The World Anti-Doping Agency (WADA) wants the US Anti-Doping Agency (USADA) to charge Steve Magness with an anti-doping rule violation (ADRV), after he was administered an L-carnitine infusion in excess of permissible limits by Alberto Salazar and Dr. Jeff Brown whilst working at the Nike Oregon Project (NOP). A Report released by WADA’s Intelligence and Investigations team highlights that on 1 November 2019, it urged USADA to charge ‘Witness A’ with an ADRV, due to a 30 September 2019 finding by the American Arbitration Association (AAA) that Salazar and Brown had administered ‘an over-the-limit L-carnitine infusion to Witness “A”’.

The only person found to have been administered an L-carnitine infusion at above WADA’s permissible limits was Magness, an Assistant Coach at the NOP. Despite what you may have read, neither USADA, the AAA, WADA, the Court of Arbitration for Sport (CAS) or anybody else found that L-carnitine infusions in excess of permissible limits were administered to NOP athletes. The full 115-page Decision (PDF below) into Salazar and Dr. Brown’s case, also recently released, confirms this (see right).

It also confirms the earlier findings of the AAA – that there is no evidence that Salazar and Brown used testosterone on any NOP athletes (see right). It agreed with the AAA finding that Salazar and Dr. Brown rubbed testosterone on his sons in order to test Galen Rupp’s claim that sabotage via skin contact was possible.

Once again, in case there is any doubt. Alberto Salazar and Dr. Jeff Brown have not been found guilty of administering prohibited substances and/or methods to any NOP athletes. 

WADA’s outing of Magness as USADA’s whistleblower should raise serious concerns for any athletes considering approaching anti-doping authorities with information about doping. But leaving that aside for the moment, the CAS was puzzled as to why USADA had gone to such efforts to convict Salazar and Brown for such minor ADRVs. 

‘The Panel can say that it considers that the circumstances of this case, the length of hearings and the allegations made at various stages of those hearings, as well as the way in which the case was conducted by USADA and the evidence was presented and, in some cases, later abandoned, seems to be out of proportion to the severity and consequences of the ADRVs that have been established’, reads its Decision. ‘None of the ADRVs directly affected athletic competition, and there was no evidence put before the Panel as to any effect on athletes competing at the elite level within the NOP’. 

In making this statement, the CAS is perhaps guilty of ignoring the background to this case. Anti-doping rules can only go so far in protecting athletes from abuse. Athletes, USADA, and the general public had good reason to be concerned about the practices employed at the NOP.

How far would you go to win?

As previously reported, one of the reasons for USADA’s relentless pursuit of Salazar and Dr. Brown was because they were judged to have crossed an ethical line during their time at the NOP. Much like British Cycling and Team Sky, they operated a ‘marginal gains’ policy, and actively sought out any permitted method that could make their charges fitter, faster, and stronger. 

Would you be happy to take unnecessary prescription medication if you were told it made you faster? Magness told BBC 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. 

Former NOP athlete Ari Lambie told BBC Panorama that Salazar and Dr. Jeff Brown insisted that she was given thyroid medication, despite not needing it. She said that it made her feel unwell. Two other NOP athletes, Kara Goucher and Rupp, were also prescribed thyroid medication.

In her first interview, former athlete Ari Lambie, claims banned coach Alberto Salazar, asked her to take a supplement as part of an experiment to see if she would fail a drugs test.#BBCPanorama #AlbertoSalazar pic.twitter.com/uUYjwtZzms

— BBC Panorama (@BBCPanorama) February 24, 2020

Operating a ‘marginal gains’ policy requires control over every aspect of an athlete’s life. Dr. Richard Freeman’s book details how diet, drink and toilet habits were controlled in order to optimise the performance of British Cyclists. In female cycling, this went as far as telling women not to shave their pubic hair.

It appears that such levels of control don’t engender a healthy athlete/coach relationship. Goucher told BBC Panorama that Salazar made inappropriate remarks about the size of her breasts after her pregnancy. Mary Cain made claims of emotional and physical abuse whilst at the NOP in an Opinion for the New York Times. This included allegations that she was made to take diuretics. On 26 July this year, Salazar was declared permanently ineligible by the US Center for SafeSport, based on allegations of sexual and emotional misconduct.

