The State of doping in triathlon
THE ANTI-DOPING LANDSCAPE
As doping scandals savage the sport of cycling, and track & field reels from a positive test by a world record holder, many triathletes wonder about the state of drug use in their sport.
This question is made more urgent with the revelation that triathlon is the world’s fourth most prolific returner of "adverse analytical findings," according to the annual report published by WADA, the World Anti-Doping Agency.
Baseball returned an adverse analytical finding (AAF) 3.69 times per 100 tests. Cycling returned 3.78 AAFs, and boxing and triathlon were tied, returning 3.41. In contrast, track & field — a sport that is not unfamiliar with drug problems — saw only 1.67 AAFs per 100 tests.
The WADA analysis also included non-Olympic sports and, surprisingly, golf almost doubled triathlon in AAFs, with 5.21 per 100 tests. Oddly enough, triathlon is not as problematic in this arena as are bridge players, 4 percent of whom returned an adverse result, and worse yet were billiards players, where 1 in 10 samples come back with an AAF.
It must be noted that an AAF has a way to go before it becomes a positive test, let alone a failed test. Included in these findings are athletes who have Therapeutic Use Exemptions (TUE) on file. Floyd Landis, as an example, has a TUE for cortisone. While this corticosteroid is technically on the banned list, he is allowed to use it for his ailing hip joint. Likewise, asthmatics are allowed the use of otherwise banned beta-2-agonists, but they must provide a doctor’s letter describing the need and the prescription.
These adverse findings are broken down by WADA into drug classes. About 43 out of every 100 are for anabolic agents (steroids, testosterone), by far the most detected performance enhancer in sport. The next most frequent class contains the beta-2-agonists favored by asthmatics as rescue medications, and 14 out of 100 adverse findings are for these (which are banned because they are reputed to have anabolic effects). Hormones comprise fewer than 4 percent of the adverse findings, and blood boosters are included in this group.
WADA's stats are also broken down by lab, and it's interesting to note the variance in findings between, say, Dr. Don Catlin's lab at UCLA (twice the size of the lab in Cologne, Germany, itself the second largest of WADA's 33 accredited labs) and the Paris-based lab that found a positive sample for Floyd Landis. The Paris lab finds an AAF three times more often than does the UCLA lab, yet the Cologne-based lab, only 250 miles from Paris, produced AAFs much closer to UCLA's rate.
While UCLA's lab returned positives for stimulants at a rate twice that of the French lab, the lab in Paris found a positive for beta-2-agonists 150 times for each single occurrence of that asthma drug in Catlin’s UCLA lab. Paris found glucocorticosteroids 75 times more frequently than the UCLA lab. Both these latter two classes of drugs tend to be associated with cycling, which may explain their more common occurrences in a Paris-based lab which, presumably, tests for cyclists more often than does UCLA's lab.
Adverse analytical findings may not result in a suspension of an athlete for a variety of reasons. Rutger Beke successfully demonstrated that a finding for EPO could be explained by his unusual natural generation of EPO that mimics a positive test. There are the TUEs on file. An athlete might successfully demonstrate that a sample’s chain of custody was unreliable. An athlete’s B sample might come back negative (WADA assures us this very rarely happens; and when the B sample comes back positive as well, that accounts for 2 adverse findings).
Triathlon’s 74 AAFs (out of 2170 total tests during 2005) resulted in the suspension of 3 athletes, one for 3 months, the current suspension of Gold Medalist Brigitte McMahon, and a suspension for Ironman athlete Rebecca Keat (the ITU, when queried, failed to list Keat's suspension). This begs the question, what of the other 70 or so adverse findings? How many were mooted by TUEs on file? How many were set aside as a result of protests and hearings that cleared the athlete? What classes of drugs are triathletes taking that account for these adverse findings?
The International Triathlon Union (ITU), has responded to triathlon's high percentage of AAFs by placing the issue on its next Congress. But it doesn’t consider this high number of adverse findings problematic. Rather, it stated, "WADA produced doping control tests which indicated that our ITU Triathletes were the 4th highest in the World and have now acknowledged that is not the case, quite the contrary in fact. Therefore we thank WADA for resolving this problem."
