The science behind anti-doping

The science behind anti-doping

Meet the science and medicine team behind our anti-doping efforts. Dr Naomi Speers, Rima Chakrabarty and Dr Laura Lallenec discuss all things anti-doping, prohibited substances and methods in sports, the dangers supplements pose to an athlete’s career and putting the pieces of the anti-doping puzzle together. 

Podcast teaser

Dr Naomi Speers: We want to make sure that athletes and everyone has genuine scientific and medical information about these substances and the risks that they present. Some of those changes that we’re seeing are the emergence of SARMs in use by athletes who are cheating or the general population. We as the science team get involved in everything that happens in the organisation so in my opinion science is highly rated.

Rima Chakrabarty: As science is improving it’s also raising a lot more questions about anti-doping and so it’s really interesting from that perspective as well.

Dr Laura Lallenec: It’s better to be informed but if you’re unsure of the answer, ask and never assume a supplements safe to take or that medication is appropriate. I’m always available as the Medical Advisor for advice for athletes as well as other medical practitioners. What we do is promote that fairness in sport but also the health side of things. We’re not just seen as the sort of injury keepers, gate keepers we’re really looking after these individuals and these people as a whole.

Interview with Dr Naomi Speers

Tim Gavel: Our first guest is Dr Naomi Speers, the Chief Science Officer at Sport Integrity Australia, and Naomi is highly respected globally, she's had a wide and varied career which we'll discuss shortly. Naomi welcome to On Side. Firstly, are you still excited by your role here at Sport Integrity Australia?

Naomi Speers: I certainly am. Anti-doping science is a really interesting field because things are always changing.

Tim Gavel: Can you tell us about some of those changes?

Naomi Speers: Yeah, some of those changes that we're seeing the emergence of SARMs in use by athletes who are cheating or the general population. So SARMs stands for Selective Androgen Receptor Modulators and they're a group of substances that act like a steroid in the body but aren't actually a steroid, and we're seeing more athletes using them unfortunately, and also the general community.

Tim Gavel: I guess education is part of it, isn't it? But also, just staying on top of the evolving nature of some of the things that are coming through with regard to substances and what athletes are trying to do illegally.

Naomi Speers: Yeah, education is key. Unfortunately, people who sell these substances don't tell athletes and the community the truth. They make out like they're genuine products with no side effects, they're only good for you, so we want to make sure that athletes and everyone has genuine scientific and medical information about these substances and the risks that they present.

Tim Gavel: What do you regard as the biggest challenge in your role? Just staying on top of things that might be sort of coming from left field?

Naomi Speers: Yeah, I think the challenge is keeping on top of everything that's changing. So we talked about different substances that people might be using and keeping aware of them and making sure that athletes are aware of them, but also changing technology and understanding that and thinking about how can we apply that to our work.

Tim Gavel: Do you think that science to a certain degree is underrated? People sort of see it there, it's very reliable, science, but it's underrated to a certain degree in the whole process?

Naomi Speers: I would say in anti-doping science is really highly rated. The anti-doping laboratories have a really significant role in anti-doping and in the testing and the high quality and difficult analysis that they do, and we as the science team get involved in everything that happens in the organisation. So we're talking about education, we're talking with our test planners and helping them understand science, with intel and investigations and legal and the comms team, like all through it. So in my opinion, science is highly rated.

Tim Gavel: Yes, so just tell us, what excites you most about the job? Is it the fact that you're working in a smaller agency than say a large sort of cumbersome agency but you're working in a smaller group?

Naomi Speers: I love working in a small agency. I love that I can know everyone in the agency and be able to talk with them on a first name basis. I also love that the Science Team get to be involved in so many different things. Often as a scientist, you're in a really narrow lane and you're an expert on one particular thing and that's your life, and that's great, but that's not me. I love doing a bit of work with the Education Team and then a bit of work with the Legal Team and learning about something new every day.

Tim Gavel: Yes, so that excites you and to a certain extent you do you forecast in your own mind things that might appear in the future? Are you able to predict at all?

Naomi Speers: Oh, I'm probably not a very good predictor but we do have questions like key questions that we're still trying to answer, and so we're always looking for solutions to those questions, but I don't know that I'm good enough to predict what the answers to those questions will be.

