Geographical heterogeneity of doping-related knowledge, beliefs and attitude among 533 Youth Olympics participants / Karsten Königstein, Katharina Gatterer, Kathrin Weber, Arno Schmidt-Trucksäss, Stéphane Tercier, Cornelia Blank. - (Journal of Science and Medicine in Sport (2021) 15 June)

• PMID: 34176766
• DOI: 10.1016/j.jsams.2021.06.001

Abstract

Objectives: Doping-related knowledge, beliefs and attitude influence adolescent athletes' susceptibility to prohibited performance-enhancing substances. They might be modified by different cultural backgrounds. This study's aim was to analyse the geographical heterogeneity of doping-related knowledge, beliefs and attitude among adolescent elite athletes.

Design: Cross-sectional study.

Methods: A questionnaire was distributed to athletes participating in the Winter Youth Olympic Games 2020 in Switzerland. Main outcomes ('subjective and actual knowledge', 'beliefs' and 'attitude') were stratified for athletes' region of origin. Geographical heterogeneity was tested with a two-way analysis of variance, and two multiple regression analyses were conducted to assess independent associations of knowledge, age and athletes' geographical region with doping-related beliefs and attitude.

Results: 533 athletes (54% females, mean age: 16.0 ± 1.0 years), completed the questionnaire (response rate: 33%). Actual knowledge was moderate-to-good (9.2 ± 2.9 correct answers out of 13), and scores of attitude and beliefs showed favourable patterns. Considerable geographical heterogeneity was found for knowledge (p < 0.001), beliefs (p = 0.004) and attitude (p < 0.001). Higher subjective knowledge and actual knowledge were favourably associated with attitude (β = -0.096, p = 0.049; β = -0.316, p < 0.001) and beliefs (β = 0.120, p = 0.016; β = 0.212, p < 0.001), independent of age and geographical region.

Conclusions: This study demonstrates considerable geographical heterogeneity of doping-related knowledge, beliefs and attitude, which are three essential target factors of doping prevention in adolescent elite athletes. This evidence should encourage medical doctors and other professionals to change their educative anti-doping approach from teaching knowledge about negative consequences into investigating and forming a young athlete's mind-set.

CAS 2020/A/7536 Ashley Kratzer v. International Tennis Federation (ITF)

Related case:

ITF 2020 ITF vs Ashley Kratzer
October 28, 2020

• Tennis
• Doping (GHRP-6)
• Duty of particular care of an athlete when applying medications
• Distinction between “reckless” and “oblivious” conduct
  
  

1. It is well-known in the world of sport that particular care is required from an athlete when applying or administering substances for therapeutic purposes, because the danger of a prohibited substance entering the athlete’s system is particularly high in such context, i.e. significant.

2. In order to qualify a behavior as “intentional” the person concerned must have accepted or consented to the realization of the offence or at least accepted it for the sake of the desired goal. On the other hand, a conduct is negligent or oblivious only, if the offender does not agree with the occurrence of the offence that is recognized as possible and, in addition, credibly – not only vaguely – trusts that the offence will not materialize. Thus, in order to separate negligence from (indirect) intent one must – in particular – look at this voluntative element. Of course, such element is difficult to determine ex post. However, as a general rule one may say that the more remote the realization of the offence is in the offender’s mind, the less he or she may be deemed to have accepted it and, thus, to have acted intentionally within the above meaning. Whether a certain behavior is “reckless” or only “oblivious” must be decided based on all relevant circumstances. Both types of behaviors are only separated by a very thin line.

On 28 October 2020 the ITF Independent Tribunal decided to impose a 4 year period of ineligibility on the American tennis player Ashley Kratzer after she tested positive for the prohibited substance GHRP-6.

In First Instance the Athlete demonstrated that she suffered from a longstanding, severe blistering problem on her heels, toes and sides of her feet. During her stay in China in April 2019 and thereafter she had used an effective Cream provided in an unlabelled bottle. Analysis of this Cream revealed that it contained a significant amount of GHRP-6.

