1. Aim of
the report
1. Despite the progress made in the anti-doping field,
this scourge has unfortunately not been contained. Doping cases
involving high-level athletes regularly hit the sporting news headlines.
However, doping is not something that concerns professional sports
alone: doping is making its presence felt on a huge scale ––albeit less
conspicuously, away from the media spotlight – in amateur sport
and sport as practised by millions of young people. This was confirmed
by the expert who helped me draft this report
and
by the experts whom we heard at the hearings on 12 March 2015 in
The Hague
and
on 2 June 2015 in Paris.
2. I am concerned by the fact that doping, as an extremely serious
violation of sports ethics, corrupts the beauty of sport by the
unlawful distortion of results. But I am also alarmed by the fact
that we are facing a major public health risk and the fact that
trafficking in doping substances feeds the financial flows which
help enrich criminal groups.
3. Sport today attaches considerable importance to winners and
records; this is also a consequence of the fact that sport has been
transformed into a business. But sport is much more than a search
for “the best”. Sport requires all athletes to comply with a set
of rules – those governing the arrangements of sports competitions and
those corresponding to what we term the “sporting spirit”.
4. Sport is therefore not limited to competitions governed by
official regulations: sporting activity is linked to “values”, to
a code of honour, a sporting ethic involving fair play, respect
for one’s opponent, solidarity among team members and respect for
one’s body and health. Becoming a champion through doping, in other
words through “cheating”, is in violation of the very ethics of
sport. It also destroys the role model which professional athletes
– especially those at a high level – represent for young athletes
and young people in general: true champions should transmit the
values of sport. Those who cheat compromise not only their own image
and career, but the image of sport as a whole and its role as a
vehicle of social values.
5. The aim of the fight against doping is to ensure “clean sport”.
However, this fight is also essential in order to protect “healthy”
sport, actually the health of millions of Europeans engaging in
sport, especially adolescents and young people. Indeed, sport is
mostly a non-professional activity in which large numbers of people
take part.
6. Associated with this practice of sport as a leisure activity
is one – perhaps the most important – of the priority aims of promoting
sport through public policies: such activities, carried out regularly
and not to excess, can improve one’s general physical (and mental)
condition and help keep people in good health. For those with problems
of obesity, high blood pressure, stress, depression, etc., sport
can help reduce the consumption of medicines. The healthier lifestyle
resulting from engaging in sport will also contribute to this. For
example, the fact of joining a club, working as a team and taking
part in sports events nurtures a sense of community and better relationships
with others. It also helps foster a better quality of life and,
consequently, a better physical and mental condition.
7. Bearing this in mind, it is paradoxical that so many young
people, under the delusion of becoming better in the sport they
engage in, ply themselves with products – more often than not of
questionable composition and with no guarantee regarding the manufacturing
conditions – or medicines used for purposes other than those for
which they are designed. Taking medicines to artificially enhance
performance is in sharp contrast to the aims of the sport we wish
to see, as something that will help to give structure to life in
society.
8. To sum up, doping is a threat to sports ethics and to health,
sport and society. The purpose of my report is therefore to explore
new lines of effective action and to encourage the Council of Europe
and its member States to work on these in order to step up the fight
against doping, at both European and global level. The Council of
Europe, which was behind the work leading to the drafting of UNESCO’s
International Convention against Doping in Sport 2005, should have
a leading role in this field.
9. In this connection, I have identified some avenues to explore:
- understanding better the phenomenon
of doping, its extent and impact;
- strengthening the current testing mechanisms;
- harmonising legislation and more effective collaboration
between stakeholders;
- establishing control of the trade in potentially doping
substances and ensuring the latter’s traceability;
- improving prevention, in particular through awareness-raising
of athletes and educating young people.
10. In the following sections, I start by dealing with the issue
of doping as a threat to public health; I then provide a few details
of the current anti-doping framework, highlighting its multiple
components and some of its limits. Finally, I provide some examples
of preventive measures.
2. Doping and its
harmful effects on public health
11. During the hearing on 12 March 2015 in The Hague,
the experts stressed the difference between “doping” in the legal
sense and “doping behaviour”; the latter can be defined as “substance
consumption to face or overcome an obstacle, whether real or perceived
by the user or by those around him, with an aim of performance”.
