HEALTH PROGRAM AND ANTIDOPING WORK IN SYNERGY!

After Mark Kangogo’s official disqualification for testing positive for two substances banned by the World Anti-Doping Agency (WADA), we wanted to pass the floor to Pierre Sallet from the Athletes For Transparency Association (AFT) – at the origin of the Health Programme, – to explain the Programme’s precise role, which is now used by the world’s biggest trail running races (Golden Trail Series, UTMB® Mont-Blanc, etc.) and more broadly in sport in general.

Could you explain what the Health Programme entails and when it started? 

The "Quartz Programme", as it is known, emerged in 2008. It was established after concern for the health of trail runners and has always been led by the Athletes For Transparency Association (AFT), which I currently chair. The main aim of the Programme or Health Policy, as it is now simply known, is to assure a runner’s medical fitness to participate in a trail running event.

At the events where we intervene, we carry out a series of medical tests, on D-30 and D-1 before the race to obtain the athlete’s biological profile, and for medical reasons in the context of this health policy, we also do toxicology testing at the race’s finish line to monitor any use of prohibited substances. Subsequently, we can prohibit a runner from taking the race start and give them a "no start", if we consider that they are not medically fit but also to downgrade them if they haven’t complied to the policy’s rules that prohibit certain substances.

We use a medical list which contains a set of substances that we judge to be dangerous for the runner’s health and subsequently we prohibit them. Obviously, this medical list contains all the substances and methods for anti-doping, but the additional substances are present because they have proven to be a danger in trail running. If we detect one of the substances afterwards, we consider that the athlete has not respected the race rules and put themselves in danger and therefore we can disqualify them for non-compliance with the rules in the same way as if they had used poles when they were not allowed.

I would also like to point out that we carry out a great deal of research on health issues with athletes and the strength of our association is having a very large international network. We work with people and structures that have the highest level of international expertise in all these areas, whether doctors, scientists, clinical investigation centres or laboratories. We only rely on published and approved scientific work to establish our Programme.

What sets you apart from world anti-doping bodies?

As their name suggests, anti-doping bodies apply an anti-doping policy, with a list of prohibited substances, and methods (such as blood transfusion for example) and they only have one aim; to detect usage of these substances or methods. The Health Programme’s aim is different, and above all consists of protecting the athlete’s integrity and health. This is why we established a medical list including additional substances to the anti-doping list and which have been proven to be dangerous in competition trail running. 

Our mission is not to catch those who cheat – although we are pleased to help make the sport fair – it’s to talk about health issues with the athletes and protect them when they aren’t able to do it themselves. We believe that if you need to take a drug that could be dangerous whilst racing, you can’t participate in a competition. First, you should get better, and then return to competition.

This is also why we have the same person who carries out all the testing throughout the year and don’t have a very protocolary, rigid scheme of doping controls, to establish a trusting relationship with the athletes. We want them to feel open to talk with us about their health, their doubts, and ask questions. We are here to answer them and support them. 

We never ask an athlete if they are doping! What we want to understand is how certain substances could have ended up in their body and if this could be linked to a pathology or other concerns. If the athlete doesn’t have a clear and reassuring explanation, we simply don’t allow them to start the race for health reasons. It should also be noted that athletes can consult all their medical results on a platform and thus benefit from regular medical checks through the Health Programme. Following the request of certain athletes, in particular female athletes, in 2023 we would like to work on more enhanced controls to offer them even higher-quality medical monitoring.

In which sports is this programme used? 

Currently, only in trail running on two major circuits who state it in their regulations: the Golden Trail Series and the UTMB® Mont-Blanc. There are also individual organisations that call on our services, such as the Marathon des Sables and the Festival des Templiers. 

We have received other requests from other sport disciplines, but it is important to understand that we are an association under the 1901 law governed by French Law, and we are volunteers. Therefore, we are currently limited in our actions and cannot respond to requests from other sports. Also, we would first like to better install the Programme in trail running and once everything is well-established and we are accepted by the whole community, we will be able to move towards other disciplines.

Despite everything, it is important to note that the UCI (the French International Cycling Union) has also adopted a health policy, which is not our Programme, but which operates on an identical principle. In 2018, they created this health policy with a medical list which only includes one substance – Tramadol – but which joins the official anti-doping authorities list. This substance will also officially join the WADA's prohibited list in 2024. In the meantime, it is thanks to this health policy that the UCI was able to disqualify Nairo Quintana from the Tour de France due to two positive tests with Tramadol, exactly as we could have done in trail running with the Health Programme.

What authority do you hold over the athletes? 

At races or circuits that use the Health Programme, we have the right to prohibit an athlete from starting or to judge that they have violated the race rules by non-compliance to the medical list. However, doping doesn’t concern us. What we are interested in are the medical risks such as thrombosis or serious kidney failure. 

I often use the Mont Blanc as an example: this summer, the risk was too great to go to the summit and all the mountain experts knew it and so did not go. However, some people, without the necessary knowledge, still attempted the ascent. So here also, the authorities had to close the refuges! It’s the same for us! Whether the athlete is under the influence of drugs or sick, our role consists of protecting them and therefore stop them from starting the race. 

