Doping has been at the forefront of Olympic discussions ever since Russian state sponsored doping in Sochi 2014 ripped the Olympic movement apart a decade ago. Now at a time when positive drug tests for trimetazidine from 23 Chinese swimmers before the Tokyo 2020 Olympics were never announced after an internal investigation found kitchen contamination to be the cause, the Olympics themselves are in jeopardy according to swimming GOAT Michael Phelps. At the same time, the traditional commitment to reject doping has also gone conspicuously missing from Olympic Opening Ceremonies speeches at the Beijing 2022 and Paris 2024 Olympic Games.
Drug testing began at the Olympic Games in at the Winter Olympics in Grenoble 1968. Since then we have had 29 Olympic Games with drug testing. There have been 446 positive drug tests reported. This resulted in 173 total medals being stripped; 57 gold, 66 silver, and 50 bronze. This shows the indelible impact of doping, and anti-doping, on the Olympic Games.
Dr. Don Catlin and Oliver Catlin at the Bird’s Nest in Beijing 2008
As the son of anti-doping guru Dr. Don Catlin I have watched anti-doping develop since I was 8 years old. Together we started BSCG in 2004 as one of the leading international providers of third-party certification for banned substances in sport. I had the chance to attend 11 Olympic Games alongside Don, who was one of the longest tenured members of the IOC Medical Commission from 1989-2012. At each of the Games we had the chance to attend the Opening Ceremonies. One thing that always stood out to me was hearing the commitment to reject doping. It made me stop and think every time, after all anti-doping was the reason we were there in the first place.
Something seemed missing in Paris.
As I watched the beauty of Paris showcased during the opening ceremony a week ago I appreciated a few things.
First, the parade of athletes was transformed from a painful multi-hour march into a wonderful boat ride, like some real life version of It’s a Small World. I remember the parade of athletes during Beijing 2008 was so long, and it was so hot and humid, one of the dancers who ringed the stadium and danced the whole time passed out and fell to the floor, only to be promptly scooped up and hauled off. This time, the made for TV event weaved in performances and entertainment to keep the billions of eyes watching happy, along with the athletes, and fans that watched from the banks of the Seine.
Usually we had to go into the lounge to have a glass of wine or two.
There has also been an attempt to reduce the administrative elements and speeches so they don’t weigh down the event. While we support the reduction of protocol some of it is important to maintain. Like the commitment to sport without doping.
Looking back, the last time IOC President Thomas Bach included the mention of sport without doping during the Opening Ceremonies speech and protocol was at the 2020 Tokyo Olympics. It has been conspicuously missing from most of his Opening Ceremonies speeches. It was not in Bach’s speech at PyeongChang 2018, or Rio 2016, or Sochi 2014. Former IOC President Jacques Rogge traditionally included a call to ‘reject doping’ in his speeches, as he did in London 2012 and Vancouver 2010.
The commitment to reject doping should not be sidelined at the Olympics. Including a few short words in the speech to remind the thousands of athletes participating, and billions of fans watching, that doping is not tolerated at the Olympics is essential to its future success. Just ask Michael Phelps. This protocol must be maintained and reinserted.
The Olympic size argument between the U.S. Anti-Doping Agency and World Anti-Doping Agency (WADA) over the Chinese swimming positives and the handling of the case by WADA has resulted in unprecedented action at the IOC level. During the announcement process awarding the 2034 Salt Lake City Olympic Games the IOC adjusted the legal language in the contract. As reported, “John Coates, chairman of the IOC’s legal commission, said the host city contract confirming Salt Lake’s right to stage the Games had been altered to allow the IOC to take them away if US authorities did not respect the “supreme authority” of WADA.”
A commitment to anti-doping and the World Anti-Doping Code was already required by the host city, but the language was adjusted to clarify termination was possible if that commitment waivered. “The IOC has reinforced the current language of the Olympic host contract in order to protect the integrity of the international anti-doping system and to allow the IOC to terminate — to terminate — the Olympic host contract in cases where the supreme authority of the World Anti-Doping Agency… is not fully respected or if the application of the World Anti-Doping code is hindered or undermined,” Coates said.
We certainly agree that commitment should be made by every host city. It should also be made by every athlete, every country, and by the IOC. That is why a commitment to sport without doping must remain part of the Opening Ceremonies of the Olympic Games.
This is the first Olympics I have taken in without the great Don by my side. Thankfully his memory, and his commitment to anti-doping lives on. He was recently awarded the R. Max Ritter Award by U.S. Aquatic Sports (USAS). On the award it says, “The hope for clean sport in the future is possible due to the contributions made by Dr. Don Catlin, a man who is regarded as the unparalleled leader in sports medicine and anti-doping. Many of the elements of the anti-doping program that athletes and sport leaders take for granted today were envisioned and pioneered by Dr. Catlin so many years ago.”
A quote from Don appears on the award as well. It says, “My hope is, and I think it’s not unrealistic, that you should be able to watch an Olympic event and be satisfied that nobody is doping.”
Olympic gold medalist Anthony Ervin was part of the group from USAS that presented the award to me in Don’s honor. He said, “If I can speak today for athletes, I would like to say that athletes cherish fair and clean sport, something which is so very important to all athletes. Our thanks for the work that your father has done to clean up sport, to create the testing and to help to lead to justice for many of the athletes that deserved it. It’s been a trying time in our sport with what has been going on recently. We need to believe in these things now more than ever. His spirit is with us. This award is a small way of thanking you and your family for all that he did for athletes.”
We need to take those words and sentiments to heart. Doping is an unfortunate part of the Olympics. We can’t try to hide that. We need to confront it. More than anything we need to ensure our shared commitment to sport without doping never wavers. That needs to start with an unequivocal statement that rejects doping at the Opening Ceremonies.
Doping threatens to dim the lights of the 2024 Paris Olympics before it even starts. Reporting by the New York Times and ARD unveiled that 23 Chinese swimmers tested positive for the heart medication trimetazidine before Tokyo. The cases were not publicly announced and were excused after only 2 months based on an internal China Anti-Doping Agency (CHINADA) investigation that found kitchen contamination was at fault with spices, samples from kitchen drains, and also cooking hoods apparently testing positive for trimetazidine. The positive tests occurred during COVID precluding outside investigation of the incident and without any evidence to the contrary the World Anti-Doping Agency (WADA) said there was no cause for action. To make matters worse, three of the swimmers tested positive for clenbuterol previously, with those cases not announced due to the explanation of meat contamination. Three of them won Olympic gold in Tokyo, eleven will be swimming in Paris in eleven days.
To be clear, food or dietary supplement contamination is one of the most common causes of doping violations, it is also one of the most convenient excuses. It is a very real concern with drugs like trimetazidine or clenbuterol. Trimetazidine is a known international water contaminant and clenbuterol a known anabolic used in cattle production in some regions often illegally. This explanation must be properly vetted in each case in order to be accepted. A case involving suspected contamination would ordinarily be reported as an adverse analytical finding (AAF) and if investigation demonstrates contamination was the source the case may be excused with no case to answer, no sanction, or a reduced sanction could be given with an Anti-Doping Rule Violation (ADRV).
In the Chinese case the contamination explanation seems questionable on its surface. They literally threw the kitchen sink at the problem. Here, food contamination from spices is co-mingled with water contamination, which would be relevant with the drains and cooking hoods. If the spices were at fault, was enough of the drug really ingested to cause a positive test? These are spices not a main course. If water contamination, then why weren’t other athletes affected? We would likely see a number of similar cases in China and around the world if these were the real culprits? Water contamination could be investigated after the fact as it would likely still be present. It is hard to believe it would only be relevant on that day. The explanation does not appear to hold much water in our view, but we appreciate the dilemma faced by WADA in that their actions must be based on evidence.
In their statement WADA vigorously defended their actions. Knowing some of the folks that work at WADA we can assure you they take their job of defending clean sport extremely seriously. In an interview Olivier Rabin, WADA Senior Director, Science and Medicine, said the following. “In this case, despite our skepticism, a thorough review of all the verifiable facts of the case revealed no evidence to challenge the contamination scenario. Rather, all the available evidence pointed towards no-fault contamination versus intentional ingestion.”
The WADA statement noted some important facts. The cases were reported by CHINADA to WADA in June 2021. WADA reviewed the case file provided in June and July 2021, along with the scientific evidence and consideration of hypothetical scenarios, and ultimately decided there was no evidence to warrant any action on their part. They reported the cases to the International Testing Agency who challenged the potential misreporting of results in early 2022. WADA investigated those concerns and found no issues. USADA had contacted WADA in 2020 with apparently “unsubstantiated” reports of a whistleblower that had reported doping cover ups in Chinese swimming. USADA contacted WADA again in April of 2023 with a similar report in regards to the trimetazidine cases.
At the end of the day, anti-doping decisions like these shouldn’t occur behind closed doors as it creates an air of suspicion and doesn’t allow the relevant facts to be analyzed. There are protocols to follow in cases of inadvertent doping involving contamination. How those were managed here should be scrutinized and investigated. Perhaps the relevant scientific facts in the case file would legitimately support a kitchen contamination argument? How much trimetazidine was found in the urine samples? How much was found in the spices, drains, and vents? We will never know if the facts are not made public as they usually are in anti-doping decisions. Those facts could allow external reviewers to consider the contamination argument. For the world to be satisfied these details must be released.
