Unfortunately, once again we have to return to the topic of doping. Scandals related to the use of illegal drugs occur almost every month, but we ignore something. This time, no matter how hard we try, we can’t get around the doping story. Another scandal broke out a week before the start of the Olympic Games in Sochi, and Russian biathletes were involved in it. In general, in the world of doping, Russia, alas, finds itself at the “front line”. Not a year goes by without our athletes being involved in doping scandals - the percentage of negative tests among Russian athletes remains at an exorbitant level. This year has just begun, and already there was the “Efimova case”, now the “Yuryeva and Starykh case”...

In general, this whole doping story dates back to the USSR, when many coaches and doctors built their careers on doping athletes with all sorts of drugs. Some still can't stop. A list of the most popular drugs was gradually formed. We are trying to figure out which of them are currently in use, in which sports they are used and what they actually provide.

1. Erythropoietin

Let's start with the doping that Ekaterina Yuryeva and Irina Starykh are suspected of using. Erythropoietin is a hormone that stimulates the formation of red blood cells from late progenitor cells and increases the yield of reticulocytes from the bone marrow depending on oxygen consumption. Erythropoietin is a kind of copy of the natural kidney hormone. After entering the blood, it activates the process of red blood cell maturation.

History of appearance
The drug appeared in 1983 and was invented by American specialists. Almost immediately I began to get involved in sports. But due to the fact that erythropoietin practically copied the natural hormone, they could not catch it. It was only in the early 2000s that a method was found in the French laboratory of Chateau-Malabry. After that, checks of old samples began, as a result of which almost all the famous cyclist racers of the past were caught using EPO. But soon new types of EPO appeared. In particular, CERA, which was widely used by cyclists, but since 2007 they have learned to recognize it too. All this led to a whole stream of disqualifications for cyclists.

Physiological role
Erythropoietin (EPO) increases the amount of hemoglobin in the blood, so the blood can carry more oxygen in the body, thereby improving endurance.

Scope of application
Cyclic sports: cycling, cross-country skiing, biathlon, swimming, speed skating.

The biggest scandals
In 2001, at the home cross-country skiing world championship, almost the entire Finnish star team was caught using EPO - Mika Myllula, Jari Isometsa, Virpi Kuitunen.
A year later, at the Olympic Games in Salt Lake City, it was our turn - Larisa Lazutina and Olga Danilova became victims of inspections.

In 2008, four people were caught at the Tour de France and a new type of EPO, CERA, was found in their blood. The overall winner Bernhard Kohl, as well as the winners of individual stages Stefan Schumacher, Riccardo Ricco and Leonardo Piepoli were “awarded” with disqualifications. The race results have been revised.

Two-time world champion, 1500 and 5000 meter runner Rashid Ramzi was also caught using CERA. He was an Olympic champion for only a few days; one of the samples taken from him at the Beijing Games showed the presence of blood doping.

The past biathlon scandal involving Akhatova, Yaroshenko and Yuryeva also did not go without mention of EPO.

2. Anabolic steroids (testosterone, stanozolol, nandrolone, methenolone)

At their core, anabolics are pharmacological drugs that imitate the action of the male sex hormone - testosterone and dihydrotestosterone. Anabolic steroids accelerate protein synthesis inside cells, which leads to pronounced hypertrophy of muscle tissue (in general, this process is called anabolism).

History of appearance
Back in the 30s of the last century, scientists learned to artificially reproduce testosterone. Then, already in the 40s in the USSR and the countries of the Eastern Bloc, the anabolic effects of testosterone began to improve. It is still believed that track and field records set in the 80s by athletes from the former countries of the USSR, as well as the GDR, were set with the help of steroids.
At the turn of the century, the American laboratory BALCO, trying to improve anabolic steroids, created tetrahydrotestosterone.

Physiological role
Due to the use of steroids, there is a significant increase in muscle mass (5-10 kg per month), strength indicators, endurance, red blood cell production increase, bone tissue is strengthened, and fat reserves are reduced.

In principle, it is still believed that steroids are the most effective type of doping, but the problem is that they have learned to easily recognize it.

Scope of application
Athletics (sprinting, throwing, long jump), weightlifting, swimming, cross-country skiing.

The biggest scandals
Scandals related to the use of steroids are a dime a dozen. I’ll just name a few names: Ben Johnson, Carl Lewis, Marion Jones, Tim Montgomery, Frank Luke, Anfisa Reztsova, Irina Korzhanenko, Nadezhda Ostapchuk. The list can stretch to several dozen pages...

3. Diuretics (chlorthalidone, acetazolamide, triamterine, furosemide)

Diuretics are diuretics that are often used to remove excess fluid from the body in order to add definition to the muscles. Usually used before competitions as the effect is quite short. Diuretics can be taken during a steroid cycle, as anabolic steroids cause excess fluid accumulation.

Intensive urination helps remove other doping agents from the body or mask their use by significantly reducing the density of urine.

History of appearance
Diuretics appeared in sports almost immediately after anabolic steroids came into use.

Physiological role
They help quickly reduce body weight and improve the appearance of athletes. Dehydration helps to give the muscles emphasized shapes.

Scope of application
Rhythmic gymnastics, figure skating, athletics, weightlifting.

The biggest scandals
Most often, diuretics are used to hide the use of steroids. At the Olympics in Seoul, the Bulgarian team won 4 gold and 1 bronze medals. However, after its representatives Mitko Grablev and Angel Genchev were caught using diuretics, the entire weightlifting team was removed from the Olympics. Two Hungarian weightlifters were also caught using similar diuretics.