12. The definition of doping in sport corresponds to infringement
of the rules set forth in the World Anti-Doping Code (see paragraph
35 below) which, besides use or attempted use by an athlete of a
prohibited substance or a prohibited method, also sanctions other
eventualities such as trafficking in or administering prohibited
substances, evading controls, or tampering with any part of doping
control and various instances of complicity, including encouragement
of consumption.
13. To understand the spread of doping behaviour, it needs to
be remembered that the use of doping products or methods makes it
possible, as the case may be, to increase mental capacities (alertness, resistance
to stress, cancelling out the symptoms of fatigue for example),
aerobic capacities (transport
of oxygen in the blood and its utilisation by the skeletal muscle
fibres)
or
muscular mass, hence muscular strength.
These physical, physiological
or mental capabilities are fundamental to performance in sport.
14. The influence of doping on athletes’ performance differs depending
on the discipline; this may account for greater frequency of established
irregularities in certain sports.
Sports
of endurance, strength and/or speed are statistically the most affected
by doping. Nonetheless, certain more technical sports (archery and marksmanship,
for example) are not immune.
15. The advantages afforded by doping in terms of performance
can be understood by referring to the case of the forced, systematic
doping organised and financed by the German Democratic Republic
(GDR) between 1969 and 1989, which was responsible for this country’s
extraordinary success in sport.
But such practices, as condemned
in the study by Giselher Spitzer, had dire consequences for the
athletes’ health. The study, which has the advantage of the hindsight
necessary to assert a definite link between doping and health hazards,
shows that of the 10 000 or so athletes subjected to systematic
doping between 1972 and 1989, 5% were afflicted with severe permanent
disorders and 10% to 15% had less severe or non-permanent disorders.
16. The public may have a vague knowledge of the risks of cardiovascular
diseases (linked for instance – but not exclusively – to the use
of anabolic steroids), but alas the dangers pinpointed in many scientific
articles are far more numerous: development of cancer; disorders
of the immune system, the endocrine glands and the metabolism; diseases
and infections of the blood; mental and psychiatric disorders (for
example, dependence); morphological alterations; heightened risks
of damage to muscles and tendons and traumatic injuries (for example,
stress fractures), and still others.
17. Quality of life but also life expectancy are at stake; a statistically
abnormal incidence of cases of “non-traumatic sudden death” of athletes
is a tragic confirmation of the fact: Professor Rieu referenced,
for France, some 800 deaths per year (2.2 per day) on sports grounds,
95% of the victims being men without any history of cardiovascular
disorder and aged 46 years on average. He also condemned the absence
of probing investigations and systematic autopsy, the reason why
78% of these accidents remain of undetermined origin.
18. Even if the general public hears about (and we talk about)
doping chiefly in the wake of scandals with high media exposure
involving sports stars and linked with major sports events, doping
concerns not only the small population of top-class players. To
realise this, suffice it to recall that 58% of European Union citizens engage
in physical or sporting activity, and 41% do so at least once a
week.
In
France, there are 16 million participants, including 7 million minors.
Combating doping is a major public health concern with regard to
this population.
19. Where doping among adults is concerned, its prevalence is
thought to range between 5% and 15%. It is reportedly higher among
young males (20-25 years) in competition, particularly at top level.
Another
study
showed that among Europe’s bodybuilding
population, 22% of the men and 7% of the women had recourse to substances
for “improving” performance.
20. I would like to insist on the extent of the doping phenomenon
among minors: in this respect, the results of most studies
converge: among girls,
the percentage who use or have used doping substances is approximately
1.5% (0.6%-2.8% depending on the studies); among boys the percentage
is 3.7% (2.6%-5.1%). Consumption may begin very young (between 9
and 13 years) and increases with age. At school, 4% of young athletes
have experienced the temptation of doping.
21. In France, according to a study by the University of Reims
conducted in schools in 2004, on the basis of the replies given
by 6 402 adolescents (average age 16):
- 4% of these young people had been confronted with doping;
- 2% were already users of a prohibited substance;
- the “inciters” were often parents, doctors and educators;
- for 21% of the children, it was impossible to become a
top-level athlete without doping.
