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India notified the National Anti-Doping Act (the Act) on 12 August 2022. Through this legislation, India appears to reiterate its commitment to compliance with the World Anti-Doping Code (the WADA Code). However, the reality of doping in Indian sports is far from ideal. India ranks second globally in terms of Anti-Doping Rule Violations (ADRVs). The question then is, what flaws existed in the pre-Act anti-doping policies? Further, how far has the developing country narrative of India impacted these policies? Finally, to what extent does the Act address the existing gaps in India's anti-doping policy? The article addresses these questions to evaluate the necessity of the Act. The article reviews the existing literature on India's anti-doping policy. The review includes government status reports, the National Anti-Doping Agency's (NADA's) decisions and WADA's ADRVs report. These documents establish that the pre-Act anti-doping policy of India had failed to stem the incidents of doping within Indian sports. The Act is a flawed piece of legislation. Consequently, India's anti-doping policy is unlikely to be impacted, though further quantitative research in the future is needed to evaluate the Act. [ABSTRACT FROM AUTHOR]

Objective: Determine whether there was an increased incidence of hit-by-pitch events in Major League Baseball (MLB) following the decision to enforce the foreign substance ban for pitchers during the 2021 season. Design: Descriptive Epidemiological Study. Setting: Major League Baseball hit-by-pitch data from publicly available Web sites ( mlb.com and fangraphs.com ). Participants: Major League Baseball players during the 2017, 2018, 2019, 2021, and 2022 seasons. Independent variables: Hit-by-pitch exposure data by season and individual pitch type. Main outcome measures: Hit-by-pitch incidence rates from the 2017 to 2019 seasons (preenforcement) and the 2021 to 2022 seasons (postenforcement). Rates were compared with incidence rate ratios (IRRs). Results: Hit-by-pitch incidence rate increased from 2.66 to 3.06 per 1000 total pitches (IRR, 1.15 [95% CI, 1.08-1.23]; P < 0.0001) following the enforcement. Incidence rates for 2017, 2018, and 2019 did not differ from each other individually, but incidence rate of all 3 seasons individually were significantly lower than that for the 2021 season ( P < 0.005). Sliders were 29% more likely to hit batters following the enforcement ( P = 0.0015). Conclusions: Major League Baseball batters were hit by pitches at a significantly higher rate following the league's crackdown on foreign substance use for the 2021 seasons compared with the same time of year during the 2017 to 2019 seasons. This was followed by a slight regression toward preenforcement levels during the 2022 season. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence of tramadol use among athletes from 2012 to 2020. Methods: All urine samples were collected from national and international in-competition doping-control tests that took place in Italy between 2012 and 2020. The analysis of the samples was performed by gas chromatography coupled with mass spectrometry with electronic ionization and acquisition in selected ion monitoring. The cutoff tramadol concentration was >50 ng/mL. Results: Of the 60,802 in-competition urine samples we analyzed, 1.2% (n = 759) showed tramadol intake, with 84.2% (n = 637) of these coming from cyclists and 15.8% (n = 122) from other sports. In cycling, a strong and significant negative correlation was found (r = −.738; P =.003), showing a decrease of tramadol use compared with the other sports. Conclusions: The decrease in tramadol prevalence in cycling in the last years may be due to (1) the deterrent action of antidoping regulations and (2) the fact that tramadol may not have any actual ergogenic effect on performance. [ABSTRACT FROM AUTHOR]

Given the prevalent use of inhaled beta2‐agonists in sports, there is an ongoing debate as to whether they enhance athletic performance. Over the last decades, inhaled beta2‐agonists have been claimed not to enhance performance with little consideration of dose or exercise modality. In contrast, orally administered beta2‐agonists are perceived as being performance enhancing, predominantly on muscle strength and sprint ability, but can also induce muscle hypertrophy and slow‐to‐fast fiber phenotypic switching. But because inhaled beta2‐agonists are more efficient to achieve high systemic concentrations than oral delivery relative to dose, it follows that the inhaled route has the potential to enhance performance too. The question is at which inhaled doses such effects occur. While supratherapeutic doses of inhaled beta2‐agonists enhance muscle strength and short intense exercise performance, effects at low therapeutic doses are less apparent. However, even high therapeutic inhaled doses of commonly used beta2‐agonists have been shown to induce muscle hypertrophy and to enhance sprint performance. This is concerning from an anti‐doping perspective. In this paper, we raise awareness of the circumstances under which inhaled beta2‐agonists can constitute a performance‐enhancing benefit. [ABSTRACT FROM AUTHOR]

For many reasons, athletes' use of supplements is highly prevalent across sports and competitive levels, despite the risk of these products containing a substance on the World Anti-Doping Agency Prohibited List. Contravening anti-doping rules through supplement use could have serious consequences for competitive athletes (e.g., ineligibility from major competitions, loss of medals and funding) due to the principle of strict liability. Indiscriminate supplement use also poses a risk to athlete health. To reduce the possibility of ingesting a supplement containing prohibited substances, independent quality assurance and certification programs have been established (e.g., Informed Sport). However, these programs do not completely eliminate risk, leading to some anti-doping organisations promoting a 'just say no' to supplements stance. Yet, this approach can be problematic as a small number of supplements may be necessary for athletes to consume, in certain situations. Recognising that athletes will continue to use these heavily marketed products, this narrative review describes a theoretically underpinned and systematic approach to preventing inadvertent doping by considering the barriers to and enablers of athlete adherence to risk minimisation supplement use guidelines (RMSUG). By outlining a conceptual shift towards a behaviourally informed approach, this review serves to stimulate the development of multifaceted interventions to prevent inadvertent doping through supplement use. Recognising that risk-minimised supplement use involves a myriad of behaviours, the problem of inadvertent doping through supplement use is framed, and research appraised, through the lens of the Behaviour Change Wheel. [ABSTRACT FROM AUTHOR]