Quite often, athletes manage to prove that the use of diuretics was not conscious; they can be included in nutritional supplements. Recently, Olympic champion swimmer Cesar Cielo Filho and Jamaican runner Veronica Campbell-Brown managed to avoid disqualification.

4. Transfusion of blood and its components (hemotransfusion) and autohemotransfusion
Hemotransfusion is a blood transfusion, a special case of transfusion in which the biological fluid transfused from the donor to the recipient is blood or its components.
Autohemotransfusion is the transfusion of the recipient's own blood.

History of appearance
It is difficult to say when athletes first resorted to autohemotransfusion, but in 1985 all types of transfusion were prohibited. This happened after American cyclists publicly admitted to having a transfusion at the Los Angeles Olympics. The first cases of detection of such a trick after its official ban were identified already in the 2000s, after which WADA insisted on the introduction of biological passports. The blood passport system is based on regular blood sampling from athletes and analysis of blood parameters: hemoglobin, red blood cells and reticulocytes. An increase in the level of blood cells and hemoglobin content leads to an increase in the function of transporting oxygen through the blood to the muscles, and therefore to an increase in performance.

Often, increased levels of red blood cells and hemoglobin are associated with various types of transfusions.

Physiological role
Autohemotransfusion accelerates the delivery of oxygen to the muscles, thereby increasing their performance.

Scope of application
Cycling, athletics, cross-country skiing.

The biggest scandals
The first to be caught with a blood transfusion was the 2000 Olympic time trial champion, American Tyler Hamilton.

London Olympic champion, Kazakhstani cyclist Alexander Vinokurov, was also caught blood transfusion at the 2007 Tour de France and disqualified for 2 years. According to experts from the Chateau-Malabry laboratory, where the doping sample was analyzed, Vinokourov’s blood transfusion was carried out on July 21, the same day that he won the 13th stage. In this regard, Alexander and the entire Astana team (at the request of the Tour de France management) left the French Grand Tour.

5. Mental stimulants (cocaine, ephedrine, ecstasy and amphetamines)

Under conditions of acute exposure, stimulants quickly change the functional indicators of brain activity (activate the bioelectrical activity of the brain, change conditioned reflexes, etc.), increase endurance for physical work. In clinical use, they have a quickly onset stimulating effect and are widely used in practice for the treatment of diseases accompanied by drowsiness, lethargy, apathy, asthenia, and depression. The increase in the functional capabilities of athletes under the influence of stimulants is largely due to the blockade of physiological regulators and the limits of mobilization of functional reserves.

History of appearance
Different types of stimulants have appeared in sports at different times. In particular, ephedrine appeared on the horizon in the late 70s of the last century.

Physiological role
These drugs increase vitality, reduce fatigue, stimulating an increase in training time or performance in competitions.

Scope of application
Absolutely any kind of sport - from boxing to rhythmic gymnastics.

The biggest scandals
At the 1976 Olympics in Innsbruck, ephedrine was found in the body of Soviet skier Galina Kulakova. True, Kulakova was suspended for only one race, since it was proven that ephedrine entered her body due to the use of a nasal spray. This disqualification was the first ever disqualification for the use of prohibited substances in skiing competitions at the Olympics.

In 1994, the famous Diego Maradona was suspended for 15 months for using ephedrine at the World Cup.

The famous American track and field athlete Carl Lewis was caught using ephedrine and pseudoephedrine, but he was never disqualified, each time he managed to convince everyone that the cough medicine was to blame...

In 2011, Ukrainian biathlete Oksana Khvostenko was caught using ephedrine.

With the introduction of the biological passport system in professional sports, the anti-doping campaign promises to reach a fundamentally new level. And it is possible that new revelations await us all in 2012.

Sergey BUTOV

The high-profile “case of Claudia Pechstein,” a five-time Olympic champion from Germany accused of doping, could have become an ordinary doping case that has become difficult to surprise anyone in modern sports. However, there was a “but” in this matter, which for many turned upside down the idea of ​​modern anti-doping capabilities. The speed skating legend was disqualified without passing a single positive doping test during his twenty-year international career! Of course, it was a shock for everyone.

The so-called biological passports were first discussed back in 2008, when the International Cycling Union, shocked by the depth of doping penetration into cycling, single-handedly began to introduce them. Even then, it became obvious to many that such passports were the future of professional sports, because their very introduction indirectly indicated the insufficient effectiveness of traditional doping control in the fight for the purity of sports.

At the end of 2009, WADA officially joined the program, and in 2010, the majority of national anti-doping organizations switched to the new track. 2011 was spent collecting blood samples that formed these same passports. The coming 2012, by all logic, should show the sports world the effectiveness of their use. If this is so, then the “Pechstein case” is just the beginning.

What are biological passports? We decided to introduce SE readers to the principles of their operation. I think a lot will become clear from an interview with one of the leaders of RUSADA, Alexander Derevoedov, and an article by a sports doctor at the University of Helsinki, Sergei Ilyukov.

Blood doping became widespread after the Olympic Games in Mexico City in 1968. Those Games were held at an altitude above 2000 m, and this was associated with a drop in the results of athletes in cyclic sports. Moreover, the results turned out to be so much lower than expected that they forced sports scientists to pay attention to the connection between high altitude and the performance of the athlete’s body, and then to come to the discovery of the ergogenic (that is, performance-enhancing) effects of blood doping.

