Monfort N, Ventura R, Platen P, Hinrichs T, Brixius K, Schänzer W, Thevis M, Geyer H, Segura J.Transfusion. 2012 Mar;52(3):647-57. doi: 10.1111/j.1537-2995.2011.03331.x. Epub 2011 Sep 2.
Bioanalysis Research Group, IMIM Hospital del Mar Research Institute, the Universitat Pompeu Fabra, Barcelona, Spain.

BACKGROUND:
Misuse of autologous blood transfusions in sports remains undetectable. The metabolites of the plasticizer di-(2-ethylhexyl)phthalate (DEHP) were recently proposed as markers of blood transfusion, based on high urinary concentrations of these compounds observed in patients subjected to blood transfusion. This study evaluates DEHP metabolites in urine for detecting autologous blood transfusion.

STUDY DESIGN AND METHODS:
One blood bag was drawn from moderately trained subjects and the red blood cells (RBCs) were reinfused after different storage periods. Group 1 (12 subjects) was reinfused after 14 days, and Group 2 (13 subjects), after 28 days of storage. Urine samples were collected before and after reinfusion for determination of the concentrations of three DEHP metabolites, mono-(2-ethylhexyl)phthalate, mono-(2-ethyl-5-hydroxyhexyl)phthalate, and mono-(2-ethyl-5-oxohexyl)phthalate.

RESULTS:
Concentrations of DEHP metabolites on the days before reinfusion were in agreement with those described after common environmental exposure. A few hours after the reinfusion a significant increase was observed for all metabolites in all volunteers. Concentrations 1 day later were still higher (p < 0.05) than before reinfusion. Variations in urine dilution supported normalization by specific gravity. Concentrations of DEHP metabolites tended to be higher after longer storage times of RBCs.

CONCLUSION:
Autologous transfusion with RBCs stored in plastic bags provokes an acute increase in the urinary concentrations of DEHP metabolites, allowing the detection of this doping malpractice. The window of detection is approximately 2 days. The method might be applied to urine samples submitted for antidoping testing.

Evaluation and analysis of exposure levels of di(2-ethylhexyl) phthalate from blood bags / Inoue K, Kawaguchi M, Yamanaka R, Higuchi T, Ito R, Saito K, Nakazawa H. - (Clin Chim Acta. 2005 Aug;358(1-2):159-66)

Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Tokyo 142-8501, Japan

BACKGROUND:

The US FDA and The Ministry of Health, Labor and Welfare of Japan have indicated that the risk assessment of di(2-ethylhexyl) phthalate (DEHP) released from polyvinyl chloride (PVC) medical devices requires immediate attention. In particular, the analysis of the exposure to DEHP from blood bags is very important for medical treatment. However, human exposure to DEHP via blood transfusion remains poorly understood. We evaluated DEHP and mono(2-ethylhexyl) phthalate (MEHP) levels, migration patterns, and metabolism in blood products for the detailed assessment of exposure to DEHP.

METHODS:
A method that is based on column-switching liquid chromatography-electrospray mass spectrometry (LC-MS) coupled with on-line extraction was used for the direct analysis of DEHP and MEHP in the blood products. From the Japanese Red Cross Society, 78 blood products (red blood cell concentrate: n=18, irradiated red blood cell concentrate: n=18, whole blood: n=18, blood platelet: n=18, and frozen plasma: n=6) were sampled in January 2003 for use in this study.

RESULTS:
The detection levels of DEHP and MEHP ranged from 1.8 to 83.2 microg/ml and from 0.1 to 9.7 microg/ml, respectively. The levels of MEHP and DEHP in the blood products were increased with increasing storage time. In addition, whole blood products in PVC bags had the highest DEHP levels compared to the other blood products. Our results indicate that the maximum level of human exposure to DEHP released from blood bags is 0.7 mg/kg weight/time.

CONCLUSION:
This first quantitative evidence may be useful for the risk assessment of DEHP released from blood bags.

