DRUGS AND THE LONDON OLYMPICS

A couple of days ago, London 2012 would have been regarded as a drug-free Olympics – that was before shot put gold medalist Nadzeya Ostapchuk (Belarus) tested positive for the anabolic steroid metenolene in samples taken both before and after her London competition. That was the first positive test by a medallist in London but two other athletes were kicked out of the Games for failing drug tests — Syrian hurdler Ghfran Almouhamad and US judoka Nicholas Delpopolo. In addition, the International Olympic Committee announced a number of positive pre-Olympics tests during the course of the Games.

The positive tests announced during the Games were:

Name	Country	Sport	Banned substance
Ghfran Almouhamad	Syria	400m hurdles	Methylhexaneamine (stimulant)
Victoria Baranova	Russia	Women’s sprint	Testosterone
Kissya Cataldo	Brazil	Single sculls	EPO
Nicholas Delpopolo	United States	Judo	Cannabis
Luiza Galiulina	Uzbekistan	Artistic gymnastics	Frusemide (diuretic)
Hassan Hirt	France	5000 m	EPO
Amine Laâlou	Morocco	1500 m	Frusemide (diuretic)
Marina Marghiev	Moldova	Hammer throw	Frusemide (diuretic)
Nadzeya Ostapchuk	Belarus	Shot put (gold medal)	Methenolone (anabolic steroid)
Diego Palomeque	Colombia	400 m	Stanozolol  (anabolic steroid)
Hysen Pulaku	Albania	Weightlifting	Stanozolol  (anabolic steroid)
Alex Schwazer	Italy	50 km walk	EPO
Tameka Williams	Saint Kitts and Nevis	100 m/200 m	“Blast Off Red” (? Stimulant)

Pre-Games bans

The World Anti-Doping Agency reported that more than 100 potential Olympians were stopped from competing at the Games because of doping.

Some medal hopefuls had been caught before leaving for London, such as defending 50km walking champion Alex Schwazer of Italy, Moroccan 1500m hope Mariem Alaoui Selsouli and Turkish weightlifter Fatih Baydar. Belarussian hammer thrower Ivan Tikhon, a three-time world champion in 2003, 2005 and 2007, was also excluded from competing before the Games as a result of drug tests dating back to the 2004 Olympics and 2005 world championships.

Six track and field athletes suspended were caught in “biological passport” tests, which measure changes in an athlete’s blood profile. Another three were apprehended in re-tests of samples from last year’s world championship. Inna Eftimova, of Bulgaria, tested positive for synthetic growth hormone, while the samples of the Ukrainians Nataliya Tobias and Antonina Yefremova both contained traces of synthetic testosterone. All three have been banned for two years.

The Moroccan runner Abderrahim Goumri, who finished third in the London marathon and second in the New York marathon in 2008, was among the six athletes who had irregularities in their “biological passports”. The others were: Russians Svetlana Klyuka, who finished fourth in the 800m at the Beijing Olympics; the 2011 European indoor 800m champion Yevgenia Zinurova; and Nailya Yulamanova; long-distance runners Irini Kokkinariou of Greece; and Turkey’s Meryem Erdogan.

The nine suspensions came after it was revealed that the Moroccan 1,500m runner Mariem Alaoui Selsouli had also tested positive for a banned diuretic. The 28-year-old had been the hot favourite to win 1,500m gold in London when she ran three minutes 56.15 seconds to win the Paris Diamond League at the Stade de France earlier this month. A silver medallist at the world indoor championships this year, she has already served a two-year suspension for doping and now faces a lifetime ban under World Anti-Doping Agency (WADA) rules.

Italian race-walking hero tests positive for EPO

The most interesting story among this group was from Italian walker and 50km gold medallist from Beijing, Alex Schwazer, who unusually among those who test positive, admitted doping. Schwazer, told his doping tale in great, and sometimes disturbing, detail. His story clashed starkly with the athlete’s clean-cut image that is highlighted in a ubiquitous Italian advertisement for Kinder chocolate bars set in the idyllic Alps where he lives.

