Pubdate: Thu, 23 September 1999
Source: Washington Post (DC)
Copyright: 1999 The Washington Post Company
Address: 1150 15th Street Northwest, Washington, DC 20071
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Note: Second of two parts
Related: http://www.mapinc.org/drugnews/v99.n1037.a08.html

DRUG TESTS, TROUBLING RESULTS

IOC's System Is Plagued By False Positives In Addition To Cheating

About five years ago, triathlete Karen Smyers learned she flunked a drug
test. A top official of triathlon's national governing body telephoned to
inform her she had tested positive for a banned substance-the painkiller
morphine - and faced a two-year competition ban.

"I'm like, morphine? I don't even know where you get morphine," Smyers
recalled. "Do you eat it? Do you inject it? What does it do for you? I was
completely flabbergasted."

She was also guilty--she later learned--of nothing more than eating poppy
seed bread on the day of competition. Poppy seeds, it turns out, contain
traces of the drug. At the time, Smyers could offer no explanation for the
positive test.

"It's funny the way people treat you," Smyers said. "[The official] assumed
I was guilty of something. Every athlete, whether guilty or innocent,
immediately comes up with an excuse."

Horrified, Smyers consulted several toxicologists seeking an explanation.
Once she identified the bread she had eaten at a hotel buffet breakfast, she
compiled her case, which included letters from the hotel pastry chef and
witnesses who saw her consume the bread. She was cleared within about four
weeks, before her test results became public.

"It was quick in the grand scheme of things, but boy, those four weeks
didn't go very fast," Smyers said.

Many athletes who compete in Olympic sports that adhere closely to the
International Olympic Committee's banned-drug list have similar stories to
tell. Drug-free athletes question a system that to them seems more likely to
root out naive--but nonetheless honest--athletes who mistakenly ingest a
banned substance, than to catch drug users who are skilled in the art of
beating tests. Scientists at the IOC's drug-testing labs share those
frustrations: They know their tests won't expose the athletes who are
experienced at circumventing drug screens. But because of the well-known
flaws in the drug-testing system, even obvious positive results--which to
them clearly brand some athletes as guilty--are decried and sometimes
discarded through long, expensive legal proceedings that seize on the
system's shortcomings.

Athletes who test positive for the steroid testosterone can fight the
results in court because of the testing method used, which measures levels
of testosterone in the body but cannot determine whether it was naturally or
artificially produced. Tests for other steroids that are not naturally
produced in the body, such as Dianabol and Nandrolone, are not completely
reliable, either, drug experts say. Athletes can time their injections so
that the drug leaves the body by the time a drug test is administered, or
they can take other drugs that mask the presence of the steroids.

Further, the Olympic sport drug-testing system has no means of catching
athletes who use erythropoietin (EPO) or human growth hormone (hGH), both of
which are powerful and apparently popular performance-enhancing drugs.

Yet an athlete is unlikely to get away with taking the cold medication
Sudafed, which contains the banned stimulant pseudoephedrine, as the IOC's
test for that is nearly error-proof.

"To some extent, they're catching the petty thieves while the people out
there who are committing major crimes are going undetected," said Smyers,
now a member of the U.S. Olympic Committee's anti-doping committee. "I have
to admit, the system as it stands is not working. I do think that changes
are being made with the pressure athletes are putting on governing bodies to
do something about it. Hopefully, it will have an effect."

Athletes such as Smyers worry they will eat something or be treated
medically with a drug that will trigger a false positive test. Other
athletes may sleep easy knowing the performance-boosting drugs they are
taking are undetectable. Or, they may devise elaborate schemes to pass drug
tests.

"Only stupid and careless and foolish people ever get caught," said Chuck
Yesalis, a professor and drug expert at Penn State University who has been a
sharp critic of drug testing in Olympic sports.

Bags of Tricks

Willy Voet, the French cycling team masseur whose arrest by customs officers
in 1998 spawned a drug scandal at the Tour de France, described a number of
tricks cyclists used to beat urine tests. In his recently released book on
the scandal, Voet said cyclists hid clean urine in pouches in their anuses
and used rubber tubes obscured by pubic hair to provide an untainted urine
sample to testers.