Backhouse SH, Whitaker L, Petróczi A.
Scand J Med Sci Sports. 2011 Aug 9. doi: 10.1111/j.1600-0838.2011.01374

Abstract

Nutritional supplement (NS) use is widespread in sport. This study applied an integrated social cognitive approach to examine doping attitudes, beliefs, and self-reported doping use behavior across NS users (n = 96) and nonusers (n = 116). Following ethical approval, 212 competitive athletes (age mean = 21.4, s = 4.5; 137 males) completed self-reported measures of doping-related social cognitions and behaviors, presented in an online format where completion implied consent. Significantly more NS users (22.9%) reported doping compared with nonusers (6.0%; U = 4628.0, P < 0.05). NS users presented significantly more positive attitudes toward doping (U = 3152.0, P < 0.05) and expressed a significantly greater belief that doping is effective (U = 3152.0, P < 0.05). When presented with the scenario that performance-enhancing substances are effective and increase the possibility of winning, NS users were significantly more in favor of competing in situations that allow doping (U = 3504.5, P < 0.05). In sum, doping use is three-and-a-half times more prevalent in NS users compared with nonusers. This finding is accompanied by significant differences in doping attitudes, norms, and beliefs. Thus, this article offers support for the gateway hypothesis; athletes who engage in legal performance enhancement practices appear to embody an "at-risk" group for transition toward doping. Education should be appropriately targeted.

CAS 2010/A/2307 World Anti-Doping Agency (WADA) v. Jobson Leandro Pereira de Oliveira, Confederação Brasileira de Futebol (CBF) & Superior Tribunal de Justiça Desportiva (STJD)

• Football
• Doping (cocaine)
• CAS Jurisdiction ratione personae over the STJD
• CAS Jurisdiction ratione personae over any athlete registered with a Brazilian federation
• Impossibility to re-classify a substance
• Standard of utmost care
• Player’s age and degree of experience
• Commencement of the suspension period

1. The STJD is a justice body which is an integral part of the organizational structure of the CBF, with no legal personality of its own. At least for international purposes the decisions of the STJD, although independently reached, must be considered to be the decisions of the CBF. As a result, the STJD has no autonomous legal personality and may not be considered as Respondent on its own in a CAS appeal arbitration concerning one of its rulings. Consequently, the CAS does not have jurisdiction ratione personae over the STJD.

2. According to Brazilian law, official sports practice in Brazil is governed by national and international rules and by sporting practice rules of each type of sport, accepted by the respective national federations. In particular, athletes practicing professional sport have the duty to abide by international sports rules. As a result of these provisions and in accordance with CAS jurisprudence, international sports rules are directly applicable to Brazilian sport. Hence, any athlete registered with a Brazilian federation is directly bound by the international rules accepted by that federation, including any provision therein giving jurisdiction to the CAS.

3. Under the FIFA Anti-Doping Regulations (ADR), the inclusion of a substance in the Prohibited List and its classification is final. Thus, a panel is bound by the fact that cocaine was classified as a prohibited substance and it cannot re-classify it as a specified substance.

4. In accordance with the applicable strict standard of utmost care, except only in the most “truly exceptional cases”, the presence of prohibited substances in an athlete’s system constitutes a failure in fulfilling that duty. A cocaine-dependency syndrome is not specific and decisive, and cannot be considered an exceptional circumstance which is so “truly exceptional” as to explain a player’s departure from the expected standard of behavior.

5. The age and experience of an athlete must be considered in the context of all the relevant circumstances in order to determine whether they might mitigate the athlete’s fault or negligence.

6. Four months after the decision was rendered appears to be a reasonable span of time to hear a doping case. In case of an adjudicating process of almost twenty months since the date of the sample collection, with this duration not attributable to the player, it is fair to apply the principle set forth in Article 53 (2) of the FIFA ADR and to start the period of ineligibility at an earlier date than the day of notification of the award.

On 6 May 2010 the Brazilian football Superior Court of Sport Justice (STJD) decided by majority to impose a reduced 6 month period of ineligibility on the football player Jobson Leandro Pereira de Oliveira after he twice had tested positive for the prohibited substance Cocaine in December 2009.

Hereafter in December 2010 the World Anti-Doping Agency (WADA) appealed the STJD Decision with the Court of Arbitration for Sport (CAS). WADA requested the Panel to set aside the Appealed Decision and to impose a 2 year period of inelgibility on the Athlete.

The Athlete asserted with evidence that he bore no significant fault or negligence because, at the relevant time, he was allegedly suffering from an irresistible coercion caused by his Cocaine-dependence syndrome that did not allow him to control the use of Cocaine:

Preliminary the Panel establishes that it does have jurisdiction ratione personae over WADA, the Athlete, the CBS and the Appealed Decision. The Panel holds that it does not have jurisdiction personae over the STJD.

In this case the Panel assessed and addressed the following issues:

• a.) Has the Athlete committed an anti-doping rule violation?
• b.) If the answer to question a) is affirmative, what would be the appropriate sanction to be imposed on the Athlete?
• c.) What would be the legal consequences of the Panel’s findings?