An independent review has been done by Swiss prosecutor, Eric Cottier, who in an interim report concluded, “All the elements taken into consideration by WADA, whether they come from the file produced by CHINADA with its decision or from the investigation procedures that it carried out, show the decision not to appeal to be reasonable, both from the point of view of the facts and the applicable rules.”
This has not quelled the concerns. “The report confirms WADA failed to investigate the facts on the ground in China and failed to uphold its own rules,” a statement from Travis Tygart CEO of USADA says, “From the beginning, our goal has been uncovering the truth and the facts of this situation on behalf of clean athletes. Until WADA leadership shares that goal and stops spewing vitriol at any voice of dissent, there will be no trust in the global anti-doping system. In fact, today’s WADA rules by fear and intimidation, as their statements make abundantly clear. It’s time for a new strategy given that WADA’s credibility is crumbling before the world’s eyes and athletes deserve openness, transparency, and truth—not more deflection and bullying.”
Millions of eyes will be watching in Paris to see what happens next. The U.S. House Committee on Energy and Commerce threatened to withhold the $3.7 Million provided to WADA annually during a hearing June 26. Olympic Champion Michael Phelps said, “If we let this slip any farther, the Olympic Games might not even be there.” The DOJ and FBI are investigating the issue under the Rodchenkov Anti-Doping Act which criminalizes doping that impacts international competition with up to 10 years in prison and $1Million in fines. The Association of Summer Olympic International Federations (ASOIF) has now threatened not to hold any further competitions in the U.S. due to the concern saying, “”The U.S. criminal investigation into an anti-doping case on foreign soil, and the recent position of the U.S. Anti-Doping Agency, threaten to undermine the role and independence of WADA, and by extension, trust and confidence in the global anti-doping system and the autonomy of sporting rules and regulations.”
Many people have voiced their concerns over this issue but few solutions have been posed. Certainly the outlined protocols need to be followed and contamination cases properly vetted before expunging them. We also echo the sentiments to provide the relevant scientific details in this case for public review and scrutiny. Beyond those immediate considerations, the following thoughts are presented as ways to address the issues with long term solutions that we believe would improve the anti-doping system.
Keep Anti-Doping Independent and Improve Result Tracking
There was a time when political factors had more impact on anti-doping activities than the analytical results. We can’t let that happen again. You can do the collections right, you can do the testing right, but if the adjudication is in some way impacted by political forces, favoritism, or a desire to protect high profile athletes then the system falls apart. This can’t be accepted as the norm. Each case should be treated and managed according to established principles and there should be accountability in the system to ensure nothing can be brushed under the rug. It is amazing that in the modern era of anti-doping with all the systems and tracking in place that 23 adverse analytical findings from 2021 for Chinese swimmers can simply vanish for years only coming to light thanks to good investigative journalism.
This concern may necessitate an improved central tracking system and auditing system for collected samples to ensure there is a matching result reported based on the principles outlined and that reported results can’t simply vanish. WADA is responsible for tracking and reporting results. The WADA Intelligence and Investigations Department is tasked in part with enforcing the WADA Anti-Doping Code. There is an Independent Supervisor at WADA that audits the Intelligence and Investigations Department. To WADA’s credit the need for independent review and audit has already been designed and implemented.
However, this case suggests we need to add some robustness and broader independent review to the result tracking and audit process. Perhaps AI can assist in exposing and identifying issues. Statistical analysis can unveil potential issues as noted here.
2. Look in the Right Direction for Modern Alternatives to Performance Enhancing Substances
The doping agents of today are very different than those of the past. Drugs like steroids and stimulants are obvious choices for people who want to enhance performance, and low hanging fruit for those that want to address doping. These days, trimetazidine and meldonium are making headlines. This appears to show a shift towards use of new categories of substances like actoprotectors, antihypoxant, anti-ischemic substances that can act as metabolic modulators and aid in endurance or recovery. Antihypoxant drugs, like Hypoxen that is advertised for sports support by the manufacturer, are not yet banned. The CAS decision in the Valieva doping case that rocked the Beijing Winter Olympic Games in 2022 noted that Hypoxen was declared alongside trimetazidine and L-carnosine. Since trimetazidine was banned in 2014 and meldonium in 2016, no related substances have been added to the WADA Prohibited List in category S4.4 Metabolic Modulators.
Meldonium was the number one reported drug in 2016 with 515 adverse analytical findings. It is clear these drugs are popular and yet the system has not broadened the coverage of the category in almost a decade. In a USA Today story from 2017 Russian Federal Medical-Biological Agency head Vladimir Uiba was quoted saying Russia has found “several drugs which are not banned and work significantly better than meldonium.” Need we say more.
Research from 2011 on metabolic modulators noted, “Metabolic modulators are a newer class of drugs that benefit heart failure patients by modulating cardiac metabolism without altering hemodynamics,… more specifically they increase glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen.” In simple terms they improve oxygenation and blood flow, which has the potential to enhance endurance, recovery, and even strength in healthy human athletes. This paper discusses trimetazidine along with three other drugs that are not banned; ranolazine, perhexiline, and etomoxir. Folks this is how people dope, they look for banned substances in the research and try to find related substances that aren’t banned. Substances like Mexidol or Cytoflavin also appear to be alternative doping agents with antihypoxic and metabolic modulation effects.
We need to start looking in the right direction and responding quickly to new categories of banned substances that are likely to be used, like antihypoxant and anti-ischemic metabolic modulators, or nootropic cognitive enhancers. These are drugs on the edge of performance enhancement that allow for doping in the margins with alternatives to doping agents that have similar biological effects but are not yet banned.
3. Protect the Innocent from Contamination and Inadvertent Doping
How low is too low when it comes to sport drug testing? The concept of a minimum reporting level (MRL) has been formalized by WADA for certain drugs and likely needs to be expanded more broadly. Testing today is super sensitive capable of detecting down to 1 part per trillion or below (ppt, or picograms/gram). Detection levels are a thousand times lower now than a decade ago. This has the benefit of expanding the window of detection for doping agents, but also increases the possibility of causing harm to innocent athletes by detecting drug contamination in food, water, or supplements at trace levels that have no benefit on performance but may cause inadvertent positive drug tests.
The anti-doping system was built to protect clean athletes and it is imperative that we don’t let it turn into a system that does more harm than good. Protecting innocent athletes from inadvertent positive drug tests is just as important as exposing those who dope. Accidental doping happens more often that you might like to consider. UFC Vice President and anti-doping stalwart Jeff Novitzky said a little less than 50% of UFC positives come with, “either definitive evidence or evidence tending to show that those positive tests were results of contaminants and not purposeful doping.” In the Olympic environment John Ruger, USOC Ombudsman from 1999-2014, said in 2013 “between 40% to 60% of positive test doping results were inadvertent (non-deliberate) cases.”
This is why we have offered third-party certification for banned substances in sport at BSCG for more than 20 years in our Certified Drug Free program. The majority of athletes use dietary supplements or nutritional supplements to fuel their performance, and batch testing for banned substances offers the maximum protection possible against the risk of such products being contaminated. A recent compilation of dietary supplement surveys noted that out of 3,132 products analyzed, “more than 28% of the analyzed dietary supplements pose a potential risk of unintentional doping.”
We must recognize the risks of contamination and respond with science and sensible policy to deal with the concern. It should be noted that WADA has a committee, the Contaminants Working Group, dedicated to dealing with the issue. In 2022 WADA formalized the concept of a minimum reporting level (MRL) in the WADA Technical Document TD2022MRPL, to deal with natural presence, contamination or other issues. Previously MRLs were outlined but not formalized. Considering MRLs for a wider group of drugs is likely justified but WADA tends not to acts until it has the science to inform the action. The body of science focused on contamination is slowly expanding allowing informed decisions on MRLs to be made and providing a broader set of data to consider in cases where contamination may be involved. More resources need to be spent addressing this concern so that scientific, instead of subjective, reasoning can be used in cases where contamination is suspected or claimed.
In the event an AAF is verified to be inadvertent due to contamination but a sanction is still deemed necessary a separate category should be considered for these victims so they do not have to bear the shame of an ADRV. Perhaps these should be called Inadvertent Rule Violations (IRV) to separate them from purposeful dopers.
4. Statistics Can Expose Issues with Nations and Compliance with the WADA Code
WADA testing statistics can identify concerns and lack of compliance with anti-doping case management. WADA publishes annual statistics that summarize the number of samples tested, initial adverse analytical findings (AAFs,), and verified anti-doping rule violations (ADRVs) by nation and sporting discipline. These figures can be used to evaluate the responsibility of nations and the response of the system overall to determine if procedures and policies included in the modern version of the Code are being followed. The theory being that if certain nations demonstrate statistical anomalies over time then asking questions may be justified.
The last available statistics for ADRVs are from 2020 a Covid year, so 2019 is the most recent non-Covid year. We look at the WADA statistics from 2019 to get a window into how certain nations approach drug testing. The number of samples tested, AAFs, ADRVs, percentages of both, and the conversion rate between AAFs and ADRVs is shown below for a list of 10 nations.
