The Explainer: Reaching the threshold and a doping Explainer?

Dear Explainer, A few weeks ago, there was talk that WADA was reconsidering its total ban on clenbuterol and then nothing. What gives? Is the discussion over? Should there be a threshold? If not, and they do allow small traces of clenbuterol, what will that do to the…

Dear Explainer,
A few weeks ago, there was talk that WADA was reconsidering its total ban on clenbuterol and then nothing. What gives? Is the discussion over?

Should there be a threshold?

If not, and they do allow small traces of clenbuterol, what will that do to the Contador case? Speaking of which, when the heck will that thing ever get resolved?
― Kevin

Dear Kevin,
We may have to wait a week or so before we find out precisely what steps, if any, the World Anti-Doping Agency has taken regarding clenbuterol.

The news reports to which you were referring involve the September 17 meeting of WADA’s executive committee in Lausanne, Switzerland. Prior to that meeting, David Cowan, the man in charge of testing for next year’s London Olympics, suggested that it might be time to establish a minimum threshold for clenbuterol.

Cowan, who is not a member of the WADA executive committee, based his reasoning on two factors. One, he conceded that there is a risk that an athlete might ingest a small amount of clenbuterol through the consumption of contaminated food. Two, Cowan said that differences in the sensitivity of testing equipment at various WADA-accredited labs means that the outright ban on clenbuterol is being applied inconsistently.

In Contador’s case, the sample he submitted on the rest day in Pau, during the 2010 Tour de France, tested positive for 50 picograms (a picogram is one trillionth of a gram) of clenbuterol per milliliter of urine.

Those tests were conducted in one of the world’s most sophisticated anti-doping facilities, the WADA-accredited laboratory in Cologne, Germany. As you might recall, Contador’s urine samples were among a group of samples from the 2010 Tour that had been flagged for exceptionally detailed analysis in Cologne. Had they been tested with the majority of other samples from the Tour, the result would probably have come up negative for clenbuterol. Hence, Cowan’s reference to uniformity of testing.

Other samples submitted by Contador – both before and after the Pau rest day – produced negative results. So, the question came down to how that trace amount of clenbuterol suddenly appeared and then disappeared from Contador’s body.

There are two competing theories out there. The one forwarded by Contador’s defense team, of course, is that he had inadvertently consumed beef contaminated by the illicit use of clenbuterol by the person who raised the cattle ultimately slaughtered to produce a cut of beef he’d eaten the night before the rest day. The other is that Contador had used clenbuterol at an earlier point in the year, a time at which he may well have extracted and stored his own blood for reinjection at the Tour. The advocates of that theory point to leaked reports of the existence of elevated levels of plasticizers in his sample as an indication that he had recently relied on transfusions. (For a more detailed discussion of that topic, see “The Explainer: Plastics” from October of last year.)

What did the executive committee decide?

While Cowan alluded to the need for a discussion of the clenbuterol threshold question, there is, as of yet, no indication that the subject came up during the September 17 executive committee meeting, or that they took action on the matter that day.

But we may have to wait until October 1, when WADA releases its revised prohibited substances and practices list for 2012, to see if there was any action taken regarding clenbuterol.

The press release issued by WADA following the meeting did mention that it had changed its policy regarding another Beta2-agonist, formoterol. The panel voted to allow therapeutic doses of the anti-asthma drug, essentially putting it into the same category as other approved medications, such as salbutamol. That means that an athlete may receive a Therapeutic Use Exemption (TUE) for formoterol, beginning in 2012.

All three drugs act to dilate a user’s bronchial tubes and offer relief from symptoms of asthma. Salbutamol is a short-acting bronchodilator, offering immediate relief. Formoterol is a long-lasting drug that is often used in combination with other drugs, like salbutamol. Clenbuterol is also a Beta-2 agonist, but it has several side-effects and is not approved for human use in many countries, including the United States. Unlike salbutamol, and now formoterol, there is no provision for the issuance of a TUE for clenbuterol under the existing WADA code and there is not likely to be one, either.

