The Anti-Doping Crisis in Sport: Causes, Consequences, Solutions

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(Editors’ Note: In this article, Professors Paul Dimeo of the University of Stirling in the United Kingdom and Verner Møller of the University of Aarhus in Denmark present an overview of their upcoming book on the global sports doping crisis. Both Dimeo and Møller are widely-recognized academic scholars in the area of sports doping prevalence and alternative anti-doping control measures. Møller wrote an earlier book entitled “Scapegoat” about the experiences of the Danish rider Michael Rasmussen, and Dimeo garnered some measure of fame in the cycling world when he was named to head USA Cycling’s committee on anti-doping in 2016 and then fired before the group’s first meeting. Their book is due to be published and available to the public in mid-April, 2018.)

This book is cast from a shared sense of bewilderment at the state of anti-doping; a system shot full of failures, dilemmas and unresolved crises. During the course of writing it, perhaps the most notorious doping system ever was exposed and inevitably badly managed by the various agencies in charge of making sport ‘clean’. However, something else occurred to us along the way: that the very agency who can make substantial changes, WADA, are the very people whose careers and reputations would be in tatters if there was any radical reform.

We set out to demonstrate why sport is in this state of crisis. Six focal points describe it: first, a failure to stop doping; second, the collateral damage of wrong and disproportionate sanctions; third, inconsistent decisions and a complex appeals process that favours WADA; fourth, the abuse of athletes through excessive surveillance and marginalisation from decision-making; fifth, lack of support for rehabilitating those caught doping; and last, the gap between researchers and experts outside the system and those closed circles of the inner sanctum, leading to unanswered questions and opaque governance.

Causes: The history of the crisis is replete with short-term over-reactions to scandals, political manoeuvring and the gradual shift of power away from athletes and towards global bureaucracy. Like all bureaucracies, inhumane outcomes are justified on the basis that ‘rules must be followed’, and individuals who participate can hide behind those rules. The testing process and sanctions emphasise the athletes’ responsibility for what is in their system. Yet, they are not always educated in the complex detail of the Prohibited List, or prepared in advance for the indignities of the urine test, or supported when facing an inadvertent or false positive. The first part of the book explains how WADA emerged, closely linked with IOC, and gradually built an empire. In parallel to which, doping continued, doping doctors could charge more money and have more exclusive clientele, whistle-blowers were ignored, and the collateral damage got worse as the monitoring of athletes became more intense.

Consequences: The middle section of the book takes a critical view of outcomes and impacts. The most obvious flaw is the gulf between the reality of doping occurrence and the number of positive tests. Around 1% of 300,000 annual tests is a positive result for a performance enhancing drug, yet a range of evidence suggests that doping prevalence could be 20-30% (as an average across all sports and countries), or as high as 80-90% in some ‘hot spots’. The science of testing does not seem able to keep up with doping innovators. Not all countries test their athletes regularly. The athletes with the best doctors have the best chance of beating the system.

The impacts we describe focus on the lack of humanity when it comes to dealing with athletes. They are all under suspicion, excessively monitored through random out-of-competition testing, those in the registered testing pool are tied to a location for an hour a day, like house arrest or like the police monitoring of convicted sex offenders. The urine test involves direct observation of their genitalia. Thus, given no choice, athletes are stripped of basic liberties and of their dignity; all in the name of clean sport.

We go on to explain a series of cases in which athletes have been sanctioned and banned from their sport for highly dubious reasons. Some of them have had to live with criticism and stigmatisation far outweighing the severity of their ‘crime.’ Some have tried to appeal beyond the Court of Arbitration for Sport; none have been successful except a few who claimed civil damages against nutritional supplement companies, and the former cyclist Kristen Worley who famously won her case on the basis of human rights violations. But most athletes have no money or willpower for a legal battle, and thus give up in the face of powerful global agencies and rigid rules, even if they have scientific experts willing to provide evidence in support of their appeal. Pulling these points together, we show that the system is inhumane and requires reform.

Solutions: A few models for reform have already been proposed, from outright liberalisation to harm reduction, improved education and criminalisation. We show that none of these are ideal ways forward to both improve deterrence and protect athletes’ rights.

As academics our role is to think outside the current regime, which means having a detached and critical view of existing issues, and being able to make suggestions which are consciously provocative; ideas that would not sit easily with pragmatists and existing committees of anti-doping leaders. It is our job, our contribution to society, to be outsiders looking in, to think in ways that others cannot (or dare not) for fear of losing their job. Anti-doping is so much based on simplistic dogmas of ‘taking responsibility’, being ‘true’ to oneself, and what ‘clean sport’ is, that we now live in an age where critics are dismissed from organisations simply for asking inappropriate questions.

Our ideas are also designed to force readers to think about the illogicality, unfairness and irrationality of the current system. We have come so far already in the acceptance of athlete surveillance, for example, that proposing we go even further might initially appear ridiculous but in the logic of anti-doping it absurdly seems like a good idea. So, we propose a series of changes, some of which are radical and lack pragmatism, others are simple and easy fixes within the current framework.

Challenges for future anti-doping: In the course of reading about decisions and cases, and speaking with various people involved in the anti-doping system, we have learned that there are many concerns. Even some sports lawyers have come to realise that the rules, and how they are applied, could be improved upon. Hearing the voices of athletes whose lives have been ruined by anti-doping is essential – many have faced severe depression, there have even been suicides. The paradox is that anti-doping agencies present themselves as protectors of clean sport, health, fair play and the spirit of sport. Until they realise that the enforcement of power and regulation leads to a wide range of failures and unintended harms, the opportunity for reform will continue to be absent. Unless external groups emerge to force change, WADA and their stakeholders will hold on to the reins of authority and keep pushing for more money and more legislative power. Our sense is that only an athlete-focused organisation can push forward reforms that are more humane and ethical, or if more cases such as Worley’s succeed in non-sports courts then we will see change forced upon WADA from civil judiciaries.

At the very least, there should be auditing of WADA, federations and event organisers. No other large-scale social activity exists without some form of watchdog to ensure that the leading organisations act appropriately. There is currently an absence of support for longitudinal studies on prevalence and how it can be reduced through specific interventions. There is no monitoring of unintended consequences. Athletes are discouraged from speaking up in case they are accused of favouring doping. Academic research is often funnelled through, and shaped by, funding opportunities – we have not yet found a grant scheme which pays for critical research in this field.

The book is aimed at students, researchers and we hope it will also appeal to readers outside academia. We have tried to avoid over-elaborate jargon, we have not summarised previous studies or spent time pointing out the problems with other researchers’ approaches. Instead, we hope the book ticks along with key points supported by case studies to build up the case that some changes need to occur such that the mistakes of the past are not repeated in the future. We expect the reaction to be mixed. However, the unavoidable conclusion is that a system that fails to deliver on its own ambitions need some help in redirecting its ideas, practices and relationships such that the very people upon whom sport depends – athletes – are treated like normal human beings: protected, listened to and respected.

Paul Dimeo and Verner Møller, March 16, 2018 (Editors’ note: an earlier version of this article appeared in on March 14, 2018)