2019 WADA Anti-Doping Rule Violation Statistics
Comparing the U.S. and China we discover that the nations test roughly equal numbers of samples with the U.S. at 11,213 and China at 9,936. The U.S. had 194 initial AAFs with a rate of 1.73%, slightly above the overall average of 1.09%. China meanwhile had only 14 AAFs with a 0.14% AAF rate, the lowest percentage of any country we evaluated and well below the average. The U.S. had 37 cases excused for medical reasons based on therapeutic use exemptions, 114 no case to answer that were closed at results management level, and 8 no sanction cases. China had none of these reported.
The difference in the AAF statistics and case management statistics is remarkable. It doesn’t take a statistician to realize that the U.S. and China appear to be approaching the application and adjudication of anti-doping very differently.
When you look at ADRVs the U.S. had 35 and an ADRV% of 0.31%, below the average of 0.65%. The conversion rate from AAFs to ADRVs was only 18% in the U.S., the lowest of any of the nations evaluated. The 114 no case to answer cases in the U.S. were by far the highest with the next closest nation having only 12, another anomaly that could be explored. China had an ADRV% of 0.12%, the lowest of any country other than Germany. China’s conversion rate from AAF to ADRV was among the highest at 86%, with only Russia (88%) and Iran (97%) higher, with the average being 60%.
Germany has become one of the most committed nations when it comes to anti-doping and it shows in the statistics. They test 15,789 samples, more than any other nation by far. They have the second lowest AAF% at 0.32% and the lowest ADRV% at 0.11%. AAF to ADRV conversion is near the lowest in the countries reviewed at 34%, suggesting that they follow the Code and provide resources for investigations and education.
AAF to ADRV conversion is interesting to consider. In nations that report and investigate all AAFs one might expect this statistic to be lower. In nations where resources are available to perform investigations to consider inadvertent contamination or other explanations the AAF to ADRV conversion rate might also be expected to be lower. In hard line nations, or those that suffer from a lack of education or resources, conversion rates might be expected to be higher.
Across nations nearly 12% of athletes who test positive initially and have an AAF reported ultimately had an explanation other than doping or medical use (228 no case to answer or no sanction cases out of 1,991). 348 cases are still pending from 2019. Why after 5 years we might ask? The statistics are not complete but 12% appears to represent a fairly high rate of inadvertent doping.
There is power in numbers folks and some of these statistics are eye opening.
Instead of burning bright, the Olympic torch will be flickering again thanks to this Chinese doping quandary. Hopefully more proactive efforts and solutions can be pursued to ensure clean athletes remain at the forefront of the Olympic movement and on the top of the podiums in the future.
The Olympic doping scandal surrounding Kamila Valieva is one of the darkest moments the Olympic movement has ever faced. The system is struggling to contain the intense anger generated in all of the clean athletes that come to the Olympics and compete alongside others from around the world for glory. Sanctioned dopers are probably even angrier as they had to serve penalties while so far Valieva has not. Let the best athlete win and all is well. Allow a doping scandal to invade and all hell breaks loose. At the center of the scandal are cardiovascular drugs that can be used to enhance endurance; trimetazidine and hypoxen. One banned in sport, the other not. She also said she was using L-carnitine. Here we explore the substances used by Valieva, and others that could be alternative doping agents.
Valieva tested positive for the anti-ischemic drug trimetazidine (TMZ) on a Christmas Day drug test reported six weeks later causing the entire Olympics to take a collective pause. One hand on a team medal in figure skating for Russia and one hand in the cookie jar. Not good. Valieva also declared the use of hypoxen and L-carnitine on her collection form. All three have a common connection in that they are cardiovascular treatments or in some way impact heart function.
TMZ is not approved for use in the U.S. but it is commonly used as a heart treatment medication in Europe. From a doping perspective it can increase blood flow and improve endurance. A study done in Poland noted that TMZ could be found in relatively high amounts in treated wastewater demonstrating that it had become an environmental contaminant. This could expose crops irrigated with treated wastewater, or even animals that eat those crops, to the potential for contamination with TMZ. I wrote about this concern right as this scandal was breaking and the Olympics were doing a twizzle.
Realize that the now infamous drug meldonium is also an Eastern European anti-ischemic drug. Meldonium shocked the world in 2016 when it was first prohibited as it became the number one substance found in the World Anti-Doping Agency (WADA) system causing 515 failed drug tests across the globe. That number had dropped to around 70 by 2019 but it was still a common doping agent. The meldonium affair showed the world athletes were looking at anti-ischemic agents that were not yet prohibited as potential doping agents.
Trimetazidine itself was first prohibited in 2014. It was originally categorized as a stimulant and has since been moved to category S4 Hormone and Metabolic Modulators on the WADA Prohibited List. There have been an average of 9 positive drug tests each year for TMZ since 2014, not that many. However, “retrospective data mining regarding doping control analyses conducted between 1999 and 2013 at the Cologne Doping Control Laboratory concerning trimetazidine revealed a considerable prevalence of the drug particularly in endurance and strength sports accounting for up to 39 findings per year.” So it seems it was used a lot more before it was banned.
Trimetzidine sits alone as S4.4.4 right after S4.4.3 Meldonium. This is where anti-ischemic cardiovascular treatments that may have endurance benefits have been categorized on the WADA Prohibited List. Only a few examples of such drugs appear.
Hypoxen is one that does not, yet it is widely available at sites that cater to Russian pharmaceuticals. One such site has hypoxen as a ‘Cardiovascular Treatment’ along with 9 others that are not yet on the WADA Prohibited List. The summary of hypoxen on the site describes, “HYPOXEN is an antihypoxant and antioxidant. It reduces oxygen consumption and increase the efficiency of the organism in extreme situations, such as mental and physical stress, accompanied by a lack of oxygen,” it goes on to outline uses as, “To Improve Performance in Extreme Conditions (Including the Highlands, Arctic conditions, Underwater Work)” and, “Ischemia of the Heart Muscle (Angina Pectoris).”
A series of other options are on the site alongside TMZ, meldonium and hypoxen. The other options include Captopril (Capoten), Corvalol, Emoxypine, Riboxin (Inosine), VALIDOL (Validolum, Valofin, Menthoval, Menthyl isovalerate), VERAPAMIL (Isoptin, Calan).
Validol is of particular interest. The description outlines that Validol, “is an anxiolytic and produces a sedative effect as well as a moderate reflex and vascular dilative action,” under uses it includes, “Ischemia of the Heart Muscle (Angina Pectoris).” Let’s see increase in blood flow, anti-ischemic treatment. Sound familiar?
Riboxin is another substance I featured in an article in August 2021 on ‘Russian Doping of a Different Sort: Russian and Eastern European Drugs Hiding in Plain Sight as Alternative Doping Agents.’ The site that sells it notes several potential benefits to athletes including, “Provides anabolic effect,” and, “It reduces the area of necrosis and myocardial ischemia by improving microcirculation. Riboxin is also considered to improve muscle development.” Blood flow, ischemia. Check. This one even has anabolic effects. Ideal.
L-carnitine, the other substance Valieva declared, is a non-essential amino acid made in the human body that helps turn fat into energy. It is important to healthy brain and heart function and other processes in our bodies. Ingestion of L-carnitine is not prohibited in sport but injection over 50ml would be prohibited. L-carnitine injections in sport were made infamous by the Nike Oregon Project and Mo Farah, who admitted to the practice, then recounted in a mysterious saga reported by the Independent. In the Farah situation it was alleged that the amount injected was 13.5ml and not illegal. High amounts of L-carnitine when injected can enhance endurance.
Alberto Salazar, the coach at the center of the Nike Oregon project affair was excited about the potential of L-carnitine for performance enhancement. In a story reported by AP October 2, 2019 Salazar, “sent an email to none other than Lance Armstrong. ‘Lance, call me asap!’ Salazar wrote to the world’s most famous cyclist, who himself was only months away from being banned for life for doping. ‘We have tested it, and it’s amazing.’”
That’s the same stuff Valieva declared. Now, she may have declared an ingestible form of L-carnitine as a nutritional supplement, which would be perfectly legal in sport, or it could be this grey area high amount of L-carnitine injection practice in action. We just don’t know and we probably never will. It is sad to think that on top of everything else Valieva has suffered in this affair she could be a human pincushion as well.
These substances and practices are out in the open and appear to be obvious substitutes or alternatives for now notorious banned substances in sport like meldonium. Hypoxen, Validol, and Riboxin appear to be substances that would have clear doping potential. In the case of L-carnitine injections, it is a convenient workaround. It is time we open our eyes wider and address some of these potential doping agents as they are obviously in use.
This whole affair is an utter shame to anyone that loves the Olympics as I do. A 15-year’s doping scandal has cast a pall over the entire Olympics. Reduced to tears after her long program in Beijing, Valieva was clearly struggling under the weight of the scandal. Reporting in People noted Valieva’s coach was “heard admonishing her performance,” as if she needed more pain. Fellow Russian 17-year old Alexandra Trusova who won the silver was quoted saying, “everyone has a gold medal, everyone, but not me. I hate skating. I hate it. I hate this sport. I will never skate again. Never.” The gold medalist, Anna Shcherbakova looked shocked and stunned after winning. That is the kind of unbelievable pressure these Russian girls are under. Meanwhile the bronze medalist from Japan cried tears of joy.