We use a medical approach, so we never divulge our results, if the athlete wishes to, that’s their prerogative to explain, or not, why they are not starting the race. It is also important to understand that in the context of anti-doping, certain athletes may appeal any Provisional Suspension decisions. In this case, they are authorised to continue running while waiting for the rest of the procedure, which can sometimes be very lengthy. As part of the Health Programme, we can still legally prevent them from participating in competitions until the procedure is entirely finalised.

What is this Programme’s legal standing?

We worked very hard to make it very simple from a legal point of view. Our work is done in the context of medical fitness and therefore able to employ a "no start" for health reasons when we have a doubt about the runner’s medical fitness. As I mentioned, we are on the same legal terms as authorising using poles in a race. We don’t want to take any risks with the athletes’ health, and this is our sole motivation.

Can a private series work directly with the anti-doping authorities?

To answer this question, you must understand what is necessary to have access to: an accredited laboratory – that's pretty easy –, a public or private supervisory authority that will come and carry out the controls – which is also easy to find – and above all you need a testing authority; the structure that decides to trigger the control. The organiser of a private series therefore cannot decide to trigger this control themselves. They can submit the request to the competent anti-doping authority, but nothing binds the latter to accept it. Therefore, if a private series wishes to have systematic testing on their races, they have no choice but to go through other solutions such as health policies.

Another important point is that on social media, some people tend to oppose health and anti-doping policies when the two are in fact complementary and work even better together. There is significant collaboration between the Health Programme and anti-doping organisations. For example, we automatically leave them our control centres when they show up at a race, we give them priority over testing, we warn them when we have abnormal profiles that appear, and during a procedure they also request all the elements relevant to the progress of this procedure. Those who try to oppose both on social media simply do not know what they are talking about!

It is also important to bear in mind that all this at the organizers’ cost, and they should really be congratulated! It costs them economically, it requires significant logistics, they also take risks, but it is essential to support what they do because they fight for their vision of sport. We are lucky in trail running to have organisers who are a driving force, and we must make the most of it. 

If we look at the recent case concerning Mark Kangogo, why wasn’t he checked by the Health Programme at the race start or the finish? 

In our regulations, we check all the athletes in the potential top 10 on D-30 and D-1 to carry out profiling before the race, and the top 5 do toxicology testing at the finish line. When the top 10 was established, Mark Kangogo was not in the list and therefore didn’t get profiled before the race. But we also have a rule: when the anti-doping authorities are present, we give them priority over the control, and we refuse to carry out any other tests on the athlete. We are aware that this means that they will not be tested for additional substances on the medical list, but we also believe that it helps to preserve the athlete’s equilibrium. For us, it would be like breaking their psychological balance to test them twice in a row. This can be held against us, but our thoughts are always focused on how to look after the athletes. We are a Health Programme and in this specific case, testing an athlete twice at a race finish would go against his health.

Where do you stand concerning the TUEs?

TUEs are Therapeutic Use Exemptions which allow the potential use of all the substances or methods on the WADA Prohibited List. Therefore, in the event of a pathology and if authorised for the TUE, an athlete can take certain medications containing one or more substances present on the WADA prohibited list. The concern is that some athletes hijack these TUEs and may claim, for example, to have tendinopathy to be able to use glucocorticoids. 

We are not here to judge whether this TUE is reasonable or unreasonable. However, what we do know is that participating in a trail running event on corticosteroids means exposing yourself to multiple risks that can be as severe as death. So, it's a no! The products that we prohibit are dangerous to use when trail running. Take for example Ibuprofen: I don't know if its use is dangerous for archery, but when trail running in intense efforts, you can suffer from severe dehydration which in turn can lead to severe renal failure.

There is also the question of chronic treatments such as for asthma. If you have this type of chronic treatment, our policy is simple: you continue your treatment as prescribed and as you are used to taking it. Then, it is two blasts of Ventolin (Salbutamol) in the morning, and it stops there. On the other hand, you take your Ventolin with you on the race, but if you need to use it during the race, it’s because you are having an asthma attack. In this case you stop and quit. If you don’t, it will be detected on arrival, and it can no longer be considered that it was used in the context of chronic treatment. 

As a health programme, do you also work on certain profiles, particularly women, who are extremely thin? 

Behavioural and eating disorders, such as anorexia, especially among female athletes, but not only, have been an increasing concern in recent years. We observe that some athletes do not have a "healthy" profile but, paradoxically, we are reaching our Programme’s limits. The Health Programme is essentially based on biological markers, however, anorexia is difficult to detect in the blood, even if deficiencies can be found. But for some time now we have been asking ourselves if we should look to other indexes, such as they do for modelling, which uses reference values ​​and refuses women with extreme body mass indexes? It is very complex because we haven’t found the right solution yet and we’re still looking.

I think it's a consideration that we must carry out collectively because if the check-ups are normal, it's complicated to exclude an athlete just because we consider they are too thin and that someone said that they don’t eat enough in the evening. We are aware of the problem, and we do want to take a step further in 2023 to deal with these issues concerning anorexia by providing an appropriate response and continuing to protect the athletes’ health!