The Analytical Zen Podcast
Unveiling the Science Behind the Mystery: Exploring Forensics, Toxicology, Medicine and Health (Mind, Body and Spirit)
The Analytical Zen Podcast
Intimate Contamination: The Kissing Defense and The Sex Defense in Sports Doping
What if an athlete could test positive for a banned substance through no fault of their own? As Wimbledon and the UEFA European Championships grace our TV screens currently, and with the 2024 Olympic Games set to begin in Paris, France at the end of July, The Analytical Zen Podcast turns its focus to the role of forensic toxicology in sports doping.
Join us as we delve into the fascinating and complex world of hair testing, discussing "the kissing defense," the "sex defense," and the challenges of cross-contamination for athletes. In recent years, several cases of drug transfer during intimate moments have been reported. This week's episode features Professor Pascal Kintz, widely recognized as the leading global authority on drugs in hair testing. He elaborates on the stringent criteria required to establish a defense, shedding light on the substances commonly involved and the inherent challenges of proving innocence.
Professor Kintz first graduated as a pharmacist from the University of Strasbourg in 1985. After a period of research in molecular pharmacology, he pursued his PhD on analytical methods for drugs of abuse at the Louis Pasteur University, Strasbourg.
Professor Kintz has held positions as Associate Professor of Legal Medicine (1990-2004) and Associate Director of the Institute of Legal Medicine of Strasbourg (1990-2004). He is a Past President of The International Association of Forensic Toxicologists (TIAFT) and the Society of Hair Testing (SoHT). Currently, he serves as a senior consultant in Forensic Toxicology, specifically in Drugs in Hair Testing, at the University of Strasbourg, and as CEO of X-Pertise Consulting (Mittelhausbergen, France). He has authored over 500 peer-reviewed papers, edited nine books in two languages on forensic toxicology, and is a regular guest speaker at scientific meetings and conferences worldwide.
Join the conversation at The Analytical Zen Podcast! Reach out to us via email at theanalyticalzenpodcast@gmail.com.
The opinions expressed by the guests are their own and do not necessarily reflect the views of The Analytical Zen Podcast.
Welcome to the Analytical Zen Podcast, where we delve into the minds of leading scientists and professionals exploring forensics, toxicology and medicine. I'm your host, Geraldine M. Dowling. What should you expect in the Analytical Zen podcast? Well, we dive into cutting edge research and topics that inspire curiosity the latest in forensic and clinical toxicology pursuits, and engaging conversations and perspectives from disciplines outside of these fields. In this episode, we're diving into the world of drugs and hair. Our guest today isn't just any scientist. He's a follicle scholar of hair testing. He's been unravelling mysteries in hair and is the global authority on the subject. He's a regular guest speaker at scientific meetings and conferences around the globe, spreading his knowledge like confetti at a New Year's Eve party. So grab your headphones, get comfy. It's an absolute honour to have Professor Pascal Kintz on the Analytical Zen podcast.
Guest:Thank you.
Dr Geraldine M. Dowling SFHEA:Geraldine, it's a pleasure to be here. Pascal, it is absolutely fantastic to have you here, and your career in toxicology is based on a lot of hard work, a lot of dedication and discipline.
Guest:What's been achieved is truly remarkable, but I'm really curious what interest did you have in school that guided you towards this field? In fact, I started really young. As a kid, I was interested in chemistry and because I was afraid of blood and hospitals, I decided not to be a medical doctor but a pharmacist. So I tried a pharmacy. I was a student and during my studies I was really impressed by toxicology. I wanted to do toxicology, but unfortunately in Strasbourg, here in France, there was no laboratory of toxicology at the Faculty of Pharmacy, but one at the Faculty of Medicine.
Dr Geraldine M. Dowling SFHEA:Fascinating. After my primary degree I was accepted into veterinary medicine, but I was also very attracted at the time to academia and to publishing. So in the end I went the latter route. But it was fantastic that I chose that route, because I've since been able to work with people from many different disciplines including the veterinary field. It was a good choice for me. So what did you do after that?
Guest:So I finished my graduate at the Faculty of Medicine, where I became a toxicologist, trying to work in the environment of forensic science. Pascal, what happened after your PhD?