The Panel finds that the elements offered by the Athlete are not sufficient to establish, on the balance of probability, that he bore no ‘significant fault or negligence’. The Panel does not find the evidence presented by the Athlete to be specific and decisive to explain the Athlete’s departure from the expected standard of behavior.

Moreover, the Panel is not convinced that the circumstances of the present case are ‘truly exceptional’ so as to reduce the Athlete’s responsibility. In fact, the Panel finds that the Athlete’s degree of fault or negligence, viewed in the totality of the circumstances, is clearly ‘significant’ in relation to the anti-doping rule violation.

The Panel has found that article 47 (1) FIFA ADR is not applicable to the case at hand, as Cocaine is not considered a ‘specified substance’ under the FIFA ADR. Furthermore, the Panel has found that the Athlete's degree of fault or negligence, viewed in the totality of the circumstances, was clearly ‘significant’ in relation to the anti-doping rule violation.

In addition, the Panel has found that imposing a two-year period of ineligibility on the Athlete is compatible with international law and human rights requirements.

Therefore the Court of Arbitration for Sport decides on 14 September 2011:

1.) The CAS has jurisdiction both ratione materiae and ratione personae to entertain the appeal of the World Anti-Doping Agency (WADA) against the Confederação Brasileira de Futebol (CBF) and Mr Jobson Leandro Pereira de Oliveira, while it has no jurisdiction ratione personae in respect of the Superior Tribunal de Justiça Desportiva (STJD).

2.) The Appeal of WADA against the decision of the STJD dated 6 May 2010 of the STJD is upheld.

3.) The decision dated 6 May 2010 of the STJD is set aside.

4.) Mr Jobson Leandro Pereira de Oliveira is suspended from 6 September 2010 for a period of two years, less the period of suspension of six months already served.

(…)

7.) All other prayers for relief are dismissed.

Haff, G. Gregory PhD, CSCS, FNSCA
Strength & Conditioning Journal: 29(1):50-57, February 2007.

summary: This is the second part of a 2-part roundtable series that presents current information and opinions about anabolic androgenic steroids.

(C) 2007 National Strength and Conditioning Association

CAS 2002/A/374 M. / International Olympic Committee (IOC)

Related cases:

• CAS 2002_A_400 Johann Muehlegg vs FIS
  January 24, 2003
• IOC 2002 IOC vs Johann Muehlegg
  February 24, 2002
  
  

• Cross Country Skiing
• Doping
• Accreditation of the laboratory to conduct EPO testing
• Nature of Aranesp
• Validity of the testing procedure to detect Aranesp Sanction in case of out-of-competition doping control

1. The fact that an accreditation for the isoelectric focusing test was not granted to the laboratory at the time when the samples were tested does not mean that this laboratory was not capable of conducting the r-EPO test. The Olympic Movement Antidoping Code (OMAC) specifically provides for the evolution of scientific knowledge and testing procedures. What must be established to the comfortable satisfaction of the tribunal is that the testing procedure as carried out was in accordance with the prevailing standards and practices of the scientific community.

2. Aranesp is a substance, which has the effect of artificially boosting the oxygen in the blood by the introduction of a greater number of red blood cells, and for an elite performance athlete these additional red blood cells translate into enhanced stamina. The natural hormone EPO and r-EPO have precisely the same physiological effects. Aranesp is an analogue and mimetic of the Prohibited Substance r-EPO.

3. Aranesp is a Prohibited Substance and can not be produced naturally unlike r-EPO that has an overlapping fingerprint with EPO and can cause doubts as to whether the isoform is natural or artificial in nature. Therefore, it does not matter that there may be overlap with the natural bands of EPO as there can be no doubt that there was use of Aranesp and its source can not possibly be that of the human body. Therefore, the direct urine test employed to detect r-EPO can also be applied to detect Aranesp. The notable difference between the two applications is that Aranesp does not require a threshold safety margin to protect against false positives because of overlap, as does r-EPO.

4. The closing words of Article 3.5 OMAC indicate that where an athlete commits an out-of-competition doping offence, at least all the results obtained after the date the sample was taken shall be invalidated. The proper interpretation of this Article could be construed as limiting the invalidation of results to those results that were achieved after the later of the date the positive result was recorded or the date final judgment on the issue is rendered. This interpretation would result in the absurdity that an athlete could compete up until the final adjudication of a doping infraction and not have any results obtained in the interim period invalidated. This is contrary to the purpose of the OMAC and such an interpretation cannot be accepted. This article operates not to determine what results will be invalidated, but the date on which the invalidation of results is effectively imposed.