Tim Gavel: When you were going through university, did you have in your own mind that you'd like to work in sport eventually?

Naomi Speers: Oh, no, not at all. But it's been a great change and I love it now.

Tim Gavel: Yeah, tell us about your career because it's been wide and varied, hasn't it?

Naomi Speers: Yeah, so most of my work career was spent with the Australian Federal Police in their forensic services area and I worked in the chemical trace evidence lab. So we analysed paint, glass, fibres, explosive residues, chemical warfare agents, gunshot residue, a whole range of different types of evidence.

Tim Gavel: How big a role do you play internationally, do you think with Sport Integrity Australia? Because I would imagine that they'd be looking at what is happening in Australia, but you'd be looking at what's happening elsewhere.

Naomi Speers: Yeah, both ways. Australia play a really significant role in anti-doping and we represent on international committees at a really high rate. So I sit on the WADA Laboratory Expert Group which is a great privilege to contribute in that way, but we're also always talking to our international partners and learning from them.

Tim Gavel: Do you find that you might see something happening overseas and you think 'Right, we’ve got to watch out for that in Australia'?

Naomi Speers: Oh, absolutely. Always talking to our colleagues overseas to see what are they seeing and is that a risk for our athletes and should we be looking forward to prevent that? There's also times when things are quite different across countries. Maybe the regulation is different or the community attitude is different, so it's not always directly applicable but we always want to know what's going on.

Tim Gavel: How important is dried blood spot testing going forward?

Naomi Speers: I think dried blood spot testing is going to be a real change to anti-doping. So it will enable us to take samples in situations where we currently can't, it might enable us to take more samples than we've been able to do in the past, and it's an additional tool which gives us more options going forward.

Tim Gavel: How does it work?

Naomi Speers: So dry blood spot is collecting a small amount of blood onto some kind of surface, a paper surface or another surface, and it's used a lot in clinical testing. When babies are born they usually get a heel prick and their blood goes on a card, that's dried blood spot. The way that we'll be using it in our anti-doping program is that there's a small device that attaches to the arm of an athlete, it just sticks on, and the athlete's able to activate it themselves, it draws a small amount of blood, I've done it myself it doesn't hurt, and collects blood onto a little device which we then ship to the lab. It is so much smaller to ship to the lab than a blood tube, so much simpler for the athlete, it's a great opportunity for us.

Tim Gavel: And is it easier to detect a banned drug by this method than say, urine testing?

Naomi Speers: No, so they are different and complementary things that we'll be using. So dry blood spot will never replace urine testing, there are advantages in urine that we'll never be able to do in dried blood spot, but it will enable us to do different things, and that's what we want to do. Have a range of tools that we can use in the right situation.

Tim Gavel: And you've also got the Biological Passport, haven't you? That is another tool that you use.

Naomi Speers: Yeah, really important tool that we use. So the biological passport indirectly looks for doping. So the normal detection of doping that we think about is a positive test, an athlete sample had a drug in it, the Athlete Biological Passport we actually look at parameters in an athlete over time. Things like their haemoglobin levels, so how much red blood cells they've got or their testosterone level, and we track what is normal for that athlete and then we can find what's abnormal for that athlete, and that might tell us that the athlete is doping.

There might be many other reasons as well and that's why it's a really complicated science to understand what's happening, but a really important tool for us and another one that's evolving. So going forward there's actually going to be a third passport introduced. So at the moment we've got a blood passport which looks for blood doping, a steroid passport which looks for doping with testosterone and next year we're going to introduce an endocrine passport, which will look for doping with growth hormone.

Tim Gavel: Oh, gee, it's quite interesting, I guess that's what you love about it isn't it?

Naomi Speers: That is what I love about it. There's always something new to learn.

Tim Gavel: Good on you Naomi. Thanks very much for joining us on On Side today.

Naomi Speers: My pleasure, thanks Tim.

Interview with Dr Laura Lallenec

Tim Gavel: This is On Side as we celebrate National Science Week, and another very important member of the Sport Integrity Australia Science and Medical Team is Medical Advisor Dr Laura Lallenec and Laura, firstly, why did you take up the role at Sport Integrity Australia?