There are many types of blood doping. Blood transfusion - both your own and donor's, the use of erythropoiesis-stimulating drugs (EPO, CERA, new generation EPO gene drugs, peptide EPO mimetics, EPO gene activators, and so on), artificial oxygen carriers such as perfluorocarbons. All of them pose a challenge to anti-doping organizations.

The list of drugs with which athletes could cheat narrowed as anti-doping developed. Blood doping, then still in the form of blood transfusions, was banned in 1985. This happened immediately after the Los Angeles Games, where the US cycling team publicly attributed its success to blood transfusions. Despite the ban on donated blood, the first victim was discovered only in 2004, when a test was developed that detects the transfusion of someone else's blood. The first to be caught was the Olympic champion of Sydney in the time trial cycling race, Tyler Hamilton from the USA, who later admitted not only to blood transfusion, but also to the use of a number of prohibited drugs.

The EPO test was introduced in the early 2000s and has been continuously improved since then. In the middle of the last decade, the test was refined and the criteria for a positive test in relation to the transfusion of someone else's blood were revised, which between 2007 and 2009 led to widespread disqualifications of athletes, including Russian ones, in a number of sports. But direct doping testing is not the only effective way to combat doping.

The graph below shows how the number of suspicious changes in parameters in the blood of professional cyclists dropped over the course of a decade. First of all, this is due to the work of anti-doping organizations. It should be noted that at the same time, the safety of the athletes themselves has increased and, as expected, the speed of completing elite mountain stages in the Grand Tours, such as climbing Alpe d’Huez during the Tour de France, has decreased. Now that the development of the biological passport is in full swing, doping control promises to reach a new level. The effectiveness of the new system has yet to be assessed, but one thing can be said now: the arsenal of means for the schemers has become much scarcer.

Speaking about the blood passport, it should be noted that its prototype back in the 1990s was the rule of excluding athletes from competitions with elevated hemoglobin levels. This was an extremely relevant rule due to the lack of reliable tests. In practice, the problem was that the drug, which artificially increased the concentration of hemoglobin and red blood cells, was removed from the body in a short time, but the effect caused by its use remained. Thus, they tried to protect the competition from completely shameless cases of abuse of prohibited drugs, when the hemoglobin in the athlete’s blood went off scale. At the same time, naturally, one should remember about people whose hemoglobin levels are naturally elevated, which was the reason for many to receive a so-called therapeutic exemption from international federations.

The blood passport system is based on regular blood sampling from athletes and analysis of blood parameters. The latter primarily include hemoglobin, red blood cells and reticulocytes. It is these blood components that are associated with such forms of doping as erythropoietin and blood transfusions. An increase in the level of blood cells and the hemoglobin content in them leads to an increase in the function of transporting oxygen through the blood to the muscles, and therefore to an increase in performance.

The huge variety of factors influencing the blood picture dictates the practice of a completely individual approach. First, a database is created for each athlete included in the testing pool, and monitoring is built in comparison with these data.

Monitoring is based on changes in a number of indicators (further we will discuss only the most basic parameters). Normally, the number of reticulocytes, the young form of red blood cells, is in the range of 0.5-1.5 percent of the total number of red blood cells, but can go beyond this range for no particular reason. When blood is introduced from the outside, the body feels a “sufficiency” of red blood cells, while the number of the athlete’s natural reticulocytes drops. However, blood introduced from outside also carries its own reticulocytes, which compensates for the loss of natural ones, and as a result may not affect the blood parameters of the passport at all (if you look only at the absolute values ​​of reticulocytes).

When an athlete’s blood is taken for subsequent transfusion as a doping agent (as a rule, this is done during the out-of-competition period after taking microdoses of erythropoietin), the body temporarily feels a lack of blood. This stimulates new blood formation, resulting in an increase in the concentration of reticulocytes.

Similar changes occur with hemoglobin, where when blood is taken, hemoglobin drops, and when transfused, it increases sharply. All these manipulations with transfusion are performed, as a rule, with the athlete’s own blood in order to avoid adverse reactions of rejection (such cases are not so rare and can lead to a hospital bed) or possible infection with diseases carried by someone else’s blood.

For the analysis of hemoglobin and reticulocytes, which underlies the monitoring of biological passports, the so-called OFF-score, or stimulation index, was developed, which is the ratio of hemoglobin to reticulocytes. With constant monitoring of the index, you can notice when an athlete performs both a withdrawal (it is accompanied by a decrease in hemoglobin and an increase in reticulocytes) and a reverse blood transfusion (an increase in hemoglobin and a decrease in reticulocytes).

You can talk for a long time about the blood passport, but nothing can be more clear than the passport itself - it is in front of you. This passport formed the basis for a study by my colleagues from Germany, in which the training-competition cycle of an athlete who manipulated the blood was simulated. The cycle was designed for 42 weeks, and during it 10 blood samples were taken from the athlete.

Looking at the passport, even a non-expert in anti-doping can see how between the 4th and 5th sampling there was a drop in hemoglobin from 139 to 127 g/dl, while the number of reticulocytes increased from 0.84 to 2.01. The OFF-score has changed accordingly. The blood taken (this is also clearly demonstrated by the passport) was transfused between the 7th and 8th blood draws, where hemoglobin increased sharply and the number of reticulocytes fell. This data is also reflected in the OFF-score.

Sergey ILYUKOV

See photos for examples of biological passports

Here are two examples of a biological passport, first provided for printing by RUSADA specialists.

The upper and lower lines in the passport mean the reference value of this athlete, calculated from his personal indicators: race, gender, weight, etc. The line in the center of the graph is the real blood indicators of this athlete. The number of points in the graph is equal to the number of doping samples taken from him.