'He was obsessed with the size of my breasts.’

Kara Goucher says her former coach, Alberto Salazar, made sexually inappropriate comments after the birth of her son.

She became a key whistle-blower in the case that saw him banned for four years for doping violations. pic.twitter.com/IvzYY6a62a

— Panorama ? (@BBCPanorama) February 24, 2020

A second aspect, which the CAS Decision makes clear, is that USADA simply didn’t believe Salazar and Dr. Brown’s explanations regarding their use of L-carnitine infusions and testosterone. As the CAS Decision reveals, it had good reason to be suspicious.

L-carnitine

L-carnitine is not a prohibited substance. Up until 2012, intravenous infusions were prohibited except in the management of medical procedures. However, the 2012 Prohibited List introduced a change: ‘Intravenous infusions and/or injections of more than 50 mL per 6 hour period are prohibited except for those legitimately received in the course of hospital admissions or clinical investigations’.

Alberto Salazar, former Head Coach at the NOP and Dr. Jeff Brown had discovered research indicating that L-carnitine could facilitate the conversion of fat into energy and the more of the compound that is present in the 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 List

Emails reveal that Salazar inquired about using an intravenous infusion of L-carnitine on Ritzenhein. However, after consultation with Dr. 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.

The AAA and CAS Decision reveal that Salazar and Dr. Brown hypothesised that this experiment would reveal whether the process worked. Emails reveal their belief that no rules would be broken since Magness wasn’t a registered athlete. In fact, Magness was still competing and could therefore be sanctioned with an ADRV. 

He hasn’t yet been sanctioned, hence WADA’s complaint. But his status as a registered athlete meant that Salazar and Dr. Brown were sanctioned for administering a prohibited method to him. Had he not come forward with information to USADA, Salazar and Dr. Brown might not have been sanctioned and might still be abusing athletes.

The CAS Decision reveals why the process Magness underwent rang alarm bells. It blurs – or perhaps obliterates – the line between treatment and doping. Magness sat with a needle in his arm for over four hours (250 minutes) whilst a 1,000mL solution containing L-carnitine was infused into him. 

There is no doubt that performing this procedure on an athlete was prohibited on 28 November 2011. All infusions were prohibited until 1 January 2012, and then only infusions of 50 mL in under six hours were permitted. In terms of anti-doping rules, L-carnitine is irrelevant. The procedure would have been prohibited if Magness had been administered water.

Salazar and Dr. Brown had planned to use the same procedure on NOP athletes. The CAS Decision reveals that Dr. Brown told Ritzenhein in a 1 December 2012 email that the procedure would take four to five hours. This either indicates that Dr. Brown intended to administer the same prohibited infusion to Ritzenhein, or that he didn’t yet know the volume administered to Magness was prohibited. 

Salazar emailed Dr. Noel Pollock of UK Athletics a day later asking him about the maximum infusion permissible under the rules, after Ritzenhein raised concerns. On 3 December, he asked USADA whether he could perform infusions on NOP athletes and on 6 December, he was again advised of the 50ml limit (see right), which he stuck to. As such, the CAS found that it was more likely that on 1 December, Dr. Brown didn’t know that the volume of the infusion he had administered to Magness and had intended to give to Ritzenhein was prohibited.

USADA attempted to charge Salazar and Brown with attempted administration of over the limit L-carnitine infusions to five athletes: Dathan Ritzenhein; Alvina Begay; Dawn Grunnagle; Galen Rupp; and Lindsay Horn. As previously mentioned, the CAS Decision reveals that USADA failed to establish this. Following the ‘experiment’ concerning an over the limit L-carnitine infusion administered to Magness, all L-carnitine infusions administered to NOP athletes were within permissible limits.

Despite email records indicating that permitted 45ml infusions were used on NOP athletes, Dr. Brown later amended the medical records of Ritzenhein, Rupp, and Grunnagle to indicate that 40ml was infused, after being informed about USADA’s investigation. This appears to be an attempt to protect himself and Salazar.

The results of the Magness experiment were that the increase in VO2max was within the range associated with blood doping. Salazar was so excited about this that he emailed Lance Armstrong. 