Although the Tribunal accepted that the Athlete had not deliberately used the prohibited substance it deemed that she engaged in conduct knowing that there was a significant risk that it might result in an anti-doping rule violation and that she manifestly disregarded that risk.

Hereafter in November 2020 the Athlete appealed the ITF Decision with the Court of Arbitration for Sport (CAS). The Athlete requested the Sole Arbitrator Panel to set aside the ITF Decision of 28 October and for the imposition of a reduced sanction.

Undisputed between the Parties are the positive test results for GHRP-6 and that the Athlete had committed an anti-doping rule violation. What is contested between the Parties is the appropriate period of ineligibility as a consequence of this anti-doping rule violation.

The Athlete denied that she intentionally tried to cheat or that she knew that the Cream contained a prohibited substance while it only was used as medical treatment for her severe blistering problems. She asserted that did not know that there was a risk of an anti-doping rule violation and consequently that she manifestly had disregarded such risk.

The Sole Arbitrator concludes that it is more likely than not that the Athlete recognized her conduct to be akin to self-medication and that she knew that there was a significant doping risk when applying or administering substances for therapeutic purposes.

Considering the circumstances in this case the Sole Arbitrator finds that during her stay in China in April 2019 the Athlete did not act intentionally or recklessly. However in view of her conduct in the months after she had returned from China the Sole Arbitrator deems that she indeed acted intentionally.

Therefore the Court of Arbitration for Sport decides on 15 June 2021 that:

1. The appeal filed by Ms Ashley Kratzer on 18 November 2020 against the International Tennis Federation with respect to the decision rendered by the Independent Tribunal on 28 October 2020 is dismissed.

2. All results obtained by Ms. Ashley Kratzer from 28 March 2020 are disqualified, with all resulting consequences, including forfeiture of any titles, ranking points, and prize money obtained at the Oracle Challengers Tournament in Newport Beach, California, USA.

3. The Award is pronounced without costs with the exception of the Court Office fee, already paid by Ms Ashley and which is retained by CAS.

4. Ms. Ashley Kratzer is ordered to pay the International Tennis Federation a total amount of CHF 4,000 (four thousand Swiss francs) as contribution towards the expenses incurred in connection with these arbitration proceedings.

5. All other motions or prayers for relief are dismissed.

No Treatment Benefits of Local Administration of Insulin-like Growth Factor-1 in Addition to Heavy Slow Resistance Training in Tendinopathic Human Patellar Tendons : A Randomized, Double-Blind, Placebo-Controlled Trial With 1-Year Follow-up / Jens L. Olesen, Mette Hansen, Ida F. Turtumoygard, Rikke Hoffner, Peter Schjerling, Jan Christensen, Christopher L. Mendias, Peter S. Magnusson, Michael Kjaer. - (American Journal of Sports Medicine (2021) 17 June)

• PMID: 34138667
• DOI: 10.1177/03635465211021056

Abstract

Background: Heavy slow resistance (HSR) training is currently recommended as part of the treatment of patellar tendon tendinopathy. However, treatment success is not reached in all patients, and combinations of different treatments could be beneficial. Local administration of insulin-like growth factor-1 (IGF-1) in humans has been shown to quickly stimulate tendon collagen synthesis.

Purpose: To study whether IGF-1 injections combined with HSR training enhance tendon synthesis, tissue structure, and patient satisfaction versus saline injection combined with HSR training in patients with patellar tendinopathy.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: Forty patients (age 18-50 years) with unilateral patellar tendinopathy undertook HSR training (3 times a week for 12 weeks) and received intratendinous IGF-1 injections (1 mg IGF-1 per dose) or isotonic saline injections (sham injections) at baseline and after 1 and 2 weeks of training. The primary outcome was collagen synthesis parameters after 12 weeks (primary endpoint). The secondary outcomes were patient-reported outcomes (scores on the Victorian Institute of Sport Assessment-Patella [VISA-P] and visual analog scale [VAS] for pain) and structural changes before the initiation of treatment and at week 3, week 12, and 1 year after the initiation of treatment.