Olympians are supposed to have the opportunity to come together alongside the best of their kind in the world to celebrate camaraderie and their unbelievable dedication to sport while proudly representing their countries in hopes of basking in Olympic glory and maybe winning a medal. Instead Valieva has to answer for the failure of the Russian system to evolve the culture to one that actually endorses clean sport. Worse yet she has to answer for the failure of the Olympic movement to manage it. So too do all the other athletes crushed by the latest Russian doping scandal. The last four Olympics have been marred by talks of Russian doping. It is about time that ends.
Is the World’s Best Figure Skater another Example of Russian Doping or an Innocent Victim of Contamination?
By Oliver Catlin
Halfway through and the 2022 Beijing Olympics are spinning thanks to the latest Russian doping affair surrounding the world’s best figure skater. The future of the Olympic movement now hangs in the balance. This is the last thing the Olympic movement needed after the worst doping scandal ever perpetrated during the 2014 Sochi Olympics. It is easy to have a knee jerk reaction to the current case, where 15-year old figure skating sensation, Kamila Valieva, tested positive for the drug trimetazidine on a Christmas Day drug test that was finally reported on February 7. Now the entire Olympics awaits a decision to be made this weekend after the Court of Arbitration for Sport (CAS) was called in to sort out the matter. Most people probably think she is a doper given the scandalous history in Russia, but as we have learned over our years in anti-doping the answer may not be that straight forward in the end.
Let’s start with what trimetazidine is so we can get a foundation. Trimetazidine (TMZ) is a heart medication that has been used in medical practice to treat angina or stroke. It is not approved for use in the U.S. One paper describes that as an “orally administered antianginal agent trimetazidine increases cell tolerance to ischaemia by maintaining cellular homeostasis.” In simple terms TMZ can increase blood flow and stabilize blood pressure and can have endurance benefits. In 2012 the European Medicines Agency, “recommended restricting the use of trimetazidine-containing medicines in the treatment of patients with angina pectoris to second-line, add-on therapy.” It is banned in sport as a metabolic modulator in category S4.4 alongside another now infamous doping agent meldonium, also an anti-ischemic agent. Overall, the WADA system reported 57 trimetazidine findings from 2014 when it was first banned to 2020.
To most people it would seem unlikely that Valieva has a heart condition at age 15 that would justify medical use of TMZ. It is now recommended only as a second line therapy perhaps making legitimate treatment even less likely. Even if there was a medical need if she didn’t get a therapeutic use exemption (TUE) and disclose the use of TMZ in advance that would be a violation in itself.
The Valieva situation is framed by several trimetazidine cases. Sun Yang, the Chinese swimmer now notorious for a string of doping concerns, tested positive for trimetazidine in 2014. Yang claimed he had been prescribed it for chest pains but he did not declare it on his collection form. Yang received a three-month ban, his Chinese doctor was banned for a year. Valieva joins fellow Russian bobsledder Nadezhda Sergeeva who tested positive for trimetazidine two days prior to her race and was banned from competition at the 2018 Pyeongchang Olympics. Sergeeva served an eight-month ban after it was considered that she had used a contaminated supplement.
A third case in 2018 also points to the concern of supplement contamination. U.S. swimmer Madisyn Cox was positive for trimetazidine and originally thought it had come from water contamination. Cox eventually had her sanction reduced to six-months after testing discovered TMZ as a contaminant in a supplement. At BSCG our business revolves around protecting athletes from nutritional supplement contamination through our industry leading Certified Drug Free program, which verifies supplements are free of banned substances. These cases illustrate how important it is for athletes to protect themselves from the risks of supplement contamination.
Sergeeva’s is an illustrative case when it comes to the timeframe of action as she was banned from the Olympics two days after testing positive. Yet we still have no answer on Valieva? It is now five days past the result being announced, 49 days since the sample was taken, and we still don’t have an answer? This stinks of politicking to us, and surely many others.
Why did six weeks pass before a final result was issued? The laboratory in Sweden that did the testing explained the confirmation of the result was delayed due to COVID issues, something we can sympathize with and understand. We don’t believe anything nefarious happened at the lab. This isn’t a lab issue unlike the debacle in Sochi.
In a powerful article, Yahoo Sportsreported that the Russian Anti-Doping Agency (RUSADA) evaluated the Valieva situation and decided on February 8 to issue a provisional suspension. Then in classic fashion RUSADA turned around the next day and overturned it with no reason provided, clearly heightening suspicion. The Russian Olympic Committee released a statement Friday saying she had “passed numerous doping tests” before and after Christmas Day.
Travis Tygart, head of the U.S. Anti-Doping Agency (USADA) is not happy. Surely there is another Russian doping fiasco afoot. In the Yahoo Sports article Tygart called the excuse, “classic diversion by the Russians.” Tygart goes on to say, “This drug doesn’t just show up in your water somehow, my guess is … there is likely someone else behind how she got this drug. Again, I don’t know the facts. But clearly you have enough to ask those kinds of questions and demand answers to them.”
We don’t know the facts either but the theories are flying. Could a rogue doctor or trainer have been responsible for giving her something? The Russians are investigating and I don’t think anyone would want to be one of the targets of that investigation. Looking for a scapegoat perhaps? There have certainly been cases where support personnel have doped athletes, both purposefully and accidentally.
Tygart’s comments to Yahoo Sports are quite interesting as they allude to another possible reason Valieva, or any other athlete for that matter, could test positive for trimetazidine or other drugs. That is contamination of food, prescription drugs, and yes maybe even water.
The research has actually proven that water, and even crops, could be contaminated with drugs banned in sport, even trimetazidine. A 2021 summary by Polish researchers explored the concern that pharmaceuticals may appear in water and pointed to 826.7 ng/L of trimetazidine that was found in raw wastewater in Poland with 457.8 ng/L in treated wastewater. Other banned substance categories like stimulants, hormones, diuretics and beta-blockers were also found in variety of water samples. A U.S. Environmental Protection Agency poster presentation demonstrated how drugs banned in sport could infiltrate crops irrigated with treated wastewater. This highlights the unfortunate reality that not all drug residues are removed during water treatment and that irrigation with treated wastewater can result in contamination of crops.
The possibility of contamination causing positive drug tests is well noted both in World Anti-Doping Agency (WADA) regulations and also in prior doping cases that have established a precedent for innocent sources like meat to be considered a likely source of a positive. WADA has now accounted for meat contamination in a technical letter outlining, “Minimum Reporting Level for Certain Substances Known to be Potential Meat Contaminants.” The document explains special thresholds to avoid innocent positives from clenbuterol, ractopamine, zeranol and zilpaterol. But are those the only potential meat contaminants?
A patent application filed in 2016 for ‘Extended Release Formulation of Trimetazidine’ describes in the abstract that, “The present invention relates to a dry ready to use modified release dosage formulation for Trimetazidine dosage forms and its salts and derivatives thereof,… also use thereof as additive to animal feeds, foods and food supplements and also cosmetic and pharmaceutical compositions.” With use in animal feeds outlined this would seem to establish a possibility that trimetazidine could not only show up as a water contaminant in the environment but also as a possible meat contaminant.
Trenbolone is a commonly used anabolic steroid implant used in the livestock industry today and yet there are no thresholds to account for it as a possible meat contaminant. This was a primary concern in the case of Alex Wilson, a Swiss sprinter who tested positive in March of 2021 for epitrenbolone, a metabolite of trenbolone.
The Sports Integrity Initiative suggested a review of meat contamination was needed after the Swiss Olympic Federation was rebuked by WADA and the Athletics Integrity Unit of CAS for considering meat contamination in Wilson’s case and voiding a provisional sanction. The sanction was reinstated by CAS and it kept him out of the Tokyo Olympics. The article notes, “when trace amounts of known meat contaminants are involved and a proffered explanation has already been accepted as likely, it seems a little perverse for anti-doping to celebrate ending an athlete’s Olympic dream.”
Meanwhile, Carl Grove, a 90-year old American cyclist, set a world record in his age group in the Masters Track National Championships in 2018 only to test positive for the same drug epitrenbolone. USADA investigated and in their statement relieving him of any sanctions they noted, “Grove provided USADA with information which established that the source of his positive test was more likely than not caused by contaminated meat consumed the evening before competing on July 11, 2018. Prior to consuming the meat, Grove had tested negative for prohibited substances during an in-competition test on July 10, 2018.” Grove was allowed to keep his result and world record.
This crazy case prompted The New York Times to delve deeper in a 2019 review that included an interview with USADA’s Tygart. “Cases like this make us bang our head against the wall,” said Travis Tygart, the agency’s chief executive. “They’re not right.” He goes on, “I don’t think the meat industry has changed significantly,” Tygart said. “The issue is now that the labs can see so much farther down that the likelihood of capturing something increases.” In conclusion the article notes, “Tygart and Usada are pushing for changes when the World Anti-Doping Agency revises its rules in November. Tygart said he backed putting in minimums for some substances that don’t have them to help ensure that tests were not merely finding environmental contamination. He also said he believed that “no fault” cases, like when tainted food, water or medicine is ingested accidentally, should not be a violation or be publicly announced.” “It absolutely breaks my heart to see a case like this with Carl,” Tygart said.
