Therapeutic Use Exemptions (TUEs) allow players with legitimate medical conditions to participate equally in elite sport. There can however be a perception that players who are using exempt medications are potentially cheating, and that TUEs could give an unfair advantage to some players. This FastFact is based on a paper that reviewed eight years of data at the Olympic games to see if those who had been granted a TUE were more likely to win a medal1.
The World Anti-Doping Agency (WADA) is responsible for maintaining the list of prohibited substances in sport. This list includes many common therapeutic agents used in legitimate medical conditions. While there is a clear need to have sports competition be fair and clean without performance-enhancing substances, it must also be ensured that players with medical conditions are not unfairly excluded. TUEs allow players who fulfill strict criteria to be prescribed these medications and to compete on the international stage.
In this paper data is presented from all TUEs recorded at WADA from 2010-2018, as well as data from the International Olympic Committee (IOC) for all athletes who competed at the five Olympic Games during the same period. The data included only those drugs that were prohibited at the time of each of the Games. A limitation of the study, that is relevant to football, is that data was restricted to athletes competing in individual sports. This is because it is hard to distinguish the impact one athlete with a TUE would have on the results of team competitions.
Where an athlete competed in more than one Games, or in more than one event, each was counted separately. The countries athletes competed for were classified into categories according to resource availability for each country (defined by Olympic team size and their annual gross domestic product in 2017). This accounts for the hypothesis that higher resourced countries were more likely to have athletes diagnosed with valid medical conditions, and have a TUE applied for and granted.
Results were reported in relation to athlete competitions (ACs) which was defined as one athlete competing in one event. The probability of winning a medal with a TUE versus that of winning a medal without a TUE was calculated for each event. Firstly, very few athletes had TUEs. Athletes competed with a TUE in only 0.9% of ACs. Secondly, the results demonstrated that athletes from lower resource countries were less likely to have TUEs than athletes from better resourced countries. This likely reflects access to medical services and highlights potential inequity. Finally, it was also shown that the risk ratio for the probability if winning a medal among athletes with a TUE over those without a TUE was 1.07. This suggests there is little evidence that having a TUE increases the likelihood of winning a medal.
The results of this study largely refute the notion that holding a valid TUE may provide athletes with a performance enhancing effect, highlights potential inequity of access to medical care and also demonstrate that only a small percentage (<1%) of athletes compete with a TUE.
1. Vernec A, Healy D Prevalence of therapeutic use exemptions at the Olympic Games and association with medals: an analysis of data from 2010 to 2018 British Journal of Sports Medicine Published Online First: 06 May 2020. doi: 10.1136/bjsports-2020-102028