Antidoping Science: Important Lessons From the Medical Sciences.

The ineffectiveness of antidoping programs in elite sport, largely due to human and political factors, is leading to a new resolve and greater transparency of antidoping authorities and those stakeholders interested in drug-free sport. The perception by the public, athletes, and the World Anti-Doping Agency (WADA) of antidoping science and current drug testing programs in elite sport varies widely from "ineffective" to "robust and reliable." Here, we discuss why a careful and considered reevaluation of the underlying premise of antidoping science is needed to bring this unique application of predictive/diagnostic science more in line with other areas of medicine. We show how the validity of doping tests are neither "stand-alone figures" generated under ideal laboratory conditions, nor figures that can be used in isolation to support the efficacy of the current drug testing program. Given the consequences of a failed doping test for the athlete, the sport, and multiple stakeholders (e.g., the sponsors), there is a need for transparent decision making to ensure those affected are well informed. We identify in this perspective the minimal essential data on drug testing that should be reported by antidoping laboratories to draw meaningful conclusions about the effectiveness of specific drug testing methods to support antidoping. In the absence of information on the validity of a doping test, it is not possible to plan or conduct "intelligent testing." It is imperative that the prevalence of doping and the likelihood of false-positive doping tests be regularly updated and made available for the wider antidoping research community to explore new approaches that could improve the validity of antidoping tests. True confirmatory testing which requires the use of different analytical technology and ideally an independent sample taken from an athlete with a positive test to transcend the present-day analysis of the B-sample. Indirect biomarkers of doping derived from new "omics"-based approaches may significantly improve the testing strategy. Biomarker molecular signatures are flexible enough to develop "normal ranges" optimized for either test sensitivity or specificity to detect a plethora of doping substances and methods.