This was before Armstrong had confessed to doping throughout his career, but during USADA’s investigation into the cyclist. Why was Salazar telling a suspected doper about new, permitted, performance enhancing substances? Such advisory exchanges are often two way.

On 5 January 2012, Salazar instructed all five NOP athletes that underwent permitted infusions to state that they hadn’t had any prohibited infusions. The CAS Decision reveals that this was because he believed that in order to be permitted, an infusion volume had to be less than 50mL and delivered via syringe and not a bag.

He believed that the way they had received L-carnitine was classified as an injection and not a prohibited infusion (see right), and therefore the NOP athletes would be answering truthfully. However, it isn’t hard to see how this caused concern amongst the five athletes involved.

It appears that this instruction was also passed to another athlete that Salazar coached. Mo Farah was allegedly given four injections over two hours at the Tower Hotel in London ahead of the 2014 London Marathon. He initially denied receiving the injections in a four hour interview, but immediately returned to admit receiving them after meeting Barry Fudge, former Head of Endurance at UK Athletics, outside.

The CAS found that Salazar held a misconception that he had breached the Code in giving permitted infusions that he thought were prohibited to NOP athletes. In misleading USADA in order to prevent them from discovering what he thought was an ADRV, he ‘tragically’ committed an ADRV of tampering (see right).

Testosterone

The CAS Decision reveals that Salazar was prescribed testosterone in 1991 after being diagnosed with testicular failure, later (from 2005) being prescribed with AndroGel. 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 any athlete guinea pigs. 

WADA experts have since concluded that ‘there is no way to believe that thyroid hormone could be performance enhancing’. However Salazar believed that it worked, and this perhaps explains why it was prescribed to NOP athletes whether they needed it or not.

Like everybody involved in sport, he also knew that exogenous extra testosterone worked. However, he argued that the purpose of an experiment involving rubbing testosterone on his sons was to ascertain if his NOP athletes could be sabotaged. A similar experiment was recently performed by investigative journalists, who concluded that sabotage using such methods is a distinct possibility.

USADA didn’t believe Salazar about the purpose of the experiment. It took the view that the ‘testosterone experiment’ was designed to see how much testosterone would trigger an adverse analytical finding (AAF – or ‘positive test’). In other words, how much testosterone could be applied to NOP athletes without breaking anti-doping rules. In the original AAA Decision, anecdotal evidence was used indicating that despite the NOP employing a masseuse, Salazar sometimes gave athletes massages.

In support of Salazar’s contention was an email (see right) he sent to Travis Tygart about an incident involving Galen Rupp. Chris Whetstine, the former Nike masseuse who had rubbed Rupp’s neck with wet hands, had previously been accused by a former Nike Coach, Trevor Graham, of applying a steroid cream to Justin Gatlin. This was alleged to be responsible for Gatlin’s 2006 ADRV.

Bill Bock, USADA’s Counsel, urged Salazar to tell Rupp to report the incident. Salazar didn’t reply.

The CAS Decision reveals that many people at Nike knew about the ‘testosterone experiment’, despite no formal approval being sought to conduct it. Ahead of the experiment, Dr. Brown altered Salazar’s testosterone prescription twice, and the CAS found that there was ‘no basis’ to do this.

An envelope was also given by Dr. Brown to NOP athlete Amy Begley in Houston, addressed to Salazar and to be delivered to him in Oregon, at around the time of the ‘testsosterone experiment’. Dr. Brown argued that it contained placebo testosterone. 

Salazar denied all knowledge of the envelope. The CAS believed the Begleys, who argued Salazar had told them it contained testosterone cream. It also found Dr. Brown’s evidence regarding the package to be unclear. It therefore found Dr. Brown guilty of trafficking testosterone to Salazar for use in the experiment, and Salazar guilty of possession of that testosterone.

Despite possessing testosterone, a prohibited substance, the CAS found that he wasn’t guilty of trafficking it to his sons, as asserted by USADA. The CAS found that in order to be guilty of trafficking testosterone under Article 2.7 of the Code, he had to give the testosterone to his sons. Administration of a prohibited substance is covered by Article 2.8 of the Code, and USADA hadn’t charged him with that.

Deja vu

All too often, anti-doping focuses on whether an ADRV has been committed, ignoring the wider picture. It hasn’t been proven that Salazar or Dr. Brown administered prohibited substances or methods to any athletes, but their methods were questionable and caused athletes to raise serious concerns.