The difference between the passports is that if on the left graph the real indicators do not exceed the reference value, then on the right this happens several times. This is a signal that there is a risk of using a prohibited drug or method.

Currently, RUSADA uses two blood passport indicators - hemoglobin level (HGB) and OFFS (OFF-score - stimulation index). Two other indicators, reticulocytes (RET%) and ABPS (abnormal blood profile) are used to gather information, although they tend to confirm the hemoglobin and OFFS indicators. At the same time, ABPS is the most stable indicator of an athlete’s blood condition, fluctuations in which are quite rare without external influence.

Alexander Derevoyedov: “We are on the way to the first disqualification”

THE PASSPORT IS NOT LOOKING FOR THE SUBSTANCE

- What is a biological passport?

I want to emphasize right away: this is not a citizen’s document with a photo, but a set of information about the biological parameters of the athlete’s body. At the moment, a biological passport means a hematological passport, that is, a blood passport. But the introduction of steroid and endocrine passports is just around the corner, which will complete the overall structure.

In the meantime, I repeat, we are monitoring the state of hemoglobin and other blood indicators of athletes. As everyone already knows, EPO can only be caught for a few days. And transfusion of one's own blood is generally difficult to detect. This is where a passport comes to the rescue - it allows you to develop a “legend” for an athlete: what happened to his body in the past and at what time.

- Why are you working only with blood so far?

If hemoglobin indicators are in one range, then indicators, for example, of steroid metabolism are in another, much wider range. Consequently, it is much more difficult to detect deviations there. Although talk about the introduction of a steroid passport has been going on since the Beijing Olympics, its development is still ongoing.

- What about the endocrine passport?

This is a certain set of parameters characterizing the hormonal spectrum. This passport is mainly aimed at growth hormone, which is quite problematic to detect during direct doping control. In any case, it is much easier to do this using indirect criteria, namely with the help of a passport. There is still a discussion going on around it, mostly behind the scenes. It will be good if it is implemented for the Sochi Olympics.

- That is, a biological passport will become a kind of medical card for an athlete?

In a way. The human body works on the principle of feedback, where almost all hormones are connected to each other in a chain. Adding even one such hormone from the outside distorts the entire chain, and harm to health is simply inevitable. At the same time, working on a passport is fundamentally different from the traditional direct doping control that is familiar to everyone in that we do not catch the substance. She is of no interest to us in this case.

- What’s interesting?

We identify the consequences of using a prohibited substance or prohibited method. Moreover, the detection time is significantly longer than during direct testing. Actually, one of the functions of the passport is that it can be used to calculate the optimal period for direct testing.

Doping is used in different ways, often in a long course, when a certain drug is administered for weeks or even months. By monitoring and collecting information, we can make a prediction about exactly how the prohibited substance was used. And at the right time, identify it through direct testing. By the way, this is exactly how some international federations acted towards Russian athletes. They came to them for samples with a specific goal - to find. And they found it.

The second punitive, let’s say, function of the passport is to use a number of its indicators for disciplinary measures. The most high-profile case so far is the “case of Claudia Pechstein.”

- Which, according to many, ushered in a new era of anti-doping.

This was one of the first attempts to use a passport to prosecute an athlete, although there were a lot of controversial issues. For example, most of the samples taken from Pechstein belonged to the period before the introduction of the WADA rule on biological passports (that is, before December 1, 2009. - Note S.B.). They found a way out of the situation by declaring that those tests were used for information, but not for applying sanctions. And they were not included in the evidence base.

However, those that were included turned out to be enough. I am familiar with the CAS decision in this case, I have read Pechstein’s own explanations, and I know how consistently WADA experts “removed” all of her evidence.

It seems to me that for now it is easier for an athlete to deal with a positive doping test - after all, there is a direct fact of a violation. It’s another matter when some people in white coats punish a person who has not passed a single positive test. This is exactly what persecution based on a passport looks like from the outside now.

The key importance is still the deviations in the passport, and not how it looks from the outside. Back in the early 2000s, international federations, on instructions from WADA, began collecting blood samples, creating data banks for each athlete. Their analysis for many years formed the basis of the so-called adaptive model, deviation from which beyond the limits of statistical reliability may indicate the use of doping.

After all, how does this work in practice? We get the indicators and simply apply them to the model. When we see significant deviations, we have reason to believe that the athlete was using something. Then the experts and the athlete himself come into play and present their arguments. Experts work anonymously, without direct communication with the athlete. Moreover, they don’t even know whose materials they received: it’s just a set of tests and some explanation of the athlete.

The expert may consider this explanation to be complete. But it may not count. And then this is enough to issue a disqualification, because by expert I mean not an ordinary hematologist in a hospital, but a doctor-level specialist, preferably certified by WADA.

Can we say that the introduction of blood passports means that traditional doping control is not effective enough?

Without a doubt. The passport was introduced in order to increase efficiency.

- Then how perfect is the passport system?

It is imperfect, like any other system, involving a large amount of data, as well as the participation of people and instruments. Until now, each new case of persecution based on a passport requires very serious work on the part of the anti-doping organization and experts, from whom they expect a professional, unbiased analysis. Moreover, any doubts, this is my deep conviction, should be interpreted in favor of the athlete.

We check all data multiple times. We find out the smallest details, down to the conditions under which the suspicious sample was taken, and so on. And if we decide to give things a go, then this is, as a rule, a well-founded and very balanced position.

It turns out that one of the disadvantages of a passport is this: while you are “targeting” a doping agent, he may have time to win the World Championship with the Olympic Games. Therefore, direct doping control should remain the same.