After studying how to take and buy the drug on the internet, he said he flew to Turkey in September 2011 for three days, exchanged 1500 euros for Turkish lira, went to a pharmacy and bought EPO over the counter. He kept the drug in his refrigerator and told his girlfriend, figure skater, Carolina Kostner that they were vitamins.

He said he took the EPO only in the month leading up to the Games, that he had acted alone, and denied that he had taken performance enhancing drugs before the Beijing Games. He challenged the Olympic authorities to re-examine his blood from four years ago.

He gave the following description of the test that found him out.  “I took the last injection on July 29, I remember because it was my mother’s birthday. I went back home to get a document I needed for the Olympics. On the 30th the doorbell rang and I was sure it was anti-doping controllers. I could have told my mother to not answer or say I was not in and nothing would have happened since it’s possible to miss two in a year. But I did not have the strength to lie any more. And I wanted it all to end. I am so ashamed but I am also glad I can start my life again”.

Kenyans test positive

Three Kenyan athletes also tested positive leading up to the Games including Hamburg Marathon winner Rael Kiyara for nandrolone (anabolic steroid) and 2012 Boston Marathon runner-up Jemima Sumgong for traces of cortisone. Sumgong was treated for a hip injury in an Italian clinic, and her use of the banned substance may ultimately be determined as inadvertent.

Mathew Kisorio, history’s third fastest half marathoner (58:46) and a fourth-place finisher at the 2011 World Cross Country Championships, reportedly tested positive for an anabolic steroid at the Kenyan Championships in Nairobi on June 14. Doping expert Hajo Seppelt, in an interview with the German media outlet ARD,  translated (roughly), claimed statements by Kisorio “give the impression that not only he is affected, but it [taking performance-enhancing drugs] is a common phenomenon in Kenya.”

Seppelt says Kisorio told him that doctors like the one who treated him “can be seen in places where preferred athletes live, such as in the training camps in the highlands. His observations on this practice [administering banned drugs] are, that this is not an isolated phenomenon, but is widespread all over Kenya.”

Kisorio has admitted to drug-taking and “apparently hopes that he gets, through the elucidation of the facts, a reduced ban by [Athletics Kenya],” explains Seppelt. “Therefore, he has gone on the offensive and has spoken to us.”

Kisorio “claims that he was incited by his doctor,” reports Seppelt. “The doctor has apparently given him injections of banned substances and also tablets. One of these tablets led to the alleged positive test.”  Kisorio was found to have taken steroids, notes Seppelt, but “he also speaks of seemingly EPO injections, i.e., blood doping, and also of [doping] products that stimulate the mind.”

Seppelt maintains that the complete lack of positive drug tests by the Kenyan Olympic team is “nothing special. In the competition controls only the dumbest get caught, because the [doping] products are already out of the [body] by then.” But Seppelt asserts “nonetheless, the credibility of the Kenyan athletics is shaken” and that East African distance-running success cannot be attributed solely to “the highland, good food and the running culture. It also plays an important role. But you must realize that certain substances are also a part.”

Previous drug cheats in London

Gold medallists at the London Games who had been involved in previous doping offences included Alexandre Vinokourov, the winner of the cycling mens road race, Tatyana Lysenko,  the winner of the womens hammer throw and Asli Cakir Alpketin winner of the womens 1500 metres. Other competitors involved in previous doping cases included American athletes Justin Gatlin and LaShawn Merritt.

Ostapchuk’s positive test

Ostapchuk’s positive test in London should not have come as a big surprise. She had been competing in her third Olympics having finished fourth in Athens in 2004 and won bronze in Beijing four years ago. In the past few years, the New Zealander Valerie Adams has dominated the womens shot, beating Ostapchuk several times. Ostapchuk won the World Championship in 2005, but finished runner-up behind Adams in both 2009 and 2011 and took bronze at the Beijing Olympics in 2008.

In London, Ostapchuk, 31, won the shot put with 21.36 metres, 66 centimetres better than Adams’ best mark. The results raised speculation of doping as Britain’s men’s shot put competitor Brett Morse hinted on Twitter that Ostapchuk was using illegal drugs. The tweet was deleted soon after.

