SII Focus 4th October 2019

Pantomime villain: Salazar case should provide pause for thought

Alberto Salazar. To older readers, the name perhaps conjures up images of a Bond villain circling a shark-infested pool. To younger readers, a connection to Salazar Slytherin, founder of the the Hogwarts House where all dark wizards began their descent. 

Alberto Salazar…

News articles have portrayed Salazar as a ‘Doping Cheat’. Yet despite his sanction, it is far from proven that Salazar is the orchestrator of doping that he has been portrayed to be. 

Having pursued the case against him for over four years, it is perhaps understandable that the US Anti-Doping Agency’s (USADA) statement has a triumphant air to it. Likewise the BBC, whose Panorama programme spent time and money pursuing allegations that Salazar had crossed an ethical line whilst Head Coach at the Nike Oregon Project (NOP). 

It is true that by pushing the boundaries of what is considered ethically acceptable in sport, he has violated anti-doping rules. And for that, it is entirely appropriate that he should be sanctioned. 

British Cycling and Team Sky were also criticised for applying a similar ‘marginal gains’ approach in a push for success. An inquiry by the UK Parliament’s Digital, Culture, Media and Sport (DCMS) Committee concluded that it ‘believed’ that the Therapeutic Use Exemption (TUE) system had been abused to improve the performance of key athletes. And it was only able to assert this under the protection of Parliamentary Privilege.

Both situations raise serious questions as to how far it is acceptable to go in sport’s pursuit for success. But they don’t turn British Cycling, Team Sky, or Alberto Salazar into a ‘doping cheat’. Such a label suggests that prohibited drugs were intentionally given to athletes in order to help them win during competition, and the evidence hasn’t shown that to be correct. In either case.

Charges

Salazar was been sanctioned with a four year ban for administration of a prohibited method; tampering and/or attempted tampering with the doping control process; and trafficking of testosterone. These are all very serious charges.

However, the full American Arbitration Association (AAA) Decision (PDF below) reveals that the circumstances are not as serious as the charges make out. All the sanctions were due to experiments on staff and family members designed to ensure his athletes didn’t commit anti-doping rule violations (ADRVs) under the World Anti-Doping Code. 

It was not proven that Salazar administered prohibited substances or methods to any of the athletes he coached at the NOP. The AAA ruled that USADA had not met its burden of proof regarding an ‘Attempted Administration’ charge relating to NOP athletes.

In fact, the AAA was at pains to state that Salazar was not ‘motivated by any bad intention to commit the violations’. It added that it was ‘struck by the amount of care generally taken by the Respondent to ensure that whatever new technique or method or substance he was going to try was lawful under the World Anti-Doping Code’.

The AAA Panel stated that it had ‘taken pains to note that Respondent made unintentional mistakes that violated the rules, apparently motivated by his desire to provide the very best results and training for athletes under his care. Unfortunately, that desire clouded his judgment in some instances, when his usual focus on the rules appears to have lapsed.’

1. Administration of a Prohibited Method

This charge involved the administration of L-carnitine, which does not feature on the World Anti-Doping Agency’s (WADA) Prohibited List. Researchers had found that L-carnitine can facilitate the conversion of fat into energy and the more of the compound that is present in muscle, the more fat is metabolised, saving sugar stores during competition and boosting endurance.

The problem was that if ingested naturally, L-carnitine could take four months to be absorbed into muscle tissue. However, studies showed that it could be absorbed quicker if infused intravenously.

The AAA decision reveals that Salazar instructed his athletes to begin using a sports drink containing L-carnitine immediately, but had concerns that this would take too long to be of benefit to Dathan Ritzenhein and Alvina Begay at the 2012 US Olympic Marathon Trials. Salazar inquired about intravenous infusion with insulin – as used in the studies – but was told that these are prohibited by WADA. Insulin is prohibited under Section S2 of the 2012 Prohibited List, which was in force at the time. 