Results: Analysis of the patellar tendon biopsy specimens at 12 weeks showed that collagen mRNA and total RNA were increased in the tendinopathic tendons compared with the contralateral healthy tendons regardless of treatment with IGF-1 or saline. Similarly, no difference between the groups was seen in tendon thickness and Doppler activity at week 12 or at 1-year follow-up. The combination of HSR training and IGF-1 injections significantly improved VISA-P and VAS pain scores after 3 weeks, whereas the overall responses after 12 weeks and at 1-year follow-up were identical in the 2 groups.

Conclusion: Although a small, immediate clinical response to IGF-1 injections was seen when combined with training, no additional long-term effect of intratendinous IGF-1 was observed on structural and clinical outcomes in patients with patellar tendinopathy.

In April 2021 the Jamaica Anti-Doping Commission (JADCO) has reported an anti-doping rule violation against the bodybuilder Weston McDonald after his sample tested positive for the prohibited substance Mesterolone.

After notification the Athlete filed a statement in his defence, admitted the violation and waived his right for a hearing. He denied the intentional use of the substance and explained that he had used a Testosterone Booster to improve his libido.

The Panel finds that the presence of a prohibited substance has been established in the Athlete's sample and accordingly that he committed an anti-doping rule violation.

The Jamaica Independent Anti-Doping Disciplinary Panel decides on 18 June 2021 to impose a 30 month period of ineligibility on the Athlete, starting on the date of the provisional suspension, i.e. on 29 April 2021.

Related case:

TJD-AD 2021-001 Disciplinary Decision - Triathlon
February 23, 2021

On 18 June 2021 the TJD-AD Tribunal decided to approve the settlement agreement between the triathlon Athlete and the Brazilian Doping Control Authority (ABCD) after the Athlete tested positive for the prohibited substances Androsterone,  Etiocholanolone, Testosterone and its adiols.

As a result of the settlement agreement the appeals filed by both parties were withdrawn.

Related case:

SAIDS 2020-10 SAIDS vs Thapelo Phora - Appeal
July 1, 2021

In May 2020 the South African Institute for Drug-Free Sport (SAIDS) has reported an anti-doping rule violation against the Athlete Thapelo Phora after his A and B samples tested positive for the prohibited substance Stanozolol.

The Athlete was tested after SAIDS had received a tipp-off  about his alleged doping conduct. After notification a provisional suspension was ordered and the Athlete was heard for the SAIDS Anti-Doping Hearing Panel.

The Athlete admitted the violation and he assumed that the supplements he had used were contaminated and the source of the prohibited substance. The Athlete argued that he was tested before without issues and that he mentioned his supplements on the Doping Control Form and that he had checked his supplements before using.

Analysis of the Athlete's sealed and unsealed supplement containers in two accredited laboratories revealed contradictory results as in some batches contamination was detected, yet not in some other containers. As a result two experts of SAIDS reported that the posibility of contamination could not be excluded.

The Panel finds that the presence of a prohibited substance has been established in the Athlete's samples and accordingly that he committed an anti-doping rule violation. Considering the evidence in this case the Panel accepts that the Athlete's violation was not intentional and that the Athlete established on the balance of probabilities how the prohibited substance entered his system.

Therefore the SAIDS Anti-Doping Hearing Panel decides on 18 June 2021 to impose a reduced 8 month period of ineligibility on the Athlete. The sanction starts on the date of the provisional suspension, i.e. 21 May 2020, whereas the Athlete is accredited for the time already served.

In December 2020 the International Tennis Federation (ITF) has reported an anti-doping rule violation against the Ukrainian tennis player Dayana Yastremska after her A and B samples tested positive for the prohibited substance Mesterolone in a low concentration. After notification a provisional suspension was ordered. The Athlete filed a statement in her defence and she was heard for the ITF Independent Tribunal.

The Athlete admitted the violation, accepted the test results and denied the intentional use of the substance. She asserted with evidence and witness statements that the postitve test was the result of contamination through person-to-person transfer.

At the relevant time she had close physical contact with her boy friend whereas she was unaware that he had used Mesteronolone. The Athlete's boy friend testified that he had ingested Mesteronolone tablets when he had close physical contact with the Athlete shortly before she had out-of-competiton Doping Control.

