Has WADA helped or hurt the anti-doping movement?

There are approximately 300 substances and methods on the World Anti-Doping Agency’s prohibited list, but it’s probably best to start with the tortellini.

Ring-shaped stuffed pasta is not considered a performance-enhancer, and that is unlikely to change unless sheer carbohydrate-based deliciousness turns out be a more powerful force than metabolic scientists yet comprehend. But in the case of Italian tennis player Sara Errani,  tortellini was enough to bring a halt to her career. And there may be no more stark example of how modern performance-enhancing drug testing for athletes has drifted from well-intentioned policing into rampant absurdism.

The story, according to Errani, goes like this: Her mother, who has spent years fighting breast cancer, stored pills containing a medication called letrozole on Errani’s kitchen worktop. Those pills were close enough to where Errani was preparing her tortellini and broth that some cross-contamination likely occurred, leading Errani to test positive for letrozole in August 2017. Errani and her husband went so far to prove her innocence that they actually conducted their own experiments, dropping a letrozole pill in a pot of broth and a meat mixture used to make their tortellini, in order to confirm that it would dissolve and prove undetectable (it did, and it was). Yet in June of 2018 — after the Court for Arbitration in Sport accepted the validity of Errani’s story — Errani’s suspension for this culinary mix-up was extended from two months to 10 months.

“I am really disgusted by this matter,” said Errani, who claimed she was uncertain whether she’d keep playing professional tennis once her suspension was lifted. “I don't think anything similar has ever happened or been managed — in my humble opinion — in such a shameful manner.”

Maybe that’s an exaggeration. Maybe it isn’t. Letrozole is an aromatase inhibitor, which means it’s used by male athletes to prevent “feminizing” side effects during a steroid cycle. It is not an anabolic steroid, and it doesn’t appear to boost athletic performance in any real way, particularly for women.

While not quite as benign as pasta, “everyone agrees it’s not a performance enhancer,” said University of Colorado professor Roger Pielke, who has spent several years studying the scientific flaws in WADA’s drug-testing policies. Yet Sara Errani’s ability to play tennis has been halted by, supposedly, her insistence upon cooking her dinner.

And the larger question is: How did we get here?

Twenty summers ago, in the midst of a baseball season that would forever alter the way American sports was perceived and consumed, Associated Press reporter Steve Wilstein  spotted a brown bottle of a supplement called androstenedione in Mark McGwire’s locker. It was not the first time a prominent athlete had been linked to the use of potentially performance-enhancing drugs — steroids had technically been banned from the game since 1991, though there was no testing for them — but with McGwire and Sammy Sosa obliterating home-run records during that 1998 season, the issue was brought into the spotlight in ways it had never been.

It was, it seemed, part of a worldwide cultural tipping point. Roughly six months later, in February 1999, the International Olympic Committee convened a conference on doping in sport in Switzerland. Soon after, it formed the World Anti-Doping Agency, which was tasked to create a single international standard for doping and performance-enhancing drug usage.

Two decades later, are we better off than we were before the curtain was pulled back on athletes such as Sosa and McGwire? Have WADA and other drug-testing efforts reduced the level of doping in sports? Or have they simply introduced more confusion, unnecessary levels of prohibition, stubborn opacity, and surprisingly little hard science into the way these issues are governed?

“WADA emerged in response to scandals in the 1990s,” said Scottish researcher Paul Dimeo. “The problem is that the scandals continue, and the true extent of doping remains unknown. Which means we can’t say for certain if WADA is doing a good job.”

In some ways, Pielke said, WADA has made progress in “harmonizing and legitimizing” the concept of anti-doping. Questions about WADA often center on the lack of due process and transparency in cases such as Errani’s or on the unresolved science about the effects of many of the substances and methods on the prohibited list.

There are also bigger and more existential questions looming, and they get at the very heart of what we want sports to be. Most notably, is it even possible to prevent athletes from experimenting with substances and methods to gain an edge? And if we can’t ever truly level the playing field, is increasing prohibition just going to worsen the problem?

In other words: Is the very principle WADA was founded on flawed?

“You look at the history of this, and they’ve never been able to make real inroads,” said Charles Yesalis, a longtime steroid researcher who is now a professor emeritus at Penn State University. “Of course, it’s not a level playing field. Do you think an athlete from an African country has the advantage of another athlete from a wealthier country? There are billions of dollars at stake here.”

Russian Olympic team is a case study for corruption

In 2017, a group of scientists and experts critical of current doping policies attended the International Network of Doping Research Conference, and came away with a list of researched criticisms of WADA that cut to the very heart of WADA’s mission. Among the declarations:

• The current total prohibition policy isn’t working.
• The prevalence of doping is higher than the testing system reveals.
• High-performance sport cannot be separated from doping.
• Athletes don’t fully trust the system.
• Society’s promotion of muscular physicality as an ideal has led to doping becoming a larger societal issue.

This conference was held in the midst of Russia’s impending ban from the 2018 Winter Olympics for repeated doping violations, even as individual Russian athletes were permitted to compete. Months later, the issue remains muddled in an ethical gray area. Years after a program of systematic doping was uncovered, Russia has yet to comply with several of WADA’s demands for reinstatement. And all of it has further eroded faith in WADA’s ability to handle such issues.