That's not the only reason. Competitive control is significantly different from out-of-competition control. For example, it makes no sense to look for a beta blocker from a shooter during training camp. The drug is effective for a short period of time and is only effective during competitions. This means that you need to catch it during competitions.

And, of course, dealing with direct doping control by any anti-doping organization is also easier for now. After all, a prohibited substance found in the body is direct evidence.

THE NEGLIGENCE FOR ANTI-DOPING HAS DISAPPEARED IN RUSSIA

- Why were Russia at least a year late with the introduction of the passport?

I can't say that we were very late. The pioneers of the introduction of passports were international federations, most notably the International Cycling Union. But if we talk about national anti-doping organizations, then RUSADA is definitely in the top five. We are now at the stage of collecting materials. We have 3-4 tests for each national team level athlete in cyclic sports, that is, in those where blood passports are effective.

RUSADA announced that in 2011 it collected 20 thousand samples. It’s great that you don’t hide the numbers, but it’s not clear whether 20 thousand is a lot or a little?

So many. For example, in 2010 there were 15 thousand. In 2012 we will again collect 20 thousand. It is possible that we are the world's first anti-doping organization in terms of the number of samples collected.

Last year there were 102 cases of positive doping tests among Russian athletes. Again, is this a lot or a little?

In fact, there were 118 cases. The figure of 102 was made public at a time when we had not yet received all the decisions of the disciplinary committees in the federations. For comparison, in 2010 there were 98 positive samples.

- What is the cost of taking one sample?

8 thousand rubles. In Europe the cost ranges from 200 to 250 euros. In America it is about 400 dollars.

- How many samples are needed for prosecution based on passport indicators?

At least five. Five to seven is better.

- How many tests per year does the passport of athletes of the level of Usain Bolt, Petter Northug or Olga Zaitseva require?

To create a passport, you need four to five samples collected at a certain interval and preferably in different conditions - during rest, during collection, on the plain, in the mountains, and so on. Next comes the collection of samples, from three to five per year. This creates a picture of the passport in which any deviation will be especially obvious.

- What is the proportion of blood samples among the 20 thousand that you collected in 2011?

2.5 - 3 thousand.

That is, we can say that at the moment you are creating blood passports for 700-800 Russian athletes?

Approximately.

- When should we expect the first case of disqualification on a passport in Russia?

We are on our way to it. This will almost certainly happen in 2012. We are not in a hurry in this matter; it is better to take another sample than to rush to blame anyone for anything. But, alas, individual passports already require analysis by experts.

- Are samples for passports collected exclusively by RUSADA specialists or, say, by team doctors too?

We will be happy to include any information from doctors in the passport, but they do not have the right to collect samples. Yes, this would look strange from the point of view of a conflict of interest. Not us, but others would have suspicions about whether this or that doctor took the sample correctly and from the right person. Blood is not urine, it is tissue. You have to know how to work with her. Therefore, we cannot allow non-accredited personnel to collect passport samples.

This is how we do it. We have an agreement with one medical organization, whose employees have been trained in the standard procedure for collecting blood as part of doping control. But in order not to distract them with paperwork, a RUSADA inspector is traveling with them.

RUSADA is sometimes criticized for the fact that you punish, but do not prevent violations, and that you only have “red” cards in your arsenal.

We also have yellow cards, so-called flags. When an athlete fails to provide or incorrectly provides information to the ADAMS system, this is a clear flag. Three such punctures within 18 months will result in disqualification. We also deal with the prevention of violations, if you don’t mean RUSADA’s educational programs, but something else. We can come to the athlete’s home without warning. Or come to the same place for several days in a row - to tone up. Or promise, but not come.

This is a normal pattern of anti-doping work, we are not the only ones doing this. We are not interested in catching, but in keeping the sport clean. If we catch it, it means the athletes themselves are to blame.

I'll tell you more. We sometimes have to face the problem of moral choice. Imagine that it is obvious from blood indicators: the athlete had a period when he used something prohibited. But lately everything has been normal, the athlete got scared and came to his senses. How to deal with this? Should I pursue or close my eyes?

- Difficult question. But, it seems to me, what is much more important is how you at RUSADA respond to it.

I would say that everything depends on further dynamics. The slightest new surge must become the basis for us to impose sanctions on the athlete, taking into account previous indicators. At the same time, you don’t want to chase a person who has taken the right path. You know how often doping is used in Russia - when the athlete is not the one to blame.

- Do you take such things into account?

We try to take it into account. You see, the moment of punishment in sports has never been the main thing. The issues of education and maintaining health are truly fundamental. Doping is fraud, doping is bad. But if a person has corrected himself, if he has won according to the rules, I do not agree with those who believe that everyone who has violated at least once should get what they deserve, regardless of the circumstances. In any case, I'm not convinced of this. The main thing is that athletes do not forget: there are anti-doping organizations, including foreign ones. Fortunately, the number of cases where Russians are caught abroad is becoming less and less every year.

Agree. And there are fewer and fewer truly loud, resonant revelations. Has the frivolous attitude towards anti-doping in Russia finally been overcome?

Our teams in some sports have sharply changed their attitude to this issue and changed their ideology. The disdain for anti-doping has disappeared. This is evident from the openness and lack of fear before the doping control procedure. Well, based on the results of this control, of course. As soon as the Ministry of Sports began to firmly express its position on this issue, the federations were inspired and no longer brushed off us: they say, you need this, you do it.

