The system for granting the therapeutic use of steroids is flawed
SIMONE Biles, the American gymnast who won four gold medals at this summer’s Olympic games in Rio de Janeiro, had little time to celebrate before receiving some upsetting news. On September 13th a group of hackers calling themselves the Fancy Bears leaked Ms Biles’s drug-testing records, which had been stolen from the World Anti-Doping Agency (WADA). The files showed that the gymnast has been taking medication to treat attention-deficit hyperactivity disorder (ADHD) for at least four years, and that the pills she has been consuming contain stimulants that are prohibited by WADA.
Ms Biles was not the Fancy Bears’ only target. She is one of 66 athletes to have drug-testing documents posted on the internet. Law-enforcement officials have told WADA that they believe the hackers are Russian. If so, the leaks could be a retaliation for the exclusion of the Russian track-and-field team from the Rio Olympics, which was imposed after WADA discovered a state-sponsored doping programme in Moscow last year. Yuliya Stepanova, a whistleblower involved in that investigation, was the victim of a similar leak in August. Vitaly Mutko, the Russian sports minister—whom WADA has identified as one of the architects of the doping regime—has denied that the cyber-criminals are Russian. There is no mention of their nationality on the Fancy Bears’ website, and one of the highlighted athletes is Russian. Regardless of the identity of the hackers, the world now knows that several top athletes—including tennis stars Serena and Venus Williams and Rafael Nadal, decorated distance runner Mo Farah and former Tour de France champions Bradley Wiggins and Chris Froome—have been taking banned substances.
There is no suggestion, however, that these athletes have committed any offences. The leaks show that they have been given special permission to take these drugs via Therapeutic Use Exemptions (TUEs). These dispensations were introduced in 1991 so that sports stars requiring treatment with banned substances—of which there are roughly 300—could receive it while remaining eligible to compete. “We have to have a system that allows for athletes who need medication for a legitimate ailment to use it,” says Ryan Madden, a spokesman for the US Anti-Doping Agency. WADA’s guidelines for TUEs require competitors to prove that the drugs in question will not enhance their performance and that there are no available alternatives.
But the leaks have prompted questions about whether there is enough oversight within this process. Miniscule gains in endurance or focus set apart winners and losers, so a system that allows competitors to take prohibited drugs needs to be heavily policed and transparent. “If abused (as they often are), an independent authority should assess athletes for the TUE condition in random checks,” tweeted Ross Tucker, a professor of exercise physiology at the University of the Free State in South Africa.
Currently, an application for a TUE simply requires a letter of explanation from a physician to the relevant international sporting federation and documentation of the subject’s medical history. That application is then reviewed by a committee (or TUEC) within the federation, which is supposed to include at least three doctors. Yet some groups allow a single physician to examine applications, and many TUEs are granted by national anti-doping bodies. Ken Fitch, an expert in sports medicine who helped to create the application process, says that while the regulations are stringent, some committees enforce them less vigilantly than they should. “There will always be a weak link in any system,” he says.
Manipulating this process is fairly easy, says Larissa Maier of the Swiss Research Institute for Public Health and Addiction. The majority of TUEs granted to American athletes in 2015 were for stimulants—normally administered to people with ADHD—which can enhance endurance and alertness. In a 2012 survey of Swiss physicians, 67% said that they would prescribe stimulants to suffering patients even if there were no clear indication of a medical need. And in a 2013 study of 600 Danish athletes published in the International Journal of Drug Policy, half the respondents claimed that competitors had been awarded a TUE without a medical need. “If your first doctor is not prescribing it, you could hop to the next one and try it there,” says Dr Maier. In addition, 67 American athletes were permitted to use glucocorticosteroids (normally prescribed for asthma) last year, which might allow them to train for longer. 30 gained exemptions to use anabolic agents, which boost muscle mass.
Though professional athletes ought to be healthier than your average Joe, they are using some substances more frequently than the general population. The most striking example is in baseball, a sport beset by doping scandals: the proportion of Major League Baseball players taking medication for ADHD is reportedly three times the national average. Irregularities exist among Olympians too. The global proportion of adults aged 18 to 45 suffering from asthma was 4.3% in 2002. Yet 5.2% of participants at the 2002 winter games in Salt Lake City were allowed to use Beta-2 agonists, which are typically prescribed for asthma but can also enhance muscle growth in high doses. That figure was 5.7% at both the 2000 summer games in Sydney and the 1998 winter games in Nagano. It fell to 4.2% at the 2004 summer games in Athens, once an Independent Asthma Panel had been set up to review submissions.
The Fancy Bears claim that such a flawed system produces “licences for doping”. Many Russian athletes, including the tennis player Maria Sharapova, have been banned for taking meldonium, a drug which is used to treat heart problems and increases the flow of oxygen around the body, and which was added to the list of prohibited substances in January. The implication of the leaks is that Ms Sharapova’s case is no different to that of the Williams sisters—though one obvious distinction is that the Russian did not apply for an exemption.
The hackers are not the only ones raising concerns about TUEs. Richard McLaren, a sports lawyer and the author of the most recent WADA investigation into Russian doping, told the BBC that the system is open to abuse and that a review ought to be conducted. Sebastian Coe, the president of the International Association of Athletics Federations, has defended TUEs but admitted that they could be exploited. At worst, they can be used to cover up systematic cheating: when cyclist Lance Armstrong tested positive for corticosteroids during the Tour de France in 1999, he secured a back-dated TUE certificate to avoid punishment.
Though many of the athletes targeted by the hackers have provided ample evidence of their ailments, and some have welcomed the extra scrutiny given to TUEs, it is clear that better oversight is needed, such as the random checks that Mr Tucker has proposed. WADA’s guidelines state that it has the power to review all TUE decisions, either “upon request by those affected or on its own initiative”. If anything has been learned from repeated doping scandals in sport, it is that initiative alone will not be enough to keep up with the cheaters.
Update: This piece has been updated to reflect further leaks since it was first published on September 19th. The affected athletes include Mo Farah and Rafael Nadal. The Fancy Bears have warned onlookers to “stay tuned for new leaks”.
This article was published and provided by the Economist Magazine.