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UNCORRECTED TRANSCRIPT OF ORAL EVIDENCE To be published as HC 1506-ii House of COMMONS MINUTES OF EVIDENCE TAKEN BEFORE SCIENCE AND TECHNOLOGY committee
HUMAN ENHANCEMENT technologIES IN SPORT
WEDNESDAY 25 October 2006 PROFESSOR IAN MCGRATH, JOHN BREWER, DR BRUCE HAMILTON and DR ANNA CASEY Evidence heard in Public Questions 106 - 197
USE OF THE TRANSCRIPT
Oral Evidence Taken before the Science and Technology Committee on Wednesday 25 October 2006 Members present Mr Phil Willis, in the Chair Adam Afriyie Mr Robert Flello Dr Brian Iddon Margaret Moran Mr Brooks Newmark Dr Desmond Turner ________________ Witnesses: Professor Ian McGrath, University of Glasgow and Chairman of the Physiological Society, Mr John Brewer, Director of Sports Science and the Lucozade Sport Science Academy, GlaxoSmithKline, Dr Bruce Hamilton, Chief Medical Officer, UK Athletics and Dr Anna Casey, Research Fellow, QinetiQ, gave evidence. Q106 Chairman: Good morning everyone. Could I particularly welcome our distinguished witnesses before us this morning, John Brewer, Director of Sports Science and the Lucozade Sport Science Academy, GlaxoSmithKline; Dr Bruce Hamilton, the Chief Medical Officer for UK Athletics; Professor Ian McGrath, University of Glasgow and Chairman of the Physiological Society; and last, but by no means least, Dr Anna Casey, Research Fellow at QinetiQ. Welcome to you all. I wonder if I could start this session by asking you to say what your role is in this particular area that the Committee is looking into, which is about human enhancement technologies in sport. Mr Brewer: I am the Director of Sports Science at GlaxoSmithKline with particular responsibility for running the Lucozade Sports Science Academy. I have a responsibility for overseeing our research and development programme for sports science and also for developing our new product pipeline for new sports nutrition products that we use to enhance sports performance. I have a background of working in applied sports science for the last twenty years. Q107 Chairman: Do you see athletics as a vehicle for selling your products or is it the other way round? Mr Brewer: We are very much focussed on developing products that meet the needs of elite sports people across a range of sports, not just athletics but team sports (rugby, soccer and so on) and in doing that we have to produce products that are of the highest quality and which work. If we can do that then we are obviously very well aware that those products will then have a knock-on effect into the mass market. It is really looking to get elite endorsement for high quality products that would then be preferred by the consumer at the mass market level. Q108 Chairman: So it is a two way process. Mr Brewer: Very much so, yes. Q109 Chairman: Dr Hamilton? Dr Hamilton: My responsibility is Chief Medical Officer at UK Athletics. It gives me the responsibility for looking after the health and wellbeing of our athletes as well as the performance component of our athletes. From my perspective the relevant issues here are the enhancement of performance through preventing injury and the enhancement of performance through the use of legitimate processes. The conflict that I always have is that we are always being asked to push the envelope where that grey area is within what is legal and what is not legal. Q110 Chairman: I think we will return to that because that is a key area as to whether there is a conflict of interest between those two particular roles. Professor McGrath? Professor McGrath: As you mentioned I have two roles here, one is that I am Chairman of the Physiological Society which is a learned society for the area of human physiology which is what sport is utilising. We have an interest in employing modern science in the area of human physiology and sport. I am not convinced that it is always the best science and we can come back to that. My day job as Professor of Physiology in Glasgow is to lead the Exercise Science group and there what we have been trying to do is to have Exercise Science embedded in a biomedical science group rather than a technologically oriented group. We have a thing called IDEAL (Institute of Diet, Exercise and Lifestyle) which means we look at the interaction of physiology and nutrition with exercise. We also have the extreme of sports studies of East African runners to see what makes them better than everybody else. We are trying to work in an area between medicine and sport to look at physiological limits in both directions. Q111 Chairman: Are East African runners different to our runners? Professor McGrath: There is an international study into that at the moment. It is very interesting because the thing at the moment that ties up best is running to school. We are looking at the genetics, we are looking at the physiology but the thing that correlates best at the moment is that those who run furthest to school do best as runners. Q112 Chairman: There are 650 people in this building who would profit from being on your study; perhaps we could talk to you afterwards about that. Last, but by no means least, Dr Casey? Dr Casey: I am Anna Casey; I am Research Leader in Human Metabolic Physiology and Nutrition at QinetiQ, formerly the Defence Evaluation Research Agency (we split from MoD back in 2002). My primary role is metabolic physiology and nutrition research. I do not have a teaching role. Our primary purpose is to support the MoD in terms of supplying research, supplying consultancy and in my case in helping the MoD to set the requirement for military feeding. Those are probably the major elements relevant to this inquiry. Q113 Chairman: Could I ask you specifically, Dr Casey, whether in fact you would put into nutritional feed for soldiers or military personnel products which would be on the banned list of WADA for athletes? Dr Casey: We certainly would not exclude that possibility. There is a very important distinction to make between performance enhancement and cheating in terms of breaking the rules of a given sport. Obviously in the military we do not have the same constraints as, for example, the ISE would have. One is always looking for something that would give military personnel an extra edge. In most cases, that is simply weaning them off hamburgers onto an appropriate diet and optimising their training. Those are obviously the two most important things. However, for a group of military personnel whose training is optimised and whose diet is optimised, who are highly trained and have great demands placed on them then we would consider that ergogenic and cognitive aids were appropriate. Of course, one is not always looking for a level playing field in a military context and in that context the overriding consideration would be one of health and safety: is that substance safe to use in the quantities that peer reviewed research has indicated is required for an ergogenic effect? I think there is an important distinction there. Q114 Chairman: If you looked at something like EPO would you feed that as a normal course for soldiers who are going to have long periods in the battle field to raise their red blood cells? Dr Casey: It is not being used by the military and there are no plans to use it. There are some safety concerns over it and that will always be the overriding factor. There are very few situations in which a risk benefit analysis would take place. Although we would not exclude that possibility I think that is further down the line. Certainly none of these things have been excluded. Q115 Chairman: You have a wonderful opportunity - or the military have a wonderful opportunity - to be able to do research into performance enhancing drugs or technologies and for that research then to be actually transferred into sport or into other areas of medicine. Are you conscious of doing that or is the MoD conscious of doing that? Dr Casey: Yes, absolutely. Q116 Chairman: Could you give us an example where something has emerged within the military which has been transferred into sport? Dr Casey: There are no obvious examples of that. In fact what happens in most cases is that the military feeding initiatives are based on developments in sports science; that is the way round it often occurs. However, there is a lot of research funded by the Ministry of Defence which is into substances like modafinil, ephedrine, those types of things which are on the banned list which UK Sport, for instance, would not want to sponsor research in. There is still research going on sponsored by the Ministry of Defence into things like this. It does not mean they are being used but it does mean that they are keeping an open mind and they are sponsoring research in these areas. To my knowledge there are no illegal substances being researched by the MoD which have been transferred to athletes in that sense. Q117 Chairman: Professor McGrath, just following on this theme, are you conscious of what is coming out of other areas of medical or military science which could be used in sport? Professor McGrath: I think from the technological side there is a great deal in terms of monitoring devices. If you know the state of your soldiers when they are out there in situations of danger, that is something the military I hope is concentrating on very much and developing. These could very much come back into the sports sphere because the military have the resources and the money to develop these things. If you can know the temperature, if you know where they are using global positioning stuff, you know about their metabolic state, you know how much they are moving, all that can now be done in a sort of sci-fi way and fed back wirelessly. I think there is a great capacity for that. The other point I would make is that there has not actually been much good research into the difference, for example, between raising your blood through good altitude and giving EPO. That is an area I think the military could work on because it is very much in their interest to get maximised metabolic performance. The military could fund that kind of research which is ethically against sports to fund. I think you could get good physiological research funded by the military. I know Britain is not funding space technology, but space technology is enormously important here because of the metabolic demands of people who are in an isolated situation and feeding back information there. There is a great deal technologically but also physiologically. There is a job there; I do not know if the military is doing it, but they should be. Q118 Chairman: What I am trying to get in this early session is a feel from you as to where the drivers for research are coming from. Obviously the military is one, but is it coming out of our medical research establishments? In your evidence you mentioned that we were pretty poor in terms of research. Professor McGrath: The problem is that there are not the drivers to do the research; the remits of the research councils do not include sport. I know that EPSRC is getting on to this at the moment; they are having a meeting this weekend and going for gold. In general it is not a medical research council's job to do the physiology in relation to sport. It is not a science in the EPSRC's remit so there is not really a strong push for the resources going into this area. The scientific possibilities are there, but people who do this kind of work tend to drift off in their career into cardiovascular research or diabetes because they can apply the biological expertise there and get funding from either charities or research councils, whereas sports science tends to be another subject which does not have the drivers. A lot of the money does come from the drinks industry and so on but it cannot be entirely independent. Q119 Chairman: John, obviously you are a commercial company at the end of the day and we fully accept that, but do you actually spend a lot of money on research which has a direct impact on the athletes whom you are hoping will take your nutritional products? Mr Brewer: We