The article notes a key fact, that any amount of a substance that has no thresholds, like epitrenbolone and trimetazidine, is a violation. “Usada is confident the positive test occurred because of the meat. Sophisticated modern testing methods showed that Grove had less than 500 picograms of trenbolone, “an extremely low level,” Tygart said. But there is no established legal minimum level of trenbolone; any amount is considered a positive.”
It appears that USADA made an exception to the rules in Grove’s case based on their investigation of the circumstances and the conclusion that the most likely reason Grove tested positive was innocent consumption of contaminated meat. Similar to what the Swiss Olympic Committee considered in Wilson’s case. Could similar reasoning be the reason why RUSADA overturned their initial provisional suspension of Valieva? Likely not since the RUSADA investigation appears to have only taken one day, but it is possible.
The case also highlights one of the challenges we face with the advancement of anti-doping testing capabilities. Today we can detect down to a fraction of a picogram (part per trillion) whereas a decade ago we were only able to see down to the low nanogram (parts per billion) level. With a thousand fold increase in the sensitivity of drug tests the timeframe of detection has drastically expanded. However, this also increases the possibility of finding miniscule amounts of substances that result from inadvertent and in many cases unavoidable ingestion of contaminated supplements or food.
Shelby Houlihan, one of America’s premier distance runners, tested positive for nandrolone metabolites before trials for the 2020 Tokyo Olympics and is now serving a four year ban. Her case put the meat contamination concern in the spotlight in The Washington Post as she blamed the finding on a pork burrito she got from an Oregon food truck. The contention was rejected by CAS, hence the ban, despite research from the WADA community in 2020 that actually demonstrated the possibility that eating pork from random sources in Germany had a 16.7% chance of making a clean person test positive for up to 24 hours for nandrolone metabolites according to current WADA thresholds. That explanation was simply not believed in Houlihan’s case.
In 2019 The Athletic reviewed several low level positive drug tests in the UFC for Nate Diaz and Neil Magny noting that we live in a ‘contaminated world.’ Both Diaz and Magny had tested positive for tiny amounts of Selective Androgen Receptor Modulators (SARMs) in the double digit picogram realm. When we say tiny we mean tiny, as in an amount equivalent to a grain of salt sliced into 50 million pieces then chopped in half. Both tested positive as a result of supplement contamination and they were relieved of any sanctions after investigation of the circumstances. Article excerpts below note some fascinating considerations that could be relevant in the Valieva case.
“Over-the-counter medicine and prescription medicine may have been contaminated for a long time, but we’re now picking them up,” said Dr. Daniel Eichner, head of the World Anti-Doping Agency (WADA) accredited Sports Medicine Research and Testing Laboratory (SMRTL) in Salt Lake City.
Jeff Novitzky, the UFC’s senior vice president of athlete health and performance who works hand in glove with the promotion’s anti-doping program that is administered by the United States Anti-Doping Agency, believes the problem of contaminants is “getting worse and worse.” This is one reason the UFC’s anti-doping program will fully enact significant changes in the coming weeks.
Novitzky said in Los Angeles during a stakeholder meeting held by the California State Athletic Commission on Oct. 15 to address “common sense” disciplinary guidelines and minimum thresholds pertaining to certain prohibited substances. “But we have seen more and more commonly what I would call benign supplements being positive for prohibited substances. We’ve seen a couple of occasions where a women’s multivitamin having a SARM — ostarine — in it. We’ve seen creatine have prohibited substances. We’ve seen pure protein powder have prohibited substances. We’ve seen prescription medication from legitimate pharmacies be contaminated with prohibited substances. And we’ve seen contaminants at compounding pharmacies, both here in the U.S. and abroad where they’re mixing their own drugs and other drugs they’re mixing getting into a different drug.”
Of the approximately 13,000 individual tests that have been administered under the auspices of the UFC Anti-Doping Program since it began 2015, USADA and the UFC have announced sanctions on 100 athletes. A little fewer than half of them have come with “either definitive evidence or evidence tending to show that those positive tests were results of contaminants and not purposeful doping,” Novitzky told the California commission.
The UFC experience mirrors others with multi-vitamins, creatine, protein, medicine and other benign products often resulting in inadvertent positives. In nearly 50% of UFC doping cases investigations unearth an inadvertent source of the drug in question. This statistic was supported by John Ruger, U.S. Olympic Committee Athlete Ombudsman, who said, “between 40% to 60% of positive test doping results were inadvertent (non-deliberate) cases,” as quoted in a swimmingworldmagazine.com article in 2014. Imagine if that holds true across the spectrum of sport drug testing. So, did Valieva really dope or is it contamination? Flip your coin.
In a progressive move, the UFC now has reporting thresholds for SARMs set at 100 picograms and epitrenbolone set at 200 picograms. As of now, these thresholds only apply in the UFC anti-doping program and have not been adopted in the Olympic movement. There are no reporting thresholds for trimetazidine in the Olympic movement or elsewhere and any amount found is still a positive despite potential sources of contamination existing as noted herein.
Things are not always as simple as they may appear in the doping or anti-doping realms. There are many innocent and inadvertent reasons why an athlete could test positive. The problem is those same reasons also give accused athletes who really doped many excuses to point to other than cheating. Sadly, testing alone can’t distinguish between purposeful use that has faded away to miniscule levels over time and accidental use of something that could have been eaten or consumed yesterday.
Nonetheless, sprinter Sha’Carri Richardson tested positive for marijuana at the U.S. Olympic Trials just before Tokyo and lost her chance to compete at the Games while serving her one-month ban. Shouldn’t something like that have happened to Valieva? We are now at 49 days and counting since the positive sample was collected and Valieva is still on the ice with a possible gold medal in hand and likely more to come if she is allowed to continue in individual competition that starts Tuesday. That is simply outrageous regardless of whether she is the next poster child of Russian doping or an innocent victim of contamination called out by advancements in testing capabilities. Purposeful, accidental, or a mistake not declaring therapeutic use, all deserve some kind of sanction.
Sadly we may never know the real reason Valieva tested positive but we will all be witness to how the Olympic movement handles the case, and so far it is not looking good. The CAS decision is due Monday morning Beijing time. The world will be watching.
Russian doping has been at the forefront of people’s minds as the 2020 Tokyo Olympic Games fade in our memories and we prepare for the 2022 Beijing Olympics to begin in February. The state-sponsored doping that culminated at the 2014 Sochi Olympics continues to cast shade over Russian sport–excuse me, the Russian Olympic Committee (ROC)–and indeed global competition, as the ensuing discussion and veiled accusations mar the Olympic spirit. But perhaps people should also be concerned about Russian doping of a different sort, one that is not often considered but should be. History has shown that athletes use Russian and Eastern European drugs as doping agents and yet few are prohibited today.
The World Anti-Doping Agency (WADA) Prohibited List outlines the substances that are banned in international competition including the Olympics. The 2021 WADA Prohibited List consists of 333 compounds listed by name, but the inclusion of catch-all language also prohibits related substances in many product categories. To be found, however, drugs have to rise to a level of concern and be targeted first and the WADA list primarily focuses on drugs of Western origin. Only four drugs of Russian or Eastern European origin appear to be included. Certainly there are others out there that would be attractive as doping agents.
Let’s take a look at the four drugs on the WADA Prohibited List that are of Russian or Eastern European origin and explore alternatives that athletes may be using today.
The story starts with bromantan, which was developed in the 1980s at the Russian Academy of Medical Sciences in Moscow. It can be found under the brand name Ladasten and is technically an actoprotector. Research out of Korea in 2012 explored bromantan in The Pharmacology of Actoprotectors: Practical Application for Improvement of Mental and Physical Performance. The writers described actoprotectors as “synthetic adaptogens with a significant capacity to improve physical performance.” The literature noted, “Bromantan was first found in an athlete sample at the 1996 Atlanta Olympics and was officially banned in 1997 as a stimulant.” There have been 11 adverse findings for bromantan in the WADA system since 2006.
Perhaps this is not surprising as a perfect alternative, bemitil, also known as metaprot, is described in the literature above and remains widely available online today, often at sites that offer Russian medicines or nootropics. The paper above explains that “nowadays, bemitil is manufactured in Ukraine (commercial name: Antihot) and is widely used in preparing Ukrainian national sport teams for international competitions.” It also notes, “Bemitil was successfully employed in preparing the athletes of the USSR’s national team for the 1980 Olympic Games held in Moscow.”
“Bemitil was successfully employed in preparing the athletes of the USSR’s national team for the 1980 Olympic Games held in Moscow.”
Bemitil was added to the WADA monitoring program list in 2018, 38 years after the Moscow Olympics you will note, but is not yet prohibited. If it does get prohibited, fear not there are alternatives for it, too. A site that sells Eastern European drugs like bemitil, MOSPharma.com, suggests four related products including noopept (see below) and trekrezan “from Russian pharmaceutical company Usolye-Siberian CPP,” with activity that “increases endurance during physical and mental stress.”