Guest:Did you have a clear vision or did it evolve over time? Previously, my career started at the Institute of Legal Medicine, where I was immediately head of the toxicology laboratory, but in fact it is an environment of medical doctors and sometimes pharmacists must demonstrate that they are at the right place. They cannot be the boss of the institute, of course, but they have to prove that they are strong enough to run a nice professional career. Rapidly, I understand that to be recognized first you have to publish and publish a lot.
Guest:And I had the fortune and the chance to meet in Luxembourg in 1990, professor Manfred Müller, and Professor Manfred Müller was head of toxicology in Homburg, in Saar in Germany, so it's less than 100 kilometers from Strasbourg and he told me Pascal, this is a topic, it is a topic for you, it is hair testing. Do hair testing. This will be the revolution and we know the outcome. He was absolutely right. He is considered as my mentor. We developed a lot of things together with Manfred and Ed Cone etc. We spent hours and hours in the United States trying to build what is now the Society of Hair Testing.
Dr Geraldine M. Dowling SFHEA:What I love about this organization is that they're trying so much to work on the promotion of research in this area, because we have a lot of technological advancements in hair testing and we need to stay on top of those and promote scientific research in the area. And the society works towards establishing standardised methods and protocols for hair analysis. Pascal, can you provide a brief overview of your role and your work in sports doping?
Guest:Yes, everything started in 1998. It was the Tour de France, the cycling Tour de France, and it is the scandal of Festina. This is the reason why the world anti-doping agency was created, but in fact, for the first time, athletes were controlled, of course, by sports authorities, but also by the french justice authorities, and we demonstrated that we had much more positive cases with abuse of doping agent in comparison with the official sports authorities. So it was the first time that hair was considered as a matrix of interest in sports and everything started with that. So later we were involved in cases where athletes challenged their anti-doping adverse analytical finding and more recently, because the science has evaluated, we are involved in demonstrating possible contamination and by contamination I want to say that it can be by meat, eating animals that were treated by steroids, with boldenone or trenbolone for example or contaminated supplements quite every athlete is using hundreds of supplements, so sometimes they can be contaminated. We have evidence of contaminated medicines and particularly pills containing ibuprofen can be contaminated by diuretics.
Dr Geraldine M. Dowling SFHEA:Pascal, you talked about athletes taking certain foodstuffs. I worked in the State Laboratory in Ireland and this laboratory has a number of different services it provides, but one of those services is it services other bodies in relation to veterinary drug residues in the National Veterinary Residue Control Plan and the whole aim was to look at the levels of residues that were present in foodstuffs. I was involved in developing a lot of methods in that particular area. Residues can be found in foodstuffs and we need to manage that. So athletes have to be very careful what they're actually eating.
Dr Geraldine M. Dowling SFHEA:One of the reasons those veterinary residues are found there is because of, for example, the use of banned substances or substances that are used to treat animals before slaughter that are off-label. And what do I mean by off-label? Well, in veterinary medicine, off-label or extra-label use of a drug substance refers to using a drug in a manner that's not explicitly approved, and this can include using a drug for a different species, for example, than it's been marketed for. It could be used at a different dosage, could be used for a different disease, or it could be given via a different administration route than actually specified on the label. And you know why would, for example, a veterinary official use drugs off-label?
Dr Geraldine M. Dowling SFHEA:Well, there may be lack of approved alternatives. Sometimes there might be no approved medications available for a particular condition in a specific species, which necessitates the need for off-label use. There could be unique patient needs. Individual animals might have specific medical needs that you know approved drugs cannot meet. Specialised treatments might be another reason. Certain diseases or conditions may require unique treatment not covered by existing drug approvals. Pascal, what about cross-contamination?
Guest:We have here in Strasbourg a specialty. It is cross-contamination between two individuals, what is called intimate moments, and the kissing defence or the sex defense. And this is what we are now working very hardly, because quite every two days I have a new case. This is the basic of our work. Nowadays, you know, the environment can bring a lot of issues and particularly because we have more and more sensitive equipments Nowadays accredited laboratories for sports, the WADA accredited laboratories produces an estimate of concentration in the picogram per annum range, estimate of concentration in the picogram per ml range, and I have seen several athletes that were accused of doping issues with 10 picograms of a specific drug in the urine. So it is not unnatural to see that they are challenging this issue and try to find somebody who can help to avoid sanctions and suspension.
