112.In 2001, the Nike Oregon Project (NOP) was founded by the track and field coach, Alberto Salazar. Sir Mo Farah, the British distance runner, joined the project in 2011. Dr John Rogers, who was formerly Medical Officer at UK Athletics, gave evidence to the Committee, and described his two-week visit to a British Athletics training camp in France, organised by the NOP. While he was there, Dr. Rogers expressed concern at the use of three treatments being given to Mo Farah, on Alberto Salazar’s advice, during that time, and sent an email to colleagues in Britain, expressing his concerns over the treatments being used. He told the Committee that: “there were some medical concerns around possible side-effects from some of the strategies that were being used and it was important that I shared that in terms of the continuity of care”.
113.One of the treatments was nasal calcitonin, which was being used to prevent stress fractures. Dr Rogers described it as a “new, novel treatment that I had not come across before for prevention. I had seen it used for managing pain related to stress fractures in the UK. My concern with regards to that specific medication was that it affected calcium metabolism and that there was a background medical issue that could have been affected”.
114.The second treatment on Mo Farah about which Dr Rogers had concerns was the use of vitamin D supplementation, due to the “particularly high” dose, which can cause high blood calcium levels, with potential side-effects. The third medication was iron supplementation. Dr Roger told us that “Mo Farah had been taking a high-dose iron supplementation, higher than the normal doses that we would probably use. […] We commonly see iron deficiency in endurance athletes who are training at altitude because there are increased iron requirements because they are making more red blood cells at altitude. Potentially using high-dose iron supplementation can cause gastrointestinal side effects. That is a common feature we see in athletes”. Alberto Salazar explained to Dr Rogers that he had recommended the calcitonin and the vitamin D supplement to prevent stress fractures, that high dosages of vitamin D would help increase testosterone levels, and that iron supplements would help in high altitudes. Dr Rogers described the fact that he had had concerns about three courses of medication as “a unique set of circumstances”.
115.It was the first time that Dr Rogers had met Alberto Salazar, after Mo Farah had moved from being coached in the UK at the end of 2010 to attending the summer camp in 2011. Dr Rogers emailed his concerns to colleagues at UK Athletics around possible side-effects to UK Athletics, writing that the vitamin D and the calcitonin had been stopped. Following the email, Dr Rogers stated that “Charles van Commenee, who was the performance director at that point in time, put Barry Fudge immediately in charge as a point of contact between the Nike Oregon Project and UK Athletics and that the medical care of Mo Farah, as it had been, needed to be led by the UK Athletics medical staff”.
116.We also heard evidence about the administering of L-carnitine to Mo Farah before the London Marathon in 2014. Dr Robin Chakraverty, formerly Chief Medical Officer at UK Athletics, explained to the Committee that L-carnitine is not a prohibited substance, but there are strict rules around its use. Athletes are permitted to take 50ml every six hours. Dr Chakraverty told the Committee that Mo Farah’s dose was 2.7 grams, and the delivery method was an injection. The purpose of a dose of that size is, according to Dr Chakraverty, to “use supplements to help performance or to protect health. In this instance it was to help performance”. He said that “this was the first and only time that we ever used L-carnitine”.
117.While L-carnitine might be on the list of legal supplements, there is a question over why an athlete should be taking a supplement to enhance their own advantage, rather than working on their own athletic prowess. Barry Fudge, Head of Endurance at UK Athletics, told us “In terms of how we operate as an organisation and as individuals, it is quite clear there is wrong and there is right and we work within the right side of it. […] There are lines, there are quite strict rules that we follow. We are quite clear on where they sit and where they are. That is down to USADA [US Anti-Doping Agency], which is doing an investigation on Alberto to decide whether he has crossed them or not”.
118.In his evidence to the Committee about the policies followed in this case, before administering the supplement to an athlete, Dr Chakraverty said: “First of all, is it a prohibited substance? No. If it is, you do not look at it. Secondly, how effective is it? Barry’s job would be looking at a supplement from a performance perspective and I would be looking at supplements from a health perspective. Then you have a hierarchy of evidence to see whether it is supportive in either health or performance.” However, surely the main consideration in prescribing medicine is health above performance.
119.The Committee heard about poor record-keeping, when it came to Mo Farah’s L-carnitine injection, and Dr. Chakraverty defended himself thus:
I am a doctor in elite sport. I was responsible for the healthcare of 140 athletes on the programme. Previously we had four doctors who were working for UK Athletics and in my time we had two doctors and one of them was not working full time. […] Where we had lapses is when you are on the road, when you are travelling. That is probably the unique thing about this role, that not all our athletes train in one area. You are constantly on call for your athletes and you travel to those athletes. If you do not record it straight away, which I did not in this case, then it can get forgotten because you have all the other things to do.