currently have a research budget for sports science which is approximately half a million pounds a year and we fund that in five academic universities, four in this country and one in Australia. I think there are two main drivers behind that research, one is for us to look at new claims and to develop new products, particularly the new product area where we are looking to fund research that will enable us to produce products which are different from the range that we currently have and which will give us cutting edge products and cutting edge claims that we can make around those products. We are also conscious of our need to fund what we would term blue sky research which is a research which may not have an immediate effect for us but which may enable us to enhance sports science knowledge and perhaps produce benefits in the longer term over the next five or ten years. Q120 Chairman: Where is the cross-over between SmithKline's main pharmaceutical research and putting out products there which would have a performance enhancement cross-over into athletics and into your nutritional drinks? Does that occur? Mr Brewer: Not to that great an extent to be quite honest. GlaxoSmithKline has, as you know, a major pharmaceutical business; we sit within the nutritional healthcare business in the UK and so we have a very much ring-fenced budget for sports science and sports nutrition research. However, it would be wrong to say that we are not in contact with our colleagues within our pharmaceutical business to look at other areas and other opportunities, but by and large there is quite a distinction between the pharmaceutical research that we conduct within a separate arm of the business and the very focussed sports science and applied sports science research that we conduct through our nutritional business side. Q121 Chairman: Do some of your general products which I could take contain substances which would be on the WADA banned list? Mr Brewer: Absolutely, categorically not. We have invested a huge sum of money in working with HFL (the WADA accredited laboratory in Newmarket) to have a process in place that enables us to say to the highest possible level that all of our products are free of substances on the WADA banned list. We have spent a lot of time and money in working closely with HFL and with colleagues at UK Sport to raise the bar as high as possible on not just the testing of the products but the whole supply chain from the production of the raw materials through to the production of the products themselves, the testing of the products and then the distribution of those products and the supply chain of those products to the athletes. We believe that it is of absolutely fundamental importance that we can provide athletes across a range of sports with a kite mark and quality assurance that enables them to purchase their sport nutrition products in the full knowledge that those products have been tested to the highest possible standards. Q122 Chairman: We have that on record. Mr Brewer: Thank you. Q123 Adam Afriyie: Are you confident that GlaxoSmithKline have not invested in any organisations or are not doing overseas research for another branch of the organisation which may be influencing the development of human enhancement technologies in sport? Mr Brewer: I can only speak on behalf of the nutritional business and I know the research that we fund which is very much focussed on legal, performance enhancing products. Obviously the rest of the pharmaceutical business of GlaxoSmithKline is huge and sits outside my remit and obviously that is done more for medical purposes and I would not want to comment on that. Q124 Chairman: Dr Hamilton, if you find the nutritional companies are doing something but there is not a great deal of research coming elsewhere, is there a push from individual athletes or coaches or sports clubs or individual sports for more research? Dr Hamilton: There is although in my experience athletes are not so much interested in research but outcomes and they will jump on a product or a technique or a strategy that they will perceive to work on the basis of no research at all. One of the issues that we have is that I am pushed into situations and encouraged to use techniques or procedures which are based on very little evidence. The push does not so much come for research, it comes to the utilising techniques. Sports medicine in this country is a relatively new profession and one of the underdone areas at this stage is access of sports medicines, sports physicians and practising clinicians to research and that is a real limitation to our practice at the moment. Q125 Chairman: Professor McGrath, what do you think are the main developments in terms of the illegal human enhancement technology at the moment? Where should we be looking as a Committee? Professor McGrath: I think pharmacology will always develop; drugs are continuously developing, they have been for the last fifty years and that will carry on. One of the difficulties is that sports people are interested in outcomes and are very susceptible to snake-oil salesmen if people come along with things that they say will help without any substantial scientific background to explain how that was developed and what the consequences are. I think pharmacology will continue to develop and we will have to try to keep one step ahead of that somehow. There are only three things that drugs can do: they can enhance the best, they can make physiological performance better (hearts, lungs, muscles, et cetera); they can cheat the brain safety devices and they can accelerate healing. Accelerating healing is probably something that is a good thing. The point of training is to make physiology better and it is a question of whether you are going to harm people by the drugs that you develop to speed that up. Probably the most dangerous things are the things that cheat the safety mechanisms of the brain. The drugs themselves might be difficult to detect and the consequences that they have may be difficult to detect. I think we will have to keep one step ahead of the game. We have not been very good at actually understanding what illegal drugs do. We have been quite quick to make them illegal and say that they might do harm, but we are not actually very good at understanding exactly what they do to the body. My thesis would be that if we understood better what they did to the body we would be one step ahead and we would be looking at the consequences of the drugs rather than having to search for unknown chemicals. It is obviously in the interests of governments and sports people all over the world to do whatever they can to enhance performance and if you want Britain to be winning medals what we have to do is find ways of stopping them using them illegal techniques. I think probably finding ourselves ways of enhancing our athletes' performance is not where we should be putting the effort in; we should be putting the effort into making sure that we understand the things that people are doing to their athletes so that we can be one step ahead to stop it. Q126 Mr Flello: Dr Hamilton, I would like to return to some of the points you were saying about the challenges and the issues and the overlap there. Can I draw out a little bit more about the main challenges to a medic in the sporting world? Dr Hamilton: We have to differentiate between the elite sporting world and the mainstream sports because the pressures and the management of athletes is entirely different. My role is one of both trying to maximise the health and wellbeing of the athletes, allow them to recover from training more quickly, allow them to progress and recover from injuries as rapidly as possible. I am also linked in closely with the science side of the sport trying to maximise the performance. Quite often maximising performance will be in direct conflict with the health and wellbeing of the athlete. We can encourage someone to recover quickly and allow them to do more training, but that training may well be having long-term consequences for them in terms of osteoarthritis, in terms of injuries that may come on post the competitive period that they are interested in. There is a conflict there all the time between my role of trying to enhance the performance and trying to manage their injuries, and that is something we deal with on a day to day basis. There are conflicts in the area of medication use. What is illegal and perceived to be inappropriate to use today may well not be tomorrow and athletes are very quick to jump on that. A relevant example would be pseudoephedrine which was prohibited until a couple of years ago when it was taken off the list because - I am uncertain as to exactly why it was taken off - it was presumably so commonly found in over the counter medications that it was difficult to control its use. It was taken off the list but subsequently it has been shown in a research paper with Birmingham University and Asker Jeukendrup to have performance enhancement capabilities. Athletes will want to use that now and I am in no position to say they cannot use it, so we try to control it from a health perspective. Then the athlete will ask the question, "If I can use that, why can't I use this?" and it is very difficult to argue against that when two substances, methods or techniques or whatever it is will actually have the same risk benefit profile. Q127 Mr Flello: What are the methods you can use legally to enhance performance in a competitive environment? Dr Hamilton: On the day performance enhancement pseudoephedrine is a product that legally people should be using within health limits. Creatines are another product that have been shown to have some performance enhancing benefits for certain events. We use a number of neuro-muscular stimulation techniques - manual techniques - to try to enhance the performance on the day to keep the muscles activated. Appropriate warm-up, appropriate fluid and appropriate diet are areas which are most commonly neglected and are big players. Q128 Mr Flello: Is there a tension on you to short cut some of those basics? Dr Hamilton: No. There are always challenges to try to maximise everything, but my personal interaction with athletes is that they will not be challenging me to use illegitimate means; they would want me to push the envelope of legal means. Yes, I will be pushed to maximise it but within legal boundaries. Q129 Mr Flello: Dr Casey, you mentioned about trying to wean the troops off hamburgers and certainly through the Armed Forces Parliamentary Scheme there seems to be a fairly staple diet at training camps at Pirbright and Sandhurst and the like. It has been commented that trying to get the troops off smoking would have more of an impact than anything else. Is there any research going on in that particular area in terms of looking at the way troops lead their social lives? Dr Casey: We are not doing any research specifically aimed at smoking. I cannot speak on behalf of the Ministry of Defence, but certainly it is my understanding that there is an on-going discussion about smoking. It has been an on-going issue for many years, as you can imagine. A lot of the studies we do which work with basic recruits do not just cover the physiological side of training; we also do a lot of profiling in terms of their physiological responses to stress and also their coping mechanisms and that type of thing. In terms of the sort of person they are, that is something that is the subject of on-going research. We do not do a lot of social research within our department with these groups of people, but going back to the question of diet, I do not think it is any secret that certainly in the past the diets have room for improvement but there has been a major overhaul over the last two years in the whole area of military feeding. When I started working with the military I started very much at the high performance end, ergogenic performance enhancement, and I have taken a step back at every stage and we are right back at the beginning now and we are really trying to