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Kraig W. Jacobson, M.D.

Allergy, Asthma & Immunology

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The reasons behind elite athlete disqualification

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Marion Jones competing at Eugene's 2004 Prefontaine Classic in the midst of her fight against the U.S. Anti-Doping Agency.

Track season is under way, and the U.S. Olympic Track and Field Trials in Eugene and the Summer Olympic Games in London will be here before you know it. Some elite athletes with allergy, asthma and related conditions, especially those with grass pollen sensitivities, see our allergy doctors before competitions in our area during high pollen months, not only to relieve their symptoms but also to apply for a Therapeutic Use Exemption (TUE) so they can use certain approved medications during competition.

Given this, you may wonder why some elite athletes are banned from competition. Unfortunately, some athletes use performance-enhancing drugs to gain an advantage over competitors. During the Trials, you will likely hear about an athlete who has been suspended or disqualified for using a banned substance.

You may remember that Marion Jones, the former world champion sprinter who won five medals during the 2000 Sydney Olympic Games, had to forfeit all medals after her 2007 admission that she took performance-enhancing drugs. To prevent doping, urine samples may be frozen and kept for testing for up to eight years after the Olympics. Offending athletes can then have their medals stripped years after competition.

Winning at all costs
In a well-known survey taken in the 1980s called the Goldman Dilemma, Bob Goldman, asked elite athletes if they would take a drug that guaranteed them a gold medal but would also kill them within five years. More than half of the athletes said they would take the drug. He repeated the survey biannually for the next decade and the results were always the same. About half of the athletes would take the drug even if it meant that his or her life would be dramatically cut short.

Categories of concern
The World Anti-Doping Agency (WADA) along with the U.S. Anti-doping Agency (USADA) set standards and publish a list of prohibited substances yearly, especially in Olympic years. We at Oregon Allergy Associates must keep up-to-date and informed on proper procedures to prevent a disqualification or a medal being revoked. A banned substance may even be found in over-the-counter medications, such as decongestants, nutritional supplements and skin creams.

Although not a complete list, here are six major categories that health care professionals must be aware of when supporting elite athletes:

  • Approved for all – These are medications that are approved for human use by the FDA and offer no competitive advantage to the athlete.
  • Approved for all but a limitation on dose – Albuterol, an asthma rescue medication, is one of the most common examples, with a limit of 1,600 micrograms per 24 hours. Therefore, it would take more than 17 puffs of an albuterol inhaler but only two treatments of albuterol solution in a nebulizer to exceed this amount.
  • Approved only with a Therapeutic Use Exemption (TUE) - If athletes need to use cortisone, they must obtain a TUE. However, athletes who are prescribed oral cortisone may take this medication without a TUE as long as the prohibited substance has cleared their system 12 hours before competition.
  • Prohibited for all – A complete list of prohibited substances may be obtained from the USADA. Of course, all anabolic steroid agents are prohibited. Other medications include substances not approved by any governmental regulatory health authority for human therapeutic use, which include those in clinical development, discontinued or veterinary drugs.
  • Prohibited because of masking effects – Diuretics are known to help mask the amount of either prohibited or limited medications in the urine and are prohibited. A recent British study found that green tea may also have a masking effect.
  • IV infusions – Intravenous (IV) infusions of more than 50 cc per 6 hours have been included on the WADA List of Prohibited Substances since 2005. They are prohibited both in and out of competition, except for those legitimately received in the course of a hospitalization or approved clinical investigation.

I hope this review explains more clearly some of the reasons athletes may be disqualified, suspended from competition or have their medal(s) taken away. To our knowledge, no Olympian from Eugene has been disqualified or suspended from the Olympic Games.

Tagged in: Asthma Olympics

An energetic problem solver, Dr. Kraig Jacobson has spent his career treating patients and teaching about the complexities of allergy, asthma and immunology. He has practiced medicine in Eugene since 1979. The bigger the challenge, the more he enjoys his work.