Nevertheless, WADA appears prepared to stand behind its numbers, even when apprised of the ITU's statement above. "These statistics come from the WADA-accredited laboratories around the world and are compiled by WADA as mandated by the World Anti-Doping Code," explained WADA’s Frédéric Donzé. "As explained to sports federations including ITU, these figures represent the number of adverse analytical findings reported by labs and not necessarily the number of sanctioned cases."
It remains to be seen how the ITU intends to refute these numbers at Congress or at any other time. Perhaps a clue can be divined in how the ITU worded its statement, specifically in the phrase, "our ITU Triathletes." As we shall see, the ITU differentiates between how it handles drug issues with what it calls "ITU athletes" versus those who race a format other than the Olympic-style format raced in the ITU's World Cup Series.
The WADA statistics to which the ITU responded were not, or should not have been, a surprise. In accordance with a WADA circular to its labs, an adverse finding must be reported to the entity requesting the test, as well as to WADA, and finally to "the responsible International Federation" (WADA Intl Standard for Laboratories, 5.2.6.10).
In other words, as these adverse findings were rolling in from labs around the world throughout the 2005 season, the ITU was apprised of them all. The ITU, when pressed on the issue, doesn’t refute WADA's stats. But it couldn't lay its hands on the data either. It replied, in the person of its Technical and Doping Director Leslie Buchanan, "You would have to contact WADA because it was their report and they have access to all this information."
Buchanan also referred us to WADA for a list of the athlete's TUEs. USAT's Sport Performance Director Scott Schnitzspahn routes the TUEs differently. They, "are usually sent here to Katie [Baker] who sends them through to USADA, who submits them to ITU. Perhaps some go straight from the athlete to USADA then to ITU. Either way, USADA keeps all the TUEs on file in the USA." In a later interview, Buchanan stated that she sets aside any adverse finding when there's a TUE on file, a further indication that the ITU not only is apprised of AAFs when they come it, the ITU also can match up the TUEs with any adverse findings.
When one looks for that organization which is in possession of all the triathlon doping data worldwide, all roads keep coming back to the ITU. It appears that all adverse findings, and all TUEs that would help qualify these findings, are sent to triathlon's world governing body.
It should, then, be able to provide a breakdown of the 74 adverse findings by class of drug. It should be able to tell us how many of the adverse findings are mooted, because of the TUEs on file. How many went all the way to positive? How many athletes accepted their suspensions? How many appealed? Were these appeals handled by the national federations, by the ITU, or by CAS? How did they turn out?
What would be the value of these statistics? Recall the Paris-based WADA lab, and its beta-2-agonist rate 150 times higher than that of the UCLA lab. Were this indicative of triathlon's adverse findings, we might want to consider, sportwide, whether we had an abuse problem, TUEs notwithstanding. Remember billiards players, with their sky-high rate of adverse findings, and consider archery, which returned a rate not far behind triathlon. Their preferred doping method would entail the use of beta blockers, to slow the heart and calm the body. Were any of triathlon’s 74 adverse findings for beta blockers, you'd dismiss these findings as non-impactful on our sport. In short, it might be instructive to know the breakdown of these 74 adverse findings.
What of the findings that result in a bona-fide positive A sample, as was the case with Floyd Landis and testosterone? How did triathlon handle these positives in 2005? Did many double positives go to hearings, only to have the bans overturned? In this case, triathlon would have to wonder whether it's hiring bad lawyers, or prosecuting a type of doping violation it ought not prosecute. What if a sport's positives did not result in suspensions because of tests from a lab rife with chain-of-custody problems? The triathlon world simply could not know these things unless it accounts for all its AAFs.
There are graver concerns yet. What if one current suspension out of more than six-dozen adverse findings is indicative of a meek federation that seeks to hide its dirty laundry under the carpet? Unlikely as this is in triathlon, it appears a question less easily answered absent a federation opening its books and accounting for its AAFs, removing any doubt as to that sport's competence and commitment to fair play.
Finally, when considering doping policies, what if a sport treats one class of athletes very differently than another and prosecution, statistics, policies, budget, energy and diligence varied widely between these classes? We will consider just this question in Part II of our investigation.
ITU VERSUS NON-ITU ATHLETES
Drug tests are carried out by what WADA calls "testing authorities." In the United States, the testing authority is usually the U.S. Anti-Doping Agency (USADA). This organization has taken over for the USOC, and is run autonomously. Practically all testing in triathlon is executed with USADA as testing authority, when the race occurs in the United States.