address the entire issue of military feeding right from the recruit who walks through the door to his daily diet. That is where the big difference would be. I have mentioned that before and I agree with Bruce Hamilton that the biggest difference to your performance whether it is physical performance or cognitive performance, your mood state, how you train, how you recover, all of those things will be governed by what you are eating on a daily basis, not what supplements you are taking and what drugs you are taking or what you can get hold of. It is your daily diet, it is your training - how good is the training, how progressive is it, are you breaking the recruits in too early - all of which has been addressed over the last couple of years. There has been a major overhaul of the whole of military feeding, from your basic recruit right through to servicewomen - concentrating on pregnant women and also on special forces - and that is on-going at the moment. Q130 Mr Flello: Is that an area where the military is benefiting from research that has been done over many years in the sports field? Dr Casey: Not necessarily the sports field but certainly in the areas of public health and general nutrition. Q131 Mr Flello: In terms of the quality of legal research in this country, how does it compare to the international position? Who are the world leaders in this area? How can the UK be the best compared to them? Professor McGrath: I think that Britain is up there with the leaders in this area. Maybe Denmark, Sweden, Canada, Britain, the US, Australia, South Africa tend to be the leaders in this area. There is a big potential for making it better. There is better science out there that could be applied to this area if, as I said, there was some driver to make people do it. In the last research assessment exercise at the universities in Britain there were only five groups that had a five star. That, in the whole of Britain, is not what you would be driving towards for an area of academic endeavour. Of these five three were very much technologically oriented groups - Loughborough, Manchester Metropolitan, Liverpool John Moores - and only Birmingham and Glasgow were embedded in biomedical science rather than in sport. There is a big potential there. There are a lot of other places in Britain who could be doing this kind of research if there was some driver. You would expect £500,000 of one MRC grant but there just are not the resources going into this area. Q132 Mr Flello: Mr Brown, perhaps I could ask for your perspective on the same area. Obviously an organisation like yours is a multi-national one, so how would you see the comparison of the UK research in that field? Mr Brewer: I guess we are in the fortunate position that we can cherry pick where we have our research done and it would be wrong to say that we do not look overseas to see if there are any opportunities there. The fact that four of the five universities that we currently fund are in the UK I think is testimony to the fact that we do rate very highly the quality of the academic research that can be obtained at key centres of excellence in the United Kingdom. Very important for us is working with academics who have the ability to do firstly high quality science but then work with us to translate that science into meaningful claims and meaningful language that we can then use to develop next generation products and to translate to the athletes and the coaches and the sports science and sports medicine support staff the benefits of those products and the benefits - as Dr Casey has said - of the correct nutritional strategy to support the supplementary parts of their diet that give them that extra half of one per cent. I think we are very comfortable with the quality of academic research that we can obtain within the United Kingdom. The outputs that we obtain from that are very good, they have helped us to develop products over the years, they have helped us to develop new claims over the years. I think perhaps the classic claim from us from a business perspective is when we funded research at Loughborough University back in the late 1980s where we were able to show that isotonic drinks can improve performance by 33 per cent. That was something that was generally known within the world of sports nutrition but it enabled us to take our products one stage further and to educate the coaches and athletes accordingly. That is very important to us, that delivery of an education message to support the product development which we can only get by working closely with academics. Q133 Dr Iddon: Professor McGrath, when you said in your written evidence to the Committee that "much research in sports related topics is not cutting edge and does not have sufficient scientific depth" were you referring only to UK work or were you referring to global work when you said that? Professor McGrath: I think it would be a global phenomenon. It is an area where you can produce certain outcomes in terms of physiological studies of athletes quite cheaply, but to achieve any depth to move the thing forward in terms of science it is much more expensive. It is incontrovertible. We are moving forward in the area of cardiovascular research, cancer research and the quantities of monies involved are many multiples of the kind of money that goes into sports related research. Because the drivers are not there, the science is not being applied there, but the science could be applied. The science of physiology, biochemistry and molecular biology is all there, but where would you get the money to apply it to sport? Q134 Dr Iddon: In your written evidence you have said that the whole science base is there, so can you perhaps tell the Committee what Britain needs to do to change this position if we are to be a world leader in our athletics with a view to the 2012 Olympics? Professor McGrath: I could say you are too late for the 2012 Olympics, but the fact is that you could do things if you put significantly more money into the system. I do not know where you would get it, but I would say that, would I not? If you put more money into the area of physiological research you would get some outcome, but I really do think that in terms of understanding the physiology behind these various forms of enhancement, if we did understand that better we would be able to set better limits. One of the difficulties in defining what should be illegal is often that you have achieved something that is way outside the norm, but we are not very good at defining the norm so we get into legal struggles about whether something is 30 per cent more than anybody else would ever have, or is it 300 times. We really do not understand those kinds of things. We are quite good at measuring oxygen consumption and heart rates but we are not very good at the fundamental science that underlies it. What are the genes that are expressed when you take these drugs? Rather than looking for the drugs, we should look at the physiological effects of them. This is all possible; this is not science fiction. If more resources were going into this area we could be one step ahead of the dopers because we would be picking up the things that they are making the body do rather than picking up the things that go into the body. Q135 Dr Iddon: With respect, that is all very negative. What we are looking for from our witnesses is to be able to make recommendations to government on the way forward. In an ideal world where do you think the money should be coming from if it were available, and who do you think should be responsible for allocating it? Professor McGrath: I think it is quite a good thing to look at the different research councils for different purposes. You could persuade the Medical Research Council to be involved if you saw this as a continuum of improving human performance/health with athletic performance being at one end of that spectrum and illness being at the other end of that spectrum. They would debate it quite strongly with you perhaps. I think the Medical Research Council could be involved there but the Biological Research Council could also be involved in terms of applying the best of modern biology to these sports related and health related issues. Q136 Dr Iddon: The BBSRC? Professor McGrath: Yes, the BBSRC. I looked at their website in vain for sports and exercise related topics. They actually had an article on sport but it was nothing to do with sport. I do not think you could persuade them to use part of their existing budget to do it. Money would need to come in from outside and it would need to be a substantial amount of money, £20 million or something like that. A project costs half a million pounds and you would probably need to have consortia working on this. You mentioned Britain versus the rest of the world, any of these projects that we are involved in - whether it is looking at East African runners or some other aspect of physiology - nearly always involve an international consortium of scientists because in order to get enough good groups who are the best in the area you have to work in that way. Q137 Dr Iddon: If you were Colin Blakemore tomorrow where would you invest your money in this particular area? In other words, what would be your top three priorities? Professor McGrath: My top priority would be looking at the gene expression consequences of some of the enhancement technologies. EPO would be a place to start. What other gene expression consequences of technologies which enhance the oxygen carrying capacity of the blood. I think that would be one area that I would look at. I would also want to go for a couple of the most common types of drugs that are used illegally and I would try to look at the gene expression consequences of giving these drugs and the physiological consequences. It would not be cheap because there is no point in doing a study with half a dozen people here; you are talking about doing it with different populations: elite athletes, normal plodding athletes, normal members of the public. Q138 Chairman: You cannot do it on elite athletes. Professor McGrath: You can do it on elite athletes if they are out of competition. That is the way these projects are planned. You cannot do the illegal doping with the elite athletes, but you can do the difference between them being at altitude and not being at altitude, those kinds of things, and you can compare it with other groups. We learn a little bit off them in terms of percentage performance. You can do those things; they are ethically possible. However, nobody is doing them because why would you? Q139 Dr Iddon: The Australians are doing it; we saw that in Australia and they do not believe that this altitude stuff makes more than half a per cent difference (that is what they told us). Do the other three witnesses before us this morning agree with Professor McGrath's analysis about who should be directing the money and where the priorities lie? Dr Casey: Yes. We obviously have a slightly different experience. The Ministry of Defence do not tend to fund research directed at sport so that is not a major issue. Q140 Dr Iddon: Why not? Running across the battlefield is very analogous to what sports people do. Dr Casey: That is what I was about to say. Sport is not named but of course the majority of the work they place within our capability is all to do with training, recovery, exercise and performance enhancement so of course it is to do with sport, it is just not named that way. There is a fairly large programme of research funded by the Ministry of Defence to address this. For instance, we have very recently formed a consortium of industry, military and government organisations such as the Health and Safety Laboratory as well as five or six leading universities in the UK. We formed a consortium called the Haldane-Spearman Consortium which has recently won a competed contract from the Ministry of Defence Research Acquisition Organisation (the RAO) to perform human sciences research, most of which is based around these sorts of topics. That is an enabling contract