Adams is now the Olympic gold medallist, but has missed out on the opportunity to celebrate her victory on the day and to receive her gold medal at the victory ceremony.

“Suspicious” performances

Whenever there is a surprise outstanding performance involving a dramatic improvement in a short period of time, the suspicion of drug use arises. Two cases that drew a great deal of attention in London. One was the Chinese swimmer Ye Shiwen who won the women’s 400 Individual Medley in world record time and famously swam the final freestyle lap faster than Ryan Lochte in the men’s event (a previously unheard of phenomenon); the other was and the Turkish 1-2 in the women’s 1500 metres (see below).

Shiwen bettered her previous PB by 5 seconds which led the US coach John Leonard to query the performance. A Chinese team mate tested positive for EPO earlier this year. The Chinese claimed Shiwen had been identified at a young age because of her large hands and feet, and her success was due to hard work.

Womens 1500 metres – surrounded by drugs

Asli Cakir Alptekin, who has served a two-year ban for doping offences, won Turkey’s first athletic gold  in the 1500m and was followed across the line by her fellow countrywoman Gamze Bulut. Both their histories are interesting

Asli Cakir was banned for 2+ years as a junior in 2004 on a doping incident. She ran the 3000m steeplechase in Beijing four years ago and failed to progress from the heats. By last year’s world championships in Daegu she had dropped down to the 1500m, but failed to qualify for the final. This year has been different though. She finished third in the world indoors in Istanbul and then at the Diamond League meeting she ran 3min 56.62 sec, a 7 second personal best. Then on the eve of the Games, Cakir Alptekin won the European championships.

Silver medallist Bulut who has just turned 20 years old, virtually came from nowhere. Before 2012, Bulut was a steeplechaser with a 10:13 PB to her name and a 4:18 in the 1500, both times from 2011. This year her times saw massive drops of 39 seconds (9:34) in the steeple and 17 seconds in the 1500 (4:01). Bulut had never been at a global championship in the past, but found her way on the medal stand her in London.

British 1500-meter runner Lisa Dobriskey, who in her whispery voice has been outspoken on this issue before, told BBC Radio 5 Live, “I’ll probably get into trouble for saying this, but I don’t believe I’m competing on a level playing field.” Dobriskey was fourth in the 2010 European Championships when one of the runners making the podium had previously been banned for EPO use and had once been arrested with vials of human growth hormone (HGH) in her luggage. In addition, Dobriskey was fourth at the 2008 Olympics in which the bronze medalist, Ukraine’s Nataliya Tobias, tested positive for testosterone at the 2011 world championships.

The women’s 1500m event has been surrounded by drug convictions in recent years. In addition to Alpketin who tested positive in 2004, Moroccan Mariem Alaoui Selsouli, the world leader and favourite for 1,500m the London Games, tested positive in July and faces a lifetime ban having returned only last year from a two-year doping suspension for EPO.

Also in July, three Russian runners, including major championship middle-distance medallists Svetlana Klyuka and Yevgenia Zinurova, were banned, while four years ago, seven Russians were caught including then-world leader and former indoor 1,500m world record holder Yelena Soboleva and former double world champion Tatyana Tomashova.  Tomashova, a silver medalist in the 2004 Athens Olympics, was later banned when it was discovered that she had tampered with a urine sample that was to be tested for drugs. She returned from the ban in April of 2011. Turkish athlete Süreyya Ayhan was the 2002 European champion in the 1500, but she received a lifetime ban after a positive test for steroids in 2007

Men’s 1500 m

In Beijing there was a surprise winner of the mens 1500 metres –  the Bahraini athlete Rashid Ramzi. Less surprisingly he subsequently lost his gold medal after testing positive for CERA an advanced version of EPO.

When Taoufik Makhloufi of Algeria won the London 1500 metres with a 3:30 personal best, having previously failed to make it out of the semifinals in the previous two World Championships, suspicions were again raised. However Makhloufi’s performance was not out of the blue as he had run a fast 3.30 1500 in Monaco earlier in the year. The most dramatic improvement in the 1500m final actually came from the Norwegian runner Henrik Ingebrigtsen who ran a personal best in finishing fifth.