Dr Geraldine M. Dowling SFHEA:Pascal, how does hair testing differ from urine or blood testing in detecting prohibited substances, in your opinion?
Guest:When you take a substance, it will be in blood or in urine for a certain period of time. It is what scientists name a half-life of a drug. For example, some hours or one or two days in blood, two or three, four days in urine. For most drugs this is an incremental measure. You take a drug, it is in your body and then after some days it is no more in your body. It totally disappears. On the opposite, with hair you have a cumulative incorporation. It means that once it has been in blood it is incorporated in hair and then it is stored in hair, and each centimeter of hair represents about one month of growth. So if you have six centimeters of hair, you can evaluate what has been circulating in your body for six months. If you have 12 centimeters, it can be one year and so on.
Guest:So what is very interesting is that it helps establishing the pattern of drug use of a subject and you immediately know if this subject has been exposed incidentally or if it is for doping purposes. And what is very interesting is that 10 years ago I had about 30% of positive cases, because this technology was not very well known and athletes try to cheat. But nowadays I have quite zero positive in hair. It is really athletes with incidental exposure coming from contamination with various scenario. We will discuss this later, but this is very interesting to see how it evolves in time from 30% of positive and nowadays to zero, and so, what is very important, you should not put into opposition blood, urine and hair. Now. It's complementary. It helps understanding what is happening.
Dr Geraldine M. Dowling SFHEA:Animal to animal drug transfer is a problem. Recycling of drugs due to ingestion of faeces and urine considerably contributes to the levels and persistence of residues in porcine tissues, poultry tissues, eggs, for example. This is really well known. Indeed, short lived contact of unmedicated animals to the excretion of medicated animals in improperly cleaned accommodations, during transport or in the slaughterhouse can result in high residue levels. So for that reason I guess athletes need to be really careful not only about what supplements they take but also what foodstuffs they're taking. Pascal, can you explain the concept of drug transfer in cases you investigate and how it might occur during intimate moments or other interactions and its significance in doping control or other interactions and its significance?
Guest:in doping control yeah you must understand that at this stage what is intimate moments? It can be kissing, it can be having sex. So you have basically two very different situations. Saliva contains a drug. It is a filtrate of the blood and so if you kiss somebody who has ingested a doping agent, it can be a transfer from the saliva of the subject abusing the doping agent to the athlete. This is absolutely possible and we have good cases with that. Second possibility is transfer via skin or sweat. What you have on your hands, what you have, you excrete in your sweat a drug. This is well known. It is the basic of some rehabilitation center testing, for example, for drugs in sweat and avoiding collecting urine or blood. So this is also possible. And third possibility is seminal fluid. That can use the drug via saliva, via contact with sweat and skin and via seminal fluid. So you must be able to document that, to see if it is possible or not, based also on the chemical properties of different drugs, and you understand that the literature is rather limited with such studies.
Dr Geraldine M. Dowling SFHEA:Pascal, what evidence is required to establish that a drug transfer, rather than intentional doping, actually led to an adverse analytical finding?
Guest:If an athlete is positive in urine and presents an adverse analytical finding in doping, you do not say a positive, you say an adverse analytical finding. First of all, the concentration must be very low. If you have something that corresponds to recreational drug use or therapeutic drug use, this is not possible. So you must have something very low in concentration. And then you ask for testing the hair of the user, the partner. This hair test must be positive to demonstrate that the partner, a male or a female, is using the drug. And then you test also the hair of the athlete and this must be negative or consistent with incidental exposure. So you have three prerequisites. The first one is low concentration of the doping agent in the urine of the athlete, a positive hair test of the drug user, the partner, positive hair test of the drug user, the partner, and a negative or incidental hair test of the athlete. And based on that it is very interesting to go to a hearing and to defend the athlete.
