"Beyond reasonable doubt : an analysis of the uncertainity behind a positive test for growth hormone abuse in sport"

Abstract

Growth hormone (GH) is a protein hormone which occurs naturally in the body and it is produced by the pituitary gland. The anabolic properties of GH have made this an attractive substance to be used by patients with catabolic medical problems and athletes that wish to enhance their athletic performance. However, to date, there is no scientific evidence to confirm that its use will enhance physical performance in sport. Aside from the morality issues regarding GH abuse in sports, the use of GH has been associated with a number of potential health risks. GH is on the International Olympic Committee (IOC) Prohibited Substance list. To date however, there is no established method available for detecting its abuse reliably. In 1999 the GH-2000 research group proposed a GH detection methodology to the IOC. The method uses the concentration values of two GH-dependent markers; Insulin Growth Factor-I (IGF-I) and Procollagen type III peptide (P-III-P). Concerns were raised by the IOC regarding the uncertainty involved in this methodology on areas such as the effect of ethnicity, injuries and the physiological variability on its ability to find an athlete guilty beyond reasonable doubt. The GH-2004 project was set up at the University of Southampton in order to address these issues by undertaking several studies to assess the effect of these potential confounding factors. This thesis used data collected by the GH-2004 project to examine the issues raised by the IOC. Furthermore, work was undertaken to validate the performance of the proposed method on independent data which will provide further evidence of the reliability of the GH-2000 detection method. An examination into the uncertainty surrounding the use of immunoassay methodology in this method was also carried out. This thesis demonstrates that the GH-2000 detection method is robust when used for individuals of any ethnic group regardless of any sport injuries experienced by athletes. Furthermore, it is shown that the physiological variability of the concentration of the two GH-dependent markers will not adversely affect the performance of this method. The validity of this method is also successfully demonstrated using independently collected data. Before this method is officially implemented, there is important laboratory analysis which needs to be undertaken, which will enable us to determine reliable cut-off limits, which will both maximise the sensitivity of the test but also reduce the rate of false positive results. It has been shown that this methodology is a powerful method and should help to cut down the abuse of GH.

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