Questions need to be asked about whether it is appropriate for a sportswear manufacturer to appoint a Coach who, by his own admission, nearly killed himself in attempts to run faster for longer, to lead a hothouse of elite athletes. But all of these issues were discussed before, after USADA first sanctioned Salazar.

As I wrote then, the reason that his actions leave such a bad taste in the mouth is because he used methods that might be considered as doping without breaking any rules. Intravenous infusions that take hours to administer, hypoxic chambers, diuretics, telling athletes what to eat, do and say. Like British Cycling and Team Sky, he sought any marginal gain that would enable his athletes to win.

A win at all costs approach is dangerous. Sport needs to recognise that, and remove people who operate such an approach from positions where they advise athletes.

The system protects the wrong people

Whether Salazar and Dr. Brown administered L-carnitine or testosterone to athletes is, unfortunately, likely to remain anybody’s guess. By issuing its Report in a manner that so obviously identifies Magness, WADA is passively aggressively telling USADA to sanction him with an ADRV. This illustrates how WADA’s system of rules discourages athletes from speaking out against those holding positions of power in sport.

In simpler terms, WADA’s view is that USADA should punish Magness for helping to remove an individual that SafeSport concluded has abused athletes. By identifying Magness as ‘Witness A’, WADA is ensuring that he will be punished for his ADRV.

It was athlete whistleblowers such as Magness coming forward with concern about unethical practices at the NOP that led to USADA’s investigation into Salazar in the first place. As previously mentioned, had he not come forward, Salazar and Dr. Brown might still be operating and abusing athletes.

“For me, the real heroes of anti-doping are the whistleblowers who come forward, sometimes risking their careers, friendships or even their own personal safety, for the sake of sport”, says Günter Younger, Director of WADA’s Intelligence and Investigations Department in a description of its Speak Up! whistleblower service. “They are very courageous people and we are extremely grateful to those who contact us. It is therefore WADA I&I’s responsibility to reassure them, guide them, embolden them and protect them throughout the process. While some whistleblowers choose to go public through the media, the vast majority choose not to have their identities divulged and they continue on with their lives unchanged while also exposing wrongdoing. In the latter case, we are their voice and we will never reveal who they are.” 

But there’s a caveat to that. If you’re guilty of an ADRV, WADA won’t protect your anonymity, as the Magness episode illustrates. No wonder athletes prefer to go to the media.

USADA’s frustration at this immense stupidity is palpable in the Addendum it insisted that WADA publish to its Report. USADA wrote to WADA and requested amendments to reflect its ‘immense effort’ in pursuing Salazar and Dr. Brown. 

It pointed out that the CAS had found that ‘Salazar’s conduct in relation to his Tampering ADRV demonstrated an intentional and orchestrated scheme to mislead USADA, which was completely inconsistent with his obligations as a coach and Athlete Support Personnel. Such conduct requires strong condemnation and cannot be tolerated in the fight against doping.’ USADA added that it had not charged ‘Witness A’ before the conclusion of the case because such a course would ‘undermine the trust between USADA and the Whistleblower and deter future Whistleblowers from coming forward’. 

To be clear, the World Anti-Doping Code doesn’t allow a whistleblower who is guilty of an ADRV to be issued with no sanction. Its Whistleblower Program outlines that sanctions may be reduced for ‘substantial assistance’. The World Anti-Doping Code clarifies that a maximum of three quarters of an applicable sanction can be removed in cases of whistleblower assistance.

Luckily, Magness is unlikely to be put in any danger by WADA’s insistence on telling USADA to complete its job under the Code. The same cannot be said for all cases involving doping whistleblowers, as the Russian State doping saga illustrated.

‘To protect the rights of athletes’ is USADA’s mission, according to its strategic plan. WADA’s mission is ‘To lead a collaborative worldwide movement for doping-free sport’. 

In its zeal to ensure that its rules are enforced, WADA has taken subtle action to remove the anonymity of a whistleblower that helped remove abusive people from sport. Doing this will discourage whistleblowers from reporting doping and abusive practices to anti-doping authorities. Perhaps WADA needs to take a closer look at USADA’s mission statement.