22. We cannot ignore the seriousness of this situation regarding
young people who are urged on by adults close to them and who have
their trust, to adopt doping behaviour and consequently become convinced
that it is not possible to achieve well in sport without a pharmaceutical
aid.
23. Often athletes, before they get to the stage of infringing
the doping regulations, follow a sequence that starts with a given
doping behaviour. The doping phenomenon also has psychological foundations.
The context of self-medication and use of products (dietary supplements,
energy drinks or others) with sometimes
unclear compositions (and in some cases outside official trade)
favours – perhaps unknowingly – the first ingestion of substances
for artificially improving sports performance, especially if the
substances in question are easy to obtain or to purchase in a pharmacy,
on line, at home, through a friend or through the coach.
24. In this connection, several experts, including Professor Michel
Rieu and Dr Richard Budgett, drew our attention to the misuse of
dietary supplements. Many professional and amateur sportsmen and
women have become big consumers and use them in particular to help
develop their muscle mass. They may also be encouraged to do so
by advertising, which exaggerates the beneficial effects of these
products, which actually have very little effect on performance.
25. In August 2013, Mr Michel Marle, Chair of the Anti-Doping
Committee at the French Athletics Federation, told Le Monde that “dietary supplements
are like a societal doping process”. The World Anti-Doping Agency (WADA)
recommends extreme caution in using these supplements; many countries
do not have strict production and labelling rules and, as a result,
athletes who use them run the risk of unknowingly ingesting undeclared
substances which are banned by anti-doping rules, such as amphetamines
or anabolic steroids. In fact, a large number of positive test results
have been put down to misuse of these supplements because athletes
think that the risk is not the same as with drugs and are less careful.
26. The conviction that certain products help reach a higher standard
brings about a state of psychological dependence which with time
can escalate from occasional to regular use, from milder to harder
products, and prompt clearly illicit practices: taking medicines
with an active principle that impacts cardiovascular, hormonal or
endocrine functions, or even using specific medical techniques and
apparatus (blood transfusions or gene doping for example) under
the control of “complicit” specialists to avoid traceability.
27. I should point out, however, that I do not claim that all
the promising youngsters in sport who use energy drinks or overdo
the painkillers to carry on training despite the pain of the sports
injuries sustained will one day be doped athletes.
28. I assert nonetheless that all doped athletes presumably started
one day with something other than a hard doping agent and that incitement
to use initially more innocuous substances, coupled with glorification
in the media of only the winners, is a seedbed later conducive to
use of substances which are more “effective” as regards immediate
sporting performance and also more dangerous as regards health hazards,
and also the stamping ground of the organised doping rings for illicit
sale of products, themselves prohibited in many cases.
3. The multi-component
framework of the fight against doping
29. At present, the fight against doping is carried out
by means of a set of standard-setting instruments, mechanisms and
prevention, testing and penalties devised at various levels – local,
national, continental and international – by States (including the
judicial and law-enforcement authorities) and by sports institutions
(and their disciplinary bodies). The table in the appendix offers
a simplified overview.
3.1. The Council of
Europe’s Anti-Doping Convention
30. At European level, historically, doping was the first
of the Council of Europe’s concerns in sport. The Anti-Doping Convention
(ETS No. 135) was opened for signature on 16 November 1989 and entered
into force on 1 March 1990. To date, it has been ratified by 52
States.
31. The main objective of the convention is to promote the national
and international harmonisation of the measures to be taken against
doping. The Contracting Parties undertake to:
- create a national co-ordinating body;
- reduce the trafficking of doping substances and the use
of banned doping agents;
- reinforce doping controls and improve detection techniques;
- support education and awareness-raising programmes;
- guarantee the efficiency of sanctions taken against offenders;
- collaborate with sports organisations at all levels, including
at international level;
- use accredited anti-doping laboratories.
32. A Monitoring Group was set up in order to monitor its implementation
and periodically re-examine the list of prohibited substances and
methods which can be found in an appendix to the main text. An Additional Protocol
to the Convention (ETS No. 188) entered into force on 1 April 2004
with the aim of ensuring the mutual recognition of anti-doping controls
and of reinforcing the implementation of the convention using a
binding control system.