which is worth potentially up to twenty million over the next six years. That is a recent development, so the Ministry of Defence is putting significant resources into preparing people for operations, preparing people for optimal performance and different environmental conditions using different technologies and different supplements and different ways of optimising performance. We have a slightly different experience in that the Ministry of Defence is putting a fair amount of money into this area. I should just add, we do not always use military subjects for these studies. A lot of these are well-controlled studies in an academic department and are performed in the same way as they would be in a university. We would often use populations of moderately trained or well trained athletes, cyclists, runners in the same way that we would in the university environment. We do use military subjects; we do need to match our subject populations to the military populations that we are addressing, but we do often do performance studies which use athletes. Dr Turner: On the question of funding, I can see why you might hesitate to ask the MRC to fund this kind of research, or even BBSRC, because they have pretty serious remits. However, what we do have in sport is a massive billion pound industry which, if we had some system of imposing a levy across the whole sports industry, you could produce a twenty million a year budget with the greatest of ease. I just wondered if anyone had ever investigated that as a possibility. Q141 Chairman: I have to tell you that when Harry Donaldson set up one of the first sports laboratories at Salford University, Manchester United were his first customers. Professor McGrath: If you go round the country a lot of sports science groups are giving support to football teams up and down the country. I think there is a requirement by the various organisations that they should have sports science support now. That has been quite a good thing in enhancing the volume of research if not necessarily the quality. Mr Brewer: Going back to the question of 2012 and where we should be directing our resources to be successful in 2012, I think we have to accept as well that our success in 2012 will not just be based on performance in endurance sports; there will be team sports and powerbase sports - hockey, basketball and so on - where we will need to be successful. One of the areas that we would like to feel that more work is being done is showing to the performers in the countries in those team sports that appropriate nutritional practices will enable them to improve, not just the marathon runners and so on where we know the science has already established a very close link between sports nutrition and performance. I think there is a lot of work to be done across a broad category of sports to show that they can enhance their performance with correct nutrition. That is something we feel very strongly about. The other area where we feel that funding could be directed is towards the whole story of recovery. If you look at sports people at the moment there are far more sports people in full time training now thanks to the Lottery than there were ten or fifteen years ago. As a consequence of that, performers at the highest level are training on a daily basis for a number of hours, day after day. Quite often in team sports there are small squads as well. The whole issue of how do performers recover properly after training so that they can go back and train more effectively and train properly on a daily basis is something that I think is very important. If we can achieve that and achieve better recovery in terms of performance and immunity from illnesses - colds and so on - then I think that is an area we would certainly like to see research and development focussed in the build up to 2012 because I think there are some big wins to be gained from that. Q142 Mr Newmark: How common is it for sporting bodies actually to undertake or commission research? Dr Hamilton: In my experience it is very rare to commission research, primarily because the sporting bodies do not have funds to do so. We do develop clinical research based around practices that we are doing, so we would do a lot of auditing about procedures and we will, using our sports scientists that we have links with in track and field in particular, develop small projects based around developments that are going on. In terms of commissioning and paying for it, it is very limited. Q143 Mr Newmark: Do you think this is something they should be doing or should it be left to other bodies to do? Dr Hamilton: I agree with my colleagues in terms of what has been said about where the support and funding should be directed. From my perspective, there needs to be a tighter link between the clinical practice (and I include in that the sports physicians and the coaching arena) and the university research. I think that is an area that I would look to tighten up. I am not certain of the evidence for that but certainly linking research to appropriate practice within the clinical realms would be a priority for me. Q144 Mr Newmark: Dr Casey, you touched a bit on collaborative research for the soldiers. How much collaborative research do you actually undertake? Dr Casey: Quite a lot, actually. Q145 Mr Newmark: Who is it with? Is it with universities? Dr Casey: Yes, we obviously now have this Haldane-Spearman Consortium and we are the prime contractor with QinetiQ as the lead partner; there are twenty other partners which include six universities (Nottingham, Loughborough, Birmingham, Cardiff, Glasgow and Cranfield School of Management), twelve specialist SMEs as well as the Health and Safety Laboratory. That is really quite new, so those collaborations are just getting up and running. We do have a long history of collaborations on fairly large research programmes with universities, in this area particularly with Birmingham, Loughborough, Liverpool and Nottingham. We have very close links with them and we do perform collaborative research with them on a regular basis. At some of these universities, such as Birmingham, we have programmes which have run end to end for ten years or so. We have quite close links with them. I think we are quite good at collaborative research and that is partly because previously the majority of the Ministry of Defence funding we received had a small amount ring fenced which we were asked to use for collaborative research - it was one of the aims of the defence programmes that were given to us - and that got people in the habit, but it is done on a regular basis. Q146 Mr Newmark: How much of that are one-off projects as opposed to long term funding for that? Dr Casey: These tend to be three year programmes so they are fairly substantial. That is probably as much as a university would receive from a funding body in terms of sponsorship. Q147 Mr Newmark: Is that a reasonable timeframe for you to do what is necessary? Dr Casey: It is, and of course what happens - and has happened - is that you kick off with a three year programme, you establish a relationship, you have trained someone up within that university to do that particular work and you then renew those programmes. The funding for these programmes that I am talking about now has almost all come from the Ministry of Defence and we are then sub-contracting universities and it might be a formal relationship in the sense that we give them a sub-contract, but it is always collaborative in the sense of an academic collaboration. Often we will do work over and above what is required for that work programme out of academic interest and to pursue this area, which is the way that all of us have to operate. Q148 Mr Newmark: John, how much collaborative research do you end up doing? Mr Brewer: We have done a small amount with Dr Casey and her team, but otherwise in terms of collaborating with other businesses the answer to that is no, we fund our own work. We have links with five UK universities at the moment. We talk with the universities on an on-going basis. Q149 Mr Newmark: Are those the same universities as Dr Casey or different ones? Mr Brewer: Loughborough, Birmingham, Liverpool John Moores University and Bath University are the four that we work with in the UK. That is not to say it is written in tablets of stone; we do talk with other universities about perhaps doing different studies involving on-going work. We also fund work at the University of Melbourne, Institute of Technology in Australia. It is very much a moveable feast. We have core universities that we have worked with for a long period of time, Loughborough and Birmingham particularly, but we are always looking for new academic partners that we would like to work with. The number one priority for us is the quality of scientific work that they can do; the second point is to make sure that when we work with them that we are doing research work or we are supporting research work that will have an output for us whether it is for new product development or claims on existing products, or potentially blue sky work where we might see a benefit in five or ten years' time. Q150 Mr Newmark: Is there much overlap between what you are doing and what Dr Casey would do, or not? Mr Brewer: Possibly not. As you would imagine, we are very sports nutrition focussed. Having said that, our sports nutrition work or research work does not just focus on the elite performers; we fund work that is looking at the overall effect of health on dehydration, for example, with people going into a gymnasium and sweating and losing fluid and how that can impair their performance on their day to day lifestyles. We have worked with Dr Casey and her colleagues at QinetiQ on that area. Q151 Mr Newmark: Professor McGrath, where does the funding for academic research in sports related topics come from? We have heard a little bit comes from the military; where else is money coming from? Professor McGrath: It comes from there and it comes from the drinks industry. It comes from devices manufacturers (people who make heart rate monitors or remote sensors for temperature, metabolism and things like that), a variety of commercial sources. People tend to get credit from research councils by doing things that are related to exercise but which have health benefits. People would tend to go for BBSRC or MRC grants in an area that was in some priority area but crossed over into sport. They would develop a science that way and then they would use a skim off of some of that to do the more direct sports related stuff. Like any other academic institution or department they would be looking everywhere, but they would not be as successful at getting a big proportion from the research councils which, in academic terms, is what you get your brownie points for. It makes it very, very difficult to build up elite groups in universities because you have to do a lot of small grants which takes up a lot of time and do not develop the science enough. That is the problem. Q152 Mr Newmark: In the universe of sports science, if you had a pie chart what percentage tends to come from commercial as opposed to military as opposed to government directly? Or through universities? I am just trying to understand where the balance is. Professor McGrath: I think compared to equivalent areas of biomedical science probably twice as much would come from commercial sources and half as much would come from research council sources. That would be my guess. Q153 Dr Turner: Professor McGrath, what can you tell us about the effectiveness of knowledge exchange between the different scientific disciplines in terms of sports related knowledge? Are the geneticists talking to the pharmacologists and the biochemists, et cetera? Professor McGrath: I should say in defence of sports science that it is a very new subject. Universities have only been running degrees in sports science for twenty years; ours has been running twenty-one years this month and it is the oldest degree. If you look at the people around you the age profile shows you