Prior research has examined the relationships between morality, attitudes, and intentions related to doping predominantly via correlational studies based on the theoretical frameworks provided by extensions to the theory of planned behaviour, and the social cognitive theory of moral thought and action. In contrast, the present study experimentally analysed a psychological process (i.e., self-validation) through which thought morality can influence attitudes and intentions. Two hundred and forty-two participants (122 males and 120 females) were randomly assigned to read a message either against or in favour of legalising several doping behaviours in sports, then listed their thoughts regarding that proposal. Next, they were randomly assigned to perceive their thoughts as either moral or immoral, then indicated the extent to which they considered their thoughts as valid. Finally, participants reported their attitudes and intentions regarding the legalisation proposal. As hypothesised, the anti-legalisation (vs. pro-legalisation) message produced more unfavourable thoughts and attitudes, as well as lower intentions to support the legalisation proposal and engage in banned behaviours if legalised in sport. Most importantly, the effects of message direction on attitudes and intentions were greater for participants in the moral (vs. immoral) thought condition. Furthermore, changes in attitudes were consistent with a self-validation process. [ABSTRACT FROM AUTHOR]

An editorial focuses on the use of complementary medicine among amateur and professional athletes, highlighting the growing demand for alternative therapies like cupping, yoga, and acupuncture. It discusses the mixed evidence regarding the effectiveness of these treatments in enhancing athletic performance and recovery. It emphasizes the need for more rigorous research to validate the claims surrounding these complementary approaches, as current studies often lack methodological robustness.

Objective: To determine the effects of glucocorticoids in enhancing athletic performance. Design: At least 2 independent reviewers conducted study selection and extracted demographic and outcome data. Relevant outcomes were stratified by administration time frame and the specific type of drug used. Study quality was assessed using the Cochrane Risk-of-Bias tool and the Cochrane Grading of Recommendations Assessment Development and Education scale. Where appropriate, meta-analyses were performed. Data sources: Embase, MEDLINE, and SPORTDiscus were searched from their beginning to April 2020. Participants: Participants of any sex and training status aged 18 to 65 years were included. Interventions and Main Outcome Measures: Any type of published randomized controlled trial (RCT) that examined any enhancement in sport as well as aerobic, anaerobic, or body compositional parameters for glucocorticoids compared with placebo. Results: There is low-to-moderate evidence suggesting that the administration of glucocorticoids may be more beneficial than placebo in enhancing athletic performance. short-term administration of glucocorticoids significantly improved time to exhaustion, maximal force, and total distance travelled. By contrast, acute administration of glucocorticoids predominantly yielded no changes to athletic performance, except for reductions in total work and maximal power output. Conclusions: Although there is evidence suggesting glucocorticoids have ergogenic effects, these improvements may differ depending on the specific type of drug, dose, and the administration time frame and are also limited by small sample sizes. Therefore, there is a need for large, high-quality RCTs as this may influence future doping policy and athlete care. [ABSTRACT FROM AUTHOR]

Policies and approaches addressing image and performance enhancing drug (IPED) use in the gym and fitness context, also known as fitness doping, vary widely by country. Fitness doping, and those who participate in it, maybe met with individual-level strategies ranging from criminal penalties to harm reduction efforts. This research compares two distinct approaches to fitness doping: Sweden's prevention-based approach and Scotland's harm reduction approach. Drawing on the risk environment framework, we show how national-level policies around possession, sale, and use that represent different approaches to IPEDs structure how to use is understood and experienced using two case studies: Sweden's national PRODIS program and a steroid clinic in Glasgow, Scotland. The results highlight how individuals and communities respond to environmental constraints around IPEDs. Restrictive anti-doping environments produce a range of risks for people who use these substances and may prevent harm reduction. Less restrictive environments may allow for more harm reducing work, but the remaining prohibitions may still produce social, economic, and policy risks. We argue that formal harm reduction focused on the health and needs of those who use IPEDs offers an environment in which safer use is supported and promoted. [ABSTRACT FROM AUTHOR]

This experiment analyzed whether attitudes toward the legalization of several doping behaviors would resist change and predict behavioral intentions when they were initially formed through thoughtful (i.e., high elaboration) versus nonthoughtful (i.e., low elaboration) processes. Participants were randomly assigned first to a persuasive message either against or in favor of the legalization, which they read with relatively high or low degrees of deliberative thinking. Attitudes and intentions regarding legalization were assessed following that message. Next, each participant received a second message that was opposed to the first one, serving as an attack against the attitude that participants had just formed. Finally, attitudes were again assessed. As hypothesized, participants showed greater attitude-consistent intentions when they formed their initial attitudes through thoughtful (vs. nonthoughtful) consideration of the first message. Moreover, the second message resulted in greater resistance to attitude change when participants formed their initial attitudes through thoughtful (vs. nonthoughtful) processes. [ABSTRACT FROM AUTHOR]