During 2005 USADA conducted 233 tests on triathletes, 79 of which occurred out of competition, the balance of 154 occurring at events. USADA chooses events at which to test almost entirely off recommendations provided it by USA Triathlon. These events are comprised of Olympic-style formats, Ironman racing, XTerra racing, in short, any sort of event USAT might sanction.
Triathlon testing in the U.S. will almost certainly increase during 2006, as the WTC and USAT now add to USADA's drug-testing budget. Virtually all Ironman licensed full-distance races, and many 70.3 events, will feature drug testing as a result of this program.
USADA also incurs the responsibility and expense of adjudication: what it calls "results management." Happily, USADA had no triathlon "results" to "manage" in 2005. There were no adverse analytical findings among any U.S. athletes at any race anywhere in the world, neither were there any AAFs generated at any U.S. races. This is the information provided to me from USAT's elite program manager Scott Schnitzspahn.
As we shall see, however, Schnitzspahn is not necessarily in a position to know of certain results. First, it would be hard for USAT to say with any surety what adverse findings were generated by U.S. athletes abroad, because such notification would only come from the ITU, and the ITU has already established that it treats AAFs covered by TUEs as 'non-events' and the 'AAF trail' stops then and there. Second, what if an adverse finding comes to the ITU from an American athlete racing in an XTerra, or Ironman, event in Europe, or South America, or Australia? More on this below.
We do know that whatever testing was carried out in 2005 in the United States generated no adverse findings, either at events or in out-of-competition testing, and this includes athletes from the United States and any foreigners tested under USADA's direction. We'll have to look elsewhere for those 74 adverse analytical findings. Where are they?
Ms. Buchanan, the ITU's Doping Director, was posed the following question: "Let's say that two athletes, a male [whom we named] and a female [whom we named] generated AAFs after Ironman Lake Placid. Would you be interested in following up on these results?"
"We would on [the female], because we'd expect to see her at ITU World Cup races," Buchanan replied. (The male we named is only a long-course athlete who specifically races WTC events.)
Buchanan was frank in her statements that the ITU has only so much time, money, staff, and its focus is on keeping the ITU-style events and athletes clean. The ITU is sufficiently honed-in on the World Cup, and World and Regional ITU-style racing, that it's sometimes the testing authority itself, as is occasionally the case with the UCI in cycling, and the IAAF in track & field. There is no question that the ITU is interested in the doping aspects of these events.
And why not, since this is the basis for triathlon's Olympic inclusion, and virtually all the ITU's money flows from sponsors, TV revenue and rev/share agreements that intersect almost entirely with Olympic-style racing.
"Would it be fair to say that the ITU is not the proper place to inquire," Ms. Buchanan was asked, "if I'm looking for a list of suspensions of non-ITU-style triathletes?"
"Yes," she replied, "I would say that would be fair." Perhaps that explains why Keat's suspension was not referenced when Ms. Buchanan was asked what suspensions are currently being served in the world of triathlon.
"The ITU does not catalogue, or database, or follow up on, these adverse findings, except that it does take note of suspensions. Do I understand this correctly?"" I asked.
"You are correct," was the reply, "in saying that I do not follow up on tests that do not involve ITU or athletes."
In the context of the verbal interview, Ms. Buchanan referenced the ITU-style events as most critical to the organization, and also the athletes that follow the World Cup circuit. Applying this context, it appears what Ms. Buchanan refers to by "ITU or athletes," is "ITU events and ITU athletes." She does, however, note that the Long Distance Triathlon World Championships, the status of which is bestowed by the ITU, is an event triathlon's world governing body will monitor for drugs.
What of the other long-distance races, specifically WTC's 70.3 series of half-Ironman events, or the full Ironman distance races? What of Quelle Challenge Roth, Fredericia, and Lifetime Fitness? What of XTerra events, and the racers who compete in them?