Dr Laura Lallenec: It's a really interesting role to me. It sort of combines my passion with sport, my background in sports medicine and really promoting fairness and equality in sport. So when I applied for the role, it was something that I thought would really be an area of interest to me, I love health administration and health governance as well as public health, so it's sort of combines those two things from me, the sports medicine clinical elite sport background and combining with that health governance, health promotion and educating athletes and other practitioners.

Tim Gavel: Yes, that'll elite sport background. Obviously you're the head doctor at the Melbourne Football Club amongst other roles, can you tell us a bit about your background?

Dr Laura Lallenec: Yeah, so I trained as a doctor initially in Darwin and then moved to Melbourne. Initially I wasn't sure what sort of field I wanted to go into, I really enjoyed orthopaedics but I also enjoyed working with individuals and having done a fair bit of sport myself that area of sports medicine really appealed to me. So I got into sports medicine, started initially working in the VFL so the state league, doing some Commonwealth Games, working with Melbourne Storm and then as you mentioned of late, working with Melbourne Football Club, the 2021 premiers.

Tim Gavel: So you bring real life experience, don't you? To the role and you're able to advise Sport Integrity Australia on what is happening within a sporting community, in elite sporting community.

Dr Laura Lallenec: That's right, really adds to my role because I have that practical on the ground experience and understand how these elite sports work and how the athletes work within the system, and the challenges and the positives in these environments for athletes and support personnel. So bringing that hat into my role at SIA really helps me to understand what's needed at those, within elite sport, within community sport, what education we need to provide, where we need to be looking at, our health promotion areas.

Tim Gavel: And that is why Sport Integrity Australia needs a doctor such as yourself.

Dr Laura Lallenec: That's right, yeah. With that outlook definitely, and then obviously the internal like advising on medical issues or medical questions internally as well.

Tim Gavel: What do you find are most of the questions coming towards you from other doctors involved in sport? What do they want to know about Sport integrity Australia about what they can do to preserve integrity in the sport?

Dr Laura Lallenec: Most of the questions I get are predominantly around anti-doping. Questions about certain medications or certain requirements such as therapeutic use exemptions, that's generally the questions that come my way, but there's a lot of interest also in the National Integrity Framework that's being rolled out that national sporting organisations are taking on board and adjusting to fit their requirements. So a lot of questions coming from NSOs, so national sporting organisations in that aspect as well on the NIF (National integrity Framework).

Tim Gavel: Do you find that you're getting asked a lot of questions?

Dr Laura Lallenec: I think definitely, it's definitely increased, and certainly as my colleagues have come to know me to work in this role they're certainly using that resource, and that's part of this role is certainly being there for my colleagues and other allied health practitioners to provide a point at Sport Integrity Australia for these sort of questions.

Tim Gavel: Does there remain a certain amount of confusion amongst players and I guess doctors and club medical staff about supplements and medicines about what they can and can't use?

Dr Laura Lallenec: I think definitely, and I think there's a lot of education and particularly a lot of education that SIA does provide, a lot of online modules and a lot of education that athletes do, but it is still a complex area to navigate, and I think complex for doctors working the field, let alone for the athletes themselves.

So it's certainly something that a lot of questions are asked about and importantly they are asked. We always say to the athletes it's better to be informed, but if you're unsure of the answer, ask and never assume a supplement's safe to take or that medication is appropriate. And that's where the SIA app is so fantastic at providing that quick access to information, and if that's not sufficient, if the answer still isn't found there, they can certainly contact us for more information.

Tim Gavel: Being involved in elite sport, what do you find is the best way to educate young athletes in particular?

Dr Laura Lallenec: Yeah, I think face to face is often quite effective. When they have someone standing in front of them often they feel a bit more comfortable or they're more motivated to ask questions. Otherwise, this day and age, a lot of the young athletes really are quite tech savvy, so they're quite good at getting online, doing modules using apps. so that's the other avenue that I think is quite an important route for education in this group.

Tim Gavel: What about young athletes coming through, do you find they've all had the same amount of education when they hit an elite football club such as The Melbourne Football Club.