120.Ed Warner, the Chief Executive of UK Athletics at the time, said in his evidence to the Committee about this incident that the lack of record keeping by Dr. Chakraverty was “inexcusable”. He added: “If my child went in to see the GP and he or she failed to record something on their records it would be as inexcusable as not recording something on Mo Farah’s records. I think they are of equal concern and improving medical record keeping is not having a gold-plated standard for a gold-plated athlete; it is to have the same gold-plated standard for all athletes. That has to be the ambition.”
121.The failure to keep proper records for the drugs given to Mo Farah draws an instant comparison with the issues we have previously investigated relating to Team Sky and British Cycling. In response to this, Ed Warner said to the Committee: “Please do not tar us with the same brush.” He also stated the improvements that have been made at UK Athletics with regards to medical records: “We have done a lot under Noel Pollock’s leadership to continue to improve that. There is not a Dropbox culture in UK Athletics. There is a central Smartabase in which all this stuff gets inputted. The 5,000 interventions—4,940 something last year—are all in Smartabase across the 140 athletes. We are very keen that things are centralised and are not left on individuals’ laptops. If a laptop goes mysteriously missing in the south of France, we still have the Smartabase database. We are not reliant on that. This is very important.”
122.The Committee was shocked to hear that the former Chief Medical Officer of UK Athletics, Dr Chakraverty, gave an injection of L-carnitine to Mo Farah—a treatment that Dr Charkraverty had never before given and that Mo Farah had never before received—yet did not record the dose on Farah’s medical records.
123.UK Athletics has a responsibility to ensure that proper records are kept for its athletes, and the Committee is pleased to note the progress that has been made since 2014. Poor record keeping not only impedes the work of the anti-doping authorities, but can make it harder for clean athletes to clear their names, once questions about their use of medicines have been raised.
124.Again, we believe that the General Medical Council (GMC) should investigate any incident where doctors working in sport have failed to properly record the medicines they are supplying to their athletes.
125.UK Anti-Doping (UKAD) is responsible for implementing and managing the UK’s national anti-doping policy. The non-departmental public body is accountable to Parliament through the Department for DCMS. Its responsibility for testing forms an integral part of UKAD. During our long inquiry, we heard from Nicole Sapstead, CEO of UKAD, on three separate occasions: 8 September 2015; 26 January 2016; and 1 March 2017; and from the Chair of UKAD, David Kenworth, on 14 June 2016.
126.In the Committee’s evidence session on 8 September 2015, the inadequacy of the UK’s response to doping was brought to members’ attention. Nicole Sapstead told the Committee about the sophisticated area of anti-doping that requires sophisticated solutions, “and they do not come cheap”. She told us that it is not just about testing, it is about a prevention programme, intelligence-led testing, which means receiving intelligence, processing it, and then acting on it. The World Anti-Doping Agency Code sets out 10 anti-doping rule violations, with only two relating directly to testing. She explained:
The other eight are what are called non-analytical violations, and that is where organisations such as us that have an intelligence function are able to prosecute and pursue athletes and athlete support personnel for things such as aiding, abetting, possession, trafficking, use, and things like that.
127.A primary conclusion from our evidence session is the fact that UKAD is severely underfunded. At the time of the oral evidence session, there was only one investigator employed who was covering 47 sports. Nicole Sapstead told us that, with a larger budget, UKAD would be in a position to test more comprehensively. She told us that, if intelligence is suggesting a particular doping issue within a sport, UKAD must channel its limited resources to that sport, and withdraw resources from other sports. As a result, some sports “will receive nominal amounts, maybe token amounts, maybe no testing whatsover at all in any financial year.
128.One of the key issues arising from our inquiry related to the adequacy or not of the UK’s official response to doping, and particularly the capability and resilience of UKAD. The witnesses from UKAD emphasised the importance of resourcing the testing regime properly, given that doping strategies are increasingly sophisticated and require up-to-date—and often expensive—scientific and investigatory resources. Dan Stevens, an amateur cyclist and whistleblower, raised concerns over the fact that UKAD are running the courts that they are trying athletes in; that the system doesn’t maintain the anonymity of athletes whose cases are under review and as such they are often open to undue prejudice and bias; and that depending on the sport, athletes will be reviewed by different bodies who might come to different conclusions and impose differing penalties. Dickinson recommended that if the board that arbitrates doping decisions was consistent and comprised of the same people, then it would be far more effective.