Buchanan specifically mentions XTerra as an event style that the ITU does not monitor, and for an understandable reason. In 2004 the following Resolution 10 was passed at the ITU Congress:
"Whereas, the following competition formats are not recognised by ITU and do not operate under the various legal and technical requirements of ITU: Ironman, Powerman, X-Terra; Battle of the Sexes [Lifetime Fitness];
"And Whereas, the ITU agreement with the World Anti-Doping Agency (WADA) is intended to cover only those events under the jurisdiction of ITU;
"And Whereas, the responsibility for all doping related matters from the above list of competitions including hearings and penalties lies directly with the sanctioning National Federation and the WADA affiliated testing agency;
"Therefore be it resolved that in agreement with WADA, ITU is not responsible for any item related to the above mentioned competitions, but most particularly matters related to WADA."
It is clear that the ITU, having "bought" the sport of triathlon worldwide when it became triathlon's world governing body, has specifically excluded "ownership" of the anti-doping governance for a fairly wide swath of the sport. Much of triathlon is largely stateless — a sort of 'sporting Palestine' — as regards worldwide governance. This not only extends to rules of competition, and the definition of how one becomes a "pro" or "elite" athlete, but specifically as regards doping.
Remember, a WADA affiliated lab only reports to WADA, the testing authority, and the international federation. If not the ITU, who worldwide is available to compile triathlon's doping statistics? Who makes sure the national governing bodies are exercising proper processes, when it comes to drug results at XTerra or Ironman races? Who compiles and presents to the world the list of suspensions all countries must honor, according to WADA's code? Apparently not the ITU, if it's an Ironman, 70.3, XTerra, or any race with a format like that employed at Lifetime Fitness.
This begs the question, what is the ITU's strategy for dealing with triathlon's 74 AAFs sportwide in its September Lausanne Congress, since WADA does not descriminate between Ironman, XTerra and ITU-style doping results? What does the ITU mean by saying, "Our ITU Triathletes were the 4th highest [per capita producers of adverse findings] in the World [said WADA, yet they] have now acknowledged that is not the case, quite the contrary in fact."?
The cynical man might suspect that the ITU is prepared to defend the honor of the athletes who race its World Cup series, and throw XTerra and Ironman athletes under the bus. But this might be hard to do, as evidence grows that these "non-ITU" athletes also tend toward testing negative. USADA tested at two XTerra events in 2005, the Keystone race and the World Championships in Maui. In both cases, no AAFs occurred.
Likewise, races comprising part of what we might call America's "classics" were among USADA-tested events: Treasure Island, Boston Monster Challenge, Escape from Alcatraz, St. Anthony's, and of course the biggie, Lifetime Fitness. Again, no AAFs.
Certainly the larger ITU-style events were the subject of USADA tests, including the Honolulu World Cup, Baker's Breakfast Tri in Bellingham, and the NYC Continental Cup. All negative.
Also negative was Powerman Alabama, and the half-Ironman event in Florida. Finally, the Hawaiian Ironman was a USADA-tested event, and no AAFs were generated by this race either.
Remember as well that about a third of the 233 tests USADA carried out in multisport last year occurred out-of-competition. These also failed to unearth a single adverse finding.
All this narrows the list of rocks underneath which these 74 adverse findings can hide.
Circling back to the source, we do know two entities that can provide with precision where these adverse findings took place, at which labs, and for which drugs. Both WADA and the ITU can provide this data. WADA will not know whether TUEs were in place, and what eventually occurred as a result of the adverse finding. But the ITU does or could know this, and it's just not telling or they have discarded the data.
Is it a burden to ask for an international federation to act as the central clearinghouse for this information? "The IAAF [world governing body for track & field] used to send us updates on who was on suspension," said Jill Pilgrim, general counsel for USA Track & Field. "Now it posts the info on its website."
"Let us say [USATF executive director] Craig Masbach ordered up an accounting of all USATF’s adverse findings from 2005, could you generate that for him?" Ms. Pilgrim was asked.
"We don’t have it on a spreadsheet, but we could provide him an accounting, yes."
Similarly, USADA produces in its annual report a "Classification of adverse findings," which lists the number of findings broken down into classes of drugs, which are U.S. cases, and which are referred to international federations (out of 31 total adverse findings, 6 were referred to IFs, leaving 25). It is interesting to note that out of 25 adverse findings generated by Americans in IOC-affiliated sports during 2005, 9 resulted in suspensions, and 10 are still in the adjudication process. These statistics give the impression that USADA's ability to bring a case to suspension is robust.