The Spanish Athlete Johann Muehlegg competed in the Men's 30 km Free Mass Start (February 9, 2002), the Men's 10 km Free Pursuit (February 14, 2002) and the Men's 50 km Classical (February 23, 2002). Muehlegg placed first in all three events acquiring Spain's only medals of the Games.

In February 2002 the International Olympic Committee (IOC) reported an anti-doping rule violation againt the Athlete after his A and B samples tested positive for the prohibited substance Darbepoetin (dEPO).

Consequently on 24 February 2002 the IOC decided that the Athlete was disqualified and excluded from the 2002 Salt Lake City Olympic Winter Games.

Hereafter in March 2002 the Athlete appealed the IOC Decision with the Court of Arbitration for Sport (CAS 2002/A/374). Also in June 2002 the Athlete appealed with CAS the decision of the International Ski Federation (FIS) to sanction the Athlete for 2 years after he tested positive for dEPO) (CAS 2002/A/400).

The Athlete requested the Panel to set aside the IOC decision and he disputed the reliability of the testing method and the  testing result.

Following assessment of the case the Panel concludes that the IOC Executive Board properly found Muehlegg to have committed a doping infraction and hereby upholds that decision. Also the Panel finds that the IOC Executive Board properly exercised its authority under the Olympic Charter and the OMAC to invalidate Muehlegg’s results in the 50km classical cross-country event, withdraw the gold medal obtained, and exclude him from the Games.

Therefore on 24 January 2003 the Court of Arbitration for Sport decides:

1.) The appeal filed by Johann Muehlegg on 16 March 2002 is dismissed.

2.) The decision of the Executive Board of the International Olympic Committee of 24 February 2002 is upheld.

3.) The award is pronounced without costs, except for the court office fee of CHF 500 (five hundred Swiss Francs) paid by Johann Muehlegg which is kept by the CAS.

4.) Johann Muehlegg is ordered to pay the sum of CHF 12’000.- (Twelve thousand Swiss Francs), to the IOC in contribution towards its legal costs.

CAS 2008/A/1558 WADA v/ SANEF & Gertenbach

CAS 2008/A/1578 FEI v/ SANEF

CAS 2008/A/1558 World Anti-Doping Agency (WADA) v. South African National Equestrian Federation (SANEF) & Jasyn Gertenbach and CAS 2008/A/1578 Fédération Equestre Internationale (FEI) v. SANEF

• Equestrian (vaulting)
• Doping (refusal to submit to sample collection)
• Right of international federations to appeal against decisions of national federations involving anti-doping rule infractions
• Refusal without compelling justification to submit to a sample collection after notification
• Young age of an athlete as exceptional circumstance for the reduction of the ineligibility period

1. According to the CAS case law, it is essential that international federations have a right of appeal against the decisions of national federations in cases involving anti-doping rule infractions in order to create a ‘level playing field’ and ensure equity in international competition.

2. An athlete refuses or fails without compelling justification to submit to a sample collection after notification even if there were departures from the rules, where it can be proved that such departures did not cause the factual basis for the athlete’s refusal to submit to sample collection. This is particularly so if the applicable rules do not place an obligation on the Doping Control Officer to advise the athlete of the precise consequences of his refusal to comply, or to advise him of what specific sanction he is likely to incur.

3. The young age of an athlete should not be regarded as an exceptional circumstance. CAS case law provides that young athletes cannot escape responsibility for the actions of parents who are in control of their athletic careers. This is particularly the case where the athlete’s father testified clearly that his son was free at all times to decide and provide a sample if he so wished.

In July 2007 the father of the rider Jasyn Gertenbach (17) denied the SAIDS Doping Control Officer (DCO) access to their house and refused any cooperation in orde to submit the Athlete to out-of-competition testing.

On 7 April 2008 the Judicial Committee of the South African National Equestrian Federation (SANEF) decided to impose a 4 month period of ineligibility on the Athlete for his refusal to submit to sample collection.

Hereafter in May 2008 the World Anti-Doping Agency (WADA), and in June 2008 the International Equestrian Federation (FEI), appealed the SANEF decision with the Court of Arbitration for Sport (CAS).

In this appeal SANEF failed to respond whereas the Athlete in his submission disputed the jurisdiction of CAS and requested to uphold the Appealed Decision.