Competitor classification schemes have been a part of sport since its origins. Eligibility criteria have developed towards inclusion and increasing diversity. The pool of competitors has expanded from the ancient Olympic Games, eligible only to free Greek men, via nineteenth-century English sport favouring primarily the upper class of so-called gentlemen amateurs, to the current global and diverse pool of men, women, children, and able-bodied as well as disabled persons. Hence, the challenge of sound classification schemes has increased. This article examines the principles of fair classification of athletes. With the help of normative theory as well as practical examples, a fair equality of opportunity principle for sport (FEOPs) is formulated. It is demonstrated how sound classification schemes combine the normative backing from FEOPs with relevant scientific insights. Current classification challenges and possibilities for change are discussed. It is suggested that in several sports, biological sex classes can be abandoned, and that in some sports, sex classes can be replaced by body size classes. It is argued, too, that sports in which body height exerts a significant and systematic impact on performance should classify accordingly. In the final part, classification is discussed in light of new techno-scientific possibilities, among them the possibility of innovative performance-enhancing prosthetics. [ABSTRACT FROM AUTHOR]

Background: The prevalence of doping in competitive sport, and the methods for assessing prevalence, remain poorly understood. This reduces the ability of researchers, governments, and sporting organizations to determine the extent of doping behavior and the impacts of anti-doping strategies. Objectives: The primary aim of this subject-wide systematic review was to collate and synthesize evidence on doping prevalence from published scientific papers. Secondary aims involved reviewing the reporting accuracy and data quality as evidence for doping behavior to (1) develop quality and bias assessment criteria to facilitate future systematic reviews; and (2) establish recommendations for reporting future research on doping behavior in competitive sports to facilitate better meta-analyses of doping behavior. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. Articles were included if they contained information on doping prevalence of any kind in competitive sport, regardless of the methodology and without time limit. Through an iterative process, we simultaneously developed a set of assessment criteria; and used these to assess the studies for data quality on doping prevalence, potential bias and reporting. Results: One-hundred and five studies, published between 1975 and 2019,were included. Doping prevalence rates in competitive sport ranged from 0 to 73% for doping behavior with most falling under 5%. To determine prevalence, 89 studies used self-reported survey data (SRP) and 17 used sample analysis data (SAP) to produce evidence for doping prevalence (one study used both SRP and SAP). In total, studies reporting athletes totaled 102,515 participants, (72.8% men and 27.2% women). Studies surveyed athletes in 35 countries with 26 involving athletes in the United States, while 12 studies examined an international population. Studies also surveyed athletes from most international sport federations and major professional sports and examined international, national, and sub-elite level athletes, including youth, masters, amateur, club, and university level athletes. However, inconsistencies in data reporting prevented meta-analysis for sport, gender, region, or competition level. Qualitative syntheses were possible and provided for study type, gender, and geographical region. The quality assessment of prevalence evidence in the studies identified 20 as "High", 60 as "Moderate", and 25 as "Low." Of the 89 studies using SRP, 17 rated as "High", 52 rated as "Moderate", and 20 rated as "Low." Of the 17 studies using SAP, 3 rated as "High", 9 rated as "Moderate", and 5 rated as "Low." Examining ratings by year suggests that both the quality and quantity of the evidence for doping prevalence in published studies are increasing. Conclusions: Current knowledge about doping prevalence in competitive sport relies upon weak and disparate evidence. To address this, we offer a comprehensive set of assessment criteria for studies examining doping behavior data as evidence for doping prevalence. To facilitate future evidence syntheses and meta-analyses, we also put forward "best practice" recommendations and reporting guidelines that will improve evidence quality. [ABSTRACT FROM AUTHOR]

Climbing as a competition sport has become increasingly popular in recent years, particularly the sub-discipline of bouldering. The sport will debut in the Tokyo Summer Olympic Games. National and international competitions have three disciplines: lead (climbing with rope protection), bouldering (climbing at lower heights with mattress floor protection) and speed (maximum speed climbing on a standardised route in 1-on-1 mode). There is also a 'combined mode' of all three disciplines (combined) which forms the Olympic competition format; all competition formats are held on artificial walls. Existing literature describes a predominantly low injury frequency and severity in elite climbing. In comparison to climbing on real rock, artificial climbing walls have recently been associated with higher injury rates. Finger injuries such as tenosynovitis, pulley lesions and growth plate injuries are the most common injuries. As finger injuries are sport-specific, medical supervision of climbing athletes requires specific medical knowledge for diagnosis and treatment. There is so far little evidence on effective injury prevention measures in top athletes, and antidoping measures, in general, requiring further work in this field. An improved data situation regarding high-performance climbing athletes is crucial to ensure that the sport continues to be largely safe and injury-free and to prevent doping cases as extensively as possible. [ABSTRACT FROM AUTHOR]

The goal of this study is to investigate the impact of nutrition, the passolig system, and ant i-doping regulations on athletic performance using training and Erythropoietin. Sport performance refers to the process of measuring an athlete's level and quality of participation in a sport. Athletes from a variety of sports are selected to take part in the study. Therefore, the method of area cluster sampling is adopted. The questionnaires are administered among the respondents through email. A total of 135 questionnaires are used to examine the data. Following data collection, the Smart PLS 3 is used for further analys is. The findings show that nutrition has a positive and significant impact on sports performance and training. Passolig, anti-doping laws, and training have little effect on sports performance. Anti-doping legislation has a detrimental impact on Erythropoiet in, and Erythropoietin has a detrimental impact on sports performance. Erythropoietin acts as a bridge between anti-doping laws and athletic performance. Training does not act as a bridge between the role of nutrition and athletic performance. From a realistic standpoint, this research suggests that privileged, focused, psychologically healthy, and fit athletes should be awarded priority in sports teams. [ABSTRACT FROM AUTHOR]

