have relied on “non-analytical positives” drawn from concepts like using an individual hemoglobin upper limit for each athlete instead of a single limit for the entire testing pool.

Since its implementation, the blood passport program has become ubiquitous in skiing, with FIS conducting 1530 blood passport samples on skiers and 238 in nordic combined over the course of the 2010-11 season.

Back to Canada

But while FIS has been covering its own bases, national anti-doping agencies are required to shoulder the burden as well. Many do not have the resources available to an international federation, and also face challenges because they need to work with athletes in a variety of sports who might resort to completely different drugs requiring many separate testing protocols.

Why are two sets of doping tests necessary? The U.S. Anti-Doping Agency (USADA) handed out 38 doping violations in 2010 and the CCES sanctioned 30 of its own athletes. Being monitored by two agencies ensures that more athletes are kept clean.

And while it might seem like being tested by both a sport federation and a national agency is too much to ask of busy athletes, FIS coordinates testing with each country’s organization to minimize duplicate testing.

Canada believes that it is one of the first countries to implement a biological passport program, and called it a “turning point” in the fight against doping.

“We are one of the first national anti-doping agencies in the world to implement the guidelines in their entirety, and the guidelines are incorporated directly into the rules of the Canadian Anti-Doping Program,” CCES Anti-Doping Operations Manager Matthew Fedoruk wrote in an e-mail. “There are currently approximately 20 agencies in the world including international sport federations and anti-doping agencies operating under the WADA guidelines.”

Because CCES is following WADA guidelines, their testing program will look a lot like the FIS system. In Canada, all of an athlete’s doping control data will be compiled electronically and after each test the agency will assess whether an athlete shows deviation from his or her own pre-established baselines in nine markers, including hematocrit, hemoglobin, and red blood cell count.

Statistically speaking, these baselines can’t be established immediately – as more tests are conducted, the reference range will become more apparent. For this and other reasons, the passport program will not replace CCES’s traditional anti-doping measures, but rather complement them. And passport programs have already proven to be effective when paired with substance-specific testing.

“Longitudinal blood profiling in the area of anti-doping is not that new a concept, as some federations such as FIS, ICU, and IAAF have had passport-like programs for a number of years,” Fedoruk wrote.

More and more doping trials have relied on this sort of evidence, and CCES hopes to add to the weapons in its arsenal in order to work more effectively.

“The recent UCI cycling cases before the Court for Arbitration in Sport (CAS) have shown the scientific and legal validity of the WADA ABP Guidelines,” Fedoruk wrote. “Athletes have been sanctioned for abnormal blood profiles which have been shown to be the result of blood doping (i.e. use of autologous blood transfusions or pharmaceuticals that boost the oxygen carrying capacity of the blood (e.g. EPO)) without the actual presence of those substances being detected.”

Reactions from Coaches and Athletes

While Fedoruk could not comment directly on which athletes had already been enrolled in the program, he indirectly indicated that both skiers and biathletes had begun the passport process.

“Due to the risk of endurance athletes using blood doping substances and methods, the ABP program is primarily focused on endurance sports,” he wrote. “Athletes may be included in the program at anytime.”

Chris Lindsay, High Performance Director for Biathlon Canada, thought that his athletes probably already had passports, although he could not say for sure because CCES doesn’t provide that information.

“I suspect this means that they will be putting athletes on the passport program as testing occurs,” Lindsay told FasterSkier. “I can say that the majority of tests in the past six months have been urine and blood, which means that theoretically every athlete on the team could be ‘passported’ already.”

Athletes confirmed that hunch.

“Yup, I’ve been involved in the program already,” said biathlete Brendan Green.

In both biathlon and skiing, coaches supported the ABP concept.

“I do think it’s a step in the right direction,” said Cross Country Canada Head Coach Justin Wadsworth. “They’ve know for a long time blood parameters can only vary so much over any given time frame, and if this can be used to help slow down doping in some way it can only be good. Do I think this will be revolutionary? Probably not, because it’s been in play with other sports for some time, but again, it all helps.”

Lindsay said that Biathlon Canada supported any program which would reduce doping in his sport, but also had some more specific praise of the program. He hoped that the passport program would lead to less frequent tests for athletes deemed low-risk.

“What most people don’t understand is that our athletes are randomly tested in the training environment,” Lindsay said. “These tests are not infrequent – and often cause major disruptions to the planned training. Testing can take an hour or more, and when you arrive at training planning on doing an hour of roller skiing, an hour of shooting, an hour in the gym, then eating lunch, then going to physio, then meeting with your coach, then going for another roller ski shifting everything by an hour is a big deal.

“Moreover when just a few athletes in your training group are tested it divides the day’s activities and burdens the coaches with managing two groups instead of one.”

What About the U.S.?

Since USADA has never publicized a passport program of their own, FasterSkier contacted USADA General Counsel Travis Tygart to find out whether they were considering a program like the implemented in Canada. Were the northern neighbors getting a leg up on anti-doping efforts?

The answer, actually, was no.

“I can confirm that we do both blood and urine testing longitudinally on our athletes,” Tygart said in a phone interview.

So while USADA has yet to announce a biological passport program, they are in fact keeping track of some of the same data that such a system would monitor.

Because USADA hasn’t spilled the beans, U.S. athletes and coaches aren’t necessarily aware of this (just as FasterSkier was not until talking with Tygart). US Ski Team Head Development Coach Pete Vordenberg wasn’t familiar with the Canadian program, but said he supported efforts like it.

“I am absolutely into measures taken to make sure our sport and all sport is healthy, fair and that everyone follows the rules of the game,” Vordenberg wrote in an e-mail. “I am absolutely into showing youth athletes that it is possible to win at the top level of sport and be a clean, ethical and healthy athlete and so I am into proving that we are training, competing and living completely clean, ethically and healthily.”

The reason that USADA doesn’t publicize its longitudinal testing program is that, like many other aspects of anti-doping work, the agency believes that the more cheaters know about a testing regimen, the easier it is for them to cheat.

“We didn’t want the athletes to be able to easily beat the test,” Tygart said.

But there have been indicators that USADA is keeping track of this data, including the Michelle Collins case in 2004. The former world champion sprinter was convicted as part of the BALCO investigation despite the fact that there was never a positive analytical finding. While she later admitted to doping, a large part of the case was built on blood and urine tests which USADA had performed.

Tygart said that for any country, a passport-type system is valuable.

“It’s one additional tool,” he wrote. “It’s not the be all end all. But it’s very important and it’s a good program… and it’s important to be willing to follow up on a non-analytical finding.”