3.2. The World Anti-Doping
Agency, the World Anti-Doping Code and the International Convention
against Doping in Sport
33. At international level, the World Anti-Doping Agency,
set up in 1999, is the agency co-ordinating and monitoring the fight
against doping. A Global Anti-Doping Programme
was drawn up to ensure the consistency
of anti-doping rules and practices among sports organisations and
governments and the World Anti-Doping Code
is the core document
harmonising anti-doping policies, rules and regulations within sports organisations
and among public authorities.
34. In this Code, doping is defined as the occurrence of one or
more of the anti-doping rule violations set forth in Articles 2.1
to 2.10 of the Code. These are:
- presence
of a prohibited substance or its metabolites or markers in an athlete’s
sample;
- use or attempted use by an athlete of a prohibited substance
or a prohibited method;
- evading, refusing or failing to submit to sample collection;
- whereabouts failures;
- tampering or attempted tampering with any part of doping
control;
- possession of a prohibited substance or a prohibited method
(unless the athlete establishes that the possession is consistent
with a Therapeutic Use Exemption (TUE));
- trafficking or attempted trafficking in any prohibited
substance or method;
- administration or attempted administration to any athlete
in-competition of any prohibited substance or method;
- complicity (assisting, encouraging, aiding, abetting,
conspiring, covering up or any other type of intentional complicity
involving an anti-doping rule violation);
- prohibited association.
35. Since 2004, WADA has been responsible for drawing up and publishing
the Prohibited List
(published for the first
time in 1963 under the guidance of the International Olympic Committee).
The World Anti-Doping Code works in conjunction with five International
Standards
– application
of which is mandatory for signatories of the Code – to ensure consistency
in the following areas of the fight against doping:
- the Prohibited List;
- testing;
- laboratories;
- Therapeutic Use Exemptions (TUEs);
- protection of privacy and personal information.
36. The International Convention against Doping in Sport (which
was adopted by UNESCO on 19 October 2005 and entered into force
on 1 February 2007) helps to ensure the effectiveness of the World
Anti-Doping Code. This convention – based on the Council of Europe’s
Anti-Doping Convention – provides a basis under international law
for the work of WADA and a legal framework under which governments
can address specific areas of the doping problem that are outside
the domain of the sports movement. As such, as UNESCO explains,
“the Convention helps to formalise global anti-doping rules, policies
and guidelines in order to provide an honest and equitable playing
environment for all athletes”.
37. It is worth noting that the World Anti-Doping Code has been
recently revised; the new text, which entered into force on 1 January
2015, includes for the first time a formal international recognition
of the relevance of human rights in the fight against doping. The
new Code refers to the principle of proportionality and highlights the
need to respect human rights of athletes, including: the presumption
of innocence; the right to defence; independence and impartiality
of the disciplinary bodies and courts; appeals; advertising problems;
prescription of sanctions; and respect for home and private and
family life.
38. The new Code also requires greater openness from the public
authorities, who should aim to reinforce co-operation and information
sharing, in particular with national anti-doping organisations and
Olympic and sports movements. The NADOs are now required to strengthen
their investigation mechanisms and promote the use of modern technologies
in their work. The governments, together with WADA, might need to
examine how they could effectively support their NADOs, and how
to facilitate cross-border transfer of knowledge, experience and
good practices.
3.3. National legislation
and sports organisations’ standards
39. Supplementing the international legal instruments
are the various national laws. The effectiveness of athlete testing
is also enhanced by the existence of legal provisions which provide
for sanctions to be imposed on cheats and anyone who fails to abide
by the legislation in force. This legislation is very broad since
it concerns the manufacture and sale of doping substances, the organisation
of a doping system for athletes, and the taking of unlawful substances
by athletes themselves. By way of example, I would like to mention
the legislation in France, one of the very first countries to legislate
in this area.
40. The first law on doping in France dates back to 1 June 1965.
A
new law was passed on 23 March 1999. In this law, now codified in
Book VI of the Public Health Code, doping is defined as “the use
of substances or methods to artificially modify an athlete’s performance.
Doping is also understood to include the use of products or methods
to conceal the use of doping substances” (Article L. 3631-1 of the
Public Health Code).
41. The objectives of this law include:
- the creation of new care facilities and treatment for
athletes (medical anti-doping centres);
- more severe penalties in the anti-doping field, with aggravated
sentences for trafficking and acts committed against minors;
- establishing a coherent care network, with the provision
of a free and anonymous helpline.