how high up people have got from British sports science developing. There are a few older people who were in physiology before and are now associated with it, but it is quite a young science. It is regarded as a kind of Johnny-Come-Lately soft science by people like geneticists and pharmacologists, but interestingly recently they have become more interested because they have seen that there are some very interesting applications of the science. We mentioned gene doping at the beginning and I have to say I think gene doping is a red herring. Gene therapy in medicine is a wonderful prospect but it is years away from being effective and to say that you can use gene doping in this area of performance enhancement I think is just a distraction. The interesting thing about genetics is not in terms of changing people's genes but in terms of having the technology to measure what other changes are happening in a person. Geneticists have started to become quite interested; even fairly hard core geneticists are quite interested. There are some good geneticists working in this area but they need to work with physiologist type sports scientists to make anything of it. You need to have people who are very good and know all about physiological changes that take place working with geneticists. A geneticist would be of no use on his own with this. You need to be in a place where you can get the resources to do this. We opened a laboratory last week with a million pounds of university money because they want to bring the geneticists and physiologists together. We have a suite of laboratories which have bicycles and treadmills in one room with a molecular laboratory next to it and there is a metabolic laboratory for nutrition next to that. This is the kind of effort that people need to make. Q154 Dr Turner: So you think there is a need for more inter-disciplinary approaches like this? Professor McGrath: Absolutely, there is no question about that. Q155 Dr Turner: What about the exchange between different sectors, not of scientific disciplines but between the academic world, industry and the military? How effective is that? Professor McGrath: The interaction with the military has always been interesting because there has always been interaction between physiology and the military. Going back before my time there were always people who were coming in from the military to do joint projects and to teach the kind of stuff they did with endurance or deep sea diving. There has always been an interesting feedback with physiology and the military. At the moment there may be more of an inhibition in information exchange between the military and the outside world in technological terms. I think this remote sensing is quite an important thing. Satellite tells you where a person is and how fast they are travelling even within a few metres, and monitoring of physiological performance. I think the military should be putting a lot of resources into that because it is extremely important. It would be terrific to transfer that into sport, but I do not know whether they would want to. I cannot speak for them, but if I were them I may be reluctant. Q156 Dr Turner: What do the military have to say about it all? Dr Casey: I cannot speak on behalf of the Ministry of Defence; I can only speak on behalf of QinetiQ. What I can say is that the UK Ministry of Defence has just placed a programme on physiological monitoring with the Haldane-Spearman Consortium and that does include remote physiological monitoring in the field. This is the type of thing you are talking about; it is being funded by the Ministry of Defence. We are not as far down the line as you might expect. I am talking here about physiological monitoring. There are other programmes within QinetiQ which deal with the physiological monitoring on a different scale. It is an on-going programme of work. I do not see any reason why that could not be translated into sport at the end of the day. I think you will find that the Ministry of Defence is always very pleased when it sees pull-through which goes beyond the military. I think that is something that both the Ministry of Defence and the providers of research for the Ministry of Defence like ourselves have not been as good at as we might have been in the past. The issue of pull-through is something they do now focus on and it is improving, not just outside but within the military. The pull-through of research into military policy is something that has improved considerably and is still improving and that does need to extend to outside the military. They are very aware of that and very, very pleased when they see examples of that happening. I think you would find a willingness to do it, it is just doing it. Professor McGrath: It is creating a forum for discussion and that may be one of the things we could bring out of this. We are bringing together people who would not normally have come together. Q157 Dr Turner: Is there any scope for improvement and enhancement of relationships in this respect between industry and academia? Mr Brewer: Yes, I think there is. To have a group where we, as a business, can raise the issues that we would like the research to be conducted in and have a team of academics who we could interact with to identify the best ways of conducting that research would be something that would be of great value. It is certainly an area that we have discussed within our business. Whilst we know the key individuals that we are working with, there may be other areas of expertise out there which we are not aware of which could give us the answers to some of the questions which we are raising. Q158 Margaret Moran: We have just had a superb example of what was quoted to us that the communication across industry, across the military and you mentioned space is not there. I think the point is very well illustrated in that discussion. Is there a recognition of the value of knowledge transfer between different sectors involved here, industry, MoD, interest in space? Obviously you can have a forum which sounds like a good step forward, but the understanding and the value and actually doing the knowledge transfer is a further step on. What are the problems associated with that? Do you think there is reluctance to do that or do you think there are other things which would stand in the way of that kind of knowledge transfer? Dr Casey: There are obviously concerns in terms of the military research in the sense that some of this is classified and would not be available in that sense. In terms of the unclassified research on performance enhancement you would find a willingness within the MoD to engage in that type of discussion. They are very open to this and it is not non-existent. To give a small example, UK Sport recently set up a short term working group which myself and your adviser sat on which brought together academics, myself from QinetiQ and UK Sport and actually produced a document for UK athletes with a view to 2012 on ergogenic aids and supplements and performance enhancement. That has now been published on the Internet. It is not non-existent; it does happen. That was actually pulled together by UK Sport and headed by them. It is a small example but that interaction is not non-existent. It is not as good as it should be, but it is not non-existent. Mr Brewer: When we are working with our academic colleagues we always encourage them and would never restrict them from publishing the data that they produce from those studies in appropriate peer review journals or present that data at conferences. We have a very much encouraging and positive attitude towards sharing that data. Obviously there will be a time delay between the point at which the studies have been completed and the time at which that data was published and we would want to use that time gap in order to make any product developments or new claim developments in order to give us the edge in terms of the products that we are producing. We would always have an open dialogue policy with all the data that we are commissioning with academia. Q159 Margaret Moran: Why has it taken so long to have this understanding of knowledge transfer between the sectors? I take your point about sports science being relatively new. I always quote that Luton University in the last two years have developed a sports science course by accident. They actually advertised for a social science course and misspelt it and then discovered they had a number of takers for the course. Some are very new and very exploratory, but twenty-one years is actually quite a long time in the development of some of these issues. What has prevented this kind of knowledge transfer so far? Mr Brewer: Can I say that I was fortunate enough to be employed by the Football Association in 1988 as their Sports Scientist and at that time I was the first sports scientist to be employed by a national governing body. To be quite frank, in that era - the late 1980s and early 1990s - there was no quest for sports science knowledge or sports nutrition knowledge by and large from the world of sport. I think we have to accept that the demands from sport and the world of sport have moved on enormously, particularly since the Lottery and especially in the last five or six years. Q160 Chairman: While performance has got worse. We had world-class athletes like Seb Coe and Steve Ovett before you all started. Mr Brewer: I suspect that people like James Cracknell, Matthew Prince and Sir Steve Redgrave would argue that. Maybe it has moved from one sport to another and let us hope that Bruce and his colleagues at UKA will soon be reaping the rewards of more medals in Beijing and 2012. I am sure they will. Professor McGrath: Scientists love doing inter-disciplinary research; it is terrifically interesting and it is great fun to do. The only reason they do not do more of it is that they tend to be in the straightjackets of their career. However, it is very easy to get together by having a workshop, but it is still money at the end of it. Q161 Margaret Moran: Does UK Sport consult industry or academia on substances on the WADA banned list? If they do not, should they? Would you welcome more consultation? Mr Brewer: If I could answer that question, the answer is yes. I have sat on the UK Sports Supplement Review Panel working closely with colleagues at UK Sport on particularly the monitoring and the measurement of banned substances in products. As I mentioned earlier in this meeting we work closely with UK Sport and with HFL (one of the two WADA accredited laboratories in this country) to have all of our product range tested for contaminate substances. One major concern that we have at the moment is that there is a suggestion that WADA may remove their accreditation from their laboratories that test manufacturers' supplements some time in 2007. We believe that is a very backward step for WADA to be taking because we do feel that having their quality assurance of the laboratories that we work with to have supplements tested is absolutely fundamental. If WADA do withdraw that accreditation then we certainly think it is a very backward step for WADA to be taking. Q162 Margaret Moran: Why are they closing? Mr Brewer: We are not entirely sure of the reason why. We think it may be due to liability issues in that if they are accrediting a laboratory that inadvertently allows a substance to be put onto the market that has a banned substance in it then WADA could be liable. We, as a business, have already put our heads above the parapet working with a number of elite sports bodies including the ATP (Association of Tennis Professionals) where we are saying that we take liability. We are confident enough in our systems and in our measurement processes with HFL to know that we can provide products that are free of banned substances and have been tested for banned substances. If WADA withdraw their accreditation from their laboratories and prevent them, in effect, from testing manufacturers' supplements then again I think that is not necessarily detrimental to us as a business