Thanks to Maria Sharapova, meldonium is the buzzword in anti-doping at the moment. If you hadn’t heard of it when it was added to the World Anti-Doping Agency’s (WADA) Monitoring Programme in September 2014, then you are not alone. In the two days before Sharapova’s announcement that she had tested positive, Wikipedia’s meldonium page reported 870 views. In the two days after Sharapova’s announcement, it was viewed 1.57 million times.

Interesting Wikipedia stat.
Page views for Meldonium for last 2 days pre-Sharapova = 870.
Views for 2 days after Sharapova = 1.57 million

— Hilary Evans (@OlympicStatman) March 11, 2016

“I received a letter on December 22nd from WADA – an email – with the changes happening for next year as well as reporting your whereabouts and a link to a button where you could press to see the prohibited items for 2016, and I did not look at that list”, said Sharapova when announcing her positive test. This is symptomatic of an ongoing problem for WADA – to borrow a horse-based metaphor, you can take an athlete to the List, but you can’t make them read it.

WADA recently admitted that the number of positive tests for meldonium since the 2016 Prohibited List came into effect on 1 January had topped 100. The Sports Integrity Initiative spoke to WADA’s Chief Operating Officer and General Counsel, Olivier Niggli, at the WADA Anti-Doping Organisation (ADO) Symposium in Lausanne, 14-16 March, about whether the organisation had done enough to alert athletes to the change in meldonium’s status.

https://twitter.com/nichols_bc/status/709662249485529089

“That’s an interesting question, because we have done what we have always do”, said Niggli. “When you look at the documents that were published at the end of September [the ‘summary of modifications’, a link at the bottom of a media release about the publishing of the 2016 Prohibited List], it’s on the first page that meldonium was added to the list so it can hardly be clearer”.

Niggli defended WADA’s handling of meldonium’s addition to the List, arguing that it is not WADA’s job to inform athletes, but international federations and national anti-doping organisations (NADOs). “We are not responsible for reaching out to every individual athlete”, he said. “The international federations, their national federation and the NADO need to do their work within their sport and in their country. It looks as if this may not have happened the way it should, but I have a hard time accepting that WADA should have done differently because we have been doing the same thing for 15 years and everybody knows what is happening. It’s always on the same dates, and it was on the Monitoring List before, so there is no big surprise coming out of the box and, frankly, it’s written in black and white.”

On meldomium – as per code – "once it's on the list, there's no query as to why it's on the list" #WADASymposium pic.twitter.com/OaHgdAWbSU

— Sports Integrity SII (@Sport_Integrity) March 14, 2016

However, the substance Sharapova thought she was taking was mildronate, another name that meldonium is known by. Athletes are not required to list the medication they are taking on a doping control form – the responsibility rests on the athlete to check that any medication they are taking isn’t prohibited. If you search the section of WADA’s internet site dedicated to the Prohibited List, or the Prohibited List itself, mildronate is not listed. This could lead to some confusion amongst international federations and athletes.

“It’s not a question of whether someone didn’t recognise the name – it’s there”, argues Niggli. “I think obviously maybe not everybody got the message, or maybe there are other reasons”.

However, it appears that one of Sharapova’s sponsors, Head, also didn’t get the message. ‘We question WADA’s decision to add Meldonium to its banned substances list in the manner it did; we believe the correct action by WADA would have been to impose a dosage limitation only’, read a statement from the racquet manufacturer. ‘In the circumstances, we would encourage WADA to release scientific studies which validates their claim that Meldonium should be a banned substance’.

Niggli dismissed this request. “It’s not a reasonable request because if they were reading the code they would know what is on the List”, he said. “That’s specifically the way that the Code’s wording has been put so that we would not have to justify why a substance is on the list. We have experts who look at it, they have three criteria. It has to meet two of the three and we never disclose nor discuss the specifics of a substance because otherwise, every time you have a positive case, there would be a challenge.”

