Comments on Lundby et al.'s "testing for recombinant human erythropoietin in urine: problems associated with current anti-doping testing". Anti-doping testing: friend or foe?

TO THE EDITOR: Ideally, anti-doping testing is designed to ensure fair competition and prevent athletes’ harm from unfair practices. While the former issue is questionable, since fairness in sports is mostly a chimera, the latter is foremost and theoretically viable (1–3). The recent study of Lundy et al. (5) proved what everybody in the field of laboratory and sports medicine has supposed for years: a poor agreement in test results for detecting recombinant human erythropoietin (rHuEpo) comparing two World Anti-Doping Agency (WADA)-accredited laboratories. Laboratory tests are not always foolproof. For various reasons, false-positive and false-negative results can occur for any test in laboratory diagnostics (3). Traditionally, both sensitivity and specificity determine the diagnostic efficiency of a certain test in the clinical practice. However, the extension of this concept to the anti-doping context is challenging. Basically, anti-doping tests are not intended for diagnosing disorders or monitoring therapies. Therefore, sensitivity is only important to identify cheaters (rarely disorders), but specificity is foremost to prevent unfair sanctioning of clean athletes. Several lines of evidence attest that the current antidoping strategy, based on repression rather than education or harm control, has returned negligible results, if none, in terms of preventing athletes from doping and modifying this upward trend. Probably it has only contributed to modify the pattern of drug consumption (4). The report of Lundby et al. must hence be regarded as an additional mainstay in the urgent process of reviewing the current anti-doping policy based on analytically questionable tests.