- a review of disciplinary measures for athletes in violation
of the law, with improved involvement of the various federations
in the fight against doping;
- co-ordination and research in the sports medicine and
anti-doping field;
- the setting up of a Prevention and Anti-Doping Council,
an independent administrative authority tasked with overseeing the
effectiveness of the fight against doping (subsequently replaced
by the French Anti-Doping Agency – AFLD).
42. Sports organisations, for their part, have adopted standards
to combat doping as well as control and penalty mechanisms. Virtually
all international sports federations have either a medical board
responsible for the fight against doping, or an anti-doping board
and a medical board. FIFA and the IAAF, for instance, have their
own anti-doping regulations. The International Tennis Federation
(ITF), the Union Cycliste Internationale (UCI) and the International
Volleyball Association (FIVB) have drawn up their own anti-doping
programmes.
4. Weak points of
the system
43. Without any claim to completeness, I would like to
mention here some of the difficulties and limits of the current
system.
4.1. Detection difficulties
44. The constant development of new methods and potentially
doping products which the technology currently used is unable to
detect remains a topical issue. The testing authorities of the national
anti-doping organisations (NADOs) are, in certain cases, almost
certain that doping has taken place, but are unable to prove it
as the test results are well within the authorised limits. By using
micro-doses of doping substances, athletes are able to “smooth”
their biological profiles, and thereby avoid a sufficiently significant
change which would constitute proof of doping.
45. In this respect, progress in the health field, which could
bring about what is termed “human enhancement”, necessitates a change
to the anti-doping strategy. The anti-doping effort will have to
contend with the explosion of biotechnology and genetic engineering
(modulation of genetic expression; evolution of gene therapy; development
of nanobiotechnologies; progress of synthetic biology).
4.2. The little-studied
problem of doping in recreational, amateur and semi-professional
sport
46. Based on the results of the studies quoted under
Section 3 and on what is claimed by several institutions and police
investigators, it appears that the number of cases of doping will
be quantitatively higher in recreational, amateur and semi-professional
sport
than in professional sport. The recent European Commission study
on doping prevention, from December 2014, concludes that “the misuse
of doping agents in recreational sport has become a societal problem
and a public health issue that must be addressed”. However, it is
almost impossible to substantiate this.
47. WADA itself acknowledges that doping in gyms and sports facilities
is a difficult problem. Of course, this does not concern the consumption,
as with high-level athletes, of EPO (erythropoietin) or the use
of other sophisticated methods or products, often under genuine
medical surveillance, but primarily the use of anabolic steroids,
cannabis and amphetamines.
48. Nonetheless, testing and police investigations are de facto carried out exclusively
in professional sport. Amateur athletes are very rarely tested.
For example, it is not possible at present to carry out searches
in the residence of an unaffiliated athlete, or someone who takes
part in a non-organised sport such as fitness exercises, bodybuilding,
mixed martial arts (MMA) or running, even if information is available
on where, when and with what that person is doping himself or herself.
Prosecutors are not interested in “isolated” doping, only in organised,
large-scale doping or doping that takes place in a formal context
(in particular accredited or recognised sports federations).
49. I believe it is a real problem that the anti-doping system
is unable today to counter the development of this phenomenon among
semi-professional athletes (those in receipt of a salary) and amateur
athletes. Furthermore, not only is there (almost) no testing,
but in addition
there is no way of measuring the impact on public health. When a
young person who, also through ignorance, misuses doping substances,
suffers from their effects and then consults a doctor, the latter
will not necessarily make the connection with the use of doping
substances, unless he or she has been told of this by the parents.
4.3. The difficulty
in co-ordinating the action of the various stakeholders
50. The complexity of the system resulting from the overlap
of the various mechanisms at different levels raises the question
of how best to co-ordinate them. I believe there could be better
co-operation between the police, the NADOs, the sports federations
and governments/sports ministries, where the latter exist. For example,
it is not certain that there is appropriate circulation of information,
and yet exchanges of information among the various stakeholders
would doubtless make for better control.
