With a belated bucket of water in hand, the latest doping scandal has the Doc all fired up

In a fast-moving world it is the lot of the weekly columnist to always arrive breathlessly at the scene of the latest excitement carrying a bucket of water just in time to find the fire has been put out. But there are some topics that manage to be both topical and everlasting.

It would, for instance, be pointless to put an article about the potential dangers of disc brakes into a time capsule because when it’s dug up in 100 years time everyone will still be having exactly the same debate.

Doping is the same. You will perhaps recall the case of Maria Sharapova and meldonium. It doesn’t matter if you don’t because there’s a new meldonium positive pretty much daily at the moment — and there’ll be one in cycling at any minute.

These positives are happening because the drug has been available for a decade, but was only banned in January this year. So in effect, what the anti-doping authorities are currently testing for is whether people check their email properly or not.

It also illustrates, in one respect at least, how the doping rules are very simple. No grey areas, no blurry lines. “Here’s a list of stuff you’re not allowed to have in your system. If we find any of this, we ban you. Otherwise, go nuts.”

If it’s on the list…
The problem is — what goes on the list? And how can something change from OK to banned? The World Anti-Doping Agency is helpful on this. After only half an hour of searching its website, you’ll find the three criteria it applies.

If a substance or method prompts a ‘yes’ to two of the following, it’s banned: 1) Does it potentially enhance performance? 2) Is it potentially dangerous? 3) Is it contrary to the spirit of sport?


This is why we’ll always have doping. We’re never going to finish enumerating all the things that might go on that list, not least because they’ll always keep changing. If you took those criteria back to Victorian Britain, the first thing they’d have banned would have been proper training because in an age of amateurism training would have fulfilled all three.

Riders would all have had to say things like: “I’ve done no training, me. I’m going to take a hiding from all these other guys who haven’t got kids.” And that despite the fact they’d actually been doing three hours a day for the past two months. Just try to imagine it.

>>> Why Maria Sharapova’s meldonium positive raises questions for cycling too

Even in a modern era, we’re never going to agree. Beetroot juice enhances performance and is certainly not good for you in large quantities. I suspect you could probably get a working majority for banning it.

But then again, caffeine fulfils the same criteria, and I don’t imagine there is more than one rider in 100 who would like to see it banned. If there was such a thing as single-estate beetroot juice at £10 a glass, or if you could buy a £500 beet-to-cup machine to tell your friends about, then the contrast might be less stark. But there isn’t, so they’re not.

Watch: Dr Hutch’s guide to coaches

Neither beetroot nor coffee is banned because there is a social construct to all doping. It’s why there are continual complaints about athletes using products that are legal, but just don’t sound quite right.

The painkiller tramadol is reportedly popular in the pro peloton and is almost universally frowned upon, yet remains unbanned. As far as most people are concerned tramadol is not doping, but only on the technicality that it’s not on the list.

But the list is all we have. Until the day we democratise anti-doping by putting the contents of everyone’s urine sample online and giving us all a retrospective vote on whether we like the look of it or not, the list is what counts. And at least it’s clear, it’s certain, and what’s more it encourages people to read their email.

  • Roberto2016

    I believe there shouldn’t be any list of banned substances, if everyone is allowed the freedom to ingest any potentially performing enhancing substance they desire then no one can complain they are at a disadvantage in their chosen sport.

  • skelto99

    Indeed. Anybody who has read Dr Hutch’s pages in Cycling magazine will know that he is a contributor mainly known for his tongue in cheek views on cycling. What has come out of the cheap snotty comments that have resulted from the web article is that there sure are some big highly opinionated childish egotists out there!

  • Tim Phillips

    Exactly, although with a point in there. Amazing how upset people get on the interweb

  • EB

    Again you didn’t answer the question

    “Can you suggest a specific clinical indication that is relevant to a world class athlete?”

    I will take that as a no then.

  • Nomad

    Gee…I didn’t know that I could answer the question with a yes or “no.” I do see that Meldonium isn’t licensed in W.Europe nor FDA approved in the States…wasn’t aware of that.

    So, therefore, it’s prescribed and utilized in Russia & Eastern Europe? Perhaps the MDs over there are clinically indicating it for their world-class athletes? And maybe that’s where all the RCTs are at…a top secret lab in Siberia or someplace? (Lol).

    How about this: A top guy at the Antidoping Commission of the European Olympic Committee thinks the evidence is very weak on Meldonium’s PE capabilities:

    “The evidence around whether it is a performance-enhancing drug is quite thin,” said Mark Stuart, a pharmacist in London who is on the medical and antidoping commission of the European Olympic Committee. (“Effects of Meldonium On Athletes Are Hazy.” The New York Times/031016).

    And there is one pro cyclist popped for it (so far); Verganov of Katusha. I checked his palmares and don’t see anything that sticks out as suspicious, or any amazing transformation (i.e. the “donkey to racehorse” analogy).

    IMO, this looks like something trendy with the Russians & Eastern Europeans, as the Americans & Western Europeans don’t seem to be buying into it…

  • EB

    You are trying to change the topic. Before I bother to answer any of your questions you need to answer the original question.