Emails reveal that Salazar inquired about using an intravenous infusion of L-carnitine on Ritzenhein. However, after consultation with Dr. Jeff Brown, it was agreed to perform the infusion of Steve Magness, an Assistant Coach, before the method was used on NOP athletes. He administered a one litre (1,000mL) bag containing L-carnitine and dextrose to Magness on 28 November 2011.

After concerns expressed by Ritzenhein, Salazar received guidance from USADA that Section M2 of the 2012 Prohibited List only permits intravenous infusions of under 50mL per six hour period. This limit remains in place within the 2019 List, as does the prohibition on use of insulin, however it has been reworded (100mL over a 12 hour period).

Salazar emailed Lance Armstrong about the effects of L-carnitine on Magness…

On 3 December, Salazar emailed USADA about the infusion received by his ‘assistant’ (Magness) without mentioning the volume infused. On 5 December, he received clarification about the 50mL limit. After this, excited by the performance enhancing effects on Magness, plans were made to administer L-carnitine infusions of under 50mL to six NOP athletes – i.e., within the limits prescribed by the Prohibited List.

However, the problem was that Magness was still registered with USA Track & Field (USATF), and was still competing in races in order to keep his fitness up due to being a ‘pacer’ as part of his coaching role. Magness didn’t compete for a year after his prohibited L-carnitine infusion. He and Salazar were vague about whether they were aware that he would be considered as an ‘Athlete’ under the World Anti-Doping Code.

In conclusion, Salazar has been sanctioned for his involvement in directing the administration of an infusion that exceeded the permissible limit to his assistant, in order to ascertain if it had an effect, before considering whether it should be administered to his NOP athletes. He didn’t personally administer the infusion to Magness, nor is there any evidence that he knew that Dr. Brown would administer an infusion in excess of permissible limits to Magness. In fact, he emailed USADA for clarification about whether such infusions were permissible. It could be argued that this is a prudent approach for a Head Coach.

‘Unfortunately, in this case, under the applicable standards which this Panel must apply, Respondent was negligent in his duty and let his enthusiasm about the L-carnitine performance enhancing potential cloud his judgment’, reads the AAA Decision. ‘The Panel is not stating that Respondent set out to violate the Code, but that according to the Code’s provisions and Respondent’s actions in this case, he did so, seemingly unwittingly’.

2. Tampering with the doping control process

Salazar appeared to convince himself that athletes wouldn’t need to declare an infusion at doping control…

This is another serious charge, and suggests changing doping test results in order to acquit athletes charged with ADRVs. However, the truth is a little more complicated. 

Salazar instructed NOP athletes to deny having received an L-carnitine infusion when undergoing doping control, as he understood that notification wasn’t necessary. He asked USADA in an email: if an ‘injection’ is under 50mL and doesn’t contain banned substances, then should an athlete answer ‘no’ if they are asked if they’ve had an infusion in the previous six months?

USADA told Salazar that Goucher would not need to declare an iron injection of under 50mL. Salazar took this to mean that infusions of 50mL would also not need to be declared…

Salazar didn’t receive a reply, but used a 2010 email from USADA clarifying that Kara Goucher could have an injection of under 50mL without having to declare it at doping control as corroboration that this interpretation was correct. He also emailed Bill Kellar, a former footballer and Nike employee outlining this view, arguing that a declaration would result in ‘questions’, as it had when Ritzenhein had received an infusion before the Olympic Marathon Trials in June 2012.

The majority of the AAA Panel found that Salazar ‘tried to prevent the normal procedure from occurring by instructing the NOP Athletes that no declaration of use of LCarnitine was required and that they should deny they had the L-carnitine infusion when asked about infusions when getting drug tested in or out of competition’. It said that Salazar knew that the athletes had been given infusions but ‘deliberately stated they were “classified as an injection” in his email to them’. 

Salazar’s instructions to NOP athletes if asked about infusions at doping control…

It also found that his original email to USADA ‘mischaracterised’ infusions as injections, despite referring to them as ‘infusions’ in the instructions to athletes. The Panel found this to be ‘intentional and fraudulent conduct that was designed to prevent normal procedures from occurring’.