As previously reported by the Sports Integrity Initiative, use of meldonium at the Baku 2015 European Games appears to have been widespread. While Niggli agrees that perhaps more NADO and international federation resources should have been diverted towards communicating the change in its status to athletes, he also points out that many athletes didn’t declare the substance on  their doping control forms. While hindsight is a wonderful thing, this perhaps suggests that there is more going on than simple ignorance.

“In light of what we see, the communication might not have been optimal at that level”, he says. “We will have to see what the reasons are for these cases. From what I understand, there are very few athletes who declared meldonium on their doping control forms. Even in Baku that wasn’t the case, so are they trying to hide it or what is the reason for them taking it?”

Niggli says that in the light of Sharapova’s case and those that have emerged from the Baku European Games, WADA may consider investigating how NADOs and international federations are communicating changes to the Prohibited List. “WADA will look at that when they look at compliance and see how organisations are communicating changes”, he says. “Clearly there is a responsibility on anti-doping organisations to make sure that they pass on the information and again, this particular process has been going on for 15 years. It’s always the same, at the same date, everybody knows what to expect. Like Santa, you expect him on the 24^th in the evening.”

It is hard to see a positive outcome for sport in any such WADA investigation. Either sport has failed to communicate the change effectively to athletes, or – as Niggli suggests – there is something more nefarious going on. The way that sport has handled the change in meldonium will fuel the arguments of those that argue that sport’s international federations have lost the right to prosecute and determine their own doping cases.

“It is a topic of discussion that was put forward by the IOC – that maybe this should change”, points out Niggli. “I think it’s a certainly the right moment to have this discussion and we’ll see where it goes, but there’s clearly a real or perceived conflict of interests, but this conflict also exists for NADOS. It’s not only international federations, there’s also a nationalistic conflict of interests. If you have good governance in place, things are done in the right way, there’s a right of appeal and the whole process is transparent, then that could work. But on the other hand, if in light of the current circumstances and in order to give more credibility to sport, outsourcing it [anti-doping management] may be a way of beginning that process.”

And it looks as if change is on the way. As previously reported by the Sports Integrity Initiative, WADA plans to launch a full stakeholder consultation on how a fully independent anti-doping agency might operate at its meeting in Strasbourg on 3 and 4 May. The proposal originally came from a resolution made as part of the International Olympic Committee’s (IOC) Agenda 2020 back in October last year, but given recent events has gathered pace.

“One outcome of the meetings was a request to the IOC to fund a project with independent business experts in order to establish the scale of the project and the funding required”, said WADA President Sir Craig Reedie at the Tackling Doping in Sport conference. “There was also a discussion about the idea of an independent tribunal delivering decisions. Once these elements of research are completed and WADA’s Executive Committee and Foundation Board have reviewed the relevant elements at their next meetings in May, WADA will establish the full consultation process necessary to include all stakeholders, including governments.”

However, is the anti-doping system throwing the baby out with the bathwater? What hasn’t been considered to date is WADA’s potential culpability in the recent glut of meldonium positives. As mentioned at the start of this article, meldonium was added to the Monitoring Programme on 29 September 2014, yet was not banned by WADA until the 2016 Prohibited List came into effect on 1 January. When WADA published the 2016 Prohibited List on 30 September 2015, it included meldonium as WADA had found ‘evidence of its use by athletes with the intention of enhancing performance’.

This is a serious loophole in the anti-doping system. When WADA adds a substance to the Monitoring Programme, it is signalling to dopers that such substances could have a performance enhancing effect. If you want to gain a performance-enhancing effect without being sanctioned for doping, where better place to look? It would be interesting to know prevalence of meldonium use before and after it was added to the Monitoring Programme, especially whether its use rose after the 2016 List was published in September last year.

It appears that the inherent conflict of interest between sport’s role in promoting its image, yet also prosecuting its cheats, may be taken out of its hands in the near future. Niggli and Reedie’s comments suggest that WADA is confident it will be central to that process. However, its handling of meldonium’s addition to the List perhaps suggests that it also needs to make changes if anti-doping is to be truly reformed.