Sports nutrition supplements have previously been reported to contain undeclared doping substances. The use of such supplements can lead to general health risks and may give rise to unintentional doping violations in elite sports. To assess the prevalence of doping substances in a range of high-risk sports nutrition supplements available from Dutch web shops. A total of 66 sports nutrition supplements - identified as potentially high-risk products claiming to modulate hormone regulation, stimulate muscle mass gain, increase fat loss, and/or boost energy - were selected from 21 different brands and purchased from 17 web shops. All products were analyzed for doping substances by the UK life sciences testing company LGC, formerly known as the Laboratory of the Government Chemist, using an extended version of their ISO17025 accredited nutritional supplement screen. A total of 25 out of the 66 products (38%) contained undeclared doping substances, which included high levels of the stimulants oxilofrine, β-methylphenethylamine (BMPEA) and N,β-dimethylphenethylamine (NBDMPEA), the stimulant 4-methylhexan-2-amine (methylhexaneamine, 1,3-dimethylamylamine, DMAA), the anabolic steroids boldione (1,4-androstadiene-3,17-dione) and 5-androstene- 3β,17α-diol (17α-AED), the beta-2 agonist higenamine and the beta-blocker bisoprolol. Based upon the recommended dose and the potential variability of analyte concentration, the ingestion of some products identified within this study could pose a significant risk of unintentional doping violations. In addition to inadvertent doping risks, the prescribed use of 3 products (4.5%) could likely impose general health risks. [ABSTRACT FROM AUTHOR]

Background: The pervasiveness of doping and findings of anti-doping corruption threaten weightlifting's position at the 2024 Olympic Games. Analysing the practices of doping in weightlifters could identify patterns in doping that assist in future detection. Methods: We analysed publicly available data on sanctioned athletes/support personnel from the International Weightlifting Federation between 2008 and 2019 and announced retrospective Anti-Doping Rule Violations (ADRVs) from the 2008 and 2012 Olympic Games. Results: There were 565 sanctions between 2008 and 2019 of which 82% related to the detection of exogenous Anabolic Androgenic Steroid (AAS) metabolites and markers indicating endogenous AAS usage. The detection of exogenous AAS metabolites, markers of endogenous AAS usage and other substance metabolites varied by IWF Continental Federation (p ≤ 0.05) with Europe (74%, 11%, 15%) and Asia (70%, 15%, 15%) showing a higher detection of exogenous AAS compared to Pan America (37%, 30%, 33%) and Africa (50%, 17%, 33%). When looking at the 10 most detected substances, the nations with the highest number of sanctions (range 17–35) all had at least one overrepresented substance that accounted for 38–60% of all detected substances. The targeted re-analysis of samples from the 2008 and 2012 Olympic Games due to the discovery of long-term metabolites for exogenous AAS resulted in 61 weightlifters producing retrospective ADRVs. This includes 34 original medallists (9 gold, 10 silver and 15 bronze), the highest of any sport identified by Olympic Games sample re-testing. The exogenous AAS dehydrochloromethyltestosterone and stanozolol accounted for 83% of detected substances and were present in 95% of these samples. Conclusion: Based on these findings of regional differences in doping practices, weightlifting would benefit from the targeted testing of certain regions and continuing investment in long-term sample storage as the sensitivity and specificity of detection continues to improve. [ABSTRACT FROM AUTHOR]

Objectives: The percentage of athletes with Therapeutic Use Exemptions (TUEs) competing in elite sport and the association with winning medals has been a matter of speculation in the absence of validated competitor numbers. We used International Olympic Committee (IOC) and World Anti-Doping Agency (WADA) data to identify athletes competing with TUEs at five Olympic Games (Games) and a possible association between having a TUE and winning an Olympic medal.Methods: We used the IOC's competition results and WADA's TUE database to identify the number of TUEs for athlete competitions (ACs, defined as one athlete competing in one event) and any associations with medals among athletes competing in individual competitions. We calculated risk ratios (RR) for the probability of winning a medal among athletes with a TUE compared with that of athletes without a TUE. We also reported adjusted RR (RRadj) controlling for country resources, which is a potential confounder.Results: During the Games from 2010 to 2018, there were 20 139 ACs and 2062 medals awarded. Athletes competed with a TUE in 0.9% (181/20 139) of ACs. There were 21/2062 medals won by athletes with a TUE. The RR for winning a medal with a TUE was 1.13 (95% CI: 0.73 to 1.65; p=0.54), and the RRadj was 1.07 (95% CI: 0.69 to 1.56; p=0.73).Conclusion: The number of athletes competing with valid TUEs at Games is <1%. Our results suggested that there is no meaningful association between being granted a TUE and the likelihood of winning a medal. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a solid effort across all sports organizations to reduce the prevalence and incidence of doping in sport. However, the efficacy of current strategies to fight against doping might be improved by using anti-doping polices tailored to the features of doping in each sport. Objectives: The aim of this investigation was to analyze the substances more commonly found in doping control tests in individual and team sports. Material and Methods: The publicly accessible Testing Figures Reports made available by the World Anti-Doping Agency, were analyzed from 2014 to 2017. Results: The most commonly detected groups of banned substances were anabolic agents and stimulants but the distribution of adverse findings per drug class was very different depending on the sports discipline. Weightlifting, athletics, rugby, hockey and volleyball presented abnormally high proportions of anabolic agents (p = 2.8 × 10−11). Cycling, athletics and rugby presented atypically elevated proportions of peptide hormones and growth factors (p = 1.4 × 10−1). Diuretics and masking agents were more commonly found in boxing, wrestling, taekwondo, judo, shooting, and gymnastics than in other sports (p = 4.0 × 10−68). Cycling, rowing, aquatics, tennis, gymnastics and ice hockey presented abnormally high proportions of stimulants (p = 1.8 × 10−5). Conclusions: These results indicate that the groups of banned substances more commonly detected in anti-doping control tests were different depending on the sports discipline. These data suggest the prohibited substances used as doping agents might be substantially different depending on the type of sport and thus, sports-specific anti-doping policies should be implemented to enhance the efficacy of anti-doping testing. [ABSTRACT FROM AUTHOR]