There is no doubt that this fits the definition of Tampering in the 2009 World Anti-Doping Code. It would appear that Salazar was attempting to avoid awkward questions about L-carnitine infusions, despite them not being prohibited under the Code. In other words, he did tamper with the doping control process, but not to cover up an ADRV.

We can only guess as the reasons why he wanted to avoid awkward questions about permitted infusions. It could be because he was aware that the Magness infusion constituted an ADRV, or because he was keen to protect the advantage from discovery. But both scenarios are pure speculation.

3. Trafficking of testosterone

The word ‘trafficking’ instantly conjures up images of criminality, due to its association with illegal drugs and illegal movement of people. However Salazar’s crime was far removed from anything so dramatic. His charge was based on procuring testosterone to use on his sons in an experiment to determine if NOP athletes could be sabotaged using testosterone gel, post race.

Galen Rupp testified that he had been approached by Chris Whetstine after finishing a race at the Oregon Twilight Track Meet on 9 May 2009, and was concerned that he may have rubbed something onto his back. Whetstine had been accused of sabotaging another athlete during a massage, and so Salazar concocted an experiment to see if it would be possible for somebody to sabotage a competitor through application of testosterone gel, post race.

The AAA Panel was alive to the fact that the ‘testosterone experiment’ could have been a cover for doping…

‘Numerous witnesses (Darren Treasure, Krista Austin, Ciarán Ó Lionáird, Alex Salazar, Tony Salazar and Galen Rupp) testified that Respondent had a long history of concern about the potential for sabotage’, reads the Decision. ‘According to Alex Salazar, Respondent was so concerned with sabotage that he poured out the water bottles of his athletes after they were left unaccompanied and he asked Galen Rupp and Mo Farah to travel with their medications and supplements locked in a metal box and keep water in a locked cooler to prevent tampering’.

Salazar and Dr. Brown devised a plan to rub testosterone gel onto Tony and Alex Salazar – who are not considered ‘Athletes’ under the Code – after they had run 5,000 or 10,000 metres, to see how much would be required for them to test positive. The AAA Panel was alive to the fact that such a ruse could be a cover for the use of testosterone on NOP athletes, but the AAA Panel and USADA accepted that the evidence suggested that it wasn’t. 

Paul Scott of Scott Analytics testified that the ‘testosterone experiment’ would be of no use in developing a doping programme…

Firstly, Tony and Alex were never asked about how they felt after the application of testosterone, nor were their performances analysed. Secondly, the experiment was conducted in the Nike Lab, in front of around 30 people. Thirdly, as this suggests, the experiment wasn’t a secret. Fourthly, application an hour after a race wouldn’t give any valuable data on whether NOP athletes using testosterone would be likely to test positive.

USADA accepted that the purpose of the testosterone experiment was to ascertain if someone could sabotage NOP athletes by applying testosterone gel post competition. But it argued that Salazar’s possession of testosterone was for his own, prescribed, personal use and not for administration to others; that they experiment was run without Institutional Review Board (IRB) approval; without informed consent, without either son having a medical need for testosterone and without a written protocol. It argued that such steps should have been taken in any ‘research study conducted by any person or organization, but especially a study involving the most abused performance enhancing steroid on the planet being conducted by an elite-level track and field coach backed by the most profitable shoe company in the world’. A fair point.

The AAA Panel’s conclusions on the ‘testosterone experiment’

Salazar was sanctioned for trafficking his own personal prescription for testosterone to his sons in order to conduct the experiment. Again, it could be argued that conducting such an experiment on his own sons was a prudent approach for a coach concerned at the prospect of sabotage. 

Allegations and obsession

To recap. Salazar has been sanctioned for directing the administration of an L-carnitine infusion to his Assistant Coach due to it being above WADA’s permissible limits. There is no evidence that Salazar knew Dr. Jeff Brown would administer such a large infusion to Steve Magness. There is no evidence that infusions above permissible limits were administered to NOP athletes.

Salazar has also been sanctioned for instructing his athletes to deny having infusions during doping control, as he incorrectly thought notification wasn’t required, albeit with good reason. His third charge was for administering his testosterone gel medication to his sons in order to ascertain if NOP athletes could be sabotaged post race.