but it is detrimental to sport. If athletes have the ability to have a kite mark for quality assurance taken away from them, then I think that is something of major concern to us as a business and should be of major concern to sport in general. Dr Hamilton: UK Sport has consulted widely with national governing bodies, sports physicians and the English Institute of Sport that I am associated with as well. The limiting factor there is the feedback that they get from the national governing bodies because there is a limited number of sports physicians working at that level, so the amount of feedback and the amount of time people can provide to give that feedback is quite limited. We try our best but there is a limited number of sports physicians working professionally in this area. Chairman: It is quite a depressing picture that you are painting this morning if I am honest. The Ministry of Defence has all the money and is trying to share it, but I make the point seriously that we are searching in this area to say that by 2012 when the Olympics are in the UK we want it to be noted in terms of its sporting excellence and not, in fact, for the other stories which come about (use of drugs and enhancements and the rest of it). We were trying this morning to really look at where is the research base and that seems to be very patchy; where are the specialists, that seems to be very patchy; where is the money coming into it, again that seems to be very patchy; this latest set of questions in terms of sports physicians, again you are right at the leading edge saying there are not sufficient people. I do not know about the rest of the Committee but I find it quite depressing really, but I will get over it as we move to Adam who is an eternal optimist. Q163 Adam Afriyie: Professor McGrath has said that genetic manipulation may be a red herring, but there are many illegal human enhancement technologies that may pose a threat at 2012: designer drugs, stimulants to the central nervous system, blood doping, hormones. Which particular illegal human enhancement technologies do you think pose the greatest threat to 2012, given the state of research as it is at the moment? Professor McGrath: Threat to Britain not winning any medals or threat to health? Q164 Adam Afriyie: Threat to the use of substances which one would consider to be unacceptable. Professor McGrath: I would go for the central nervous system which in effect overrides the body's safety mechanisms. I think that is the way people will die. The body has very well built-in systems that limit performance and if you can override them a little bit there is usually enough extra capacity in the heart and lung muscles et cetera to give you that advantage if you override the safety mechanisms. I would pin-point that as the most dangerous. If you start interfering in the healing process in an ill-informed way you could cause a lot of long term problems. Q165 Adam Afriyie: Dr Hamilton, would you agree that it is the central nervous system or do you have a different view? Dr Hamilton: I agree with that from a health perspective, I think that is one of the major risks we face. In terms of performance enhancement illegitimately there have been a lot of developments in the designer anabolic agents that we are still playing catch-up on, of which the THG is one. For an endurance sport the EPO I think will continue to be a problem through 2012. Q166 Adam Afriyie: In your experience, Dr Hamilton, how common is human enhancement technology use at present? Is it widespread? Dr Hamilton: Human enhancement technology is widespread; we use it all the time (legitimate human enhancement technology, that is). As for illegitimate human enhancement technology I can only suppose that it is widespread. Every time we see a performance that we think does not quite fit that is the first thing people are thinking of these days, which is tragic for sport. I cannot give you a definitive answer to that question. Q167 Adam Afriyie: You suspect but you do not have evidence that illegal use is that widespread. Dr Hamilton: If you look at the positive tests as an appropriate measure of utilisation then the positive test rate is very low and so we would assume that 99.9 per cent of athletes are not using illegitimate performance enhancing drugs but that is a poor outcome measure. Q168 Mr Newmark: You say that but I can tell by your body language that clearly there is a lot of abuse going on and that somehow people are getting around the system. I am curious, how are they getting around the system? Is it through use of other drugs or are the drugs they are using so smart that they are always one step ahead of the testing regime? Dr Hamilton: We suspect that it is a combination. We suspect that there are new drugs being used out there that are beyond the scope of the testing because we do not know what we are looking for. Q169 Adam Afriyie: Who is making these drugs if there is so little research in the area? Dr Hamilton: Until THG was found Balco Laboratories were producing the stuff, so until we knew what to look for no-one knew to go to the laboratory and look for it. We continue to suspect that that goes on in other places although I have to say that one of the great things that WADA did was to highlight the plight of the practitioner involved in drug practices and the number of people who have been prosecuted in the States now around the Balco episode will make people more nervous to be involved in the development of those types of drugs. Q170 Adam Afriyie: In your experience how often is it that an athlete will place pressure on their medic to assist them with doping or performance enhancement substances that are close to the line, if not across the line? Dr Hamilton: In my experience I have never had an athlete ask me for something that was illegitimate. Athletes are constantly pressuring you to do legal means of enhancement. Q171 Adam Afriyie: Yes, and understandably with the competition. When athletes are caught they often say they did not know they had taken the substance. There is a view that some athletes are unintentionally taking substances because they are in vitamin supplements and other supplements that they may take. Do you think that over the last five, ten, fifteen years when regulations around labelling have improved, that the situation of inadvertently taking banned substances has decreased or is less than it would have otherwise been? Mr Brewer: If you look at the plethora of products that are available for athletes - you only have to go onto the Internet to see how many sports nutrition supplements are available - it is always going to be very difficult and very confusing for the athletes to know what works and also what is free of banned substances. That is why I would make the plea that we should have a recognised kite mark, a recognised standard of labelling. Q172 Adam Afriyie: WADA accredit laboratories, do they not? Mr Brewer: Yes, and the point I made earlier is that WADA accredit the laboratories which conduct two areas of analysis. One is the urine analysis of the athlete and the second is the area that we have moved into over the last five years which is the testing of our products prior to releasing them for sports people and, indeed, for the mass market. The issue that we have, as I mentioned earlier, is that WADA are looking to say to those laboratories that if they want to remain WADA accredited they can no longer test manufacturer's substances. That, for us, is a really big negative step. What we would rather do is work with WADA or work with colleagues at UK Sport to have a recognised kite mark that has a standard of manufacture, a standard of distribution and a standard of testing that enables a kite mark, a tick mark or whatever that would be, to be put on products that gives athletes across a range of sports the security in knowing that those products have been tested for all of the substances listed on the WADA banned list. Q173 Adam Afriyie: Dr Hamilton, do you think that if that were done world-wide there would be no excuse whatsoever for an athlete saying he did not realise he had taken an illegal substance? Dr Hamilton: Yes, I think it is important to clarify the difference between accidentally taking something that has a contaminate in it and accidentally taking something like ephedrine which you might have bought for a cold because people will still accidentally take something. We do not pay athletes for being smart or anything like that; we pay them for being athletes. We can all make those mistakes and so athletes will make those mistakes. Strict liability applies so that is the way it is. Q174 Mr Newmark: You say that but at the end of the day an athlete knows that anything other than meat or vegetables that he is putting in his mouth, anything that looks, smells or tastes like a supplement - a pill, something for a headache - will have an impact on any urine or blood test. I still do not understand; do they not ask before they put any tablet in their mouth, if it is going to have an impact because there is a competition the following week. You say they are not that smart, but they are. They know that if they put a tablet in their mouth that is going to have an impact on a test. Dr Hamilton: I did not say they are not that smart; I said that we do not pay them for being smart (many of them are very smart). It does not happen very often, but every now and then, under the pressure of a given situation - and every situation is different - I am sure that people do inadvertently take something that they should not take. As an example, many athletes will not take pseudoephedrine and yet pseudoephedrine is not on the banned list. They do not know that; they have not caught up with that and yet we are three years down the line. They are almost overly-protective. Q175 Mr Newmark: Why can there not be a mechanism whereby if an athlete has a cold they inform the dope testing people they are going to take a particular legal substance. Dr Hamilton: There is such a process. Professor McGrath: A point has been troubling me in this area recently which is that the ignorance of the pharmacology here is fantastic right throughout the whole world. What is fascinating is how do these people develop these designer drugs? Drugs companies spend hundreds of millions of pounds developing drugs, what is the actual process by which these people get these compounds and how do they test them to know which ones work because they must be making dozens of compounds? There just is no academic literature out there which describes all this and I think it would be much better if there was more information in the public domain through which you could educate both the coaches and the athletes so that you know what these things are, how they have been developed and how dangerous they are. These people are very clever; they make up these compounds and the work but we know absolutely nothing about the toxicity of these compounds. I think that is another area where there should be some effort put in. Dr Casey: I do think that one of the major threats to 2012 is potential contamination of food supplements which are taken in good faith and that is why I entirely support what Mr Brewer was saying in that there has to be, between now and 2012, more effort put into making available certified, contaminate free food supplements. I think it is entirely naïve to take the view - which used to be the view of UK Sport - that we tell athletes not to take anything. I think it is an entirely naïve position. It has been shown not to work. We have to accept that they will take supplements; we have to accept that some supplements are worth taking. Some supplements are legal, they are worth taking and they will aid training, they will aid recovery and we have to accept that that is the case. What we need to do, I believe, is to put far more effort in and this is something that could be done between now and 2012. I agree with Professor McGrath that there is probably little we can do about the basic research base in the next six