Background: Given implications associated with the use of performance-enhancing substances (PESs), stakeholders must remain informed about usage precipitants and anticipate conditions signaling athlete vulnerability to hazardous exposures. Objectives: To gain deeper qualitative insight into high-level athlete PES usage; explore the variables leading them to escalate their PES use regimens; reveal PES experiences during their careers and, unlike other studies, not to focus exclusively on "doping" as measured by the use of WADA-banned substances. Methods: A macro life course–based framework from which the data could emerge through a thematic coding analysis was utilized. Sixteen narrative life course histories of recently retired high-performance athletes report on the factors impelling their escalation in PES use, including for some, the first use of banned PES. Results: Informant reports, thematically coded, reveal performance maximization urgency to be a central factor in escalating PES use, driven by four variables: Requirements, Opportunities, Influencers and Outcomes. These variables each comprise two key components that stimulate an urgency ecosystem affecting an athlete's proximity to an escalation threshold. Conclusions/Importance: Such a comprehensive investigation of PES use precipitants has not previously been undertaken. Advances in PES use were instantiated by a substantive, sometimes radical and often sudden increase in urgency to improve performance related to output requirements, specific demands, knowledge and access, timing windows, the competitive landscape, loyalty to coaches, efficiency expectations and likelihood of detection. This study informs incremental models of doping, the use of which is encouraged in order to analyze life course narratives to better understand athlete behaviors. [ABSTRACT FROM AUTHOR]

The List of Prohibited Substances and Methods (the List) is the International Standard that determines what is prohibited in sport in- and out-of-competition. The official text of the List is produced by the World Anti-Doping Agency (WADA), the international independent organization responsible for promoting, coordinating and monitoring the fight against doping in sport. The drafting of the annual List is a highly interactive and consultative process involving scientific and medical experts in anti-doping, sport federations and governments. In this article, the elements that compose the List as well as the process behind its annual revision and update are presented. [ABSTRACT FROM AUTHOR]

The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations. [ABSTRACT FROM AUTHOR]

An essay is presented on pediatric and adolescent doping in Great Britain. It notes the credibility of medical ethics on weighing the potential harms against benefits in sports. The author concludes that Gillick competence should not be viewed as a precedent for adolescent or pediatric consent to doping.

The article focuses on M. Andrew Holowchak's article discussing the ban on anabolic steroids, and presents philosopher Michel Foucault's response to it. A discussion is given on some of the positive claims Holowchak makes about justifications for the ban on steroid use in sports and critically investigates their logical integrity. Holowchak's position relies on the assertion that athletes who take drugs must necessarily value victory over concerns for their own health, other athletes, and the sport itself. Yet if this standard is applied to drug takers, it should also be applied consistently to all other athletes and all other athletic practices.

The article provides an analysis of the transition of antidoping policy from a series of relatively discrete processes, confined to individual sports, events, or countries, to a global policy that comprises a complex network of relation- ships involving governmental and nongovernmental organizations. Regime theory is used to examine the nature of the policy process at the international level, focusing particularly on the difficulties of defining the objective of harmonization and of achieving compliance. The characteristics of the regime are identified, and issues of resource dependence, capacity building, verification of compliance, and the increasing centrality of government to policy implementation are examined. Despite the constant risk of defection and the tensions within the regime. the conclusion is drawn that the regime should not be deemed ineffective. Increasing effectiveness, however, is likely to occur at the cost of progressive marginalization of sports organizations. [ABSTRACT FROM AUTHOR]

Asthma is prevalent in athletes and when untreated can impact both respiratory health and sports performance. Pharmacological inhaler therapy currently forms the mainstay of treatment; however, for elite athletes competing under the constraints of the World Anti-Doping Code (Code), a number of established therapies are prohibited both in and/or out of competition and/or have a maximum permitted dose. The recent release of medical information detailing inhaler therapy in high-profile athletes has brought the legitimacy and utilisation of asthma medication in this setting into sharp focus. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance and employs a theory of behaviour to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma. [ABSTRACT FROM AUTHOR]

Globalisation has seen regulation move beyond the state. International sports offer a strong example, with the evolution of an extensive system of global regulation and law. The creation of the Court of Arbitration for Sport, the development of the world antidoping regime, and more recent efforts to battle corruption, are but a few of its more prominent elements. A significant feature of this system is the international partnering of private and government bodies. However, this partnership is not without its challenges. Its evolution reveals inherent tensions between international and national regulatory regimes, as international sporting organisations challenge the sovereignty of the nation-state. This article critically examines the evolving private-public partnership that is international sports regulation. In particular, it investigates two case studies: the International Olympic Committee and the Fédération Internationale de Football Association. The intellectual lenses of public-private partnership and of power are adopted to analyse these cases. The social, cultural, political and economic importance of sport makes examining the evolution of international sports regulation an interesting and valuable exercise. Studying it also potentially offers valuable insights and lessons for the development of international regulatory systems and global law-making more broadly. [ABSTRACT FROM AUTHOR]