WADA and FEI requested the Panel to set aside the Appealed Decision and to impose a sanction of 2 years on the Athlete. They contended that CAS has jurisdiction to hear this appeal and that there were no grounds for a reduced sanction.

Following assessment of the evidence and the Athlete's conduct in this case the Panel deems that:

• CAS has jurisdiction and the appeals filed by WADA and FEI are admissible.
• The Athlete was legitimately subject to out-of-competition testing by SAIDS.
• The DCO did have authority to conduct a sample collection on the Athlete at any time or place.
• The Athlete refused to submit to a sample collection after notification as authoried in the FEI AD Rules.
• Alleged departures of the IST could not have caused the Athlete's refusal to submit to sample collection.
• There are no grounds for a reduced sanction.

Therefore the Court of Arbitration for Sport decides on 4 March 2009:

1.) The Appeal filed by the World Anti-Doping Agency against a decision of the Judicial Committee of the South African National Equestrian Federation dated 7 April 2008 is upheld.

2.) The Appeal filed by the Fédération Equestre Internationale against a decision of the Judicial Committee of the South African National Equestrian Federation dated 7 April 2008 is upheld.

3.) The period of ineligibility of four months that was imposed on Mr Jaysn Gertenbach by the Judicial Committee of the South African National Equestrian Federation is hereby increased to two years, commencing on 7 April 2008.

4.) All competitive results obtained by Mr Jaysn Gertenbach between 5 July 2007 and 7 April 2008 shall be disqualified.

5.) (…).

6.) (…).

7. All other prayers for relief are dismissed.

CAS 2007/A/1415 Michael Benjamin v/Federation Equestre Internationale (FEI)

CAS 2007/A/1415 B. v/ Fédération Equestre Internationale (FEI)

Related case:

FEI 2007 FEI vs Michael Benjamin
September 25, 2007

• Equestrian
• Validity of the notification to undergo an anti-doping test
• Refusal to submit to doping control
• No compelling justifications and mitigating circumstances
• Determination of the sanction

1. No exact time limit is prescribed in the International Standard for Testing (IST). Even if the notification takes place when the Athlete had finished his ride, dismounted from his horse and proceeded to the bar it cannot be said that the notification is too late. The 15 minutes elapsed from the end of the ride to the notification cannot be considered excessive. Even if the Athlete had left the place of the Competition he could have been subject to an Out-of-Competition Test.

2. The intentional refusal to submit to doping control with the purpose to hide that the Athlete had drunk alcohol, which he was not sure was prohibited in connection with a competition, and also to cover the fact that he had taken another medication, which he was not sure of, constitutes anti-doping rule violation.

3. The possibility for the athlete of establishing No Fault or Negligence does not apply to violations under Art. 2.3 (refusal to submit to doping control). According to Art 10.5.4 and 10.2 the sanction therefore has to be two years ineligibility.

In November 2006 the South African Institute for Drugfree Sport (SAIDS) has reported an anti-doping rule violation against the Athlete Michael Benjamin after he refused to provide a sample for drug testing. Consequently on 25 September 2007 the FEI Tribunal decided to impose a 2 year period of ineligibility on the Athlete.

Hereafter in October 2007 the Athlete appealed the FEI decision with the Court of Arbitration for Sport (CAS).

The CAS Panel determines that aim of the Athlete was to avoid that the test would establish that he had taken alcohol and a medication that might be forbidden substances. This is exactly what the Rule in Art. 2.3 intends to prevent.

If the Athlete considers the alternatives of refusing the test or of revealing at the occasion of a test that he has taken some contingently forbidden substances, the sanction shall be the same in both cases.

The Panel rules that towards this background the Athlete in this case cannot be deemed to have had any compelling justifications. On the contrary he has acted in a way which the relevant Rule aims to forbid.

Therefore the Court of Arbitration for Sport decides on 24 April 2008:

1.) The Appeal filed by the Athlete is only partially admitted.

2.) The decision issued by the FEI Tribunal is upheld except regarding the commencement date of the period of ineligibility which is fixed on 1 June 2007 instead of 27 October 2007. The period of Ineligibility thus will end on the 30 May 2009.

3.) The Athlete is disqualified from the Event CSI-W Cape Town, which took place between 23 and 26 November 2006, and his results obtained at this Event are annulled.

4.) All other motions or prayers for relief are dismissed.

5. (…).

CAS 200S/A/834 Dubin, Österreichischer Behindertensportverband & Austrian Paralympic Committee v/ IPC

In October 2004 the International Paralympic Committee (IPC) reported an anti-doping rule violation against the Austrian Parathlete Wolfgang Dubin after his A and B samples tested positive for the prohibited substance Propylhexedrine.