According to drug experts, a ploy among female athletes is to hide a bag of
clean urine in their vagina and contract the vaginal muscles to release the
urine when called upon for a post-competition test. Other scams involve
injecting clean urine directly into the bladder--a painful procedure. Such
extreme measures are employed because athletes are required to be naked
around their midsection when they give urine samples. They also are followed
into the bathroom by Olympic drug-testing officials.

Athletes also can use testosterone at levels that never trigger a positive
result yet provide performance enhancement, drug testers acknowledge.
Several drug experts said the chemical composition of known steroids can be
altered slightly even by amateur chemists so they cannot be detected--at
least for a while--by drug testers.

"If they're using drugs, they know ways to get around" tests, said U.S. high
jumper Charles Austin, the 1996 Olympic gold medalist. "There's always an
escape clause."

Certainly, drug testing is at least somewhat effective. At this year's Pan
American Games alone, seven athletes--including five gold medalists--tested
positive for some kind of banned substance. About 30 Chinese swimmers have
tested positive and been suspended by the international governing body of
swimming (FINA) since 1990. Out-of-competition tests, in which athletes are
given unscheduled tests, have become prevalent among international and
national governing bodies in recent years and have been effective in
detecting drug violations. Surprise tests led to positive results and
suspensions for Irish swimmer Michelle Smith, U.S. sprinter Dennis Mitchell
and U.S. shot putter Randy Barnes.

Still, a positive drug test does not automatically result in punishment to
an athlete, who is entitled to a hearing.

But even USA Track and Field CEO Craig Masback, an attorney, has been
critical of the hearing process. When an athlete tests positive for a banned
drug, that athlete's national governing body--which likely supports the
athlete through stipends and other rewards--is required to prosecute the
case. If the athlete wins the hearing, however, the national governing body
then switches from the prosecution side and defends the athlete before the
international governing body.

In a number of recent cases, athletes have won their initial hearings and
thus earned the support of their national federations. USA Track and Field
supported stars Mary Slaney and Mitchell, both of whom tested positive for
testosterone. The International Amateur Athletic Federation (IAAF) later
overruled the decisions and levied competition bans. In Slaney's case, the
adjudication process lasted three years.

British track star Linford Christie also tested positive for Nandrolone and
was exonerated this month by a disciplinary panel for the British national
governing body, UK Athletics. The Evening Standard in London reported that
UK Athletics called no experts to examine Christie's defense of the drug
charges in a one-day hearing. The panel determined that although Nandrolone
metabolites were found in Christie's urine sample, it wasn't clear that the
metabolites came from a prohibited substance.

"I can't conceive of anyone making that kind of decision," said Larry
Bowers, director of the IOC-accredited laboratory in Indianapolis, about
Christie's case. "We need to find a way to really do these cases so they
don't hinge on opinion or strange science. . . . When I look at something
like UK Athletics, they are the prosecutor on the case, and their statement
when they lose is that they're really happy the athlete has been exonerated?
It makes me skeptical."

Besides being a metabolite produced by certain so-called food supplements
that can be purchased over-the-counter in the United States, Nandrolone
exists naturally in small quantities in normal human beings, and it can show
up in the body for a variety of reasons, scientists say. Which means that
the athlete who knowingly takes Nandrolone has an array of ready-made
excuses for how it got into his system.

"The 'it's natural' excuse is going to be a big one now," said Donald
Catlin, head of the IOC-accredited drug laboratory at UCLA. "It is going to
be, I'm afraid, a big legal mess."

The most skeptical of critics, such as Yesalis, say drug testing is nothing
more than a marketing campaign to fool sponsors and the public into thinking
that Olympic governing bodies are cracking down on drugs. Smyers argues that
sports officials are sincere about wanting to catch cheaters, but simply
lack the scientific or legal means to do it.