The presence of performance-enhancing drugs in dietary supplements poses serious anti-doping and health risks to athletes and military service members. A positive drug test, suboptimal health, or adverse event can ruin a career in either setting. These populations need to be certain in advance that a product is of high quality and free from performance-enhancing drugs and other banned substances. However, no regulatory authority conducts or mandates a quality review before dietary supplements are sold. Under the Food Drug and Cosmetic Act, the Food and Drug Administration does not have a role in the premarket safety review of dietary supplements. Due to the increasing demand for high-quality, properly labeled dietary supplements, multiple companies have stepped into this void by offering testing and quality review programs for dietary supplements. Each of these third-party programs has its own quality assurance program with varying testing components. It is difficult for consumers in the sport and military settings to assess whether a particular certification program reduces the risks enough so that they can use a product with confidence. This article puts forward the consensus of the authors on current best practices for third-party certification programs for dietary supplements consumed by athletes and military service members. Also discussed are important ways that third-party programs can develop in the future to improve access to safe, high-quality dietary supplements for these populations. [ABSTRACT FROM AUTHOR]

The World Anti-Doping Agency is responsible for maintaining a Prohibited List that describes the use of substances and methods that are prohibited for athletes. The list currently contains 23 substance classes, and an important reason for the existence of this list is to prevent unfair competition due to pharmacologically enhanced performance. The aim of this review was to give an overview of the available evidence for performance enhancement of these substance classes. We searched the scientific literature through PubMed for studies and reviews evaluating the effects of substance classes on performance. Findings from double-blind, randomized controlled trials were considered as evidence for (the absence of) effects if they were performed in trained subjects measuring relevant performance outcomes. Only 5 of 23 substance classes show evidence of having the ability to enhance actual sports performance, i.e. anabolic agents, β2-agonists, stimulants, glucocorticoids and β-blockers. One additional class, growth hormone, has similar evidence but only in untrained subjects. The observed effects all relate to strength or sprint performance (and accuracy for β-blockers); there are no studies showing positive effects on reliable markers of endurance performance. For 11 classes, no well-designed studies are available, and, for the remaining six classes, there is evidence of an absence of a positive effect. In conclusion, for the majority of substance classes, no convincing evidence for performance enhancement is available, while, for the remaining classes, the evidence is based on a total of only 266 subjects from 11 studies. [ABSTRACT FROM AUTHOR]

World Anti-Doping Agency considers doping transgressions strict liability offences. Strict liability offences that restrict human rights may be morally justified where legitimate social interests outweigh the rights of individuals. The World Anti-Doping Agency Code is currently under review, with a revised Code expected to be issued in January 2021. This article critically examines whether the Code conforms to international human rights standards, and whether strict liability can be ethically justified on the basis that they are in the public interest. It also considers how the principles of anti-doping policy may be shaped by and for athletes through a Rawlsian critique of anti-doping regulation. [ABSTRACT FROM AUTHOR]

Context: Recombinant human growth hormone (rHGH) has become a target of abuse in the sporting world. Conversely, sports medicine clinicians may encounter athletes using rHGH to achieve normalcy in the context of growth hormone (GH) deficiency.Evidence Acquisition: Medline and PubMed databases were queried using the following keywords: GH, GH physiology, GH deficiency, acromegaly, GH athlete, GH sports, GH athletic performance, and GH deficiency concussion. Articles focusing on GH physiology, deficiency, excess, and its effects in both deficient and healthy patients were included.Study Design: Clinical review.Level Of Evidence: Level 3.Results: GH is a naturally occurring hormone with important roles in human physiology. Patients with GH deficiency (GHD) present variably, and GHD has numerous etiologies. rHGH treatment has substantial therapeutic benefits for patients with GHD. The benefits of rHGH treatment in otherwise-healthy adults are uncertain. GH excess may cause health problems such as acromegaly. Professional, collegiate, and international sports leagues and associations have banned rHGH use to maintain athlete health, safety, and fair play. Athletes misusing GH may face prolonged suspensions from competition. Implementing GH abuse testing is challenging, but new methods, such as the biomarker testing procedure, are being finalized.Conclusion: rHGH is not only an important therapeutic agent for GH-deficient patients but also a target of abuse in competitive athletics. Its benefits in a healthy, adult population are uncertain. A safe exercise and competition plan, developed with a physician knowledgeable of GH use, physiology, and abuse potential, should be of benefit to a longitudinal clinician-patient relationship. [ABSTRACT FROM AUTHOR]