The ITF contended that the Athlete intentionally had used the prohibited substance and it rejected the Athlete's explanation on how the substance had entered her system.

The Panel considered the evidence in this case and accepts the Athlete's explanation, her corroborating evidence and the testimonies of the expert witnesses. The Panel is satisfied, on the balance of probabilities, that the Athlete has established the source of the prohibited substance.

Therefore the Panel deems on 21 June 2021 that No Fault or Negligence has been established and that no period of ineligibility shall be imposed on the Athlete.

Related case:

ISR 2019 KNWU Decision Disciplinary Committee 2019010 T
January 11, 2021

In September 2019 the Royal Dutch Cycling Federation (KNWU) has reported an anti-doping rule violation against the Person after his sample tested positive for the prohibited substance Salbutamol in a concentration above the WADA threshold (1900 ng/ml).

In First Instance the ISR KNWU Disciplinary Committee rejected the Athlete's scientific expert report and considered that the Person had confirmed that as treatment for his Asthma he had used 1200 ng/ml within 10 hours. The Person also had refrained from a controlled pharmacokinetic study in order to demonstrate that the found concentration in his sample was the result of his therapeutic use of Salbutamol, the tropical weather conditions and dehydration.

Consequently the Committee deemed that the Person had committed an anti-doping rule violation without grounds for a reduced sanction. Therefore the ISR KNWU Disciplinary Committee decided on 11 January 2021 to impose a 4 year period of ineligibility starting on the date of the decision. 

Hereafter in January 2021 the Person appealed the KNWU Decision with the ISR KNWU Appeal Committee.

During the proceedings the Parties reached a settlement for an Acceptance of Sanction in May 2021 and they requested the ISR KNWU Appeal Committee to render a Decision without a hearing based on this Settlement Agreement.

In the Settlement Agreement the Person:

• accepts that he had committed an anti-doping rule violation;
• accepts the disqualification of his results; and
• accepts the proposed period of ineligibility.

Therefore the ISR KNWU Appeal Committee decides on 21 June 2021, in accordance with the Settlement Agreement:

• to annul the Decision of 11 January 2021 rendered by the ISR KNWU Disciplinary Commission;
• to impose a 2 year period of ineligibility on the Person, staring on the date of the provisional suspension, i.e. on 1 September 2019; and
• to disqualify the results obtained by the Person.

Fees and expenses for this Appeal Committee shall be borne partially by the Person.

CAS 2019/A/6148 World Anti-Doping Agency v. Mr Sun Yang & Fédération Internationale de Natation (FINA)

Related cases:

• CAS 2019_A_6148 WADA vs Sun Yang & FINA - Annulled Award
  February 28, 2020
• FINA 2019 FINA vs Sun Yang
  January 3, 2019
• Swiss Federal Court 4A_287_2019 Sun Yang vs WADA & FINA
  January 6, 2020
• Swiss Federal Court 4A_413_2019 Sun Yang vs WADA & FINA
  October 28, 2019
• Swiss Federal Court 4A_318-2020 Sun Yang vs WADA & FINA
  December 22, 2020
• Swiss Federal Court 4A_406-2021 Sun Yang vs WADA & FINA
  February 14, 2021

On the evening of 4 September 2018, an attempt was made to collect blood and urine samples from the Athlete Sun Yang at the Athlete’s residence compound. This was an out-of-competition (OOC) sample collection mission. The mission was authorized by FINA as the Testing Authority. FINA has Results Management Authority. However, International Doping Tests and Management (IDTM) was the Sample Collection Authority. IDTM attempted to collect blood and urine from the Athlete during the Athlete’s previously selected ‘60-minute’ time slot from 10 p.m. to 11 p.m. on September 4, 2018.

No blood or urine samples were ever analysed as a result of the OOC mission conducted by IDTM. Blood was collected but the blood container was destroyed and the collected blood was never sent to the relevant WADA accredited laboratory. The blood remains in the possession of the Athlete’s doctor. No urine sample was provided by the Athlete. It is safe to describe the entire OOC mission as problematic, highly unusual and, at times, confrontational. Both FINA and the Athlete offer vastly different explanations regarding what happened, why the evening unfolded as it did and, critically, what consequences must result.