51. At the hearing of 12 March 2015, Mr Ram referred to the numerous
difficulties concerning co-operation and exchange of information
which the Dutch Anti-doping Authority encounters on a daily basis
and stated that international exchange and alignment between law-enforcement
agencies has its problems as well. Ms Battaini-Dragoni highlighted
the need to examine how to facilitate cross-border transfer of knowledge, experience
and good practices, and to identify areas where synergies between
relevant actors can be developed.
4.4. Conflicts of interest
and exposure to external pressure
52. It would appear that, in certain cases, the national
anti-doping agencies are too exposed, on the one hand, to the risk
of corruption and, on the other, to the risk of undue political
pressure to avoid the outbreak of scandals which could tarnish the
image of high-level athletes and that of their country. This raises
the question not only of their independence, but also, I believe,
of unequal treatment of athletes depending on the country where
they engage in their activity.
53. A case which I find testifies to the serious aberrations that
may occur is that of athletics in Russia. In December 2014, the
German public television channel ARD broadcast a documentary that
gave damning evidence of the existence of an organised doping system
in Russian athletics. I consider it unlikely that such a system
could be established and sustained without a certain complaisance
– not to say complicity – on the part of the national federation
concerned and perhaps also the national authority in charge of anti-doping
controls. The producer, Hans-Joachim Seppelt, a specialist on doping,
interviewed by
Le Monde,
condemned the attitude of the International
Association of Athletics Federations (IAAF) since his revelations
and pointed out the difficulty of investigating these practices.
He did not hesitate to say that in his opinion most of those responsible
for the anti-doping drive did their best, in the IAAF and elsewhere,
but had no money, were under a lot of political pressure, and must
protect their jobs and families, so did not speak out.
54. There are also differences between various sporting disciplines.
I refer here to the specific case of football, an environment acknowledged
as being extremely difficult to enter in order to carry out testing.
Some NADOs are not even authorised to test footballers! That does
not mean that players are not tested, but the fight against doping
in football is carried out exclusively or almost exclusively by
the football authorities: the national, continental and international
federations. In my opinion, the risk that the interests at stake
– both economic and in terms of the image of the sport – could lead
to ineffective testing (too predictable or incomplete, for example) is
too high. People like to say that football is a clean sport and
we would all like to believe it without any reservation, but I am
not completely convinced.
55. An international federation which has come under severe criticism
but seems to want to remedy the errors committed is the UCI. Following
the revelations of the U.S. Anti-Doping Agency (Usada) about the conduct
of Lance Armstrong’s teams and the protection which he allegedly
received within the UCI itself, Brian Cookson, the current president
of the federation, commissioned a report from the Cycling Independent
Reform Commission (CIRC) which was set up in January 2014. In this
report (published on 9 March 2015) it can be read that for the CIRC
under Hein Verbruggen the federation’s combating of doping was nothing
but a front, with an ineffective testing strategy. The CIRC also
considers that there is still a doping culture in cycling. It notes here
that doping programmes are becoming more sophisticated to elude
the controls, that doctors play a key role and that certain medicines
or treatments not prohibited by WADA or legitimised by Therapeutic
Use Exemption are diverted to improve performance.
4.5. Inadequate monitoring
of the commercial flow of doping substances
56. As confirmed by Mr Vansteenkiste, there is a correlation
between the fight against doping, in particular doping in “grassroots”
sport, and the fight against networks of traffickers of doping substances,
which in turn is linked to drugs trafficking in general. This is
clearly not only a national or even a European problem, but an international
one. It is crucial to identify the criminal networks behind the
phenomenon and combat organisations responsible for production (illegal
laboratories manufacturing illicit medicines and substances) distribution
and trafficking of illicit doping products.
57. At European level, it is essential to strengthen police resources
to identify, investigate and then prosecute those who set up and
run illegal laboratories manufacturing doping substances (including
new substances such as synthetic molecules whose health effects
can be extremely damaging).
58. The pharmaceutical products sector is already subject to regulations.
But it is not enough to focus on the traditional pharmaceutical
laboratories which are already well-known: it is the illegal networks
that are the issue. Several innovative methods
are mastered throughout the
world by numerous small biotechnology laboratories which are hard
to record and control, unlike the mainstream pharmaceutical industry
with which it is possible to adopt a contractual approach in order
to be informed of the new molecules which have a doping potential
and await marketing. It is essential to work on this matter in conjunction
with bodies such as INTERPOL and EUROPOL.