Objectives Under the World Anti-Doping Code coaches have designated anti-doping roles and responsibilities. Yet, their experiences, opinions and behaviours in relation to these expectations are poorly understood. This study responds directly to this absence of evidence in order to move the field forward. Design A qualitative thematic analysis approach. Method Twelve football and rugby league coaches, working in a performance development context, took part in semi-structured interviews to explore their (anti-)doping experiences, opinions and behaviours. Nine coaches participated in follow-up interviews where particular attention was paid to existing anti-doping policy directives. All interviews were analysed using inductive thematic analysis. Results Coaches were supportive of anti-doping efforts and exerted their influence by monitoring, giving advice and creating the ‘right’ culture. Performance prioritisation rendered coaches reluctant to engage proactively in addressing anti-doping in their practice; a situation exacerbated by a lack of self-efficacy to advise/act in accordance with the rules. Consequently, coaches tended to rely on others (both internally and externally to their club) to provide anti-doping support, and anti-doping is deemed unnecessary/irrelevant. Critically, coaches' current behaviours were not driven by policy, as they were unaware of expectations and consequences outlined in the Code. Conclusions Coaches are willing to support anti-doping efforts, but are generally passive in their everyday practice. The gulf between anti-doping policy and coaching practice raises cause for concern for anti-doping policy makers. To bridge this gap systematic programming of activities designed to ensure coaches are able and willing to take a proactive role in doping prevention is required. [ABSTRACT FROM AUTHOR]

The use of certain performance-enhancing drugs (PED) is banned in sport. I discuss critically standard justifications of the ban based on arguments from two widely used criteria: fairness and harms to health. I argue that these arguments on their own are inadequate, and only make sense within a normative understanding of athletic performance and the value of sport. In the discourse over PED, the distinction between “natural” and “artificial” performance has exerted significant impact. I examine whether the distinction makes sense from a moral point of view. I propose an understanding of “natural” athletic performance by combining biological knowledge of training with an interpretation of the normative structure of sport. I conclude that this understanding can serve as moral justification of the PED ban and enable critical and analytically based line drawing between acceptable and nonacceptable performance-enhancing means in sport. [ABSTRACT FROM AUTHOR]

Background: The zero-tolerance approach to doping in sport has long been criticised. Legalising 'doping' under medical supervision has been proposed as a better way of protecting both athletes' health and fair competition. This paper investigates how elite athletes might react if specific doping substances were permitted under medical supervision and explore athletes' considerations about side-effects in this situation. The results are interpreted using a framework, which views elite sport as an exceptional and risky working environment.Methods: 775 elite athletes (mean age: 21.73, SD = 5.52) representing forty sports completed a web-based questionnaire (response rate: 51%) presenting a scenario of legalised, medically supervised 'doping'.Results: 58% of athletes reported an interest in one or more of the 13 proposed substances/methods. Athletes' interest in a specific product was linked to its capacity to enhance performance levels in the athletes' particular sport and depended on gender and age. 23% showed interest in either one or more of erythropoietin (EPO), anabolic-androgenic steroids (AAS), blood transfusions and/or Growth Hormone if permitted and provided under qualified medical supervision. Male speed and power sports athletes of increasing age had the highest likelihood of being interested in AAS (41%, age 36), female motor-skill sports athletes had the lowest (<1%, age 16). 59% feared side-effects. This fear kept 39% of all athletes from being interested in specific substances/methods whereas 18% declared their interest despite fearing the side-effects.Conclusion: Interpreting results with the understanding of sport as an exceptional and risky working environment suggests that legalising certain 'doping' substances under medical supervision would create other/new types of harms, and this 'trade-off of harms and benefits' would be undesirable considering the occupational health, working conditions and well-being of most athletes. Assessing the risks and harms produced/reduced by specific drugs when considering sport as a precarious occupation may prove useful in composing the Prohibited List and reducing drug-related harm in sport. [ABSTRACT FROM AUTHOR]

A speech is presented by Professor Richard McLaren, after accepting the National Sports Law Institute’s Master of the Game Award. It mentions about maintenance of sports integrity; an account of doping in Sochi Winter Olympic Games, in which International Olympic Committee band Russian athletes caught doping; and laws governing doping in international sports.

The article discusess International Olympic Committee's role in providing punishment to athletes caught in doping. Topics discussed include anti-doping laws of the committee; blanket ban of the Russian Olympic team; amd efforts of World Anti-Doping Agency and International Federations in eliminating the use of performance-enhancing drugs by athletes.

Background: This article deals with arguments that challenge the possibility of an ethical justification for a doping ban.Hypothesis/purpose: It shows that a justification for the doping ban is only possible if its implementation can be safeguarded.Study Design: Systematic review.Methods: Based on the proposition of the game theory, this article examines the scope of the arguments of naturalness, health, equal opportunity and fairness used in scientific literature.Results/conclusions: Ceteris paribus, athletes will always prefer a situation that presents no health risk to a situation in which they face a threat to their health. They will therefore consent to a doping ban on the condition that it is ensured that all parties are bound to this rule, so that anyone complying with the rules will not be afraid of losing the competition as a result. For even if we condoned self-harm, it could still be argued plausibly that the individual should not suffer more disadvantages than absolutely necessary for the sake of gaining an advantage over others. Of course, it is possible to plead for a restricted approval of doping measures with acceptable risk. But even taking minor risks would not seem sensible under the condition that all participants without exception adhere to the same conditions when there is the option to renounce the (avoidable) risks. So as far as the use of performance-enhancing substances or methods is concerned, we can maintain that even if minor health risks are to be expected, a ban on doping can be justified from an ethical point of view. [ABSTRACT FROM AUTHOR]

