A 2011 study which indicates that as many as 57% of elite athletes may have used prohibited substances during the past year was officially published in the Sports Medicine journal on 28 August 2017, after the International Association of Athletics Federations (IAAF) attempted to suppress its publication. The study used the randomised response technique (RRT) to anonymously ask 2,167 elite athletes competing at the IAAF’s 2011 Daegu World Championships and the 2011 Pan American Games Doha if they had used a prohibited substance or method during the past year.

The Tübingen study calculated the estimated prevalence of doping during the past year at 43.6% for Daegu 2011 (95% confidence interval at between 39.4% and 47.9%); and at 57.1% (52.4% to 61.8% confidence interval) for Doha 2011. Interestingly, it also estimated the prevalence of past-year supplement use at the Doha Pan American Games at 70.1% (65.6% to 74.7% confidence interval).

The study

The Tübingen study was commissioned by the World Anti-Doping Agency (WADA) in 2011. It utilised the randomised response technique (RRT), which is an established method used by social scientists in order to get a true picture of the answer to a question that may implicate those taking part in a survey. WADA was keen to test the usefulness of the RRT in ascertaining a true picture of doping prevalence amongst elite athletes, as it had found that athletes had failed to give honest answers in previous surveys to avoid implicating themselves.

‘Results from a recent study part-funded by WADA have confirmed that individuals who have taken banned drugs are likely to manipulate answers so they fit the image of someone who is clean, even strongly anti doping’, read a statement from WADA announcing that it would be exploring new survey techniques to ascertain doping prevalence. The RRT was originally developed in 1965 to avoid this problem, by asking the respondent one of two possible questions.

In the case of the Tübingen study, athletes were asked to think of a person close to them whose date of birth they knew. Then, if this date fell between the 1st and 10th day of the month, the athlete was asked to answer a non-sensitive question, Question A: ‘Is the person’s date of birth in the first half of the year (January through June inclusive)?’ However, if the chosen person’s birth date fell between the 11th and 31st day of the month, the athlete was asked to answer the sensitive Question B: ‘Have you knowingly violated anti-doping regulations by using a prohibited substance or method in the last 12 months?’ Mathematical models are then used to calculate estimates at a 95% confidence interval regarding the answer to the second question.

WADA needed the agreement of the IAAF to carry out the study at its events and it is understood that the IAAF agreed to this, on the basis that it had to give its approval to any publication of the results. This is where problems began.

IAAF suppression

Both WADA and the lead author of the Tübingen study, Dr. Rolf Ulrich, have accused the IAAF of blocking the results of the study, something which the IAAF denies. In a statement, the IAAF said that it had ‘serious reservations as to the interpretation of the results made by the research group’, and had asked the research group certain questions, but had not received a response.

In oral evidence given to the Culture, Media and Sport Committee (CMS) of the UK Parliament in December 2015, the IAAF made the same arguments. However, in an extraordinary letter (PDF below) to the CMS Committee published following the hearing, the authors of the study accused the IAAF and its President, Sebastian Coe, of giving ‘contradictory’ and ‘untrue’ statements to the CMS Committee.

Ulrich argued that the IAAF had not submitted questions on the methodology of the study until July 2015. ‘We are […] still unsure as to whether we can or cannot submit the paper to a journal’, he wrote in the letter. ‘The only explanation we can have for the IAAF’s actions is that the IAAF is afraid that these results are actually accurate, and will have a negative impact on the IAAF’.

In his letter, Ulrich explains that the study was rewritten for inclusion in the journal Nature. ‘WADA then wrote to us to inform us that the paper would be forwarded to the IAAF’, he writes. ‘Only at this point [April 2013] did it become clear to the authors that WADA could not act independently from the IAAF, because WADA had made an agreement with the IAAF which was not disclosed to the research group’. Ulrich states that he has a 22 May 2013 email from WADA stating that IAAF permission would be needed to publish the study.

Ulrich argued that the study has been ‘repeatedly and publicly criticised and thus stigmatised’ by the IAAF, damaging the scientific reputation of all involved. ‘If these organisations – as they claim – are really concerned about doping, we don’t understand why the IAAF blocked the publication of our paper now for over three years and why IAAF officials did not respond to the successive emails’.

As reported by The Sports Integrity Initiative in 2015, the CMS Committee of the UK Parliament decided to publish the study in full under Parliamentary privilege, also accusing the IAAF of blocking its publication. As the Tübingen study now features in Sports Medicine, presumably the IAAF has consented to its publication, however it has yet to comment.

‘These are disappointing and concerning statistics but it is worth viewing them in context’, said UK Anti-Doping (UKAD) CEO Nicole Sapstead in a statement. ‘Significant improvements have taken place since 2011 when this data was collected. Testing methods continue to advance but testing is only one part of the anti-doping process. There is now greater investment in educating elite and up and coming athletes about the dangers and consequences of taking banned substances, as well as a greater emphasis on intelligence and investigations as an alternative way of catching those who seek to break the rules.’