Dr Geraldine M. Dowling SFHEA:What are the legal challenges that athletes face when claiming contamination through intimate contact?
Guest:In fact the athlete must demonstrate that he or she is innocent. If this is not possible, depending on the type of drug, but generally it is four years of suspension. If it is a contamination by a supplement, for example, or a scenario without identifying the source the source can be the exact nature of the contaminated supplement or the partner the suspension can be reduced to two years. But if you can demonstrate that you are not knowing that your partner is taking the doping agent and that you are absolutely negative in your hair, most cases outcome is no suspension at all. So no fault, no negligence, and we have good recent cases with such a situation.
Dr Geraldine M. Dowling SFHEA:Pascal, can you discuss substances that have been detected through drug transfer? How do their pharmacokinetics complicate the detection and the legal defense?
Guest:In fact, until cocaine was considered as a recreational drug and that WADA changed the position about these drugs cocaine, heroin, ecstasy and so on Cocaine was number one just by contamination. Cocaine is so much used for recreational purposes. We have massive cases of cocaine Nowadays. We have much more cases on SARMs, much more cases on SARMs, such as SARMs are selected androgen receptor modulators. It acts closely to an anabolic steroid, but without the side effects. And in the SARM family you have ligandrol, you have osterine, you have S23, and so on. And these are the drugs that are nowadays observed, and sometimes also some anabolic steroids continue to be detected.
Dr Geraldine M. Dowling SFHEA:Pascal, what future research or technological developments could help clarify the extent and impact of drugs transfer during?
Guest:intimate moments. At this moment, what is very important is to understand the major difference between a criminal court and sport court. In a criminal court, it is to the prosecutor to demonstrate that somebody is guilty.
Dr Geraldine M. Dowling SFHEA:On the opposite.
Guest:in sport courts, and because of the WADA code, it is the task of the athlete to demonstrate that he or she is innocent, and this is totally different.
Guest:There is a reversal of the proof, and it is much more complicated to demonstrate that you are innocent in comparison of having proof that you are guilty. So what? I must understand that it is complicated, and particularly for the demonstration of intimate moments, because this is private life, it is privacy of the athlete and you imagine, and you can easily imagine, whether it is in an official couple wife and husband or the reverse. It is complicated but you can arrange because you are in your family, but when it is not your official partner, this is one real problem because you can involve a lot of issues, including divorces, give evidence because he doesn't want to have his or her name associated with sex and so on, with a non-official person. You can have problems and issues with homosexual people, because in sports, you know, it is complicated to say that you are homosexual. It is even complicated in the normal life, but to produce a coming out due to an anti-doping challenge can be also very complicated. So the first issue we have is that it is a real difficulty to have controlled studies. No one is taking a pill having sex and you collect everything from the other side In some occasion. This can be done, but it is very complicated, and so for the sports authorities it is very complicated, and so for the sports authorities, it is very easy to challenge.
Guest:Yes, you say what you want. It is not documented by the science, nothing has been published. So we have fight. We, as a member of the legal team of the athlete and the defense, we have to face with unfair people Sometimes what people are really unfair and they say no, no, no, this is not possible. You try to say it is still a possibility that you are wrong, and so on. So it is complicated and there is obviously a lack of controlled studies and a background, because you are dealing with the privacy of the athlete.
Dr Geraldine M. Dowling SFHEA:Pascal. Are there any preventative measures that athletes can take to avoid inadvertent contamination through intimate contact?
Guest:This is very complicated because it is life. They have to inform a special software named ADAMS where you are Every day. You must say I am here, I am here, I am here and I am here. This is very complicated. So if you put another sanction, which is you are not allowed to have intimate relationship, it is female athlete.
Guest:We are contaminated by a male partner. And why is this situation? Because in most cases the male partner is thinking oh, I am not really athletic. I have a girlfriend that is really a top athlete, a very nice girl with a lot of muscles, very pretty and so on. I must also be very strong, with muscles, attractive. So I use some drugs, but in a hidden fashion manner.
