Time for change: a roadmap to guide the implementation of the World Anti-Doping Code 2015.

A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward.

The Athlete Biological Passport from the perspective of an anti-doping organization.

The introduction of the Athlete Biological Passport is a landmark in the fight against doping. Contrary to traditional toxicological anti-doping analysis, its aim is to detect the biological consequences of doping through the measurement of different specific biomarkers which generate individual profiles for each athlete. This new approach allows anti-doping organizations to convict those athletes showing abnormal profiles for the use (not the presence!) of even undetectable forbidden substances or methods. Additionally, these data can be used for other purposes: to conduct targeted conventional anti-doping tests on those athletes showing unusual results and to evaluate the prevalence of doping within a population of athletes. By now only the hematological biomarkers of blood doping have been validated, but in the future additional modules will be introduced to detect other forms of doping.

Case studies on ESA-doping as revealed by the Biological Passport.

Blood doping, through the increase of red cells, induces changes of hematological parameters. The aim of the Biological Passport is first to analyse individual longitudinal profiles in order to identify, through variations of the specific parameters, doping manipulations. Additionally, on the basis of abnormal values or profiles, athletes can be targeted for traditional anti-doping tests in order to detect forbidden substances or methods. We report the experience of the International Cycling Union in applying the Biological Passport to target athletes for the presence of erythropoiesis stimulating agents. All positive results which have been reported between 2008 and 2010 concerning athletes enrolled in the Biological Passport program are presented. Four cases are discussed more in details. To conclude, we propose possible ways of using the Biological Passport in order to better understand athletes' doping modalities, so that testing programs efficiency can be improved.

Implementation of the biological passport: the experience of the International Cycling Union.

The concept of the biological passport is to evaluate, on an individual and longitudinal basis, the effects of doping substances and prohibited methods--blood doping and gene doping--on the body. Indirect biological markers can be measured and used to establish an individual's biological profile, when variations in an athlete's profile are found to be incompatible with physiological or medical conditions; a disciplinary procedure may be launched on the presumption that a prohibited substance or method has been used. As such, an athlete with a biological passport is his or her own reference. The International Cycling Union (UCI) launched the biological passport programme in January 2008 in cooperation with the World Anti-Doping Agency (WADA). The UCI programme includes more than 850 athletes. These athletes are subject to urinary and blood anti-doping tests both in- and out-of-competition several times a year. Almost 20 000 samples were collected in 2008 and 2009. In this article, the real-time process from sample collection to the opening of a disciplinary procedure is described. The establishment of this large-scale programme is discussed; the modalities which have to be applied and the difficulties encountered are presented. As for the results, some examples of normal and abnormal profiles are illustrated and indirect deterrent advantages of the programme are shown. Suggestions to improve the efficacy of the fight against doping through the implementation of the biological passport are discussed.

[Doping and performance among adolescent athletes]. / Dopage, adolescents et performance.

If doping is generally considered a phenomena of the sports world, the use of substances to achieve a better performance is an attitude which is rapidly spreading out in our society. Doping behavior is defined as the consumption of a product in order to face or pass an obstacle and be more performant. Even among adolescents, the will to increase the efficiency in sport or to modify the body appearance, push some people to use any kind of products: nutritional supplements, doping agents (anabolic steroids, amphetamines, etc.), with all the associated risks due to the doubtful origin of some of these substances, the way they are consumed or their side effects. It is important that the medical community, and those who are in contact with the adolescents, realize that this kind of behavior exists, so to face it in an adequately manner, the same way they deal with the problem of alcohol, tobacco or drugs.