One of the side-effects of clenbuterol is rooted in its “thermogenic” qualities, which essentially stimulates a user’s metabolism and increases the rate at which one burns fat. For a skinny mountain-goat climber type, that is helpful. It’s also helpful for beef and pork producers who want to keep animals lean before slaughter. Both practices are banned.

If the WADA executive committee did take action on clenbuterol, it is likely that it merely established the sort of testing threshold suggested by Cowan. That would probably be considerably higher than the 50-picogram result produced by Contador, but would still be well below the level that would provide any performance-enhancing benefit to a user. It would, therefore, also eliminate the complicated “contaminated beef” defense in future clenbuterol cases.

So how would Contador fare?

So, assuming that the executive committee does establish a minimum threshold, how would that affect Contador’s case?

It’s hard to offer a definitive answer to that question. Strictly interpreted, even if the new WADA policy were to establish a minimum threshold for clenbuterol, that rule wouldn’t go into effect until January of 2012. Contador is charged with violating the rules as they were written in 2010, when there was an outright ban on the presence of any clenbuterol in an athlete’s body.

Nonetheless, the International Court of Arbitration for Sport could take the new policy into account when rendering a decision in the Contador case. The case law when it comes to clenbuterol has been inconsistent and CAS may look to any new WADA policies for guidance.

Earlier clenbuterol cases have had distinctly different results. RadioShack’s Li Fuyu, for example, tested positive for trace amounts of clenbuterol at the 2010 Dwars door Vlaanderen and was suspended for two years. He did not appeal.

As the Spanish cycling federation ruled in the Contador case, German table tennis player Dimitrij Ovtcharov was cleared of a clenbuterol charge by the German Table Tennis Federation when he claimed he had consumed contaminated food. Unlike the Contador case, however, the decision was not appealed by the international governing body or WADA.

At this point – following numerous procedural delays – CAS is scheduled to hold a hearing on the appeal of the Spanish federation’s decision, filed by the UCI and WADA, in November. It should be interesting … and even more so, if WADA changes its policy toward clenbuterol for 2012.
― Charles

Will the Explainer be doping?

The Explainer gets hair-care advice from Patrick O'Grady (left).

Dear Explainer,
I just read that you are undergoing chemotherapy. I wish you the best and, not to make light of the situation, but will that mean you will be using EPO any time soon? That would be ironic, wouldn’t it?
― Jennifer

Dear Jennifer,
Yeah, it would be. But, as it turns out, the FDA has pretty much shut the door on my opportunity to try out the elixir of drug cheat cyclists the world over. Dang!

Aside from hair-loss (which I beat to the punch with a new haircut), one of the common side-effects of chemo is that the patient suffers a decline in both red and white blood cell counts. Doctors would often prescribe EPO, Aranesp or the wondefullly-named (at least in cycling circles) “ProCrit” to patients who suffer from chemo-induced anemia. Studies, however, have shown that patients receiving such “off label” doses of EPO and other erythropoiesis-stimulating agents are at high risk for stroke, heart attack and a return of the cancers the chemo is supposed to be fighting.

As a result, the FDA issued a so-called “black label warning,” which pretty much means that if a doctor does prescribe the drug and the patient suffers the predicted side-effect, the doctor risks a loss of his or her license and opens the door to some killer lawsuits. The alternative is for a patient suffering from severe chemo-induced anemia to receive transfusions. Yup, if it gets bad, I’ll be doing the old homologous blood-doping routine, but as of yet, it hasn’t been an issue. No matter what, I doubt I’ll be climbing l’Alpe d’Huez at a record-setting pace – or at all – any time soon.

I am receiving regular doses of something called Neulasta, which promotes white blood cell production. That should boost my immune system through this whole process. For the price, though – $3,600 a dose – you’d think it would also make me skinnier, better looking and smarter, but alas, as you can see, neither is on the list of obvious side effects.
― Charles