Dear Gopichand, doping in India is not an ‘over-the-counter’ problem

July has been a month of sensational news on the doping front in Indian sports, nay Indian athletics. One is not forgetting the record medal haul by the Indian athletes in the Asian Championships in Bhubaneswar, but later developments have cast a shadow over the overall achievements of Indian athletes through this season.

The news of decathlete Jagtar Singh testing positive ahead of the Asian championships did not cause much of s stir. But two reports on successive days by a Hindi daily of Asian champion shot putter Manpreet Kaur being caught in the anti-doping net created a huge impact even as the Athletics Federation of India (AFI) was getting ready to finalize the squad for the World Championships in London in August.

To make matters worse for the AFI, its president, Adille Sumariwalla, was quoted in an expose by a TV channel saying that there was a “rate card” that ranged from Rs 50,000 to Rs 5 lakh for switching urine samples. Clearly, Sumariwalla’s finger was pointed towards the National Anti-Doping Agency (NADA) as well as his own colleagues including coaches.

That the All India Council of Sports (AICS), meeting in New Delhi on July 22, devoted much time to the topic of doping in Indian athletics following the sensational allegations, was natural and expected only. What was not was an observation from Dronacharya awardee, former All-England champion and Olympic Task Force member, P. Gopi Chand, during that meeting.

This is what a release from the AICS stated: “Shri Gopichand mentioned that most of the sportspersons take off the counter medicines like Corex and get caught in dope. In the recent case of women athlete also, it is doubted that she took medicine for stomach upset and got caught in dope, Shri Gopichand suggested that NADA should create a 24x7 helpline so as to enable sportspersons to seek advice before taking any medicine.”

This was a surprise

This is not the first time people associated with sports in the country have tried to project the “innocence” of the athletes. Dope hearing panels keep stressing the importance of “educating” the athletes about the perils of doping and about the risks involved in taking medications without doctor’s advice. The village and educational background of an athlete come into consideration when an order is eventually passed for a suspension or reprieve.

But coming as it did from a sports personality of the stature of Gopichand this was a surprise. Public would be tempted to think that cough and cold medications often land athletes in the melting pot of doping but that would be wrong. It might think that elite athletes get no medical support and thus fall into the doping trap. Wrong again. It might presume that a medicine for a stomach ailment could easily turn up a positive test for a steroid and a stimulant (dimethylbutylamine in the case of Manpreet). Nothing could be farther from the truth.

Manpreet’s positive test for stimulant dimethylbutylamine (DMBA), a substance similar in structure to the more famous methylhexaneamine (MHA), came at the Federation Cup at Patiala in June. A day later, the Hindi daily reported Manpreet’s steroid violation at the Asian Grand Prix at Jinhua, China in April. She could face a suspension of up to four years in the normal course. Lesser sanction is also possible depending on the defence she puts up.

It seems supplements manufacturers brought in DMBA after many countries including the US and Britain either banned the sale of MHA or ordered them to be removed from stocks. Despite warnings, MHA has continued to figure in doping cases across the world. Manpreet’s was the first DMBA case in India.

To come back to Gopi Chand’s argument at the AICS meeting. Corex is a cough and cold medicine. Most athletes think most cough syrups contain banned drugs and if they take any they would get caught! I have heard athletes complain about their predicament of not being able to use a cough syrup or a cold medication for fear of turning up a “positive”. Mostly these were exaggerated notions of their “plight”.

Not all bad

It is not all that bad, however. Corex, a common medication used for cold, cough, watery eyes etc, for example, does not contain a banned substance! Both its ingredients, cholorophenarmine maleate (also known as chlorphenamine) and codeine phosphate are not in the banned list.

Gopi Chand surely must have intended to portray the perils of taking something as simple as a cough syrup which could lead to the travails of an athlete and he might not have actually meant “Corex” to be the possible cause of trouble.

But let us also take some other commonly used medication for cold and cough. Phenylpropanolamine, the ingredient in D’Cold Total that badminton star Aparna Popat tested positive for in 2000, is no longer in the banned list. It is, however, currently in the batch included in the “monitoring programme” as it had been for a few years. Phenylephrine, another cold medication, now used in D’Cold, is also in the “monitoring programme”.

Ephedrine, methylephedrine and pseudoephedrine, also popular medications found in several cold remedies, continue to be banned. But WADA has prescribed certain threshold limits for these medicines. A normal therapeutic use will mean no danger to the athlete from an anti-doping perspective since he or she would not cross the thresholds prescribed.

They do try but stipulations for therapeutic use exemptions (TUEs) are getting stricter and stricter. TUE is a certificate that an athlete can obtain from the authorities for the use of a banned drug. It is a different matter that of late there had been a debate about the “misuse” of TUEs by the athletes.

It is pertinent to note here that in the list of 715 dope cases available on the NADA website as those disposed of – a recent report quoted NADA to say that so far 852 cases had been reported since 2009 – there is only one case of ephedrine. That was in 2010 by discus thrower Krishna Kumar Sharma who was suspended for two years.

We have to somehow get rid of decades-old idea that Indian athletes are being snared into the doping net because of lack of education and readily available information on banned drugs or because medicines of everyday use could easily lead to a positive test. Internet is no longer a luxury for the general public including athletes. The Prohibited List is available on the NADA website as well as dozens of other websites.

Taking some common over-the-counter medications like paracetamol or D’Cold or Corex is not going to send an athlete into a spell of suspension. Athletes need to consult a doctor at the earliest instead of treating themselves. The national-level athletes have the advantage of the services of a doctor at the training centre where they are practicing. Such doctors are mostly aware of the banned list.

One look at the list of athletes given out on the NADA website will reveal what is popular among the Indian athletes – steroids. It is a world-wide phenomenon, of course. Of the 715 cases listed 518 are that of steroids, over 72% that is.

In 2015, of the 3,432 adverse analytical findings by WADA-accredited laboratories from over three lakh samples, 1,728 were for anabolic agents, mainly steroids. Stimulants accounted for 528 and of that 19 were for ephedrine, nine for pseudoephedrine and four for methylephedrine. MHA contributed 56 and DMBA 24. You know cold medications or those for fever or even anti-biotics are not the real “villain” here.

Among stimulants, the Indian athlete seemed to have taken a particular liking for mephentermine, an injectable cardiac management drug which is used to control blood pressure. Of the total cases of 147 currently available on the NADA website 71 are that of mephentermine. MHA, which is not available in any medicine across the world, accounts for 39.

Stimulants, by the way, are banned only during competitions, not outside them. That means athletes can use medicines containing such stimulants including cough syrups, if they need, away from the competitions and make sure they cut the medicine off days ahead of the meet.

If an athlete requires long-term treatment with a banned drug he or she could apply for a TUE, which then would be reviewed by a medical panel and either granted or rejected. Unless an athlete is seeking to use testosterone, which also had been granted in very rare instances, a genuine exemption is a possibility if supported by medical opinion and investigation reports.

The Ministry, NADA and SAI would do well to organize education programmes for athletes at camps where not just the “don’ts” are explained but also what could be taken for a cold or a fever without breaching the anti-doping rules. This could be done by “expert doctors” familiar with doping rules.

The apparent hysteria being created by well-meaning internationals, sports and anti-doping officials about Indian athletes falling prey to over-the-counter medicines or contaminated supplements has to be tempered with facts available from the hundreds of doping cases on the NADA and WADA records. The more we try to shy away from accepting the bitter truth that there is rampant doping going on in our country the worse we could end up with in the longer run. Athletes dope to enhance performance. The “accidental doper” invariably gets relief.