4.6. The need for continued
legislative harmonisation
59. Police and judicial collaboration between countries
is not always an easy matter. In particular, legislative differences
may hinder effective co-operation. In this connection, I consider
that the Council of Europe Convention on the Counterfeiting of Medical
Products and Similar Crimes involving Threats to Public Health (CETS
No. 211, “MEDICRIME Convention”) offers a common framework which
would make it possible to achieve the necessary degree of harmonisation.
60. This convention, which is not yet in force, is concerned not
only with the intentional manufacturing of counterfeit medical products,
active substances, excipients, parts, materials and accessories,
but also with similar crimes involving threats to public health
(Article 8), including the manufacturing, keeping in stock for supply,
importing, exporting, supplying, offering to supply or placing on
the market of medicinal products without authorisation and of medical
devices not in compliance with conformity requirements.
61. The convention recommends the introduction of appropriate
criminal sanctions and of measures for prevention and for protection
of victims. Being open to countries all over the world, it also
offers a framework for international co-operation, as well as providing
for measures to improve co-ordination at national level. I therefore
consider that its ratification and implementation would significantly
strengthen the legal framework for combating doping.
5. Doping prevention
methods and actions
62. I believe that it is necessary to address doping
more effectively by acting further upstream through prevention.
Sports authorities and public authorities have their respective
roles – and responsibilities – in this regard. One should therefore
distinguish between, on the one hand, the methods of the sports
movement and the actions mounted in this context and, on the other,
the prevention methods and actions in the remit of the public authorities,
including the national anti-doping organisations. The following
paragraphs synoptically present some ideas.
5.1. Sports movement
63. In a few countries (for example Bulgaria, Germany,
Greece, Poland and Spain), sports organisations have produced handbooks
intended to further knowledge of anti-doping regulations and to
raise sports participants’ awareness of the health hazards. These
handbooks are adapted in three grades aimed at different audiences:
juniors, regular amateur players, and top-level and professional
athletes.
64. On sports organisations’ websites, messages are often found
concerning the need to play one’s sport cleanly for the sake of
ethics and one’s own health, together with up-to-date information
(legal or medical) on the regulations in force (particularly WADA’s),
TUEs, anti-doping controls, prevention of injuries and self-medication.
65. Some sports federations organise training sessions for young
athletes, including video and a recreational approach and in the
form of quizzes and role-plays. For example, UEFA has an awareness programme
aimed especially at young players. Sessions of instruction on the
fight against doping are conducted in the final stages of all UEFA
junior competitions. Educational materials are handed out to players to
alert them to this issue, inform them of the UEFA anti-doping rules
and procedures and prevent them from making any procedural errors.
66. Under its education programme for sports doctors, UEFA has
also offered an anti-doping module since 2015; the doctors who receive
this training (one per national federation) are all provided with
the necessary materials to train other doctors at national level,
thus producing a positive knock-on effect. There is also a specific
module on dietary supplements, whose message is clear: just 2 to
3 supplements may be useful in some circumstances, but, in general,
if the substance works, it’s probably banned; if it’s not banned,
it’s probably ineffective; whatever the case, the risk of players
being contaminated is relatively high.
67. Special mention should be made of the “athlete biological
passport” (ABP), based on the monitoring over time of selected biological
variables – individual markers – whose variations may indirectly
reveal the effects of doping. In January 2008, cycling became one
of the first sports to use the biological passport. It was decided to
create an individual electronic file for each cyclist containing
the results of all his or her urine or blood tests.
68. By monitoring the selected biological parameters throughout
an athlete’s career, it is possible to establish his or her haematological/steroidal
profile in order to determine his or her “normal” values and identify more
clearly any variations. WADA took over the development of the biological
passport concept in 2009. Initially, WADA introduced a standardised
approach to the profiling of individual athlete haematological variables
(haematological module). A steroidal module was recently added.
69. WADA also launched, in 2005, its Anti-Doping Administration
& Management System (ADAMS), an online management system acting
as a clearing house where various kinds of data can be stored, in
particular laboratory results, therapeutic use exemptions and information
on anti-doping rule violations. It facilitates the sharing of information
amongst relevant and authorised organisations. The system has expanded
rapidly.