Well, public opinion around the problems of combating doping, it seems to me, has seriously changed. They stopped presenting us as enemies in the press.

Sergey BUTOV

The theoretical basis for the use of blood transfusion is to increase the body's resistance to low oxygen content in the atmospheric air and, for the same reason, to a lack of oxygen under conditions of intense muscle activity. The most commonly used term for the procedure described above is blood doping, although other names exist - blood support, blood loading and inducible erythrocythemia.

Blood doping can be achieved by different methods, one of which is homologous transfusion - obtaining blood from a donor with the characteristics necessary for its transfusion. The second method is called autohemotransfusion, in which the athlete is injected with his own blood. Its essence is that the athlete’s blood is first taken and stored for about two months. During this time, the content of red blood cells in the body is restored to normal levels. For long-term preservation, red blood cells are pelleted by centrifugation, separated from the plasma and frozen. They are subsequently thawed and mixed with saline to speed up transfusion. When whole blood or red blood cells in a saline solution are introduced into the bloodstream, the total amount of blood in the body increases, causing an increase in blood pressure. This increase is undesirable for the body, and therefore excess plasma water is excreted by the kidneys, but at the same time red blood cells continue to remain in the bloodstream and the concentration of red blood cells in the blood increases.

Hemoglobin found in red blood cells ensures the transport of oxygen in the body, so the physiological mechanism of the effects of blood doping in sports is quite obvious. With an increase in the concentration of red blood cells and, accordingly, the concentration of hemoglobin, the ability of the blood to deliver more oxygen to the working muscles also increases. This means that the use of blood doping can have a positive effect on performance indicators in those athletes for whom the manifestation of aerobic endurance is very important.

Dependence of effectiveness on the technique of performing the procedure. As was established in ten carefully conducted studies, the increase in aerobic capacity of athletes under the influence of blood transfusion significantly depends on the correct implementation of this procedure.

Legal and ethical aspects. Despite the fact that blood doping is one of the most effective ergogenic aids, its use is considered illegal as it is prohibited by the IOC and the NSAA.

Despite the fact that anti-doping control can be carried out immediately after competitions, however, at present there are no sufficiently reliable methods of control for blood doping, and therefore research in this direction requires further development.

Medical aspects. Improperly performed blood transfusions can pose certain health risks.

One of the most reliable ways to increase the safety of blood doping is autohemotransfusion, that is, transfusion of an athlete’s own blood, taken from him in advance and left for preservation. But with blood transfusion, problems may arise due to the risk of infection from the needle or from air entering the blood, but the likelihood of such cases is under medical control. The amount of blood administered should be limited, and its viscosity (or density) should not be excessive. The high density of injected blood can cause blockage of blood vessels and even cause cardiac arrest. According to the results of several studies, the optimal volume of transfused blood, which provides an increase in athletic performance and at the same time does not cause a significant change in its viscosity, is 1 liter.

Homologous transfusion, compared to autotransfusion, may pose a greater risk to the athlete's health. One of the non-acute reactions of the body to homologous transfusion is chills, fever and nausea. More serious consequences, including death, can occur in cases where the compatibility of the donor blood and the recipient's blood is incomplete.

Another danger may lie in the presence of certain types of viruses in the donor’s blood that can cause diseases such as hepatitis, liver infection, or acquired immunodeficiency syndrome (AIDS).

Thus, not only from the point of view of legal and ethical positions, but also for medical reasons, the use of blood doping as an ergogenic aid cannot be justified. Those athletes who decide to use blood transfusion should have a clear understanding of the possible consequences of its use.

In total, there are currently three doping methods prohibited in sports.

Blood doping
Use of artificial oxygen carriers or plasma expanders
Pharmacological, chemical and physical manipulations

Blood doping

Blood doping is the use of blood or blood-based products to increase the number of red blood cells in the body. At the same time, the volume of oxygen entering the muscles increases and, accordingly, endurance increases. For these purposes, blood previously taken from the athlete or another person is used.

What are the medical reasons for taking blood or blood products?
In medicine, red blood cells are used to treat severe forms of anemia or significant blood loss after surgery or injury.

Why is blood doping prohibited?
Artificially increasing the amount of oxygen carried throughout the body improves the physical condition of athletes and therefore provides an unfair advantage. Blood doping is mainly used in those sports where endurance comes to the fore - middle and long distance running, cycling and cross-country skiing.

Side effects
The use of blood doping can pose a serious threat to health, and possible side effects include:

• allergic reactions (from rash and fever to kidney disease) when using the wrong blood type,
• jaundice,
• circulatory overload,
• blood clots, heart failure and heart attack,
• metabolic shock.
  An athlete who uses the blood of another person risks problems with the immune system, fever and viral infections such as hapatitis and AIDS.

Artificial oxygen carriers

What it is?
Artificial oxygen carriers are chemical compounds used to increase the amount of oxygen in the blood. Examples of such carriers include perfluorocarbons (PFCs), hemoglobin-based oxygen carriers (HBOCs), and liposome-packaged hemoglobins (LEHs).

Medical use

Artificial oxygen carriers can be used when real blood is not available, there is a risk of contracting an infection, or there is no time to check the compatibility of the donor and recipient's blood. Currently, such products are little used, they are constantly being improved, and more scientific research and clinical trials on this topic are required.

Why are artificial oxygen carriers banned?
There is evidence that some athletes have used these products to increase oxygen transport to improve endurance, but this effect has not been confirmed.

Side effects
Side effects from the use of artificial oxygen carriers can be very serious, in part because it is difficult to calculate the dosage of these substances.