years - I believe it probably is too late for that, the pull through is a much longer time than that - but I think what can be done between now and the Olympics is to put much more effort into making available certified, contaminate free supplements to athletes. I think that would avoid a lot of the bad publicity that we have had in the past. Q176 Adam Afriyie: Would there be unanimity of view on that level, that the accreditation, the proper labelling of supplements so that athletes know they can take them not with rash abandon but knowing that they will not be taking, unless through contamination, an illegal substance? Does everybody agree with that? Dr Casey: I think it is less an issue of labelling. These substances are not subject to any controls; there is no requirement for research to do be done on these things. As long as they are not drug claims they can make essentially what claims they like. It is not a question of labelling; I think it is a question of doing our best to produce contaminate free lines of the legal food supplements and other substances that we know they would like to take. I think that the initiative that Mr Brewer is talking about is very valuable in that case. That is something that can be done in the short term, something that you could do something about. Q177 Adam Afriyie: John, surely there must be a commercial incentive to do that and, if there is, why are commercial organisations not producing contaminate free or properly labelled, marketing the positive aspects of their brands? Mr Brewer: There are manufacturers that are doing that. The problem is that in order to do that at the moment there is no regulation; there is no standard to enable you to put that tick mark on your product. What we are saying is that we should raise the bar as high as we possibly can and have a recognised audited process from the production of the raw material through to the manufacture of the product, the testing of the product, the distribution of the product that a manufacturer has to comply to in order to put that tick mark on their product. There are manufacturers - ourselves included and others I am sure within this room - who are producing products where they make contaminate tested claims. That is great and we would completely and utterly endorse that across the industry. What we are saying is that we should raise the bar as high as possible and perhaps consider having a global tick mark, one that is recognisable - a kite mark, whatever it would be - by sports people, certainly in the UK if not around the world. Q178 Chairman: It would be asking WADA to actually endorse particular products and give a kite mark. Mr Brewer: Conceivably. Q179 Chairman: I can see a major problem with that. Mr Brewer: Or it could be industry led. We, as an industry, have already done that. Q180 Chairman: Sorry, I thought you were arguing for WADA to do that. Mr Brewer: No, not necessarily. We would say that we would do it in conjunction with UK Sport or, as I say, led by the industry. Q181 Chairman: You would want those tested through WADA approved laboratories? Mr Brewer: We would like WADA to retain their accreditation of the laboratories to allow them to test manufacturers' supplements. As I said, it would be a retrograde step to take that away. As a general point, if we think that our athletes across sports are under pressure at the moment, in the build-up to 2012 those pressures are going to be immense. We will come out of 2008 with the Chinese host nation I am sure doing extremely well, so the pressures on our athletes to perform - as we are already seeing today - will be immense as we get to 2009, 2010 and beyond. I think anything that we can do to give them that quality assurance to enable them to enhance their performance will be beneficial. Q182 Dr Turner: There is obviously agreement that something needs to be done to avoid the situation, whether by ignorance or by contamination through the manufacturing process of the vitamin supplements, where athletes get into trouble. Anecdotally I think most of the cases that I have read about of athletes getting into trouble have been through this route. We agree we need a process to quality assure these products. Who should take responsibility for it and who is doing something about it? You have all agreed that it is highly desirable but nobody has said that So-and-So should do this. Professor McGrath: The EU and the US drug administration have been struggling for years with what is a drug, what is vitamin and what is a food supplement. It is an extremely difficult topic to define what should be in what category. WADA then makes its mind up and puts things in one bin or another. It is an extremely difficult area to operate in. Her Majesty's Government is about to allow homeopathic medicines to be sold as if they did anything. If we are in a world where that happens legislatively - and I hope you are all going to oppose this - we are in a very difficult labelling situation here where all sorts of nonsense can get put on labels by governments, so how on earth we are going to separate these nutritional supplements from drugs. I think it is very difficult. Mr Brewer: I think there is also the issue that we have to make sure before we accredit a product and say that it has been tested that it actually works and does what it says on the label. That is why working with good quality scientists is crucial to ensure that we are producing products that will enhance performance. The issue that we have is that in improving performance, if we move away from endurance sports, quite often the magnitude of improvement that you will see from any form of nutritional supplement is less than one per cent. In order to prove that statistically to a level that then enables papers to be published to say that these products work is often very, very difficult to do. To give an example, you may have ten subjects in the study. If six or seven of those subjects improve but three or four them do not improve, that may not allow you to have the level of statistical significance that would enable a paper to be peer reviewed and published. Q183 Dr Turner: In practice, you already have half a mechanism; you have a WADA list of banned substances, all you need is a mechanism for ensuring that where products are sold they do not contain any WADA list banned substances and they can be demonstrated and accredited that they do not. However, no-one seems to have any idea as to how or who should take responsibility for doing that. Clearly that would resolve a lot of the problems that happen. Mr Brewer: There are colleagues from UK Sport here and others in the industry with whom we work very closely to put that process in place and a lot of work has gone on to ensure that the bar is raised as high as possible and there is a recognised standard for having that labelling put on products. What we would argue is that there should be a standard label and that the bar should be as high as possible. Q184 Dr Turner: I just want someone to say who is actually going to take responsibility for putting this in place. Dr Casey: It will probably rest at least initially with UK Sport, I would suggest. The problem you would have with this approach is that it would favour the larger companies that can afford to do this. This is a very expensive process and that might be one of the sticking points because smaller companies that produce nutritional supplements may simply not be able to afford to assure the provenance of their products right from the production of raw materials. There are many issues surrounding this but I would suggest that if you wanted a starting point then potentially UK Sport would be that starting point. Q185 Dr Turner: Who wants to speculate about what the next challenges in the detection of illegal enhancements are going to be? Is it going to be growth hormones or what? Where are the next big challenges coming from? Dr Hamilton: The challenges are everywhere. My personal belief would be that every component of the WADA code will be challenged over the next ten to fifteen years because all of those areas will be areas where people are looking for enhancement. The challenges for us are developing tests for detection of substances that currently cannot be detected. Growth hormones and derivatives are classic. Those areas are extremely difficult scientifically to confirm or otherwise and then to develop a test that is appropriate is extremely difficult. That is just the stuff we know about at the moment. I am sure, as we were talking a moment ago, there are areas of development going into substances in the same areas of androgenic anabolics and of stimulants that will be being produced with the sole purpose of enhancing performance. WADA are very much trying to think ahead and to put their caps on as if they were the cheats and to think in those directions, but it is a very time consuming and very expensive procedure. I think all of the areas of the WADA code have challenges. Q186 Dr Turner: There is the moral and philosophical debate that needs to be heard about what methods of enhancing human performance are acceptable and which are unacceptable and should be illegal. How much serious debate on this is going on through the different sports controlling bodies? Dr Hamilton: There is a lot of debate going on. If you take an example - and you can argue whether it is appropriate for WADA to be doing this or not - WADA were recently looking into the use of artificial hypoxic chambers (artificially induced hypoxia) as a training aid and whether that should be on the prohibited list or not. Their findings were that they found that it was performance enhancing; they were not sure whether it was dangerous or not but they felt that it required further research as to whether it was dangerous and that it was against the spirit of sport. That was a long, drawn out process where they asked for submissions from all of their clients world-wide and there was a great deal of input. Essentially they decided that it met two out of three of the criteria which would enable it to be put on the list. At some point behind closed doors it was not put on the list so here is something which WADA have said meets their criteria but for undisclosed reasons has not been put on the list. We would agree with not putting it on the list but there is no transparency in whether it was a commercial interest that stopped them putting it on the list or whether it was the practicalities that stopped them putting it on the list. The sort of moral and scientific high ground that WADA have claimed - and they have claimed that ground - is challenged a little bit by the process which lacks a little bit of transparency. Q187 Dr Turner: That sounds rather worrying. Are there any more examples of that? Dr Hamilton: I can give you an example close to my heart whereby beta agonist - the salbutamol puffer that you will use for you asthma - the majority of the evidence is that it is not performance enhancing; there is very little clinical risk to someone using low dose inhaled beta agonist. The spirit of sport argument is somewhat weakened. If something is against the rules of a sport it is going to be against the spirit of sport, so while something is on the prohibited list it is very difficult for it not to be against the spirit of sport. For example pseudoephedrine would not be against the spirit of sport now because it is not on the banned list. The point being that because it is on the banned list the majority of people would come in and say that it is against the spirit of sport to use inhaled beta agonist; it is a self-fulfilling prophecy, if you like. That is an example whereby it does not meet the criteria - it is not performance enhancing, it is not dangerous, so it does not meet two out of three criteria - but it continues to be on the list. Not only does it continue to be on the list, but there are very strict criteria required in order to actually use it for legitimate purposes. Q188 Dr Turner: Are you saying by inference then that if salbutamol