Guest:So this is the problem. You cannot ask to your partner do you take drug, do you take drug? So this is very complicated. So it is complicated for these athletes. They must indicate where they are located, they must take care on what they eat because, as you mentioned, eggs can be contaminated by clobifen, beef can be contaminated by boldenone or trenbolone, pork can be contaminated by nandrolone. So everything they do must be under control. And this is incredible. We are fighting, we are a small group around the world and also some other people to try to convince WADA to put thresholds for reporting drug use and not going so deep in the picogram per ml range, because this is obviously a possibility and an open door to contamination.
Dr Geraldine M. Dowling SFHEA:A number of cases of contamination involving drug transfer during intimate moments have been described. This scenario was first reported in 2009 with the Richard Gaskier case. Since that time, several athletes have been allowed to return to competition with no charge, based on strong evidence that the source of contamination was drug transfer during intimate moments. As some of these cases are public, and because, pascal, you performed hair tests for the majority of the international athletes involved in such procedures, it would be wonderful to discuss the strategy of the defence and the scientific basis of discussion.
Guest:Let's start with the first case, richard Gasquet. So Richard Gasquet is a French athlete, a tennis man, and he is a sort of reference. Now His case is really very important for the forensic community. Richard Gasquet was playing tennis in Miami and because he was injured he retired, but nevertheless he went in a restaurant where he met the famous French journalist. They kissed and so on.
Guest:However, what is very important is that he was accused of doping with cocaine because they found very low concentration in urine 151 nanogram per ml of benzoil agonin and minute amounts of power and cocaine.
Guest:So Richard Gasquet was the first time where hair tests were accepted by the Court of Arbitration for Sports in Lausanne in Switzerland, because we demonstrated that Richard Gasquet was totally negative in his hair and we know, and the scientific community knows, that one line of cocaine, about 100 milligrams, is detectable in hair.
Guest:So we had very low concentration in the urine of Richard Gasquet, the presence of parent cocaine negative hair test. So Richard Gasquet was here in Strasbourg, I cut his hair and we tried to discuss. He had a very good legal team and we demonstrated that it was because he kissed a girl who, just before entering the restaurant, sniffed cocaine. Later this girl was tested in her hair that were absolutely positive for cocaine. She was a cocaine abuser and we demonstrated that she had enough cocaine on her lips and her saliva that transferred to Risha Gaske to produce what was detected in her hair. And this was accepted by the Court of Arbitration for Sports and was the first case with strong biological evidence, as we do in forensic science. So it is really a reference for all the scientists that it is possible to have a drug transfer via kissing.
Dr Geraldine M. Dowling SFHEA:And the next case, Sean Barber.
Guest:Barbara, a Canadian athlete it was just before the 2016 Olympics was very stressed. He called a cold girl and later the cold girl confessed that, just joining Sean Barbara, she took cocaine by sniffing and she also had some cocaine in her mouth, around her lips, and this was also accepted by the sports authorities.
Dr Geraldine M. Dowling SFHEA:What was the scenario presented in the Jill Roberts case?
Guest:Yes, this is another case of saliva transfer Gail Roberts and there was a CASS hearing in New York. He was accused to have very low concentration of probenecid. Probenecid is considered as a masking agent for some drugs and particularly for anabolic steroids, so he explained that he has a girlfriend who used medication containing probenecide and they kissed during the afternoon. She took the drug at one o'clock in the afternoon. The control was at four or five, if I correctly remember the same afternoon and they found nine nanograms per ml of probenecid. And during a very famous case, wada sent a high-profile scientist and in this case we won because we were able to convince the tribunal that it is more likely than not that kissing was the reason of being positive. The source was identified, transferred via saliva, and this is also very interesting for that.
Dr Geraldine M. Dowling SFHEA:What were the key arguments and evidence used in the Madeleine Nichols case regarding ligandrol contamination?
Guest:in the Madeleine Nichols case regarding ligandrol contamination, yeah, we tested both the partner and the athlete for the drug ligandrol, which is a serum that enhances and allows muscle building. She was negative in her hair, the partner was positive in his hair, the concentration in urine was very low and, putting everything together and in the fact that they had sex just before the control, usada, which is the anti-doping agency of the United States, accepted this evidence.