Applying Standards

In recent years, the response of sports officials has been to increase the
frequency of tests. FINA, considered one of the most committed in the
anti-drug fight, recently said in its newsletter that it increased its
out-of-competition tests from a total of seven in 1993 to 802 in 1998. The
USOC spends approximately $12 million of its $500 million quadrennial budget
on drug control. More than half of that, about $8 million, goes to testing,
and about 15 percent, less than $2 million, goes toward research.

The IOC's list of banned substances is long and comprehensive--more than 100
stimulants, narcotics, anabolic agents, diuretics and hormones are included.
Many over-the-counter items contain banned stimulants that could trigger
positive drug tests.

Sports officials take care to warn athletes to steer clear of such products
in order to avoid violating stringent drug rules. The USOC drug control
education guide notes: "Ignorance is never an excuse. . . . Even when used
for medical treatment, the detected presence of a prohibited substance
constitutes doping."

There are many times, drug testers say, when they give the benefit of the
doubt to the athlete and disregard samples that contain only tiny amounts of
drugs common in over-the-counter products. Still, standards are not
necessarily applied uniformly. An amount that one lab deems an "accidental"
dose might be deemed a positive test by another.

When Italian high jumper Antonella Bevilacqua tested positive for the
stimulant ephedrine in May 1996, she blamed a Chinese herbal product she had
been taking, which did not list the drug among its ingredients. The IAAF
nonetheless levied a three-month competition ban. In 1990, three track
athletes -- sprinters Antonio McKay and Larry Myricks and long jumper Trevor
Marsh -- tested positive for stimulants found in common cold medication
products. All claimed the ingestion of the banned drugs was accidental, but
all were suspended for three months by the IAAF.

In Slaney's case, attorneys argued that her over-the-limit ratio of
testosterone to epitestosterone was caused by her age, the use of birth
control pills and the ingestion of alcohol. Three-time Boston marathon
champion Uta Pippig, suspended last year, made a similar argument about her
high test. Mitchell, a bronze medalist at the 1996 Games, tried to refute
his two-year drug suspension by arguing that a night of drinking beer and
having sex with his wife contributed to high testosterone levels.

Keeping Tabs on Athletes

The out-of-competition tests administered by the USOC and other Olympic
sport governing bodies require that elite athletes submit schedules of their
whereabouts months in advance. If the athletes are not available when drug
testers come knocking on their doors (or sometime within the next 24 hours)
some organizations will issue the athletes a "strike"--a measure to prevent
them from ducking tests. For FINA, three strikes in one year is considered
equivalent to a positive drug test. (The USOC, on the other hand, has no
penalty for a missed out-of-competition test, according to Wade Exum, USOC
director of doping control.)

U.S. swimmer Ron Karnaugh, who is a medical doctor, said that when his
mother fell and fractured her hip a year ago, he missed an unannounced drug
test because he traveled to Maplewood, N.J., to take care of her. Drug
testers showed up at his home in Philadelphia while he was gone.

Karnaugh said he submitted a urine sample within the mandatory 24-hour
period but still received a letter from FINA stating that he had earned a
strike for a missed test.

"There are so many factors that can go wrong for you when you're a clean
athlete," Karnaugh said.

Several athletes have suggested that drug testing should simply be
abolished, thereby erasing what they say is a facade that cheaters are being
filtered out of competitions and innocent athletes are being protected from
false positive results. Most drug experts and doctors, however, argue that
even faulty testing is better than no testing.

"If you don't test, then these people will emulate body builders at these
hometown gyms," said Robert Kerr, a California sports medicine physician who
admitted giving steroids to world-class athletes in the 1980s. "At least the
testing makes athletes behave themselves to a certain extent."

Indeed, for some cheaters, testing remains a threat.

This summer, a Belarussian triple jumper who won a gold medal at a junior
track and field competition ran from the stadium when she learned she had
been randomly selected for a drug test.