    “Can you suggest a specific clinical indication that is relevant to a world class athlete?”

    Answers may include “no”

  • Nomad

    So…Where’s the data with athletes? Can you provide just one (1) published blinded placebo-control trial with athletes? Or are you saying that because Sharapova & other athletes have taken Meldonium for so long that it must/should be performance-enhancing?

    You said…”a clinical need for elite athletes seems rather unlikely.” And since Sharapova was using Meldonium for all those years, you personally believe she “cheated” in her competitions. Now…you know very well that absent a placebo-control study, suspicion of a performance-enhancing drug/sustance is anecdotal and speculation.

  • EB

    “Specific” was the word used. Not can you copy and paste something general.

    The drug has been around for a long time and doesn’t have a license in western Europe or America.

  • Nomad

    According to the published medical studies Meldonium demonstrated cardioprotective results involving subjects with cardiovascular disease (e.g., heart failure, myocardial infarction, arrhythmia, atherosclerosis, diabetes). One of the studies involved heat stress with patients with CV disease in which Meldonium improved their quality of life in summer time heat conditions. And if some athletes have CV disease, the drug might be indicated under a doctor’s care for that group.

    All the therapeutic medical studies are indexed on PubMed. However, there are no RCTs of Meldonium involving any potential performance-enhancing effects with athletes. If you think you can find such a study – please post it (and good luck).

    However, whether Meldonium is actually performance-enhancing or not doesn’t matter since it’s officially banned now. And with a long glow time there will probably be more positives. And guess who benefits the most from all of this? Try the pharma industry: “Meldonium sales through the roof after Sharapova admission.” (Othersports/031816):

    “The doping scandal was a very good advertising boost for Meldonium,” says CEO of DSM Group, which monitors the pharmaceutical sector.

    …I can hear pharma laughing all the way to the bank.

  • Gary Jogela

    Isn’t Doctor Hutch’s column just a bit of fun?

  • Roger

    Who knows. Maybe you just couldn’t be bothered or had greater thoughts on your mind.

  • EB

    People who ‘know little about pro cycling’ well outweigh those that do and, together, have more money to spend.

  • EB

    you talk in very non-specific terms about Meldonium’s ‘cardioprotective effect’. Can you suggest a specific clinical indication that is relevant to a world class athlete?

  • EB

    If I was as brilliant as you I’m sure I would have included the full stop….

  • Roger

    Right. And there is a full stop missing from end of your last sentence.

  • Nomad

    IMO, I think those kind of people you’re talking about know little about the history of pro cycling and get too upset as if the sport was ever clean. Look at Wikipedia’s “List of doping cases in cycling.” Doping goes all the way back to the early ~1900s. My goodness they were using cocaine & amphetamines like candy back then…they even referred to it as “dynamite.” And don’t forget Bjarne Riis was quoted as saying that back in the 90s, the peloton didn’t consider doping as cheating but “the normal preparation of a professional cyclist.”

    I certainly hope that mindset has changed…but what if it hasn’t? Some, perhaps many, fans would be in “shock & awe” and total disbelief. The same type of fans that believed Armstrong was clean because he “passed all those tests” and looked us in the eye and said; “I have never taken performance-enhancing drugs” (I foolishly fell for that back then).

    I believe other more realistic fans understand there has been a culture of doping in cycling that could still exist today. For them it’s no surprise nor mind blowing. They probably would still follow their favorite rider (s) and buy the sponsor’s products. I know it wouldn’t change my outlook as I find the sport very entertaining. Btw, not just cycling…same doping concerns in distance running, triathlon, XC skiing.

  • Nomad

    WADA can be hard to figure out at times. There are no peer-reviewed published studies demonstrating performance-enhancing effects of Meldonium with athletes. There are many studies that demonstrate Meldonium is a cardioprotective drug for some people with cardiovascular disease, which it’s clearly indicated for in a medical setting.

    Nevertheless, Meldonium is now banned as a PED. However, if the drug’s primary purpose is performance enhancing, why did WADA wait ~10 years to ban it? WADA should have a lot of data on it since it was part of their “monitoring” program for so long. And if it’s a safety issue with athletes, why wasn’t it banned much sooner?

    For example, look at EPO. It reared it’s ugly head in pro cycling around 1987/88 or so, and came into full swing in 1990. It was banned by the IOC in 1990 and by the UCI in 1991. The first of several peer-reviewed published studies on the performance enhancing effects of EPO was conducted in 1991 (“Effect of erythropoietin administration on mammal aerobic power.”/Ekblom & Berglund). The UCI wasted no time in banning EPO due to it’s performance enhancing characteristics, and also safety issues related to EPO-induced high hct…even though there wouldn’t be a test developed until 2000.

    So, where’s the evidence for Meldonium?

  • EB

    I was wrong. Your badge should actually say “I am brilliant and if you don’t agree it is because you have difficulty understanding how brilliant I am”

  • Roger

    That was about competitors, not about rule-makers. Are you deliberately misinterpreting what I wrote, or do you have difficulty understanding it?

  • EB

    You; “What “people” consider cheating is irrelevant”

  • Roger

    Where did I suggest the rule-makers think society is irrelevant?