Possible side effects:

• fever,
• reduction in platelet count,

• lymphocyte overload,
• diarrhea,
• blood poisoning if the drug is not pure enough.
  Possible side effects from hemoglobin-based drugs:
  high blood pressure,
• vasoconstriction (narrowing of blood vessels),
• renal failure,
• iron overload.

Plasma Expanders

What it is?
Plasma expanders are substances used to dilute the blood and increase its quantity. Examples of such substances are Haemaccel (polygeline), Gelofusine (gelatin), Albumex (albumin) and Hespan (hydroxyethyl starch).

Medical use
Plasma expanders are used in medicine to replace fluid in cases of shock, which can be caused by blood loss after surgery or as a result of injury.

Why are these substances prohibited?
Some athletes use such drugs to mask erythropoietin.
Side effects may include allergic reactions and anaphylactic shock (a dangerous allergic reaction that can result in death).

Pharmacological, chemical and physical manipulations

What is meant by pharmacological, chemical and physical manipulation of urine?

Pharmacological, chemical and physical manipulation is the use of substances or methods to change the composition of urine or replace its sample.

Prohibited practices include:
catheterization,

• substituting urine or falsifying a sample,
• use of substances that modify or suppress urine flow (for example, probenecid),
• use of epitestosterone.

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Since the first sports competitions, our ancestors have included those who cheated to win.

From figure skaters who broke their competitors' legs to marathon runners who got lost in the crowd and drove part of the distance by car.

Scandals accompany virtually the entire history of sports.

“Modern athletes not only cheat with judges and opponents, they play a very dangerous game with their bodies, putting their own lives and health at great risk,” says Pierre Weiss, former secretary general of the International Athletics Federation IAAF.

Sport brings people together, but the mixture of vanity, politics and big business can kill its spirit.

Stimulants are as old as sport itself.

If we accept the World Anti-Doping Agency (WADA) version, the term "doping" itself most likely comes from the Dutch "dop", which means an alcoholic drink made from the skins of grapes, which Zulu warriors drank for courage in battle.

Ancient Greek athletes used special diets and stimulant potions to increase strength and endurance, and athletes of the 19th century had already mastered strychnine, caffeine, cocaine and alcohol.

For example, the famous early 20th century track and field athlete Thomas Hicks ate raw eggs, injected himself with strychnine and drank a little brandy before the race, which helped him win the 1904 Olympic marathon.

In the first half of the twentieth century, the term “doping” was first used in the context of the illegal use of drugs at horse racing, which was popular in those years. In 1928, the International Athletics Federation became the first sports federation in history to officially ban doping.

Doping tests were first used during the world championships in football and cycling in 1966, and in 1968 these tests successfully debuted at the Olympic Games. By the 1970s, they were used by most sports federations on the planet.

Although, along with the development of doping tests, doping itself also developed.

WADA: Setting Anti-Doping Standards

WADA set anti-doping standards for the first time in 1999, following the major scandal at the Tour de France cycling race in 1998. These standards “aim to assist, coordinate and monitor the fight against doping in sport in all its forms.”

Every year the organization updates its list of prohibited substances and doping methods.

The criteria for inclusion in the WADA blacklist are:

• Ability to improve athletic performance
• Potential risk to the body
• Inconsistency with sportsmanship

The WADA list of prohibited substances for 2016 is available on the organization’s official website.

Classes of prohibited drugs

In total, there are 6 classes of substances prohibited in sports: stimulants, diuretics, anabolic steroids, beta-2 agonists, narcotic analgesics, hormones and peptides.

Stimulants

Stimulants increase performance and help overcome fatigue, increase heart rate and blood pressure. They can also cause aggression, which can be an advantage during sports competitions.

Many stimulants, including amphetamines, cocaine and ephedrines, are strictly prohibited in sports.

Scientific research shows that stimulants very often lead to the death of athletes, especially the amphetamine group. With excessive load and narrowing of peripheral blood vessels, stimulants interfere with the body's ability to cool down. Overheating leads to dehydration, impairs blood circulation and can cause collapse, respiratory and cardiac arrest, organ failure and death.

Stimulants can also be highly addictive.

Anabolic steroids and glucocorticoids

Anabolic steroids, or simply anabolic steroids, help athletes train more intensely, quickly build muscle mass and strength, and speed up recovery after exercise.

Testosterone is the main male sex hormone with a steroid structure that has anabolic and androgenic effects. Anabolic effects are associated with muscle gain, and androgenic effects are associated with the development of secondary male sexual characteristics, such as a rough voice and facial hair. Modern anabolics are derivatives of regular testosterone, significantly modified and enhanced.

Risks associated with taking anabolic steroids include: kidney and liver damage, hypogonadism and infertility in men, increased aggressiveness, hypertension, thrombosis, atherosclerosis, baldness, acne.

In the United States, steroids continue to be popular. Recent surveys show that 4.9% of schoolchildren (including 2.4% of girls!) have used them at least once. Such drugs are usually sold by illegal distributors via the Internet.

There is another large group of steroid hormones - glucocorticosteroids, or glucocorticoids. These include cortisol, prednisolone, dexamethasone. These hormones have a multifaceted effect on the body, including reducing inflammation.

Athletes use glucocorticoids to hide a serious injury or to recover faster after heavy exercise. What does this mean? Continuing to train while injured is dangerous in itself. But glucocorticoids, especially in huge “sports” doses, can affect the metabolism of carbohydrates, fats and proteins, and disrupt the regulation of glycogen levels and blood pressure.