129.Nicole Sapstead of UKAD agreed that if they had a bigger budget they would be able to test more. She said that a number of sports had major problems at amateur level, which UKAD simply does not have the resources to police. Since Nicole Sapstead gave evidence, UKAD’s income has increased, in nominal terms. From UKAD’s latest annual accounts for 2016/17, by far the majority of the organisation’s funding came from grant-in-aid, received from the Department for Digital, Culture Media and Sport. In addition, UKAD generates income from testing, consultancy and other activities, which in 2016/17 came to just over £3 million, up from £2.2 million the year before.
130.The following table and graph below show UKAD funding received as grant-in-aid and total expenditure:
131.The UKAD Annual Accounts for 2015/16 suggested planned budget increases:
The outcome of the November spending review saw UKAD’s baseline grant in aid budget protected, with a 7% inflationary rise over the next four years. In line with the government’s Sport Strategy, UKAD continues to find ways of generating commercial income to enable us to grow our current activities, ensuring that any such activity ties in with our strategic plan. The most obvious objective being ‘to promote a level playing field of athletes by influencing international policy and practices’.
132.However, in written evidence to us, Ms Sapstead clarified that putting increased funding into broad anti-doping programmes would not necessarily solve the problem. She argued that tackling doping in sport needed to be meaningful, targeted and based on intelligence. She added that it should be carefully balanced with the other tools available to anti-doping organisations, be it additional analysis for substances such as erythropoietin (EPO) or growth hormone or implementation of the athlete biological passport. And she also argued strongly for a comprehensive and wide-reaching education and prevention programme.
133.On 30 January 2018, the Government announced its intention to provide UKAD with an additional £6 million of funding over the next two years. The Government’s decision followed the first full-scale review of UKAD since its establishment in 2009, with the final report providing several important recommendations designed to improve UKAD’s ability to effectively tackle doping. In particular, the review recommended that UKAD consider submitting a framework to the Government and sports to allow doping control officers to have unfettered access to conduct random testing at competitions. The review also called for sports in receipt of public funding to report annually on their anti-doping education programmes to UKAD, and to make this information publicly available on their websites. We welcome the findings of this review, as well as the Government’s increased commitment of financial support for UKAD.
134.However, UKAD is not—and should not be—solely dependent on public funding. The sports that use its services also contribute, but they vary widely in their support with some of the smaller sports giving a considerably higher percentage of their income than larger ones. Nicole Sapstead said that sports such as football and rugby (especially the amateur leagues) had major problems with doping.
135.Ed Warner of UK Athletics argued that across all sports, a way should be found to secure more revenues for the fight against doping. He called on the International Association of Athletics Federations to set aside a fixed percentage of all its sponsorship income to spend on anti-doping measures. He argued that if football did the same, then WADA’s financial problems would be completely transformed. He said:
A wealthy sport of that sort with a very small proportion of its global television income, for example, to go into anti-doping agencies worldwide would make a lot of sense. Football probably would not notice the difference but WADA certainly would.
136.We also note calls from WADA President, Sir Craig Reedie, who spoke at WADA’s Annual Anti-Doping Organisation Symposium in Lausanne, Switzerland, in March 2016 calling for major sport sponsors to start considering how they might help fund clean sport.
137.UK Anti-Doping (UKAD) clearly faces unpalatable decisions on priorities. It has neither the investigative nor the testing resources to respond to all the demands placed on it, which is likely to result in a responsive rather than a strategic approach to the problem of doping in sport. Its scientific and technical skills are not in doubt; its capacity is.
138.The experience of Dan Stevens raises questions about whether UKAD even has enough resources to follow an intelligence-led approach satisfactorily. We therefore support the recommendation by the Chair of the Independent Review, Andy Ward, that UKAD, in agreement with the World Anti-Doping Agency, reviews and clarifies Article 10.6.1 of the WADA Code in relation to the status of athletes who decide to provide substantial assistance. We are pleased that UKAD’s Board has accepted all of the nine recommendations made by the Chair of the Independent Review.
139.It is important that both WADA and UKAD are adequately funded to deal with the huge problem of doping in sport. These important anti-doping bodies cannot fulfil their mandate with insufficient funding. An obvious solution is that sports that benefit from their activities—and particularly wealthier sports—should contribute more. We are attracted by the idea of sports contributing a fixed percentage of their income—from sponsorship or overall—to give the anti-doping bodies some security in planning their programmes and expanding their resources. We are pleased to note the increase in funding from Government to UKAD following the Tailored Review. However, given the pressures being placed on UKAD, it may need even greater resources that these, and there should be a larger contribution from the sports themselves to supporting the enforcement of the anti-doping rules.
170 UKAD, “”, 30 January 2018
173 Turning Adversity into opportunities
2 March 2018