In June 2012 DMAA (1,3-dimethylamylamine), an ephedrine-like vasoconstricting substance which had been included in many popular sports supplements, became a scheduled substance in Australia, following bans in several other countries. The underlying rationale for this ban was that DMAA use is unsafe. This paper aimed to critically review the available evidence on the acute and/or long-term harms of DMAA. Using five research databases (PubMed, Embase, ProQuest Health and Medical Complete, and Web of Science) and the key terms 'methylhexaneamine', 'DMAA', 'dimethylamylamine', '1,3-dimethylpentylamine' and '2-amino-4-methylhexane', 842 articles were identified once duplicates removed. Sixteen studies met the inclusion criteria and were included in the review. Of the included studies, eight were case studies, which reported on eight patients who presented to emergence departments. All were retrospective in their reporting. The patients displayed various outcomes; while the patients were presenting with serious problems, in most patients conditions subsided on cessation of supplement use. The remaining eight experimental studies were low powered, with a number of studies conducted by a single research group with industry ties, and broadly investigated the effects of DMAA on physiological outcomes. Mixed findings were apparent, although escalations of blood pressure were present on acute dosing, as well as decreases in measures of body weight and body fat. There is a shallow evidence base describing the adverse effects of DMAA and the dose above which such effects may occur. The scheduling of DMAA in many countries may now impede research efforts to determine whether there are safe doses at which DMAA can be consumed. [ABSTRACT FROM AUTHOR]

The author comments on an editorial article on anti-doping ethics written by Julian Savulescu in the journal "Bioethics," as of May 2016. He states that Savulescu has emphasized more rational and philosophical perspective of doping regulation, and cites his reputation as a World Anti-Doping Agency (WADA) critique. It notes that Savulescu has questioned the place of Meldonium in the Prohibited List, and cites the need of transparency in sports.

The authors respond to the article "Performance-Enhancing Drugs, Sport and the Ideal of Natural Athletic Performance," by Sigmund Loland, that was published within the issue. Topics discussed include the shortcomings of banning performance enhancing drugs (PED) based on the notions of fairness and protection of athletes' health, the biological approach to defining natural, and the emergence of gene editing technologies.

Background: Salbutamol abuse detection by athletes is based on a urinary upper threshold defined by the World Anti-Doping Agency (WADA). However, this threshold was determined in healthy, untrained individuals and after a dose of salbutamol inhaled that might not really mirror the condition of asthmatic athletes and the experts's guidelines for asthma management. We aimed to revise this threshold in accordance with recommended clinical practice (that appear to be different from the actual WADA recommendation) and in exercise conditions.Methods: For the present open-label design study, we included 12 trained male cyclists (20 to 40 y/o) with asthma. Differently from the previous pharmacokinetic study supporting the actual salbutamol urinary upper threshold, we decided to administer a close to recommended clinical practice daily dose of 3x200 μg.d(-1) inhaled salbutamol (instead of 1600 μg.d(-1) as authorized by the anti-doping policy). Urine salbutamol concentration was quantified by liquid chromatography-tandem ion trap mass spectrometry and corrected for urine density, at rest and after a 90-min cycling effort at 70-80 % of the maximal aerobic power.Results: The maximum urine salbutamol concentration value peaked after the cycling effort and was 510 ng.mL(-1). That is twice lower than the actual WADA threshold to sanction salbutamol abuse, this "legal" threshold being based on pharmacokinetic data after a daily dose that is 8 fold the total dose sequentially administrated in our study. Considering its 95 % confidence interval, this threshold value could be more stringent.Conclusion: By using conditions in accordance with the experts' clinical and safety guidelines for asthma management in athletes undergoing an intense exercise bout, our study suggests that the urine salbutamol concentration threshold could be lowered to redefine the rule supporting the decision to sanction an athlete for salbutamol abuse. [ABSTRACT FROM AUTHOR]

The aim of the article is to evaluate the contribution of bilateralism to global anti-doping policy. The article begins with an assessment of contemporary challenges facing the World Anti-Doping Agency in attempting to strengthen compliance with the World Anti-Doping Code and notes the weaknesses in compliance. The analytical framework for the article is derived from regime theory, neo-institutionalism and the concept of isomorphism. This is followed by a discussion of the nature of the anti-doping global policy regime and the part that bilateralism might play in the various stages of regime development. The development of bilateral collaboration is traced, and the leading role played by Norway in its development is examined. The central section of the article utilises neo-institutionalist theory and the concept of isomorphism to explore the case of Norway’s bilateral links with China and identifies the outputs of the collaboration and also the motives of both partners. The article concludes with an analysis of the factors that contributed to the longevity and success of the Norway–China collaboration and the extent to which this success could be replicated. [ABSTRACT FROM PUBLISHER]

The current Brazilian situation is such that it is difficult to obtain a worldwide evaluation of failure in education, intervention, or prevention programs. How fragile Brazil's anti-doping system is, its appropriateness as well as its relevance, with needed policy infrastructures for achieving the selected goals, and how wide the gap is between education and prevention program effectiveness between high-performance athletes and recreational practitioners who just want to look good. An additional concern, and ever present flaw regarding Brazil's “common sportsman” in day-to-day society is their not receiving known and necessary “sports education,” enabling the development of an “at-risk” population for self-harm. Reflections on public health policy are noted. [ABSTRACT FROM PUBLISHER]

Copyright of German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin is the property of Verein zur Forderung der Sportmedizin Hannover e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Doping, used to improve sports performance, is legally prohibited. This paper describes Brazilian regulations, resolutions, and Federal laws addressing the issue of doping and antidoping which were collected in 2012 from official websites. We conclude that Brazilian laws have constrained doping, and have been updated over the years to conform to worldwide legal guidelines. Study limitations are noted. [ABSTRACT FROM AUTHOR]

Copyright of Physical Culture / Fizicka Kultura is the property of University of Belgrade - Faculty of Sport & Physical Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)