  • EB

    No you are not. You’ve made up your own “facts” and desperately want the rest of the world to agree with you. Good luck with that.

    Have you thought for even a second what is running through the officials mind when they write the rules? You honestly think they aren’t considering the ‘opinions of strangers’ and think society is, as you dismiss it, “irrelevant” to what they write?

  • Roger

    I am not even talking about professional athletes specifically. At any level of sport, it is the governing bodies, anti-doping authorities etc. that decide what is allowed, not the competitor or a spectator.

    I don’t need a badge saying “I am brilliant”; I am merely stating the facts.

    Also, I doubt very much that any athlete, professional or otherwise, is going to base his or her preparation on the random opinions of some stranger.

  • EB

    I’d agree with you on the importance of self, team and sponsor happiness. I’d question though what makes sponsors happy. If something is not on the list, but lots of the people who the sponsor want to buy their stuff think it is cheating, are they going to be happy?

    Similarly, I don’t imagine athletes would be happy if what they did was’within the rules’ but the general population thought they were a cheat. I don’t know any world class athletes & maybe they have a different mentality. I’d be surprised though.

    I would also wonder what the underlying purpose of the list is. Is it to reflect the personal morality of the authors? Is it to keep the athletes safe? Is it to protect the image of the regulatory authority as perceived by the general population? If the list is, atleast in part, aimed to be a representation of common morality then it has already been ‘democratised’ to a similar degree as our representative democracy.

  • EB

    “What “people” consider cheating is irrelevant…”

    Wrong already. If a person thinks/feels a rider is a cheat, based on how they (not you) choose to make a decision on that, they will be less likely to follow the athlete or buy the things their sponsor sells.

    Good look with telling them their opinions are ‘arbitrary’ or ‘ill-informed’. Maybe you could get a badge saying “I am brilliant and you are wrong”. That would work.

  • Roger

    What “people” consider cheating is irrelevant when they are competing with others in events organised or regulated by a third party. In such events it is the rules set down by the organisers and regulators that apply, not the arbitrary and perhaps ill-informed or poorly thought-out opinions of random competitiors or spectators.

  • EB

    I don’t in the slightest care what you think or whether you think I can deal with shades of grey. You obviously love your opinion and believe in your brilliance though. To quite spectacular levels. You may think this. Having read your post I think quite the opposite.

    The point I made was that people won’t be using lists, or as you alternatively would like; ‘logic’/’consistency’. People have their own morals and will use them to individually decide for themselves what they feel is cheating, they certainly won’t listen to people of your ilk.

    Now go and find someone else to start an argument with. I don’t think you are worth the bother & there is a famous saying about wrestling pigs that I would apply here.

  • sola scientia

    There is simply no published evidence that meldonium actually enhances performance. Given that, how is it “cheating” to take it?

    In contrast, there is published evidence that beet juice, caffeine and other non-banned substances do enhance performance. Given that none of these materials are medicinal, let alone essential — you can live your entire life without any of them — your “logic” tells us that a cup of coffee or a beet extract pill _IS_ cheating.

    So you haven’t even made it to simple consistency — and you don’t even appear to know it. How on earth can we think you will be able to deal with “shades of grey”?

  • Derek Biggerstaff

    When it comes to cheating in sport you’re never going to run out of grey areas, and you will never run out of people willing to argue that black is in fact white when they want it to be. I still think this article is a bit smartarsed while shedding no light at all. Is the bit about beetroot any more helpful or meaningful than pointing out what a proven performance enhancer food is, or water?
    Thanks for your reply.

  • EB

    A list allowing black and white decisions may be very helpful to those who sit in judgement at WADA, but most people don’t know what is and isn’t on the list and make their decision on what they feel is morally cheating.

    In the case of Meldonium, it is used in short courses for angina and heart failure. A clinical need in elite athletes seems rather unlikely. Even when it was officially legal I personally still believe it was cheating. In Sharapovas case she has said she was taking it for many years, including those she won grand slams in. I personally think she cheated in those competitions, even though it was legal.

    Dr Hutch has been deep in sport bureaucracy for so long he has lost sight of how the ordinary population do not find it so hard to deal with shades of grey and will make up their own minds on moral issues.

  • blemcooper

    An interesting point made in the article is that “there is a social construct to all doping”. We often hear the point that we should stop calling it doping and just call it cheating. But then so many other forms of cheating are tolerated because they are “part of the sport”, which is also a social construct.

    Witness the recent debate about Arnaud Demare’s win at MSR. Did he take a tow, or just a sticky bottle, or just draft cars (which he admits to, but says isn’t forbidden even though it is, though to be fair, some amount of it is unavoidable).

    Social constructs, judgement calls, ambiguity, uncertainty in so many things cheating, but we often want to view it as black and white.

  • Derek Biggerstaff

    I’m not at all sure if I could see any point being made there.

  • Andrew Gleeson

    “Until the day we democratise anti-doping by putting the contents of everyone’s urine sample online and giving us all a retrospective vote on whether we like the look of it or not, the list is what counts.” True that. If you’re happy to stand by the contents of your cup, and your sponsors/team are happy to back you, then is that what counts?