Meldonium conundrum

Doping : Wave of positive tests of the drug is a reminder of athletes' constant search for a pharmaceutical edge

Larry Bowers, the chief science officer for the United States Anti-Doping Agency, gave a presentation on October 4, 2014, at the organisation’s Symposium on Anti-Doping Science.

Bowers stood before a small, international group of researchers at the Phoenix Marriott Tempe in the Arizona hills and spoke about a novel drug that was unfamiliar to most in the room: meldonium, which had been developed in Latvia in the 1970s as a heart medication. The concern was that elite athletes were abusing it to enhance their performance through its ability to energise the cell’s powerhouses, the mitochondria.


Bowers’ talk foreshadowed the latest doping crisis in international sports. Less than two years later, meldonium has had an unforeseen side effect: chaos in global sports, affecting athletes in sports as varied as tennis, speedskating, wrestling and track and field.

In the first 10 weeks of 2016, at least 99 athletes have tested positive for the drug, according to the World Anti-Doping Agency, demonstrating widespread use of a substance believed to enhance endurance and aid recovery by improving blood flow throughout the body.

“Ninety-nine is an extraordinary number to get in that short a period,” said Richard Ings, the former chief executive of the Australian Sports Anti-Doping Authority.

On several fronts, the last six months have been a period like no other in the long-running anti-doping tussle. Russia was barred from international track and field because of systemic doping, and allegations of widespread corruption have been levied against the top of track and field’s global governing body.

Now, along comes meldonium, a once-obscure drug — not approved for sale in the US or the European Union but sold over the counter in Russia and some Eastern European countries — whose name suddenly rolls off the tongues of sports fans as easily as those of established performance-enhancing drugs.

A positive test from tennis star Maria Sharapova, one of the world’s most prominent athletes, has driven much of the global interest, but the number of positive tests — expected to soar past 100 this week, if it has not done so already — has experts grasping for context.

“Never seen anything like it,” Max Cobb, the chief executive of US Biathlon, said in an interview. “It’s definitely shocking and disturbing for me personally because I think it’s probably not the only pharmaceutical being used to enhance performance.”

Experts and officials struggled to suggest a precedent, although David Howman, WADA’s director-general, referred to 2010, when the stimulant methylhexaneamine was added to the banned list, resulting in a flurry of positive tests. Accredited WADA laboratories would report 123 that year. While that number may have been unimposing compared with the 337 positive tests for the anabolic steroid stanozolol in 2010, it did make an immediate impression, partly because of methylhexaneamine’s presence in many nutritional supplements.

“I don’t like to express views on numbers, but I think what you find is that when the substance has been new on the list, there is a time for people to sort it out,” Howman said. “Methylhexaneamine was a similar situation. There were a number of cases in the first three or four months.”

The high number of positive tests for meldonium has been a reminder of athletes’ continual search for a pharmaceutical edge and has raised questions about the ethics of using a prescription drug for performance enhancement even when it is legal. It also has some wondering whether elite athletes in all parts of the world are being educated sufficiently about imminent changes to the banned list, or if they are simply not using their ubiquitous smartphones smartly enough.

“This generation of athletes competing is so digitally connected, and every athlete in the world is on some noticing programme,” Cobb, the US Biathlon official, said. “It’s very difficult to imagine the information not being properly transmitted to them.”

Sharapova, who claims to have taken meldonium since 2006 for a variety of medical conditions, has said she takes full responsibility for not clicking on a link to the 2016 banned list that was sent to her by email in December. Her extensive support team apparently did not notice the rule change or alert her either.

“There are also probably a lot of athletes who are pretty negligent and who haven’t read or who have missed the instructions about the changing regulations,” said Tom Bassindale, a senior lecturer in forensic and analytical science at Sheffield Hallam University in Britain. “Word could not have filtered down. That could honestly be an issue, but certainly for the top elite, they would have had that briefing.”

Asked about the possibility that athletes were not getting the message, Craig Reedie, WADA’s president, said in an email, “We take great care to inform our stakeholders of any amendments to the prohibited list.”

Though WADA posts changes to its code on its website, it does not inform athletes directly of changes, relying instead on its partners: national anti-doping agencies and international sports federations. The question is whether those bodies have all done a thorough a job of spreading WADA’s word. Turmoil in Russia’s sports and anti-doping community may have created communication problems, but Howman disputed that there was a link. “That’s a major reach, because this list went out in September 2015,” he said. He also noted that it was not until November that a report by WADA’s independent commission revealed damning findings on Russian sport.

But Anna Antselovich, the head of Russia’s anti-doping agency, told the state-run news agency TASS Thursday that the sanctions against the agency in November had damaged the information chain on meldonium. “We had no possibility for a certain period of time to hold educative seminars with athletes, coaches and the personnel of national teams,” she told TASS.

Russian athletes in some sports apparently received notification more expeditiously than others. Sergey Shubenkov, the reigning world champion in the 110-meter hurdles, said he received word through official channels. But Elizaveta Tuktamysheva, the 2015 world champion in women’s figure skating, told that she had been taking meldonium before the ban but stopped, only because she found out about the change “from my friends who are skaters.”

Several of the most prominent athletes who are publicly known to have tested positive for meldonium are Russian, including Sharapova, who has been based in the United States since age 7. But it is not uniquely a Russian issue; athletes from several other countries, including Sweden and Georgia, have also tested positive.

There is also the matter of whether the banning of a drug that has long been legal for use in some parts of the world might require an exceptional level of communication from WADA and its stakeholders.

What seems evident is that with the high volume of meldonium cases now pending, there could be legal challenges as to whether the drug should have been banned by WADA in the first place. But Cobb and others have not accepted the argument that taking the drug for an extended period before its ban is a strong defence.

 “I don’t have a lot of sympathy for people using it who didn’t check the list,” Cobb said. “As far as I’m concerned, they had found a way to use a performance-enhancing drug that was not being tested for, and that’s a moral line I wouldn’t cross. If you are going to go that route, you better damn well be sure you read the memo.”