Supplements and Inadvertent Doping
Dr Lucienne Attard
Chairperson Medical Commission
In this issue we shall continue discussing the topic of athletes inadvertently testing positive. We had already emphasized that athletes have to be very careful about any supplements that they take.
Athletes nowadays have ready access to supplements from overseas via mail order or, Internet sales and personal importation. it is important that they have a global understanding of the regulation of supplements. In countries such as the US, there is less regulation of the production and marketing of supplements than under the Australian system. For example, pro-hormones are permitted ingredients in over-the-counter preparations, supplements and sports foods. All forms of food and non-food supplements fall under the jurisdiction of the Food and Drug Administration (FDA). The Dietary Supplement Health and Education Act (DSHEA), passed in 1994, reduced the regulation of dietary supplements and broadened the category to include new ingredients, such as herbal and botanical products. The DSHEA shifted responsibility from the manufacturer to the FDA to enforce guidelines for safety and claims, but the FDA is allowed to investigate a supplement only after a safety problem has been reported. Requirements for good manufacturing practice and accurate labeling are included in the DSHEA, but there has been little enforcement. This means that products advertising the fact that they are FDA approved are not necessarily free from banned drugs.
In the absence of rigorous government evaluation, quality control of supplement manufacturing is trusted to supplement companies. Large companies that produce conventional supplements such as vitamins and minerals, particularly to manufacturing standards used in the preparation of pharmaceutical products, are likely to achieve good quality control. This control includes precision with ingredient levels and labeling, and avoidance of undeclared ingredients or contaminants. However, there is evidence that such control does not occur with all supplement types or manufacturers:
So we where do we go from here? Here are some ideas that might help to reduce the rate of positive doping outcomes:
- Educate coaches, athletes, trainers and other sports science/medicine staff. The message: there will always be a risk that dietary supplements will cause a positive doping outcome, and that the responsibility lies with the athlete. The risk is small, but real, and the price is a substantial loss of earnings and respect.
- Develop programs that help athletes to distinguish levels of risk with various supplements. For example, in Australia discussions are taking place that an accredited assessment/testing program could allow Australian manufacturers to have their products assigned by brand name into categories of “low risk”, “unknown risk”, “restricted” and “banned”. This information could be circulated like lists of permitted and banned medications. Athletes who wish to use supplements could be directed to use only those products designated as low risk.
- Stop trying to excuse or exonerate athletes who claim that their positive tests are the result of supplement use. This claim is almost impossible to prove, after the fact. Even if you could show that a supplement contained banned substances, how could you prove that it was taken inadvertently by the athlete, or that the athlete was not also taking other proscribed agents at the same time. The International Court of Arbitration for Sport has held that athletes are liable for drug offences, in that they have a duty to be aware of banned substances and to know what they are ingesting. Although it is sad to think that innocent athletes may be punished (e.g., the Romanian gymnast at the Sydney Olympics), drug education messages are quite clear that athletes are responsible for their own actions.
- Apply pressure to supplement companies to produce only high-quality well-labeled products. Changing government regulations to set up surveillance of the supplement industry is a desirable but almost impossibly huge task. Self-regulation might improve if customers demanded higher standards, or if there were real penalties for providing contaminated, mislabeled products that failed to deliver the promised ingredients. The sports supplement industry flourishes because athletes are prepared to buy anything that claims to improve performance. What would happen if a few celebrity athletes who have had their careers ruined because of a positive drug test sued the company that made the supplement containing an undeclared banned substance? We all might be better off if athletes undertake complicated legal battles with supplement companies rather than sporting organizations or drug testing agencies.