But the sanctions don’t tell the whole story. Athlete and public vitriol has been directed at Salazar because his approach was judged to have crossed the line dictating what is acceptable in the pursuit of sporting success. As illustrated by the above, the secret to his success is that he did this, largely, without breaking any rules.

Steve Magness…

It was athlete concern that he had crossed an ethical line that prompted an investigation into Salazar in the first place. Magness told Panorama that he had seen reports whilst at the NOP suggesting that Galen Rupp was using testosterone and prednisone medication from 2002, when he was still at high school. At this point, it is important to state that the NOP terminated Magness’s contract in 2012.

Rupp explained that the former Head of the Nike Lab, the late Dr. Myhre, may have written testosterone on his form after he told him he was taking Testo Boost. Incidentally, this was also what Salazar told the BBC back in 2015. There are a number of supplements that go by this name, all of which claim to ‘naturally’ boost testosterone, but none of which appear to contain testosterone. 

Rupp didn’t explain the inclusion of prednisone on the form seen by Magness, but this anti-inflammatory glucocorticoid is often used to treat inflammatory conditions, such as asthma. Salazar has already clarified that Rupp suffers with asthma-related conditions and held a therapeutic use exemption (TUE) for use of prednisone. 

In 2017, a cache of emails illegally accessed by Fancy Bears – the Russian hacking group found to be under the control of Russian State agents – suggested that Rupp had been flagged as ‘likely doping’ under the Athlete Biological Passport (ABP) programme. However, as we originally reported, this is a long way from a doping positive. The fact that Rupp’s case was never progressed suggests that he was able to explain any inconsistencies.

Kara Goucher also expressed her concerns that Salazar had instructed her to take thyroid drug Cytomel in 2011. The synthetic T3 steroidal hormone doesn’t feature on WADA’s Prohibited List, despite concerns that it may have been used for performance-enhancing purposes. Goucher didn’t hold a prescription for Cytomel, and told the AAA Panel that she was concerned about Dr. Brown’s role on the team, because every athlete at the NOP seemed to have a thyroid problem.

Salazar told athletes that Cytomel would help increase testosterone production…

Another athlete told the AAA Panel that Salazar had told them that using thyroid medication would increase testosterone levels and prevent injury. Although the athlete’s blood values were normal, Dr. Brown put them on thyroid medication the next day. At least four of the NOP athletes were diagnosed with thyroid problems by Dr. Brown, and three of them were treated with thyroid replacement hormones. 

The focus on thyroid medication is odd, especially considering that WADA experts concluded that ‘there is no way to believe that thyroid hormone could be performance enhancing’, in the words of its Senior Director of Science, Dr. Olivier Rabin. It is odd until you consider the medical history of Salazar.

Salazar was prescribed AndroGel from 2005 until the present day, the AAA decision reveals. This was to raise his testosterone levels due to symptoms of hypogonadism. Upon meeting Dr. Brown in 2006, Salazar was told that his low testosterone was caused by decreased thyroid function. He stopped taking testosterone with a view to thyroid surgery, but suffered a heart attack in 2007.

After this, he was prescribed testosterone by Dr. Brown to combat symptoms following the heart attack. So Salazar had prior first hand experience of the effects of both testosterone and thyroid medication on performance. He did not need a guinea pig for this particular experiment. 

Steve Magness said he had witnessed Salazar doling out prescription medications to NOP athletes…

And athletes testified that Salazar, who had been prescribed with AndroGel, sometimes gave certain NOP athletes massages, despite NOP employing a masseuse for this purpose. Magness also testified that he had witnessed Salazar doling out prescription medications to NOP athletes.

USADA’s contention was that Salazar fabricated his low testosterone diagnosis in order to gain access to prescription medications to dole out to NOP athletes. However, the AAA found that although Salazar was prescribed testosterone, USADA had not met its burden of proving that his possession of it was for anything more than personal use. One might view this as an unsatisfactory conclusion for both parties.