70. In football, the UEFA anti-doping programme for the 2015-16
season includes the creation of biological passport profiles for
players participating in European competitions, which will be useful
at national level too. UEFA’s aim is to share this information with
national anti-doping agencies in order to co-ordinate tests and,
if necessary, target certain players according to their profile
results. UEFA has already signed an agreement with WADA for the
use of ADAMS and is now endeavouring to finalise a co-operation
agreement for submission to national agencies.
5.2. Pubic authorities
71. A classic example of a prevention method is that
of national information campaigns (for example posters, television
and radio, good practice guides, etc.). Nevertheless, this type
of action alone cannot possibly achieve the expected results.
72. Countries like France and Germany have national doping prevention
programmes. France organises its prevention at the level of government
departments and of its various regional directorates of youth, sport
and social cohesion (DRJSCS); in the case of Germany, the national
anti-doping agency takes responsibility.
73. In France, an “anti-doping hotline” has been set up, which
amateur players, parents, team-mates, friends and others can call
to report or simply talk about doping. The French Court of Auditors
has expressed misgivings about the results obtained in relation
to the cost of the service. I feel it is important, however, that well-trained
operators should be available and ready to listen. We know that
this meets a need.
74. There are examples of more targeted prevention programmes
such as the one on misuse of anabolic steroids among Swedish adolescents,
which has concerned 451 adolescents.
75. The creation of support agencies also assists in preventing
doping behaviour. For example, France has a staff within its DRJSCS
responsible for doping questions, trained to encourage preventive
actions directed at local and regional sports clubs. They could
have as an additional assignment awareness-raising and training for
doctors and other health professionals directly involved with physical
and sporting activities (osteopaths, masseurs, physiotherapists,
mental/physical trainers, sophrologists, etc.).
76. Instruction for doctors and health professionals is fundamental
as these persons have a vital role to perform in the prevention
of doping because athletes are often closer to them than to their
coaches. For instance, many doctors do not have an adequate knowledge
of the WADA regulations and particularly of the prohibited substances
list. Thus they might unwittingly prescribe medicines containing
substances forbidden in competition or training.
77. In France, the Ministry of Sport and the National Council
of Pharmacists signed an agreement on 24 February 2015 on the “prevention
of doping related to the use of dietary supplements by athletes”.
This is a good approach.
However, bearing in mind that most purchases are made via the Internet,
it appears insufficient to counter the spread of these products,
especially in amateur and semi-professional sports circles. Information
programmes and awareness-raising schemes implemented by sports organisations
should probably lay greater emphasis both on the hidden risks and
on the futility of this practice.
6. Conclusions
78. The clear desire of national and international stakeholders
to combat doping must be welcomed. However, I believe that any anti-doping
strategy should take more account of the need to devise prevention campaigns
directed at young amateur and semi-professional athletes and to
step up the fight against trafficking in doping substances, which
also enriches criminal groups. These should in fact be two priorities
of the strategy.
79. As we also pointed out in relation to the manipulation of
sports results, where the aim is to protect sport and its values
at the same time as the law and to combat sports fraud at the same
time as fighting organised crime, it is essential to ensure that
there is the highest possible co-ordination between State services
and full co-operation between the various stakeholders. With regard
to the latter, I am thinking as much about strengthening police
co-operation as promoting increased interaction between the world
of sport and public authorities.
80. All the experts who were heard on the subject agreed on the
need to work together to be more effective. This applies not only
to the system of testing for, detecting, prosecuting and punishing
violations of anti-doping rules, but also to the prevention aspect.
There is a need to reinforce collaboration with grass-roots associations and
sports instructors. In this respect, I suggest developing the certification
of sports halls and the dissemination of codes of conduct excluding
the marketing (and all forms of encouragement for consumption) of
products having doping effects (even where they are lawfully on
the market) with the aim of enhancing physical performance.
81. I am also convinced that the national education system should
be involved in any information and prevention activities in this
area and work in collaboration with the sports movement. Indeed,
I attach particular importance to the role that schools could have
in this field, not only in making young people more aware of the risks
involved in doping behaviour and doping, but also, on the positive
side, in promoting the ethics and values of sport. It is by taking
pre-emptive action that we can obtain the best results.