Editorial

Fairness in Olympic sports:How can we control the increasing complexity of doping use in high performance sports?☆

With the Rio Olympics just a few months past,we remember the excitement,the incredible performances,and the controversies.As happens so often,the Olympic Games focus attention not only on athletic achievements but also on how athletes may reach ever-increasing levels of performance.Doping,medical doping exemptions,and the ban of the Russian team for state-sponsored organized doping of its athletes dominated the discussions.

After the Rio Olympics,it was revealed that many prominent athletes had health-related drug exemptions and thus were allowed to use medication containing substances banned by the World Anti-DopingAgency(WADA).Particularly,exemptionsforasthma medication and attention defici hyperactivity disorder came under scrutiny.The numberofexemptionsbecame suspiciouswhen itwas revealed that in certain sports(e.g.,cycling and swimming),the percentage ofathletessuffering fromasthma ismuch greaterthan in the average population.Asthma medications,such as salbutamol and terbutaline,are said to be notperformance enhancing,butthey will increase performance in asthmatic athletes by up to 10%.1However,it is impossible to know what the normal performance levelofan asthma suffererwould be were she orhe free ofasthma. This argumentis reminiscentofthe discussions surrounding Oscar Pistorius,the double-amputee“blade runner”who participated in the London Olympics,and scientists’disagreementsaboutwhether Mr.Pistorius had an unfair advantage running with his specialized lower limb prostheses.Of course,we will never know,because nobody can determine with certainty how fast Mr.Pistorius could have run the 400 m sprinthad he had his“normal”legs.One might arguethatwhen adrug containsbanned substances,thereshould be no medicalexemptions.Asthma sufferersshould be allowed to use banned substancesbutshould be categorized as Paralympic athletes and compete againsteach otherin a separate competition.In swimming and cycling,approximately 40%of all Olympic athletes would fall into this category,making winning in the asthma category ascompetitiveastheregularOlympicswimming and cycling competitions.

Another drug that has received intense scrutiny and press is meldonium,which can be purchased under the trade name Mildronate.Meldoniumwasdeveloped in the1970satthe Latvian Institute of Organic Synthesis in the former Soviet Union.It is primarily used as a treatmentagainstcoronary artery diseases and has seen widespread use among Eastern European athletes. WADA put meldonium on the list of banned substances on January 1,2016,and subsequently several high-profil athletes were caught using the substance.Prominently,in early March of 2016,the international tennis superstar Maria Sharapova announced that she had failed a drug test at the Australian Open Tennis Tournament.Meldonium had been found in her system, and she admitted of having used meldonium for the past 10 years foravariety ofhealth problems.Sheargued thatshewasnotaware that meldonium had been put on the banned substance list.Nevertheless,she was suspended by the InternationalTennis Federation for a 2-year period(a suspension that has been appealed).

In theJournal of Sport and Health Science,Lippi and Mattiuzzi2give a detailed account of the health benefit of meldonium and its possible benefit on athletic performance. They argue that meldonium has no proven effect on performance in elite athletes.However,meldonium’s mechanism of action suggests that it might enhance endurance and might allow for faster recovery from intense workouts.

The world of professional and Olympic sports has become big business,and today’s superstar athletes have contracts worth millions of dollars.The prestige associated with an Olympic gold medal,and the possibilities for converting success in sport into a lucrative career,make itincreasingly difficul to keep sportsclean.I believe thatthe issue ofmedicalexemptions and the punishmentof athletes for failed drug testing need to be re-evaluated based on strong philosophicaland ethicalgrounding.Thecurrentsystem isa patchwork with good intentions,butitisnotfairand notworkablein thelong term.Ifwe wantto preserve“clean”competitions,WADA needs to rethink the current system and policies from their very foundations.

Reference

1.Stokes S.Why do so many elite cyclists have asthma?Available at:https:// cyclingtips.com/2016/04/why-do-so-many-elite-cyclists-have-asthma;2016 [accessed 30.04.2016].

2.Lippi G,Mattiuzzi C.Misuse of the metabolic modulator meldonium in sports.J Sport Health Sci2017;6:49–51.

Walter Herzog,Co-Editor-in-Chief

Human Performance Laboratory,Faculty of Kinesiology,

University of Calgary,Calgary,AB T2N 1N4,Canada

E-mail address:wherzog@ucalgary.ca

Accepted 8 November 2016

Available online 9 November 2016

☆This is an editorial on Lippi and Mattiuzzi’s article,“Misuse of the metabolic modulatormeldoniumin sports”,published in JournalofSportand Health Science.

http://dx.doi.org/10.1016/j.jshs.2016.10.009

2095-2546/?2017 Production and hosting by Elsevier B.V.on behalf of Shanghai University of Sport.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).