USADA had also alleged that Salazar had arranged for Dr. Brown to traffic testosterone to him via Andrew Begley, the husband of NOP athlete Amy Begley, in an envelope. Dr. Brown’s medical records showed that the testosterone was transported in August 2009, when Dr. Brown had proposed running further testosterone contamination experiments. 

The Panel labelled USADA’s assertion ‘unconvincing’ and said that it did not meet its burden of proof in establishing trafficking in this case. It appeared to base this conclusion on the fact that Salazar’s testosterone experiment was performed on his sons in July 2009, and the package was transported in August. Again, this doesn’t appear to be a firm conclusion that will provide closure to either party.

Bad taste

There are two reasons that Salazar’s case leaves such a bad taste in the mouth. The first is because he apparently ignored athlete concerns whilst fanatically pursuing sporting success. The second is that his actions, whilst largely permissible under WADA rules, appear contrary to the spirit of sport. 

Whilst the ADRVs for which he was sanctioned were all due to attempts to prevent his athletes from testing positive, the evidence suggests that NOP athletes were required to implement any marginal gains available, without question. It would appear that a greater emphasis was placed on sporting success than on and concerns raised by athletes.

Salazar took a dangerous approach to his own athletic career. ‘My drive and determination as an athlete is well known’, he wrote in an Open Letter in response to the original allegations. ‘I pushed myself as far as my body could go. In fact, I trained and ran so hard it nearly killed me and I still suffer today the negative physical effects of my excessive training. I have that same drive and determination as a coach, combined with much more wisdom. I push my athletes to be the best but will not hurt my athletes like I hurt myself.’

Salazar isn’t joking, as his Wikipedia profile reveals. The human physiology generates endorphins as a result of success and winning, which can turn them into addictive feelings. It would appear that Salazar was addicted to running. As a Coach, did he become addicted to winning? Sport needs to consider the ethics behind employing somebody that suffers from such issues in coaching elite athletes. Sometimes, sporting success isn’t the most important criteria.

Salazar only confided the real reason that athletes shouldn’t declare infusions with colleagues…

However, perhaps more importantly, sport needs to learn to listen to its athletes. Athletes are not stupid, but the AAA decision reveals that on occasion, Salazar may have treated them as such. For example, he instructed them not to reveal any infusions at doping control, without explaining the reason. Yet he disclosed the reason to his Nike and NOP colleagues. Such an approach is bound to breed suspicion in the eyes of an athlete.

USADA is to be commended for the level of detail involved in its investigations into Salazar and Dr. Brown, but they don’t conclusively prove that NOP athletes were doping. Its announcement has resulted in the International Olympic Committee (IOC) pouring suspicion on all athletes involved in the NOP, despite zero evidence that any of them committed an ADRV. 

As detailed above, all three of Salazar’s ADRVs were in connection to measures designed to ensure that NOP athletes didn’t fall foul of the World Anti-Doping Code. Salazar was ‘shocked’ by the outcome, and is appealing. He alleges that it is incorrect that the NOP prioritised winning over athlete safety. Striking a balance in this area is a difficult issue, and it is clear that Salazar and USADA CEO Tygart disagree on whether the NOP overstepped the boundary. 

Elite sport is often about using any method within the rules to improve performance. But the playing field in sport is never level. Not all athletes have access to performance optimisation centres such as the NOP; not all can afford to sleep in an oxygen tent; not all can afford the latest equipment or to train at altitude. 

We have been in this situation before with Team Sky and British Cycling. Should we be gearing every aspect of athlete life towards success on the field? Success is important to athletes, but there needs to be a way of ensuring that it doesn’t eclipse all other concerns. Where should the ethical line be drawn?

Perhaps it is time for WADA to consider sanctions for actions that contravene the spirit of sport. Such a rule would be difficult to implement, but may prove more effective in resolving such issues than the current focus on actual ADRVs.


Notes

• The AAA also published a decision regarding the NOP’s Dr. Jeff Brown. Click here to view.
• The original allegations against Alberto Salazar are detailed in this article.
• Alberto Salazar’s response to the original allegations are detailed in a two-part response (Part One; Part Two).

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