was taken off the banned list there would be a dramatic reduction in the number of asthmatic cyclists? Dr Hamilton: We are comfortable that the numbers of people using salbutamol in sport are appropriately using it, so I do not think it would change anything now. Q189 Chairman: It is very difficult to explain why there are so many cyclists with asthma. Dr Hamilton: The proportion of athletes with asthma corresponds to the proportion of the country with asthma. The highest incidence of asthma in athletes is found in those countries with the highest incidence of asthma in their general population. Professor McGrath: There is not enough attention paid to what these drugs actually do. It was mentioned there that if WADA said it probably causes harm but they do not know what it does, maybe there needs to be more research. It all points to understanding these things better. If you understand what they do you can combat them better both through knowledge of what it will do to the body so that you can pick it up even if the drug is undetectable, and what harm does it do. We have not heard any discussion - we could probably discuss it all day - about what a beta agonist does to the body. That happens to be very close to my own very specialist interest that you really do not want to start me talking about. We know very little about what it would do to the athlete. It may be that by doing not all that much research you could find that out, but nobody knows. If it is a legitimate for our purposes you really need to know why it would be harmful, not just that it enhances performance. Chairman: The whole issue of the ethical question that Des raised is very, very pertinent. If you have hypoxic chambers which are legal, why should you not be using an EPO drug to have the same effect which is readily or cheaply available? I think there are very big questions which hopefully we will try to address as we go through this inquiry. Q190 Margaret Moran: Bruce, you have made it very clear that you think that the WADA prohibited list has some significant flaws in it. Do you think that there are particular substances - you mentioned one there - that you would like to see added or removed? Dr Hamilton: The WADA prohibited list is a huge step forward from where we were prior to 2000 so it is a good thing in general. They are in the process of flux all the time so any comment I may make may well be something they are looking at changing in the future anyway. For example, they have taken pseudoephedrine off which, in some ways, was entirely appropriate but in other ways challenges the whole process. They have taken caffeine off; again the same principles apply. In some ways it has been trimmed but the problem is that while the categories may have been trimmed the number of substances within that category will expand. For example ten years ago there might have been four or five stimulants listed, now there is a massive list of stimulants on there and it is very difficult to say that any particular one of those may or may not be performance enhancing or dangerous to use so it is hard to make a comment on those. The inhaled beta agonist is an area that for all sports physicians working in elite sport, is the single biggest factor that causes us concerns and anxieties within the list in terms of a failed drug test for legitimate use. That causes us a great deal of concern. The other area which is, in my opinion, weak in the WADA code is the use of glucocorticoids. Glucocorticoids, for example a corticoid steroid injection for a joint inflammation, have definitely been abused in different sports in the past. The majority, however, are used for quite benign conditions. To give examples of the inconsistencies, you can use a glucocorticoid nasally - so you can use a nasal spray glucocorticoid - without requiring a therapeutic use exemptionary notification at all, but if you use exactly the same substance but inhale it through your mouth you are required to fill in the paperwork. If you are shown to have taken it through your mouth and test positive for it - which is, I admit, extremely unlikely - you can actually end up with a sanction. Those are subtle things and for a physician working with a team of perhaps eighty athletes, half of which he may not have come across before, trying to sort out all those things on all those athletes can be quite stressful. Also, the paperwork associated with it actually takes you away from the role you are trying to do so instead of doing educational talks or whatever you end up doing just paperwork on substances that are really quite irrelevant. It does not really matter if someone is using inhaled beta agonist because it does not work anyway; it is not very dangerous for them. All of my time leading up to the Commonwealth Games for example was spent filling out paperwork for inhaled beta agonists. Q191 Margaret Moran: Here UK Sport both tests and prosecutes for doping offences; the Australian system is very different. Which do you think is better? Dr Hamilton: I think it is difficult to have your educational supporting body being your prosecuting body. UK Athletics has exactly the same problem. Our anti-doping department will one day be the person who is ringing you up to make sure everything is okay and that you have filled out all the paper work and everything is good; the next day they will be shutting all the doors up and letting you know that you are under a sanction. It is extremely difficult. Q192 Chairman: You would support separating the two functions. Dr Hamilton: Absolutely. Q193 Dr Iddon: A number of people have been critical about the way we tackle this doping problem, particularly blood doping. We have received some evidence, for example, from Michelle Verroken of Sporting Integrity. She believes there is an over-reliance on urine testing rather than more reliance on blood testing. She reckons that if we are serious about detecting the use of growth hormones and EPOs we really ought to concentrate on blood testing rather than urine testing. Would you agree with that, Dr Hamilton? Dr Hamilton: I am not certain of the science behind that statement. In principle there was a debate some time ago about the ethics behind blood testing and I think in general most athletes are supportive of it so the ethical argument has been put aside. The real question is, is there an appropriate test? There is no point in taking blood if we do not have an appropriate test. If there is an appropriate test developed for the substance we are looking for then I would support the use of more blood. However, if, for example, you could get just as good a test from saliva then I would equally support saliva. Professor McGrath: There is an awful lot more in blood than there is in either saliva or urine and sometimes even if you do not know what you are testing for if you have that in the deep freeze you can test later. I think there is a big case for what has been referred to as the athlete's passport where you have a profile of the blood samples over a period of time. In a sense what is important is if there is big spike and something changes rather than what the base line levels are. I think if you wanted to get really serious about how to tackle these types of problems it would be to monitor the athletes, keep samples from the athletes throughout their career at regular intervals, particularly around performance but also in between. Even years later, even if they have been using something that is not detectable, later we may have a way of detecting what it did. I think that is the only way you are going to get enough serious material because you have the science of looking at proteins, looking at small molecules, DNA, RNA; all of that can be done. Q194 Dr Iddon: The idea of an elite athlete's anti-doping passport came over very strongly when we were in Australia. The lady I have just mentioned has proposed that that is the way forward, to have such a passport. Because people's biochemistry - as you rightly point out - changes with time and it is even so different between one person and another, the only way to detect alterations in a person's biochemistry due to doping technologies is to regularly monitor their biochemistry. Michelle Verroken also suggests that there should be more in the passport than that, not just the analytical data from biochemistry but the prizes that people are winning as well should be recorded. Do you agree with that and is there anything else that you would add to the profile? Professor McGrath: I do not think it would be all that difficult to make up a kind of CV for an athlete of what they are doing at any particular time: where they are, what they were doing, whether they are performing, whether they are winning, whether they are not winning. That is the kind of information that is going to be collected anyway by the coach. I would have thought that it was not a very big step to move in that direction. Dr Hamilton: Using indirect markers which you are going to propose as a cheating mechanism is difficult because variables will change for reasons other than cheating. It is the distinction between a cheat and a non-cheat through indirect markers which is very difficult and is something you would have to get to a point where you were actually testing for something and you were very confident about it otherwise, as we have seen, it will not hold up in a court of law. Q195 Dr Iddon: The final point I want to make - this is a point that Michelle Verroken has made as well but we picked it up in Australia too - is that where an athlete is performing at the very highest levels of international competition and winning huge prize money (which happens, of course) the penalties on those athletes when they are caught with a strange substance in their blood or urine are not great enough. They are earning large amounts of money but really if they are caught doping, since they are such serious role models in international sport, they really ought to be paying a large percentage of their prize money back if they are caught. She believes, and other people believe, that the penalties are not great enough when people are actually caught with illegal substances in their body fluids. Would you agree with that? Dr Hamilton: I would agree with that but again I do not believe you can apply it across the board because there are different gradations of cheating. Q196 Chairman: Let us take Dwain Chambers, for example. Should he have to pay everything back? Dr Hamilton: Speaking generically when you admit to using a performance enhancing substance of that nature for that duration when money is made, I think it would be more than reasonable for an athlete to pay it back. I support what Michelle is saying; I just think it is not always black and white when someone is cheating. Mr Brewer: I think there should also be a commonality across not just the Olympic sports but the professional sports as well and we have to recognise that there are a huge raft of sports that sit outside of the Olympic movement - both professional and non-professional - and we do need a common standard of punishment across all sports and not just allow individual governing bodies or associations to decide their own level of punishment for their particular sport. Q197 Chairman: Dr Hamilton, in terms of WADA there seems to be a great deal of satisfaction in the way in which WADA is working. Are there any serious weaknesses to the WADA organisation that we should be aware of? Dr Hamilton: I think WADA has revolutionised our approach to doping in sport and as a general rule I think the approach they are taking is very strong. I think their consultation process is difficult because of the number of interested parties that they have and that will always slow things down and make it difficult for them to be transparent. I certainly support the approach they have taken. Chairman: On that note can I thank you all, John Brewer, Dr Bruce Hamilton, Professor McGrath and Dr Anna Casey, for your responses this morning. I also thank my colleagues and members of the public. |