Next on the list of Russian doping agents is mescocarb, a central nervous system (CNS) stimulant and a dopamine reuptake inhibitor patented originally in Russia in 1970 by Vni Khim Farmatsevtichesky. Also known as Armesocarb, it is currently in clinical trials as an antiparkinsonian drug from Melior Pharmaceuticals. It has been sold under the brand name Sydnocarb with a nod to the technical chemical category in which it fits, mesoionic sydnone imine. Mesocarb does not appear to be widely available today online. It has been prohibited in sport since at least 1996 based on references to it at that time, but it has only been responsible for two adverse analytical findings since 2006.
There are also Russian alternatives to CNS stimulants with semax as one option. A poster on black market products with suspiciously doping relevant ingredients – annual report from the 2016 Manfred Donike Workshop discussed that semax “acts as a nootropic agent on the central nervous system and regulates dopamine and serotonine levels.” MOSPharma.com describes semax as “100% original from the Russian CJSC INPC Peptogen,” and notes it is used “to stimulate the central nervous system and enhance memory, focus, mental and physical performance, analytical skills.”
Carphedon, otherwise known as phenylpiracetam, is the next on our list and one of a family called racetams that are generally considered nootropic drugs. In 2019, researchers from the Czech Republic considered Carphedon at the Crossroads: A Dangerous Drug or a Promising Psychopharmaceutical? They explain this substance was “developed in Russia as a stimulant to keep astronauts awake on long missions, and occasionally used in Russia as a nootropic prescription for various types of neurological disease.” Carphedon “was synthesized in 1990 by Russian chemists as a combination of two drugs, nootropic piracetam and amphetamine stimulant.” A 2012 review of Piracetam and Piracetam-Like Drugs describes them as “modulators of cerebral functions,” used for, “various therapeutic interventions relating to the CNS, including (i) cognition/memory; (ii) epilepsy and seizure; (iii) neurodegenerative diseases; (iv) stroke/ischaemia; and (v) stress and anxiety.”
Handwritten notes from 1997 show carphedon was considered by my father, sports drug-testing guru Dr. Don H. Catlin, and colleagues at the IOC Medical Commission for addition to the prohibited list at the time. The notes describe carphedon as, “adaptogenic, registered in 1994 in Russian pharmacopeia that might help with space travel and improve workload.” The drug has caused 122 adverse analytical findings since 2006.
If you peruse the piracetam review highlighted above, you will find nine other racetam options that may be considered as doping agents. None is listed by WADA today. Neither is noopept, otherwise known as omberacetam, which has become one of the most popular nootropic agents on the market today. The National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) notes that “noopept was patented by Russian-based pharmaceutical company JSC LEKKO Pharmaceuticals in 1996.” The information cites that the “research shows Noopept has similar effects, but works differently than other nootropics in the racetam-family.” A number of sites compare the effects of phenylpiracetam to noopept with nootriment.com, suggesting that “both are purported to have benefits for memory, concentration, mood and alertness.”
From a banned substance standpoint, phenylpiracetam is on the WADA Prohibited List while noopept is not listed nor is it targeted. A synthetic drug, noopept, is widely available in supplement form despite it not qualifying as a dietary supplement ingredient according to the Dietary Supplement Health and Education Act of 1994 (DSHEA), which defines legal supplement ingredients in the U.S. It shows up in 32 dietary supplement products in the NIH Office of Dietary Supplements Dietary Supplement Label Database. In 2016 a BSCG blog post I wrote considered noopept could be the next big doping agent hiding in plain sight. That still remains the case today.
Last but not least of the four Russian doping agents is meldonium, otherwise known as mildronate. One will remember the maelstrom that ensued when meldonium was added to the WADA Prohibited List in 2016. There were 515 positive drug tests for meldonium in 2016, making it the most common substance found that year in Olympic sport. Tennis star Maria Sharapova was among them. There were 269 more positives from 2017 to 2019 for a total of 784. Meldonium is included on the WADA Prohibited List as a metabolic modulator in category S4.
Scientists from the University of Latvia and the Latvian Institute of Organic Synthesis that created meldonium, described it as “an anti-ischemic drug.” Its performance-enhancing potential has been the subject of much debate likely because it is a complex substance that has a variety of effects. An excerpt from a 2005 paper written by the aforementioned scientists, Mildronate: An Antiischemic Drug for Neurological Indications, describes it as follows.
“Mildronate was designed to inhibit carnitine biosynthesis in order to prevent accumulation of cytotoxic intermediate products of fatty acid oxidation in ischemic tissues and to block this highly oxygen-consuming process. Mildronate is efficient in the treatment of heart ischemia and its consequences. Extensive evaluation of pharmacological activities of mildronate revealed its beneficial effect on cerebral circulation disorders and central nervous system (CNS) functions. The drug is used in neurological clinics for the treatment of brain circulation disorders. It appears to improve patients’ mood; they become more active, their motor dysfunction decreases, and asthenia, dizziness and nausea become less pronounced.”
The meldonium saga more than demonstrated athletes around the world had recognized an obscure anti-ischemia agent as a doping option and had started to use it. When it was prohibited, Russian scientists boasted they already had alternatives. As reported in USA Todayfrom Moscow, “Federal Medical-Biological Agency head Vladimir Uiba says Russia has found ‘several drugs which are not banned and work significantly better than meldonium.’”
You don’t have to look far. Mexidol is broadly available on sites that cater to Russian medicine as well as on a site called DrDoping.com; very subtle. It is also available on Amazon from Pharmasoft at $21 for 50 tablets with a label that suggests it be used for “Anxiety Relief, Anti-Stress, and Ischemic Condition.” Mexidol, an anti-oxidant, was patented in 2002 in Russia with the patent describing the “invention relates to preparations used for prophylaxis and treatment of different forms of cardiac ischemia disease, atherosclerosis and acute circulation disturbances, cerebral insults.” With indications for ischemic conditions, it certainly appears similar to meldonium.
In a 2007 paper, Mexidol effects in extreme conditions, T.A. Varonina with the Institute of Pharmacology, Russian Academy of Medical Sciences notes, “Mexidol can be prescribed to humans to maintain efficiency in all kinds of extreme situations.” Could hundreds of Olympic athletes be using mexidol as an alternative to meldonium today?
A 2019 review from Russia of Pharmacoeconomic analysis of the neuroprotective medicines in the treatment of ischemic stroke compares mexidol to actovegin, which gained some notoriety as a potential doping agent around 2009 as explored in the Daily News. Actovegin, which DrDoping.com carries in pill form, is an extract from calf blood and is not on the WADA Prohibited List. In the article Olivier Rabin, WADA’s science director, suggests, “Actovegin could be used as a component of sophisticated blood doping methods, in which athletes withdraw, manipulate, and re-inject their blood to boost their endurance, or in conjunction with the use of erythropoietin, or EPO.”
When we ran independent drug-testing programs for several leading cycling teams in the peloton years ago, a key member of a team said to me after an event, “You know, Oliver, we aren’t doing anything that is over the line but we are doing everything we can up to the line.” That simple philosophy likely rings true across sport today.
People often ask if the Olympics or sport in general is clean today. To answer that simply, the system is very good at finding drugs that are currently defined as prohibited substances. None of the Russian or Eastern European drugs we note here–bemitil, trekrezan, semax, noopept and other racetams, actovegin, or mexidol–is on the WADA Prohibited List today. These Russian or Eastern European drugs certainly seem to be potential alternatives to prohibited drugs, but if they are not yet defined as such then using them is not yet considered doping. If sites like DrDoping.com has found them, who else might have them?
Oliver Catlin is the longtime president and co-founder of BSCG (Banned Substances Control Group), an international third-party certification and testing provider. With a background in sports anti-doping, he is widely regarded as a thought-leader in the field of sports nutrition and dietary supplements.
Earlier this week, the United States Congress moved closer to establishing federal criminal penalties for international doping fraud conspiracies, such as the Russian Doping scandal that rocked the Olympic world in 2016. “The Rodchenkov Anti-Doping Act of 2019”–controversially named after a chief perpetrator and eventual whistleblower of the aforementioned scandal–was passed by the House of Representatives on October 22. If signed into law, H.R. 835 would establish significant criminal penalties–up to 10 years in prison and $250,000 in fines for an individual–and make it unlawful to “knowingly carry out…a scheme…to influence by use of a prohibited substance or prohibited method any major international sports competition.” Under the Act, such an international competition must (1) have at least one U.S. athlete participating, (2) have at least three non-U.S. athletes participating, (3) be governed by the World Anti-Doping Code, and (4) receive sponsorship or broadcast rights money from a U.S.-based organization.
Importantly, a person’s intention is a key element of the section of the Act establishing criminal penalties. A person must knowingly intend to influence an international competition through doping fraud to violate the Act. Unless the actions of the person are fairly blatant and backed by evidence demonstrating an intent to cheat the system, establishing the “knowingly” element may be a significant bar for a federal prosecutor to clear in many cases. This should largely alleviate concerns of criminal penalties for certain actors who are inadvertently responsible for positive doping tests. This includes dietary supplement companies and executives whose products are found to be contaminated (unintentionally) with a banned substance. However, such potentially negligent actors may still be found responsible for the consequences and face significant civil damages and penalties, as is reaffirmed by the Act.