Dr Geraldine M. Dowling SFHEA:Pascal, what were the circumstances of the Diana Jastrzemska contamination case involving Mestrolone?
Guest:Yeah, this is another case for a well-known tennis player. Again, she was with low concentration of the metabolite of Mesterolon in her urine. We received the hair of the female athlete no Mesterolon in her hair. And we received the hair of the boyfriend, highly positive for Mesterole. And then we learned that because he wanted to be strong and very athletic, he was taking on a regular basis Mesterole and also one capsule each time before sex having sex, he, he confessed, and so of course, transfer was an evidence and this was accepted by the sports authorities.
Dr Geraldine M. Dowling SFHEA:Pascal, outside of your professional life, what do you enjoy doing in your free time?
Guest:Oh, this is very easy. I have one major passion. That is diving, being underwater. I am a professional teacher of diving and as soon as I have a moment, for example this evening, I will teach diving in a small lake in the neighbor of Strasbourg. I spend all my holidays on that neighbor of Strasbourg. I spend all my holidays on that.
Guest:I try to find a location for the holidays where it is possible to dive. This is very interesting because then I choose tropical islands with warm water, with color fishes, with sharks, with snakes, with whatever, and my real interest is to find seahorses and small snails the name is nudibranches, it is very short animals with extraordinary colors. So this is really what I do when I am not involved in toxicology, because it is possible to work nowadays by video, and I am often on a hearing during the time the morning I'm diving, at noon I am testifying and the afternoon again under the water. Pascal, where is your favourite place to dive? Oh, probably it is in Asia, for example, maldives islands are extraordinary for small things and very big things like whale sharks or other sharks, yeah, and also the Caribbean island, because you can also mix, but only on the evening. Good diving and rum, which is another little drink that I am particularly fond of.
Dr Geraldine M. Dowling SFHEA:Pascal, if you had one piece of advice for aspiring scientists, for researchers, professionals, what would that be?
Guest:Yeah, if you are interested in toxicology, immediately go to a laboratory. There is no need to put to try to make a lot of diplomas. What is important is to be as soon as possible in a laboratory where you will be able to learn on site. Once you are in the laboratory, it is time to make your diploma, and you make your diploma not for general science but directly for toxicology. Then you have also to publish, but you have to publish in national journals in your mother language, so all the people from your country will know who you are. And, of course, at an international level, you have to visit as much as possible other labs In my career, much as possible other labs In my career I have learned in Luxembourg with Roger Wening and in Germany with Hans Saps, manfred Müller and Hans Maurer.
Guest:This is very important and you have to try to be creative, innovative, and this is what is important Try to be innovative. We have been very innovative in 96 when, with some other people from Spain, from Italy and from the United States, we created the Young Scientist of TIAFT, because there was nothing for the Young Scientist and nowadays there is no scientific scientist that doesn't have a young scientist committee, and I am particularly proud to have created this concept.
Dr Geraldine M. Dowling SFHEA:Pascal, what do you hope to accomplish in the next phase of your career?
Guest:My career is almost finished, but you have to understand that if you want to leave something, you have to consider toxicology as exciting. It can be fun, although it is sometimes very stressful when you have to go to court and things like that. You have to find a spirit, a style and finally, for me, what is very important is when I have a student here for two months who is asking me can I stay in your laboratory, do you have a future? For me, this is the most important, so being able to give the good spirit to your students.
Dr Geraldine M. Dowling SFHEA:This is fascinating. What legacy do you hope to leave behind in the field of toxicology?
Guest:In fact the input. Once you have somebody who wants to do exactly the same as you have done, I say good luck. Of course it's not so easy, but this is the ultimate recompense.
Dr Geraldine M. Dowling SFHEA:Pascal, before we wrap up, is there anything you'd like to share with our listeners?
Guest:Yeah, in fact, for me, success in forensic toxicology is probably the addition of good knowledge of the science, a good background, a large community for sharing. To try to be open-minded and never, never, consider you have finished the work, because it never ends.
Dr Geraldine M. Dowling SFHEA:So thank you for taking time to talk about your career and for joining the analytical zen podcast thank you, geraldine, the pleasure was mine be sure to join us next time. Stay curious, thank you.