At the same time, a USADA spokesman was unclear whether therapeutic exemptions were subtracted to yield the 25, or whether the 6 findings for which "no violation" was found includes TUEs. It appears that USADA's stated number of "adverse findings" is unreasonably low, especially when one considers that the UCLA lab alone returned 531 adverse findings last year. One would think that WADA's stats from the UCLA lab — the only one in America — would roughly match USADA's stats. In this case, if you do the math, what USADA calls its "adverse findings" are really the findings after more than 90 percent had been dismissed via some mechanism, and therapeutic use exemptions seem the most likely guess.
Applying that math to triathlon, where 74 unaccounted-for adverse findings should have resulted in 4 or 5 suspensions. We have in place two, one for an ITU athlete and one of an Ironman athlete.
While it's possible the sport of triathlon is "behaving," there is a gaping void in accountability, and a lot of adverse findings to explain.
The largest outstanding question to this reporter concerns the 531 "Adverse Analytical Findings" generated by the UCLA lab, according to WADA, and the 31 total "Adverse Findings" during the same 2005 year according to USADA. Assuming Dr. Catlin's WADA-specific results, and USADA's results, are reasonably analogous in size, where are the missing 500 adverse findings? Certainly the difference can be explained by TUEs, in which case WADA and USADA simply use different nomenclature.
Also, WADA's Mr. Donzé reminds us, "As for the UCLA lab, it does not analyze only USADA samples, but other organizations' samples as well (international federations, professional leagues or other organizations outside the Olympic Movement) that may not be part of the WADA Lab Statistics." But WADA does separate Olympic from non-Olympic results, and 414 of UCLA's 531 results were for Olympic sports, according to WADA's stats.
In any case, it seems odd that such a high percentage of tests are somehow ineligible for consideration because of a therapeutic use exemption. Is the entire sporting world on asthma medication? It seems not, since only 2 of UCLA's 531 AAFs were for beta-2-agonists.
LIES, DAMNED LIES, AND "ADVERSE FINDINGS"
One always hates to explain the joke, but doping is a prickly subject and in the course of my interviews I've noticed folks are often skin-sensitive. So let me say right out I'm accusing no one of telling falsehoods. The famous Benjamin Disraeli phrase, "Lies, damned lies and statistics," is apropos here because these damnable statistics impede our understanding of the mythical 74 adverse findings WADA told the world the sport of triathlon generated in 2005.
An "adverse analytical finding," according to WADA, describes any laboratory test that uncovers the existence, in an athlete's blood or urine, of a banned substance; or a substance in a saturation over the allowable threshold limit; or two allowable substances occurring in rarely seen ratios in the human body (absent doping).
Many or most of these "paper positives" are eventually determined not to warrant disciplinary action against the athlete. In this case, the entity tasked with "results management" finds "no violation" has occurred.
What causes a finding of "no violation?" The athlete might have a "therapeutic use exemption," such as Floyd Landis' TUE for cortisone, or an asthma sufferer's TUE for his inhaler. An athlete might naturally produce an unusual amount of red blood cells, testosterone, or EPO. It might be determined that metabolites of an anabolic steroid naturally occur in an athlete's body.
During the past two or three years anti-doping agencies have given an accounting of their test findings in an annual report. It was WADA's annual report that caused a stir in triathlon, by ignominously announcing to the world that this fair sport is anything but, with only cycling and baseball outpacing it in per capita adverse findings. Onward, then, went the hunt for these 74 eyebrow-raising test results.
As previously reported, no "adverse findings" occurred in triathlon in the United States, neither among U.S. athletes racing anywhere in the world, nor among anyone in the world racing in America. At least this is the way it was reported to USA Triathlon.
But we do not, in fact, know whether U.S. athletes racing in other countries have produced a positive result. Let us say the testing authority in Germany, or Australia, finds a high T/E ratio in an American athlete in a test conducted either in or out of competition. What does this testing authority do? Usually, the case is referred to the international federation. In triathlon's case, one might conclude there is no international federation if we're talking about athletes who race Ironman, XTerra, Powerman (really anything outside of the ITU's chosen sphere of interest, and it's questionable how expansive that sphere is). So what happens when the International Triathlon Union receives a test result? "I do not follow up on tests that do not involve ITU or athletes," replies the ITU's doping officer, Leslie Buchanan. Accordingly, how would USA Triathlon know if there's an adverse finding generated by an American athlete who races the Ironman distance overseas?