Consequently on 28 February 2020 the Court of Arbitration for Sport (CAS) decided to impose an 8 year period of ineligibility on the Athlete Sun Yang for committing a second anti-doping rule violation.

The CAS Panel concluded that the Athlete failed to establish that he had a compelling justification to act as he did and forego the Doping Control and accordingly that the Athlete committed a tampering violation under Article 2.5 FINA DC.

Hereafter the Athlete appealed the CAS Award with the Swiss Federal Court. One of the Athlete's grievances was based on evidence of bias on the part of the presiding arbitrator by reasons of prior comments the presiding arbitrator had made on social media. The arbitrator in question spontaneously resigned shortly. The two remaining arbitrators on the CAS Panel also withdrew and on 22 December 2020 the CAS Award was annulled. A new second CAS Panel was arranged with an all new membership, charged with rehearing this case.

At first the Panel establishes that it has jurisdiction in this Appeal, that it was filed by an authorized representative and that it is admissible.

The Athlete and FINA asserted that the attempted sample collection on 4–5 September 2018 violated numerous provisions of the ISTI, violated the Athlete’s fundamental human rights, and were therefore null and void. These defects fully justified the Athlete to refuse to submit to a defective and unjust process.

WADA contended that the attempted sample collection on 4–5 September 2018 complied with all relevant provisions of the ISTI. Upon meeting the Athlete, the DCO notified the Athlete by showing a Letter of Authority from FINA, as well as a copy of her IDTM Doping Control Officer card. Although they were not required to do so under the ISTI, the DCA and BCA also showed valid identification documents. The DCO’s documents sufficed, in WADA’s view, to establish that the Sample Collection Personnel, under her leadership, was duly authorized and credentialed. The Athlete’s refusal to be tested despite having been properly notified by the DCO placed him in violation of Articles 2.3 and 2.5 of the FINA DC.

Considering the facts of what happened on 4-5 September 2018 at the Athlete’s residence compound the Panel assesses that the Athlete was told numerous times the samples had to leave with the DCO. He refused this. A last-ditch bid at persuading the Athlete’s entourage, perhaps ill-advised, ended in a sample’s destruction. The DCO multiple times tried to notify the Athlete of the potential consequences that this could entail. At the very least, these facts should have created questions in the Athlete’s mind whether his chosen course of action was correct.

As a result the Panel is comfortably satisfied that the Athlete tampered with any Part of Doping Control, at latest beginning with his refusal to allow the blood samples to leave with the Sample Collection Personnel. The Panel is also comfortably satisfied that the Athlete refused and failed to submit to sample collection.

The Panel regards that this is the Athlete's second offense and that under the 2021 FINA Rules and 2021 WADC a greater degree of mitigation is possible in determining the period of ineligibility for the Athlete's anti-doping rule violations.

The Panel deems that the circumstances surrounding the Sample Collection of 4-5 September 2018 merit a period of ineligiblility at the lower end of the range starting on the date of the Annulled Decision, i.e. on 28 February 2020.

Therefore the Court of Arbitration for Sport decides on 6 July 2021 that:

1. The Court of Arbitration for Sport has jurisdiction to hear the present dispute.

2. The appeal filed on 14 February 2019 by the World Anti-Doping Agency against the decision issued on 3 January 2019 by the Doping Panel of the Fédération Internationale de Natation is admissible and is partially upheld.

3. The decision issued on 3 January 2019 by the Doping Panel of the Fédération Internationale de Natation is set aside.

4. Mr. Sun Yang is sanctioned with a period of ineligibility of 4 (four) years and 3 (three) months, beginning on 28 February 2020.

5. (…).

6. (…).

7. All other and further motions or prayers for relief are dismissed.

2020 (Reiwa 2) program report : from April 1, 2020 to March 31, 2021 / Japan Anti-Doping Agency (JADA). - Tokyo : JADA, 2021