Diuretics (diuretics)

Diuretics increase the rate of fluid and sodium release, which helps reduce body weight and volume and remove excess fluid from tissues. In medicine they are used for hypertension, heart and kidney failure, cirrhosis, lung diseases, etc.

Despite the ban on the use of diuretics since 1988, modern athletes continue to take them for two reasons. One of them is the removal of excess water from tissues and rapid weight loss, which allows, for example, to get into the desired weight category. The second is to hide the use of doping by quickly eliminating prohibited substances in the urine, reducing their concentration and changing the pH of the urine.

Dangers posed by uncontrolled use of diuretics in sports: decreased blood pressure, collapse, thromboembolism, water-electrolyte imbalance, arrhythmia, etc.

In addition, diuretics can increase the level of triglycerides and “bad” cholesterol (LDL) in the blood, and on the other hand, reduce the level of “good” cholesterol (HDL).

Diuretics have many dangerous drug interactions!

Many bodybuilders have paid with their lives for using diuretics. Frenchman Mohammed Benaziza died at the age of 33 (1992) due to severe dehydration and heart failure associated with diuretics. Another bodybuilder, Austrian Andreas Münzer, died at age 31 (1996) due to dehydration.

Narcotic analgesics and cannabinoids

From a pharmacological perspective, narcotic analgesics are opioids - substances with a diverse chemical structure that act on the so-called opioid receptors.

Opioids in sports help overcome the pain of injury and provide the ability to train and compete, but it also increases the risk of further injury. They are addictive.

Peptides and hormones

Peptides and hormones prohibited in sports include: human growth hormone (hGH), erythropoietin (EPO), insulin, human gonadotropin (HCG) and adrenocorticotropic hormone (ACTH). In medicine, these drugs are used to treat cancer, premature babies, and diabetes.

Possessing the highest biological activity, they also have the greatest destructive potential if used incorrectly. In particular, EPO, favored by Lance Armstrong and many other professional cyclists, can cause fatal thromboembolism.

EPO has been used since the late 1970s to improve strength and endurance by producing more red blood cells and increasing the blood's ability to carry oxygen. In addition to pulmonary embolism, stroke and heart attack, EPO has been linked to blood cancer and anemia.

Erythropoietin was banned by the International Olympic Committee in 1990, but the lack of reliable tests made the hormone difficult to detect until 2000, when WADA approved a new test to detect EPO. Meanwhile, from 1990 to 2000, this hormone killed at least 18 famous athletes.

Gonadotropin is an anabolic hormone that is used to build muscle mass and physical strength, but scientific research does not support the beneficial effects of hGH on human strength and endurance.

Although gonadotropin does build muscle, it leads to impaired growth, cardiovascular disease, hypertension, diabetes, thyroid problems, malignant diseases of the hematopoietic system, and arthritis. Other side effects of hGH: joint pain, muscle weakness, visual disturbances, myocardial hypertrophy.

Alcohol, marijuana, and local anesthetics are also prohibited in sports.

Blood doping

Blood transfusions, or blood doping, have been used since at least the 1970s. Officially, this procedure in sports has been prohibited by the IOC since 1986.

For blood doping, you need either your own blood, which is taken from the athlete in advance, stored and administered if necessary to increase the level of red blood cells and hemoglobin, or donor blood. In the first case, as a rule, 2 units of blood are taken a couple of weeks before the competition, frozen, and 1-2 days before the desired moment they are thawed and injected back.

When using blood doping, serious, sometimes fatal consequences are possible, since high blood density is dangerous for the heart. If an athlete uses donor blood, then add here the risk of contracting an infection, including hepatitis or HIV.

Artificial oxygen carriers—hemoglobin oxygen carriers (HBOCs) and perfluorocarbons (PFCs)—have also been banned for sporting use.

Gene doping

This type of doping originates from gene therapy, which consists of injecting the desired DNA into the patient’s body in order to change the genetic structure of its cells and cure the disease.

The gene developed by scientists is added to the patient’s genome, where it then performs certain functions inherent in it. Gene doping is a high-tech fraud that is impossible without the cooperation of the athlete with reputable companies or even government institutions.

WADA defines gene doping as “the non-medical use of cells, genes, genetic elements, or modulation of gene expression to enhance athletic performance.” Since gene doping changes the very structure of an athlete's DNA, increasing his strength or endurance, detecting traces of such doping is almost impossible.

Genetic scientists have successfully introduced the erythropoietin gene into animals, but there are suspicions that similar experiments were carried out clandestinely with athletes. Since it is difficult to prove such manipulations today, WADA encourages researchers to work more actively on new tests.

The results of animal experiments are controversial, but they cannot be confirmed in humans for ethical reasons. The secrecy surrounding gene doping only fuels interest.

Currently, a muscle biopsy is required to determine gene doping, but this procedure is not practiced in sports. The American Anti-Doping Agency (USADA) states that with the current level of technology it is impossible to detect genetic doping.

“Our agency, working with colleagues from a number of companies and research institutes, continues to improve technologies for identifying gene doping, which is becoming popular in sports. The illegal use of stem cells and gene therapy allows athletes to go into super-physiological states, and it is clear that this will be done in the future,” says USADA Scientific Director Matthew Fedoruk.

The long-term effects of gene doping are still poorly understood. How will the athlete feel in 20-30 years? What will he be sick with? What kind of children will he have? All these questions haunt the anti-doping committee, but, unfortunately, do not come to the minds of some athletes.

It is not for nothing that gene doping is called the doping of the future. But do the athletes themselves need such a future?