Caught by stadium workers at a nearby canal, Natalya Kostitchenko was taken
back to the doping control area. Her coaches allegedly offered a bribe to
the drug testers, who refused the offer. Kostitchenko then ran out of the
stadium again--and received a two-year ban for refusing to be tested.

Perhaps the most remarkable aspect of drug testing today is the number of
substances that still cannot be detected.

"We walked on the moon 30 years ago," Voet said, "and we can't find these
products in blood today?"

Washington Post correspondent Anne Swardson contributed to this report from
Paris.

Trip Though a Drug-Testing Lab

An athlete wins a medal in a competition and is drug-tested. Or an athlete
is asked to give a sample at his home. Either way, a drug-testing official
is present and certifies that the urine sample -- divided into two bottles
- -- came from the athlete. The athlete watches the official seal both
bottles, which are coded with a number rather than a name. The samples are
bagged, boxed with other coded samples, and sent away to the lab.

1.A box of six pairs of samples arrives at UCLA lab in Los Angeles.

2.A chemist at lab begins a chain of custody, in which each person who
handles the samples must sign them in and out of his or her possession. This
ensures that someone is responsible for them at all times, and that that
person can later be tracked down if the testing process is challenged. When
the person with custody goes home, he or she puts the samples into a locked
refrigerator.

3.The chemist takes the box of new samples to a locked room, opens the box,
checks the condition of the packaging of each sample and notes any
irregularities in the paperwork.

She makes sure there is an A and B sample for each number, because the
number is the only way the lab can identify the sample. No names are
attached, so no one at the lab knows which athletes the samples came from.
The chemist puts B samples, unopened, in a box to be stored.

Using an instrument called a pippette, she puts urine from each A sample
into seven different test tubes. She then takes one tube from each sample
and tests the urine in two ways: a refractometer makes sure the urine isn't
too diluted to be useful and pH strips make sure the urine is not too old.

4.The remaining tubes then go to the chemistry process, where another
chemist 'cleans' the urine, extracting all but the molecules needed for each
of five tests. After this process, which takes about four hours for six
samples, the tubes appear to be empty, but are not. Each goes in a
dessicator, or drying machine, for half an hour so that all moisture is gone
before the next phase.

5.Next another chemist adds a few drops of a volatile liquid,
trimethylsilyl, to prepare the samples for the test. This takes half an hour.

6.A fourth chemist injects the liquid into a gas chromatograph, which turns
it into vapor. The molecules travel through a tiny, coiled tube in the
machine at different speeds depending on their weight and makeup. Now the
test begins.

7.The vapor is shot from the chromatograph into a mass spectrometer, the
machine that will identify and measure what was in the urine. An electron
beam shatters the molecule, and the mass spectrometer identifies the pieces.
Each sample's trip through the mass spectrometer takes about 20 minutes.

8.All that is left is reading the data, which takes a certifying scientist
about 15 minutes per sample. If the sample tests negative, the process is
finished and the B sample is discarded. If any part of the test comes up
positive, a new test is scheduled on the A sample and the process starts over.

9.After the second round of tests, another scientist looks over the data. If
the sample is again positive, a report is faxed or mailed to the appropriate
sport's governing body.

The B sample is then put in a locked freezer and the athlete or his
representative is invited to the lab to inspect the opening and testing of
the B sample.

SOURCES: Don Catlin, USOC, IOC

Coffee Crisis?

Although caffeine is one of the drugs regulated by the IOC, a cup of coffee
in the morning won't jeopardize an athlete's medal. Caffeine and several
other drugs are banned only in very high concentrations -- amounts that
almost couldn't be reached accidentally.

The limit on caffeine is 12 micrograms per milliliter of urine, far more
than could be reached with conventional doses of household products. In
order to top that, an athlete would have to gulp more than eight cups of
coffee two to three hours before the test.

Product

Amount required 2-3 hours before the test to exceed the caffeine limit

Midol

25 pills

Cans of cola

17+

Excedrin tablets

12+

No-Doz

8 pills

Coffee

8 cups

Vivarin

4 tablets

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MAP posted-by: Jo-D