Without “trust and integrity from all organizations…the whole process can be corrupted,” Dimeo said.

That trust and integrity, of course, has to begin with WADA itself. But cases such as Errani’s have eroded that trust. The perception among many athletes is that WADA’s regulations are confusing and complex, and that the adjudication process is opaque and shrouded in secrecy. WADA’s list of prohibited substances has grown 100 percent in the past decade, Pielke said, and the process for adding substances to the list is “not very transparent, to be polite.”

There are also questions whether WADA has the resources or the ability to test for all these things, given that the science surrounding many of the substances and methods on the list hasn’t been revolved.

“There’s some stuff that’s banned that probably shouldn’t be,” said steroid researcher Victoria Felkar. “And there’s some stuff that isn’t banned that probably should be.”

Yet another example of this might be found in the case of another star tennis player who tested positive for a substance she said she didn’t even know was banned.

On Jan. 1, 2016, WADA announced that it would ban meldonium, a Latvian medication used to treat heart and cardiovascular diseases, in response to what it said was an increasing number of athletes using the drug. This, despite the fact there is a dearth of research on meldonium and its performance-enhancing effects. One anti-doping expert, Don Catlin, told USA Today, “There’s really no evidence that there’s any performance enhancement from meldonium. Zero.”

About 140 athletes tested positive for meldonium in the three months after it was banned, underscoring WADA’s position that use of the drug was widespread and, likely, increasing. However, with a dearth of research on the drug, WADA had banned the drug based on the notion that athletes were using meldonium with the intent of enhancing performance, instead of on its actual effects.

“We can think of performance-enhancing drugs as innocent until proven guilty, or guilty until proven innocent — which is that, if an athlete’s taking it, there must be something nefarious going on,” said Pielke, who heads the Sports Governance Center at the University of Colorado. “That’s how you get to a list of 300 substances.”

In April of 2016, at the Australian Open, WADA scored its highest-profile meldonium user to date: tennis star Maria Sharapova, who said she was prescribed the drug a decade earlier after doctors saw irregularities on her electrocardiograms (and may have been confused because she knew meldonium by its brand name, Mildronate). She was initially suspended for two years, before having her suspension reduced to 15 months.

Sharapova later wondered if she was targeted by anti-doping investigators in order to set an example for others; other athletes complained that they tested positive for the drug because traces remained in their system after the ban took effect. But this leads to further frustration from athletes, who feel that they’re often beholden to a process that they have trouble understanding and offers limited opportunities for due process.

The most recent example of this: A law passed by the government in Quebec, where WADA is headquartered, grants WADA officials immunity from civil lawsuits. “If we were to say executives at Exxon were immune from civil lawsuits, that might raise an eyebrow,” Pielke said. “We tend to treat sport differently, and it is different, but it’s important to understand … how these institutions can be held accountable. For the athletes, these are not just international sports issues. It’s their job.”

U.S. sports leagues take a different path

Major American sports — with the exception of mixed-martial arts and boxing, which have adopted the United States Anti-Doping Agency’s rules — have evolved in a more independent direction over the course of the past couple of decades. Thanks in part to the power of collective bargaining, major sports leagues such as Major League Baseball and the NFL have generally negotiated lighter sentences for first-time performance-enhancing drug offenses. The NCAA has a separate list that includes caffeine, among other things. Pielke offered an example: If caught taking human growth hormone in the NFL, the player gets a four-game suspension. If caught taking HGH by WADA, the player gets a four-year suspension.

“Generally speaking, the U.S. leagues are much lighter, and have much fewer substances on their lists,” Pielke said. “The best thing about the U.S. leagues is that their anti-doping policies are determined in partnership with their athletes.”

So is there a way to find a happy medium between sports turning into a “chemical freak show,” as Pielke put it, and a doping protocol that isn’t unnecessarily confusing and prohibitive? Dimeo offered a thought: What if we abandon the “level-playing field” notion, and focus more on health instead of performance-enhancement?

“Protecting athletes’ welfare should be paramount,” said Dimeo, who pointed out doping and corruption often go hand-in-hand. “The level-playing field is a vague abstraction and assumes some form of ‘natural parity.’ Also, athletes have so many other performance-enhancing methods that we’ve lost the logical underpinning.”

This, of course, would require more scientific study. Dallas Mavericks owner Mark Cuban has advocated for more studies of human growth hormone to determine what effects it could have on performance and recovery. And perhaps with more study, that list of 300 could be culled to something more reasonable and understandable, more focused on substances that are known to enhance performance and could cause harm. What if, Pielke wondered, WADA was forced to cut its list to 30 or so substances that we know can enhance performance?

“One idea is that if there’s a substance out there that doesn’t even have the performance kick that caffeine does, why are we even worrying about it?” he said. “It’s in the noise, so to speak.”

Is that likely to happen? Probably not anytime soon. And in the meantime, said one steroid researcher who preferred to remain anonymous, the playing field is never going to be level. Instead, it will depend upon the country you hail from, and the infrastructure around you, and the way you’re able to take advantage of the system.

“If you have money,” says the researcher, “then you’ll win.”

Michael Weinreb is a freelance writer for several outlets, and is working on a book about football as it relates to the evolution of American culture.

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