WADA vs. CAP

Another championship season is upon us.  Is USADA ready?  If they know what kind of chemistry is associated with winter triathlon performance they are one step ahead of the athletes, coaches, and the scientific community.  For the foreseeable future winter triathlons will remain an art not a science, unlike the disciplines that host elite divisions.

Nonetheless, perhaps the US Anti-Doping Agency (USADA) and the World Anti-Doping Agency (WADA) can clarify standards.  The blood collection protocol calls for supine for 10 minutes, which is all well and good.  Tourniquet application time is vaguely defined by WADA.  For College of American Pathologist (CAP)-certified laboratories, the limit is one minute to prevent concentration of cells, large molecules, etc.  Evidence I've noted does not show significant concentration within two minutes of tourniquet application; but, significant changes have been noted by five minutes.  For endurance athletes I speculate no tourniquet necessary is the rule not the exception.  However, a real standardization could involve dermal puncture and Microtainers for complete blood counts.  The athlete would do well to receive a carbon copy of any complaints expressed during the collection process.

Hematocrit (i.e. percentage of blood consisting of red cells) has long been an analyte for detecting doping.  It is noteworthy that normal hematocrit ranges vary across different ethnicities, with some African and Asian male populations showing lower hematocrits than white Caucasians.  Typical clinical laboratory range for a white, Caucasian male population is 42 - 52 percent.  Endurance athletes are know to have a narrower range due to the balance of increased plasma and erythrocyte (i.e. red blood cell) volume.  While 52 percent may be a normal hematocrit for a white male, it is unheard of among seasoned, undoped endurance athletes.  I have yet to find, in publication, how cells and plasma equilibrate in non-Caucasian endurance athletes.  As isolated populations enter the competitive field, just imagine.  This conundrum has been best addressed by WADA's Athlete Biological Passport Operating Guidelines, adopted in 2009.  The expectation that the athletes hematology and chemistry will be monitored throughout their careers, perhaps equivalent to an International Normalization Ratio for oral anticoagulants.  While this passport depends on doping beginning after entry to the testing pool, it alleviates the fallacy of population-based reference intervals used in clinical laboratories.  For example, if a drug made Alan Webb run a mile in 5:30, from a clinical standpoint he would be asymptomatic (see upcoming blog post).

The approach of science to fairness in sport will likely be an asymptote rather than an intersection.  You can expect that the integrity and assertiveness of the athlete will remain indispensable to fairness and sport.