Fancy Bears and Fancy Questions

Who would have guessed protesters charging the Dancing With the Stars stage wearing anti-Lochte T-shirts and the Fancy Bears hack team leaking the confidential medical records of Olympians are the two dominant post-Rio narratives?

Putting aside Lochte's "road to redemption" tour after embarrassing himself and insulting most of Brazil, the more complicated storyline is the green light to take banned substances by the World Anti-Doping Agency (WADA) revealed by the hackers.

The using of medications to improve performance is not new. The testing of athletes for drugs to gain a competitive edge is relatively new to professional and Olympic athletes. The granting of a special therapeutic-use exemption to competitive athletes is an even more recent phenomenon.

These changes came about in response to public outcry over lack of credibility and accountability in professional and Olympic sports drug protocols.

For example, ten years ago, Major League Baseball conducted its first investigation on performance-enhancing drug use and identified 89 doping offenders. The list included the names of prominent players like Barry Bonds and Roger Clemens. Under the threat of Congressional action to enact a sweeping anti-doping policy or else, baseball complied. The negotiated agreement covers a list of banned substances, testing protocols, penalties, and due process rights.

Baseball's drug-use policy also contains an exemption category for therapeutic use (TUE). Congress held another hearing after the drug policy went into effect. It discovered that 26 major league ball players claimed an exemption for attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD). A year later, the number rocketed to more than 100.

Stimulants, like Adderall, Dexedrine, and Ritalin, are commonly prescribed drugs for an attention deficit disorder diagnosis. These medicines contribute to athletes' energy level and performance. Players that qualify for the exemption avoid a mandatory two-year suspension. No lab test exists to diagnose this medical condition. Today, nearly 10% of all major league ballplayers claim ADHD and ADD related exemptions. And this is just one category of performance enhancing substances.

How many of these athletes are gaming the system to receive performance improving prescriptions for substances that otherwise are banned?

Fancy Bears illegally obtained and published private medical records of dozens of Rio Olympic athletes who obtained TUEs. Olympic sports officials quickly defended these athletes on the grounds the athletes adhered to the global rules for obtaining permission to use drugs needed because of their medical conditions.

Their earnestness to strongly condemn the publication of privileged medical information fails to address an equally serious issue. Do any of these high-performing athletes take advantage of a global system that gives them a legal advantage to play well, but not fair?

In Olympic competition, either the sport's international federation or its national anti-doping agency acts as the initial review body for a therapeutic use application. In tennis, the International Tennis Federation (ITF) is the preferred sports body players turn to for a banned substance waiver. It's no wonder because the ITF approves over fifty percent of all requests. Additionally, about half of all ranked professional tennis players enjoy a TUE.

The Fancy Bears leaks targeted three prominent US tennis stars that received exemptions to use drugs through the ITF. The 31-year-old US Open Doubles winner Bethanie Mattek-Sands won a gold medal in Rio after receiving permission to take a steroid to treat an adrenal insufficiency. Earlier, but not during the Rio Olympics, the ITF granted her request for DHEA.

Here's the concern over permitting an Olympic athlete to turn to DHEA to increase muscle power, provide energy, assist in adrenal gland build up, or strengthen the immune system. According to WADA, "the use of an androgenic pre-cursor such as DHEA carries a significant ergogenic potential with performance enhancing consequences across virtually every sport." And as athletes age, their natural production of testosterone declines, which can cause fatigue, loss in motivation to compete, and a decline in performance.

The hacked WADA database release revealed the winner of 22 Grand Slam championships, Serena Williams, received an exemption to use for therapeutic purposes oxycodone and hydromorphone (opioids), prednisone, prednisolone, and methylprednisolone. Her sister, Venus Williams, was approved to take prednisone, prednisolone, triamcinolone and formoterol.

The ITF bears responsibility for carefully examining the justification for each opioid, stimulant, and steroid exemption request. In each instance, these three athletes complied with WADA's guidelines after determining there was no alternative, non-prohibited medication or treatment to alleviate their conditions.

The Olympic athletes "outed" by Fancy Bears did not cheat. They played by the rules, as they exist. The question remains, whether the system enables some athletes to misuse the therapeutic exemption to gain an unfair performance advantage?

The task of differentiating a legitimate medical necessity based on an accurate medical diagnosis against attempts to manipulate the system remains an undisclosed challenge for sports officials.

Fancy Bears hack of WADA files highlights the extensive use of medical exemptions of banned substances for therapeutic reasons. Greater transparency is needed from sports officials. It begins by releasing the types of medicines, medical diagnoses, history of use, number of exemptions denied and granted for each professional and Olympic sport.

The public wants assurances the drug protocols are credible. Athletes want assurances the playing field is level.