Dr Laura Lallenec: Definitely through the academy pathways and I think AFL is particularly good at providing this education right from the start of their talent pathway. Obviously other organisations that also provide that sort of education it's just sort of dependent on the level. If they're at a level that requires them to get in-advance therapeutic use exemptions for medications, they're certainly provided the education around that. However lower-level athletes may still be, are still as able to be tested but may not have that education in advance, so that's where they need to be somewhat proactive and sporting organisations proactive in sourcing their education materials to assure that athletes are informed.

Tim Gavel: Laura, what about your role in terms of therapeutic use exemptions? What do you do there?

Dr Laura Lallenec: So my role within that is mainly around the education process. I don't myself review the use applications that's reviewed by the ASDMAC council, which is a council of medical practitioners. 

However, I'm always available as the Medical Advisor for advice for athletes as well as other medical practitioners and I would certainly encourage people to access the website's resources, SIA's website, particularly in relation to the checklist required for applications, factsheets related to WADA requirements, it's a very helpful resource and really ensures athletes and doctors when they submit their applications are submitting a thorough application that will be reviewed and considered rather than having to be sent back for more information.

Tim Gavel: In terms of therapeutic use exemptions, we are looking here at a drug such as asthma medication, which athletes do provide a prior clearance to do so before they perform and before they go on the field?

Dr Laura Lallenec: Correct and that's athletes of certain level. If you're in a national testing pool and which athletes that are in this would be notified of that, if you're a lower tier athlete but you can be still tested, certainly you could be asked what we call a retroactive therapeutic use exemption so asked after the fact after the fact, after the time you were tested, sorry.

Tim Gavel: And one of the grey areas comes in community support, doesn't it? Because they don't face the same restrictions as elite athletes do so there is that grey area, isn't there?

Dr Laura Lallenec: Yeah, and the crucial thing here is anyone can be tested. Even if you're not at that elite level or sub-elite level, you have to be aware that you can be tested potentially by SIA, by WADA for banned substances and really what we do is promote that fairness in sport but also the health side of things. You want to know what you're taking in your supplements, and that's where the SIA app is really useful to determine those supplements that are already checked for prohibited substances that may or may not be harmful to your health so you can use that resource to make sure you're sourcing the supplements that won't affect you in an adverse way.

Tim Gavel: Just on your role at the Melbourne Football Club and your experience through elite sport, you're there to advise not just on what medications they can take, but I'd assume there's other advice that you offer athletes as well.

Dr Laura Lallenec: That's right. As a sport and exercise physician our role at these clubs and for looking after athletes is really to provide holistic care, it's looking at the acute injuries or chronic injuries they might be suffering from, looking after their WADA requirements, but also looking at their mental health, their general health, their colds, their flues, it's sort of a holistic and sort of all in approach looking after these athletes.

Tim Gavel: Almost a duty of care role, isn't it?

Dr Laura Lallenec: Yes, correct. It's really important that we provide that as well, and we're not just seen as the sort of injury keepers, gatekeepers, we're really looking after these individuals and these people as a whole.

Tim Gavel: Of course concussion is a massive issue in AFL at the moment and one you're obviously very well aware of.

Dr Laura Lallenec: Yeah, definitely and it's an important one that we continue to educate ourselves on and continue to get better at managing. Obviously knees, you injure a knee later in life, we hate to see but you can certainly replace a knee you can't replace your brain, you're with your brain for life so it's important we look after it and it's important that we continue to do research on concussion to fully understand the consequences of concussion and particularly repeated concussions, and there's a real obviously priority at the moment in all contact sports and in most sports on managing concussion properly and appropriately and putting that athlete at the front of that management.

Tim Gavel: From a personal point of view, what do you like most about your roles?

Dr Laura Lallenec: I love the variety. I love that I get to two or three days a week work with a footy team, work in the AFL, attend the games on the weekend, two days a week I get to work at SIA and I really enjoy that work, that switches on my brain, it's much more intellectual and policy related work, and then a day a week I get to see my everyday patients, my weekend warriors that are trying to keep fit and healthy. They're trying to get better so that they can keep running their kilometres on the weekend, they can keep swimming, so it's a really nice mix of elite, of recreational athletes as well as some policy and government work.

Tim Gavel: Alright thanks very much for joining us on On Side today.

Dr Laura Lallenec: Thank you.

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