In the second part of our discussion on drugs in tennis, we ask Dr Stuart Miller, the head of the ITF anti-doping programme, why there are so few blood tests, whether there will be changes to the rules and just how big a problem doping is in the sport.

In 2011, there were only 21 out of competition blood tests carried out by the ITF: 18 men, three women. Why is that figure so low?
There are things I can tell you and things I can’t tell you. I will tell you that there were certain constraints about blood testing under the programme previously. Those have been moved aside and we’re increasing the proportion of blood testing we’re doing across the whole programme, not just out of competition but in competition as well. So blood testing is becoming an increasingly large part of, and we anticipate that it will continue to do so, over time.

What were the problems? Expense, intrusiveness?
There have been challenges with blood sampling, previously. That’s all. And we’re overcoming those challenges.

How much do blood tests cost to carry out?
I can’t give you a specific number because it depends on who, where, when, where the sample’s being sent to, how many samples you’re collecting, what you’re analysing it for and it can be a huge range. It can cost easily up to $1000 per sample, to collect a single sample.

Wada say they’d like to blood tests, as a percentage of overall tests, reach 15-20 percent.
Well, their published value is 10 percent.

Is that enough?
There’s a balance to be struck (between) what is in the interests of the programme and what are the constraints that are being applied in applying those best interests. The constraints are always going to be financial. When you’re collecting samples, if you suddenly start collecting samples that are more expensive, then something else has to go. So you have to strike a balance. There are also more prohibited substances that can be detected in urine samples than there are in blood samples. One might, therefore, suggest there is more value for urine samples than there is in blood sampling. And then there comes the logistics of collection and analysis. For example, if you’re doing tests for certain substances, the analysis comes as a kit of analysis for multiple samples. If you put one sample in, you pay for the whole analysis kit. So you have to decide whether you’re happy to waste the money for all the others or you go and collect more samples to have analysed at the same time, which is an additional cost and has logistical challenges. You’re always balancing certain things, be it cost, availability, logistics, shipping, all sorts of things.

Is 10 percent enough? That’s not for me to decide. We are increasing the proportion of blood sampling under the programme. I anticipate that we’ll continue to increase that proportion in the future. I can’t tell you where that will end up but it’ll be a greater proportion than it currently is, I would say.

Blood testing covers what? EPO?
EPO is a urine test. It covers synthetic oxygen enhancement; haemoglobin-based oxygen carrying agents, human growth hormone – they are the fundamental ones.

The Wada code is being reviewed next year, is that right?
It will be finalised in November, 2013, for implementation on January 1, 2015.

Do you think there are likely to be changes, to the whereabouts rules?
Well, whereabouts aren’t under the Wada code specifically, they’re under what’s called the international standards. The prohibited list is an international standard, there’s one for laboratories, there’s one for protection of privacy and personal information and there’s one for testing. Whereabouts rules come under the international standard for testing, which is also being reviewed separately. It’s up for grabs like anything else and I have no doubt there will be a lot of submissions on rules underlying whereabouts for the next code. So will it change? I am sure it will in some form, not quite sure yet, but sure it will.

What’s your biggest frustration? Is it mis-reporting?
That’s an interesting question. There is mis-reporting, of course. I look at it two ways. If it’s mis-reporting that is through ignorance or deliberate, then I accept that it is what it is. If in any case, what it does, the first thing you do is not question what other people are doing but makes you look at yourself – I’d be lying if I said we don’t look at what we’re doing, all the time, and say, you know what, there are some good points here, let’s look at how we do this, how we can improve. We’re always looking to improve. Sometimes we get information, ideas, from other anti-doping organisations, or from Wada, from everywhere. It’d be naïve and I think blinkered to ignore ideas that people provide, or suggestions, because sometimes they’re pretty good. Never would we say that we’re perfect. There’s always room for improvement.

How big a problem is drugs in top-level tennis?
There’s clearly a risk. The fact that there have been 63 violations over the years is testament to that. There are great rewards at the top of tennis and it’s not inconceivable that they’ll give rise to temptation to cut corners. So never would we say there is no risk. Nor would I say that we think we will catch everybody because unfortunately we can’t test every player every day. It’s about balancing the resources we have to provide education, prevention and deterrent. To what extent do I think there is a problem? Well, we’re clear that there has been and probably is, and probably will continue to be some use of prohibited substances in tennis. Is it systematic and endemic? We haven’t found any evidence of that despite our best efforts so far. That doesn’t mean we’re going to stop trying; we’re going to keep looking. We’ll do the best we can within the means that we have.

Andy Murray once said (February 2009) he was tested around 25 times per year. That seems a lot, to me. Is it possible to give an average?
No. In general top players tend to be tested more than lower-ranked players. If he was tested 25 times a year, that’s quite a lot. That would be a lot for anybody in any sport. But, if you were a top player, you would probably be in double figures.

Some players don’t like being tested and moan a lot.
There is always two sides to it. There’s the imposition on their time and privacy. I can’t deny that it is (an imposition). However, the alternative perspective is that it’s protection. The programme protects players from somebody on the other side of the net getting an unfair advantage; it protects them from ingesting things that can damage their health; it protects the sport as a whole, allowing it to say: ‘we’ve got a robust programme and we think we’ve got some integrity in sport’. That should be attractive in and of itself. You take an example, some people have accused…there was this French-Spanish issue that was around (recently) and the programme allows a player to stand up and say: ‘hold on, it’s being implied that I’m involved in doping, yet we’ve got a tennis anti-doping programme that tests me in competition and out of competition, with no advance notice and I’ve been tested 10 times this year’. It’s a protection. I know it will never happen that everybody will see it that way, but that is what it’s there for.

Do you personally educate players on the subject?
We do, in a variety of ways. We try to print a lot of material, thousands of wallet cards, which contain key information on the programme, where you can get TUEs (Therapeutic Use Exemptions) and information, what’s on the prohibited lists, how the doping tests work, why you shouldn’t do supplements, things like that. We post notices in doping control stations and locker rooms, we do face to face presentations (through the ATP University, (we are doing one at the junior Davis Cup). We have a 24-hour helpline that players can ring to ask about prohibited substances.

Does that get used?
Yeah, of course, it’s there for people, if they haven’t got (the wallet) or if their doctor can’t help them – it’s another resource. We’ve got a website where we publish information so there are lots of ways we try to get the message across to players. We do our best to do that. Unfortunately, there are some people who would rather not look at it, but it’s there and we do our best to promote it while we can.