Back to the question of athletes racing on U.S. soil. Is it really true that none of them generated an adverse analytical finding during 2005? So says USAT's high performance manager, Scott Schnitzspahn, and he's getting his info from USADA. But is this in fact the case? We asked USADA's editor of its annual report, Carla O’Connell, and were told that any TUE's were part of the 31 total adverse findings that listed in USADA's annual report.
Still, 31 total findings, out of roughly 8000 tests conducted across all Olympic sports just did not make any sense. This averages out to 0.4% of all tests resulting in adverse findings, and out of the 40 or so Olympic sports, WADA lists only luge and softball as having adverse findings that low.
Several days later, after speaking to both the USOC and USADA general counsels, I received a phone call from Ms. O'Connell, saying that there were in fact three (of what WADA calls) adverse findings in triathlon, involving two athletes, in each case for high T/E ratios. It was explained to me that these adverse findings resulted, after investigations, in no violations, because the ratios were shown to be naturally occurring in the athletes' bodies.
I have no doubt that USADA exercised due care in the case of both these athletes, and I'm comfortable that were there a justification in either case for USADA levying a suspension, one or more would've been levied. At the same time, according to WADA's definition, the tests demonstrating these high T/E ratios were, in fact, "adverse analytical findings." In other words, when looking for these 74 adverse findings WADA says triathlon generated, we've just located 3 more of them, but not without digging into hardpan with picks and shovels.
There is no doubt that a high T/E ratio constitutes an adverse finding according to WADA's nomenclature, even if such high ratio (the threshold of which has been successively lowered over the years, yielding an increasing number of false-positives) is easily explanable. Speaking of thresholds, it is also apparent that USADA's threshold for "adverse finding" is higher than is WADA's. The World Anti-Doping agency considers any adverse "A" sample descriptive of a nominal or technical "adverse finding." The U.S. Anti-Doping Agency obviously considers an "adverse finding" something more serious or problematic, based on two pieces of evidence: triathlon's T/E ratios would've been considered by WADA adverse findings, but were not so labeled by USADA; and WADA's worldwide rate (2.12% of its labs' tests generate adverse findings) is five times higher than USADA's rate.
This means three things. First, that the anti-doping world has a nomenclature problem. WADA, USADA, and the rest of the anti-doping agencies need to decide upon a definition of "adverse finding." If "adverse findings" were currency, and USADA's annual report omitted 80 percent of its dollars because they were dollars that just didn't rise to the occasion of meriting mention, there would certainly be a hue and cry. Arguably, USADA's adverse findings are more dear than currency, and need that much more close husbanding, that is, in the world of anti-doping the "adverse finding" is more mighty than the almighty dollar, so it behooves the anti-doping world to play less fast and loose with its nomenclature.
Second, which organization's statistics are more illuminating when it comes to helping the world fight doping in sport? Is WADA's expansive accounting akin to the movie editor falling in love with his footage, giving us a 4-hour miniseries instead of the 90-minute movie we want? Or is WADA giving us our properly-edited movie, and USADA's annual report the movie's trailer? Are we supposed to trust USADA that the movie itself was Oscar-worthy?
I am not sufficiently wise to know which organization's approach is more prudent, but I can conceive a value in giving us the entire picture, even if it's the miniseries we must wade through. For example, what if triathlon's pair of unusually-high T/E ratios was really an octet? Or instead of 8, what if it was 18? At what point would the triathlon world have wanted to know this more expansive story, and not simply how many total tests resulted in suspensions? What if triathlon had a rate of beta-2-agonist usage sevenfold higher than the rate in the general population? Doctors notes and spirometer tests notwithstanding, wouldn't we like to know this, so that we could determine for ourselves whether we might have an abuse problem in our sport?
There is a third question still unanswered. Who will account for these 74 adverse findings WADA says triathlon generated last year? Through much toil I've so far found 6. WADA says it's not its responsibility to generate any further accounting, even though it's within WADA's power to, within 30 minutes, tell us the class of drug, the lab, and the testing authority, behind what Disraeli would call these "damned lies." While both WADA and the ITU can provide detail behind these adverse findings, neither has done so, both say it's the other's responsibility, and neither indicates it is prepared to change its posture.