Another significant aspect of the Act is related to information sharing between the United States government and the United States Anti-Doping Agency (USADA), a non-governmental Colorado non-profit corporation that conducts anti-doping activities for Olympic sports in the United States. Under the Act, the U.S. Department of Justice (DOJ), the Department of Homeland Security (DHS), and the Food and Drug Administration (FDA) are required to coordinate with USADA with regard to any investigation related to an international doping fraud conspiracy, unless the integrity of that agency’s criminal investigation would be affected. This coordination specifically includes that the agencies must “shar[e] with USADA all information in [their] possession…which may be relevant to any such potential violation” of the Act. If the Act is signed into law, this new information sharing requirement could prove to yield a treasure trove of knowledge that may have been previously inaccessible to USADA.
Ryan Connolly is a Los Angeles-based attorney serving as counsel to various businesses, individuals, and dietary supplement / anti-doping-related organizations, including Banned Substances Control Group (BSCG).
USA CRITS 2018 season champion David Guttenplan of the Support Clean Sport/Guttenplan Coaching Team earlier in his remarkable season. Photo by Lee McDaniels, USA CRITS.
On Sunday at the Gateway Cup in St. Louis, professional bike racer David “Gutt” Guttenplan finished with the orange Colavita Overall Leader Jersey on his back after becoming the USA CRITS 2018 season champion. Though Gutt and many observers had expected such an outcome due to his commanding lead going in to the final race, the victory nonetheless resonated with him and all those who care about clean sport.
“With the series, you just never know how it’s going to go,” said Gutt in a post-race interview. “I just have to give a big thanks to (teammate) Tyler Locke. He’s really stepped up, and he’s been getting up there every single time. It’s been great.”
Locke took sixth place overall and their Support Clean Sport/Guttenplan Coaching Team placed second in the team competition. The excellent results cemented their reputation as one of North America’s premiere cycling teams and delighted sponsor Support Clean Sport.
“We’re thrilled for Davey and these guys and all they represent,” said SCS Executive Director Oliver Catlin. “They faced some serious obstacles and have shown that it is possible for clean athletes to reach the podium. The team as a whole worked really hard to help get Davey to this point, and as a sponsor we couldn’t be more proud.”
Many find the personal stories of both Gutt and Locke compelling. Gutt suffered a serious accident while cycling in 2016 that left him in a coma for five days and in need of surgeries. Some wondered whether he would ever compete again. Locke has had to face his own personal obstacles, notably going sober with the help of the bike. He said that when he made a conscious choice to channel his energy into his riding his racing performance skyrocketed and turned him into the capable lieutenant he is today.
Catlin says he hopes the results help to diffuse the naysayers who don’t think clean athletes can compete in cycling. “We’ve never stopped believing that athletes who chose not to dope can still succeed in their sports, whatever those sports might be,” he said. “And when they do best their competitors, they can hold their heads high.”
As the team coach, Gutt echoed these sentiments in an interview prior to the season’s final race. “Doping takes the fun out of it,” he said. “I tell my guys that if you can’t be proud of your results, what’s the point?”
Catlin hopes to build on the success of the 2018 season by expanding Support Clean Sport’s involvement with the Guttenplan team and investing in other teams. With SCS having sponsored Team California Juniors and 706P, Catlin hopes the concept can grow and expand into new endeavors. “We will be fundraising in the coming months to raise money to support these worthy athletes and to help others follow in their paths.”
One new idea Support Clean Sport is considering in the coming year, says Catlin, is a program that helps addicts of various types find a new path through cycling. Such a program would likely include an addiction management campaign and cycling clinics specifically designed for people to combat their addiction problems.
As with Locke, participants in such a program would have a new avenue in which to put their energies and hopes. Gutt and Locke, as well as Coach Sean Wilson of Team California Juniors, have already signed on as willing instructors for such clinics.
“I’m excited about this concept and continuing to grow Support Clean Sport,” said Catlin. “But we can’t do it alone. We need people who care about cycling and clean sport, as well as those wanting to fight addiction, to step up and donate, in whatever amounts that they can, and to show their support for healthy and clean competition.”
Please consider donating what you can to this worthy cause; simply click on the Donate button in the upper right-hand corner of the Support Clean Sport homepage. Donations will go directly to team support and to the launch of our addiction clinics. Join SCS foundational sponsor BSCG (Banned Substances Control Group), a leading supplement and natural product testing and certification provider, in expanding the SCS concept. To learn more about SCS, visit the Support Clean Sport website, like Support Clean Sport on Facebook and follow SCS on Twitter.
Support Clean Sport Executive Director Oliver Catlin (center) joins David Guttenplan and Tyler Locke of the Support Clean Sport/Guttenplan Coaching Team for a practice ride on July 25 in Los Angeles.
David “Gutt” Guttenplan had a vision. He’d been a professional bike racer since 2003, specializing in criteriums, popular cycling races requiring a mix of speed, endurance, and strategy. And he wanted to commit himself even more fully to the sport. He realized he wanted to coach and ride, and in 2010 began working to put a team together. But he wasn’t looking to manage just any team; he wanted his riders to lift up the sport by showing that success can be achieved without turning to performance-enhancing drugs.
“I’ve seen the culture of the sport through all these years, and the one thing that’s always been near and dear to my heart is to do it the right way, because otherwise what’s the point?” he said in one recent interview. “I’d rather be doing something else if I’m going to be cheating.”
Gutt recruited a range of riders, from the young—new to the criterium circuit—to the accomplished—winners of established races. His coaching efforts focused on the less experienced of the group but to all he preached that doping was the wrong path. “Doping takes the fun out of it,” he said. “I tell my guys that if you can’t be proud of your results, what’s the point?”
Soon Gutt found a committed sponsor in Support Clean Sport (SCS), a grassroots movement initiated by the nonprofit/NGO ADR (Anti-Doping Research) and sponsored by BSCG (Banned Substances Control Group), a leading certification provider of a range of products such as supplements popular with elite athletes.
David Guttenplan heads into Sunday’s USA CRITS Series season finale, the Gateway Cup, with a commanding lead of more than 250 points. Unless something unforeseeable occurs, Gutt is likely to take the Colavita Overall Leader Jersey and become the USA CRITS 2018 season champion.
The victory, to be sure, will not just be a triumph for him but for his Support Clean Sport/Guttenplan Coaching Team. Some observers, such as Nathan at the blog A Cyclist in a Strange Land, say it will cement “the legacy of his Support Clean Sport/Guttenplan Coaching team as one of North America’s premier domestic cycling teams.”
“We’re incredibly proud of Davey and all that he has managed to accomplish with his team and his cycling,” said Oliver Catlin, Support Clean Sport Executive Director. “He has proven with his own dedication and drive that it is possible for a clean athlete to reach the podium.”
Catlin added that he also stands in admiration of the entire Support Clean Sport/Guttenplan team. He noted other riders have performed well this season, including Tyler Locke, who enters Sunday’s finale in a close fifth place. Locke has had to overcome his own obstacles, notably going sober 100% from alcohol, but he has seen his racing form skyrocket from channeling all that energy into his winning cycling performance!
Others on the Support Clean Sport/Guttenplan Coaching roster include Stefano Barberi, Adam Farabaugh, Benjamin Foster, Johnathan Freter, Coulton Hartrich, Marcos Lazzarotto, Steven Perezluha, Justin Prior, James “Jimmy” Schurman, Rolly Weaver and Scottie Weiss.
“It’s hard not be in awe of these guys,” said Catlin. “They’ve embraced high standards and embody everything good about sport, demonstrating that a clean approach can fuel teamwork and victory.”
Catlin encourages others to join Support Clean Sport and its proactive vision of clean sport. Anyone, from athletes and sports fans to companies and nutritionists, can be involved in the movement. To learn more about SCS, visit the Support Clean Sport website, like Support Clean Sport on Facebook and follow SCS on Twitter. Consider donating to this worthy cause; simply click on the Donate button in the upper right-hand corner of the Support Clean Sport homepage.
To see David Guttenplan “race for the orange” on Sunday, Sept. 2, tune in to a live broadcast of the event at USACrits.TV, https://usacrits.tv/.
As the Tour de France rolls onto stage 7, few in the general public know of the story of 21-year-old Linas Rumsas, but they need to consider it. Especially on this day, July 13, 2018, the 51st anniversary of cyclist Tommy Simpson’s death.
People ask us all the time why doping control matters. Some argue that it doesn’t and that we should just let folks use what they want. A doping free-for-all. Cynics might say that plenty of dopers have already escaped through the net in sports, at least for a time: Lance Armstrong, Tim Montgomery, Marion Jones, to name a few.