The Athlete explained that he used for many years prescribed medication for his epilepsy while he was unaware that it contained a prohibited substance. The IPC concluded that the Athlete's violation was not intentional and that he had failed to apply for a TUE.

On 8 November 2004 the IPC decided on 8 November 2004 to impose a warning and a reprimand on the Athlete including disqualification of his results. Following the Athlete's appeal the IPC decided on 2 February 2005 to uphold its previous decision.

Hereafter in February 2005 the Athlete, the Austrian Paralympic Committe and the Austrian Anti-Doping Committee appealed the IPC Decision with the Court of Arbitration for Sport (CAS).

Following assessment of the case the Panel determines that:

• The presence of a prohibited substance has been established in the Athlete's samples and accordingly he committed an anti-doping rule violation.
• The Athlete did not use the substance intentionally, but only as treatment to control his epilepsy.
• The IPC acted not in accordance with the WADA Code during the analysis of the Athlete's B sample while the IPC already rendered its decision and a press release.
• The substance Propylhexedrine was listed on the 2003 IOC Prohibited List, but was then removed in 2004 without any explanation by WADA.
• The Athlete nor his doctor were fully aware of the situation, due to the ambiguous listing / de-listing of substances on the 2003 and 2004 Prohibited Lists.
• The Athlete acted with No Fault or Negligence.
• No period of ineligibility has been imposed on the Athlete and the warning and reprimand are cancelled.

Therefore the Court of Arbitration for Sport decides on 8 February 2006:

1.) The Appeal filed on 21 February 2005 by Mr Dubin, the Austrian Paralympic Committee and the Austrian Anti-Doping Committee against the decision issued on 2 February 2005 by
which the appeal against the Decision of 8 November 2004 was dismissed is partially admitted.

2.) The Decision of the IPC Management Committee of 2 February 2005 is corrected in the sense that the waming and the reprimand imposed on the appellant Wolfgang Dubin are fully cancelled.

3.) The present arbitration procedure is rendered without costs, except for the CAS Court Office fee of CHF 500 (five hundred Swiss Francs) already paid by the Appellants which is retained by the CAS.

4.) The Respondent shall refund the CAS Court Office fee of CHF 500 (five hundred Swiss Francs) to the Appellants.

5.) Each party shall bear its own costs.

CAS 2004/A/717 Intemational Paralympic Committee v/ Broekman & WADA

In July 2004 the TUE Committee of the International Paralympic Committee (IPC) decided to dismiss the TUE application of the British Parathlete Andrew Brockman.

By contrast on 23 August 2004 the WADA TUE Committee decided to reverse the IPC decision and to grant the Athlete's TUE application for the use of his medication.

Hereafter in September 2004 the IPC appealed the WADA Decision with the Court of Arbitration for Sport (CAS). IPC requested the Panel to set aside the WADA Decision and to deny the TUE granted to the Parathlete.

IPC argued that a TUE can be denied even in the case the Technical Criteria are satisfied, when the health of the athlete would be seriously impaired by the use of the otherwise prohibited substance and/or by the practice of sport under the effect of the otherwise prohibited substance.

WADA, on the other hand, while agreeing on the importance of the "health factor" for the practice of sport, claimed that the list of the Technical Criteria Is exhaustive, so that an athlete has the right to obtain a TUE if he fulfils them all.

In view of the evidence the Panel determines that the Athlete was suffering from a chronic medical condition, that the otherwise prohibited substance was not specificaliy used for sport, but also in the course of the normal life of the Athlete.

The Panel deems that the administration of the otherwise prohibited substance was medically justified. The Panel finds that no evidence, assessed on the basis of a direct examination of the Athlete, was given that the cessation of the practice of the sport by the Athlete was a reasonable alternative to the administration of the prohibited substance.

As a result, the IPC, by denying the TUE, did not properly apply the Technical Criteria (as set forth by the WADC TUE International Standards and by the IPC Anti-Doping Code). WADA, therefore, was entitled to reverse the IPC Decision
pursuant to Article 6.3 of the IPC Anti-Doping Code.

Therefore the Court of Arbitration for Sport decides on 8 June 2005:

1.) The Appeal filed by the International Paralympic Committee on 15 September 2004 is dismissed.

2.) The decision adopted by the Therapeutic Exemption Committe of the World Anti-Doping Agency on 23 August 2004 is confirmed.

3.) (...)

4.) (...)