The interesting aspect of the London 1500m final was the failure of all the favourites to perform on the day, although the defending champion and current World champion Asbel Kiprop was obviously injured. You would imagine that the way the race was run it would have suited a fit Kiprop who was the fastest 800m runner in the field. Makhloufi was the second fastest 800m runner in the final!

Will there be more positives?

Urine and blood samples taken at London 2012 and tested by scientists at the high-tech anti-doping lab in Harlow, east of London, will be stored for up to eight years. As American cyclist Tyler Hamilton, a 2004 time trial gold medallist, found out last week, cheats both past and present can be named, shamed and stripped of their titles even years later.

Experts say the liquid chromatography and mass spectrometry equipment used at the lab to screen samples for more than 240 banned substances in under 24 hours has provided the best anti-doping system officials could have hoped for.

A spokesman for the International Olympic Committee (IOC) said on the Saturday before the Games’ closing ceremony, that there had been 4,686 anti-doping tests so far, of which 3,729 were on urine samples and 957 had analysed blood.

Who gets caught?

The WADA Director General, David Howman, has drawn a distinction between “dopey dopers” who still have traces of banned substances in their system during major competition, and sophisticated cheats who are able to beat the system outside competition.

While strides have been made in the out-of-competition testing regime, including the introduction of the controversial “whereabouts” policy that requires elite athletes in every sport to make themselves available for spot testing at any time, there are huge concerns about whether they are doing enough to keep up.

Although sophisticated new methods are being developed to test for EPO and Human Growth Hormone, they are expensive and require refrigerated blood samples to be carried for sometimes thousands of miles to the labs capable of carrying out the tests. WADA is concerned the cost is preventing many countries carrying out as many tests for blood doping as they should be.

It is feared that of the 258,000 tests conducted annually, as few as 2% include the blood tests that can detect the use of Human Growth Hormone. In 2010 there were just 36 positives – a total WADA regarded as “disappointing”. Across sport, there are fears that one in 10 athletes is attempting to cheat but of those only one in five is being caught.

 Was London 2012 relatively drug-free?

There were very few actual positive tests from the 2012 Olympics. This relative paucity of positive drug tests could mean one of two things.

That we are winning the war against drugs and the extensive testing and prospect of retrospective disqualification had succeeded in putting athletes off.

Alternatively, as has always been the case, that the athletes, coaches and scientists have perfected the art of avoiding detection using regular low dosages of drugs and hormones that are too small to detect. There are certainly plenty of rumours of endurance athletes using daily low doses of synthetic blood products which maintain high red blood cell count rather than using EPO. Victor Conte of BALCO fame was in London (I thought he was in jail!!) and claimed that 60% of athletics medallists were taking drugs. Probably not the most reliable witness, but he certainly knows the drug scene!

I believe that the use of performance-enhancing drugs is still widespread in certain Olympic sports. History tells us that there have always been athletes and coaches trying to gain an advantage. History also tells us that they are invariably ahead of the drug testers, thus the relatively small number of positive drug tests at Olympics. Out-of-competition testing and the co-operation of customs and law enforcement agencies have helped catch some drug cheats, but I cannot believe there are not lots more out there getting away with it.

Dr Peter Brukner (@PeterBrukner) is an Associate Editor of BJSM and an Australian sports medicine physician, author and media commentator living in Liverpool, UK. Currently working with Sky Sports News and one of the sports physicians working with the Australian cricket team. This blog was reposted from Peter Brukner’s website http://www.peterbrukner.com/news/  where you can find other blogs about the Olympics and sport and exercise medicine broadly.

Related BJSM papers:

Traditional Chinese medicine and sports drug testing: identification of natural steroid administration in doping control urine samples resulting from musk (pod) extract.  Mario Thevis et al.  http://bjsm.bmj.com/content/early/2012/05/05/bjsports-2012-090988.full

Would you dope? A general population test of the Goldman dilemma. J M Connor, J Mazanov

Doping prevalence among preadolescent athletes: a 4-year follow-up. P Laure, C Binsinger.  Br J Sports Med 2007;41:10 660-663 http://bjsm.bmj.com/content/41/10/660.abstract