Linas Rumsas was an up-and-coming cyclist whose life was cut short after he abused performance-enhancing drugs. Photo: Team Altopack-Eppela
The story of young Linas, a promising cyclist whose life was cut short after abusing performance-enhancing drugs, reminds us that doping can kill. We would be wise to remember that it has happened before. Linas’ story is one of the saddest we have come across and it powerfully demonstrates why many of us who have chosen to pursue anti-doping continue to do so. This one story illuminates in no uncertain terms the realities of what we all face with the scourge of doping, and yet outside of Italy and frequent readers of Cycling News, few sports fans have probably heard of it.
There have been others who have perished from doping. According to ProCon, which provides a comprehensive historical timeline of doping in sports, the first modern athlete chronicled to have died from doping was the Danish cyclist Knut Jensen at the Summer Olympics in Rome in 1960. Heat was the initial culprit but his autopsy found traces of Ronicol. ProCon describes Ronicol as an amphetamine, but Ronicol would be described more accurately as a vasodilator and can be used as an anti-ischemia drug. Though it is not on the 2018 WADA Prohibited List, it is similar to meldonium in many ways.
Stop to consider that the first drug to have been implicated in the death of an athlete in the Olympics in 1960 is not banned today! Ronicol, otherwise known as nicotinyl alcohol, is not prohibited as confirmed by the Global DRO. Its cousin meldonium wasn’t prohibited by WADA until 2016, when it caused hundreds of athletes to test positive. Some might like to think that doping is behind the peloton, but we fear it may still be in the middle. Just in a form we don’t currently define as doping, like Ronicol.
Fifty one years ago today on July 13, 1967, Tommy Simpson infamously died on the slopes of Mount Ventoux during Stage 13 of the Tour at the age of 29. His death was one of the central moments in anti-doping history. Shortly thereafter that same year the International Olympic Committee (IOC) created the IOC Medical Commission and the first drug testing began at the Olympics in 1968, with narcotics and stimulants making up the initial prohibited list. Steroids were not added until 1975.
There have been other examples of athlete deaths that have been seminal. MLB pitcher Steve Bechler, of the Baltimore Orioles, died during drills in 2003. Ephedrine was indicated as a contributing cause in his premature death, which played a role in the regulation of ephedrine as a dietary supplement ingredient in the United States.
Steroids have played a role in the demise of many young athletes, including Taylor Hooton, Efrain Marrero, and just two days ago, a young 18-year-old Irishman in Limerick. Numerous stories exist of athletes who went too far with blood doping, or performed transfusions the wrong way, leading to dire consequences. Many stories are out there but few are known to the broader sporting public.
Linas Rumsas’ story reminds us that the scourge of doping is still present and that it is just as deadly today as it was in 1967 when amphetamines derailed the promising life and career of Mr. Simpson.
Linas Rumsas is the son of Raimondas Rumsas, who himself was a professional cyclist and took third place in the 2002 Tour de France. After Raimondas’ wife Edita was caught with a van full of drugs on the way home from that Tour, they both received four-month suspended sentences in 2006. Raimondas later tested positive for EPO during the 2003 Giro d’Italia. Sadly, this experience did not seem to deter them from apparently assisting their two children with doping.
Linas rode for the Altopack-Eppela squad in Italy and had already been a national road race champion. But in May 2017, he died at age 21 of a heart attack. It was nearly 50 years to the day after Mr. Simpson had died.
Upon Linas’ death, police searched his family’s home and seized a number of banned substances and medications. In September 2017, his older brother Raimondas Jr. tested positive for the prohibited substance GHRP-6, a peptide that produces natural growth hormone. It seems a cocktail of banned substances and other medications were being used at the family home.
The result of all this has been one family torn apart, again, from doping. Perhaps doping didn’t matter to the Rumsas family either until their son died. But Linas didn’t just die, if the allegations in this case hold true. He died as a result of family support and encouragement to dope.
It gets worse. In the course of the investigation, six people have been arrested in an apparent team-sponsored doping program including the team owner, directeur sportif, pharmacist, and trainer, who stand accused of providing drugs to riders. Seventeen other people are being investigated. Sadly, however, it is too late for Linas.
Unfortunately, the recent decision to allow Chris Froome to ride again with no sanctions after testing positive for elevated levels of salbutamol has called into question the validity and utility of the anti-doping system, again, at least in some people’s eyes. WADA has tried to explain the reasoning now, including clarifying the levels (1,428 ng/ml of urine, when adjusted for specific gravity, which is above the decision limit of 1,200 ng/ml). The reasons may not satisfy everyone, or anyone, but Froome’s case is certainly not a reason to give up on anti-doping.
Linas’ story personifies why giving up on anti-doping is simply not an option and should remind us all that doping is a significant matter. In fact, it is all the more reason to recognize that the failures of the anti-doping system are largely due to a lack of resources and money. For that to change, more people will need to truly understand what is at stake when athletes dope and to demonstrate the will to do more to combat the problem.
Don Catlin, M.D., at Vancouver 2010 Opening Ceremony – Photo by Oliver Catlin
We watched with the rest of the world as the 2018 PyeongChang Winter Olympic Games unfolded. In the face of tense politics, doping scandals, and other controversy, the Olympic ideals still shined through, sometimes in unexpected ways. Having been fortunate to attend six amazing Winter Olympic Games (Don got to go to seven, I think), we figured why not provide some perspective on these. Here is our 2018 PyeongChang Winter Olympic Games Review.
Most Amazing Victory – Ester Ledecka. Who knew someone could win a gold medal in snowboarding and skiing! Some people don’t think that the two sports are compatible, some don’t even want both sports on the same mountain. This woman just went out and ripped it up, twice, however many planks were strapped to her feet. Well done, Ester.
Clean Athlete Awards – Jessica Diggins and Kikkan Randall. In an Olympics marred by the Russian doping scandal, we always appreciate it when you can literally see that athletes are clean. Not that we advocate that a visual determination replace anti-doping testing, but some people you can just tell are not doping. We thoroughly enjoyed watching these ladies win clean, and with amazing smiles! We also appreciate the other courageous cross-country skiers who signed the letter in 2016 demanding a stronger stance on doping, including notably the four Russian women who signed. Thanks to all of you for working to defend your sport from the scourge of doping.
Classiest Athlete – Yevgenia Medvedeva. OK, we admit we watched the ladies figure skating final and it was pretty amazing. The talent and class displayed by all the young ladies is unbelievable. However, one shined above the rest. Despite missing the gold medal by a heartbreaking 1.31 points that even experts could not decipher, this woman took disappointment with amazing class for an 18-year old. She genuinely embraced her younger upstart Alina Zagitova and accepted her silver medal with a smile. She could be overheard saying she “did everything she could.” That statement represents what Olympic athletes are all about. We don’t know much about this Russian athlete otherwise, but in PyeongChang this little Anna Karenina showed enormous class.
Most Notable Olympic Farewell – Lindsey Vonn. Although you leave the 2018 PyeongChang Olympic Games with a bronze medal, which most people could only hope for, you will always be the golden girl of American skiing. You took yourself to the pinnacle of your sport and beyond, and you brought your country with you. Along the way you’ve inspired generations of Olympians for years to come. We wouldn’t be surprised to see a woman like you one more time in Beijing four years from now, but if not thank you for all the amazing Olympic moments.
Strangest Doping Incident – Doping in Curling, really? We thought people drank beer during curling, but doping? Of course it would be an Olympic Athlete from Russia with meldonium as the offending substance, such perfect irony.
Ugliest Controversy – The ugliest controversy in these Olympics goes to the argument between Dick Pound and others in the IOC over whether or not to allow the Russian delegation to be permitted to fly the state colors during the closing ceremonies. It took long enough to finally get some kind of ban enacted and the corresponding statement made that state-sponsored doping is unacceptable, and it was going to be overturned during the Games? Way to go Dick Pound for sticking up for clean sport, as always! Or should we thank the second Olympic Athlete from Russia for doping and closing the door on that argument.
Most Inspiring Olympic Athlete – One athlete that epitomized the ideals of the Olympic movement and displayed them proudly in every fiber of his being by bringing athletes from all nations together sadly was not present in PyeongChang, but he was there is spirit. And his spirit we know will continue to inspire generations of Olympians for years to come. The Olympic Family lost Steven Holcomb, a beloved member of the bobsled community, in May 2017. But in the true spirit of the Olympic movement he went down the track many times in PyeongChang in the form of tribute bracelets on the wrists of many of his sliding colleagues, his parents cheering with tears in their eyes in the stands. Despite not being present, this man, and his spirit, made for the most inspiring Olympic athlete of this Games. We wish we could have known him and been inspired by his spirit.
Most Amazing Olympic Moment – It was hard to miss the unity demonstrated at the Opening Ceremonies with South Korea and North Korea marching together as one. This was a powerful symbol of the peaceful celebration of sport that the Olympics represent. We appreciate that this unity was achieved during the Games, and I think we all hope the peace was more than just for show and lasts.
The Olympics are truly an amazing gathering of athletes from all different countries, politics, races, sizes, sexes, orientations, faiths, and more. For all these moments and more, the Olympic Games remain one of the most amazing spectacles of human interaction and accomplishment in this world. They deserve to be truly appreciated, celebrated, and protected. We can’t wait for the years to pass to see what amazing feats and memorable moments Tokyo, Beijing, Paris, and Los Angeles will produce.
The Catlin Perspective 