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How Russian pharmaceutical sport lost war

Forbidden World Anti-Doping Agency since the beginning of 2016 a heart drug meldonium detected in samples of about a hundred Russian athletes. In particular, it found in the body of the famous tennis player Maria Sharapova, champion skater and Paul Kulizhnikova, Olympic champion in figure skating Yekaterina Bobrova, Olympic champion in short track Seeds Elistratova. And this is just one of a series of doping scandals involving Russian athletes. What is happening and who is to blame?

- Meldonium-mildronate - metabolic drug that improves metabolism, reduces stress on the heart, improves the condition of the vessels and due to this state of the organism as a whole. It is not a stimulant, - explained the "PP" Mehman Mammadov, professor, head of the laboratory evaluation and correction of cardiovascular risk of the State Research Center for Preventive Medicine, Ministry of Health of Russia.

Meldonium hit the WADA list only this year, but was created in the 70s of the last century. Homeland meldonium - Latvia, then still part of the USSR. Almost at once the drug has become almost mandatory for all professional athletes of the Soviet (and later the former Soviet Union). Therefore, it puts a ban post-Soviet and foreign athletes in unequal conditions in the pharmaceutical war for sporting achievements. And it's not that meldonium offers advantages in the results, and that it is guaranteed not to find in the samples of athletes who do not use the help of the Soviet pharmacology.

Holy water

Meldonium registered and sold mainly in Russia and in the territories of the former Soviet Union. In Europe and the US about this drug do not know much, but most athletes enjoy analogues, which are not prohibited.

Not all of those medicines are consumed athletes are necessarily doping. Often this vitamins and various substances which promote recovery of the body after heavy loads. With the amount of work being done by a professional athlete, the body without help simply can not cope. And meldonium long time it was seen as supporting the drug. Its scope is wide: in accordance with the manufacturer, indications for use is the treatment of cardiovascular diseases, abstinence, as well as post-operative period to accelerate rehabilitation. In addition, this facility increases efficiency with the physical and mental overload.

According to Ivar Kalvins, creator meldonium, it protects the development of the human body, which is experiencing a high load, but still the main task of the drug - to treat heart disease. In our country it is even included in the list of vital and essential medicines. But the Soviet certification process has made it vulnerable to global estimates for doping: decision-makers, experts can refer to the lack of study of the drug.

- Any medication should be evidence base. In meldonium it is minimal, because the drug Soviet (he was over 30 years) and clinical trials, corresponding to modern requirements, it is almost not received or not received at all. Meldonium is widely used in cardiology is assigned when a general designate nothing more. As they say, to "improve the metabolism of the heart muscle." It is cheap, it is sold in capsules or capsules white. No harm meldonium can not bring. Checked probably on millions of patients. And if you favor and brings the minimum. Its effectiveness is close to holy water, - says Yuri Shubik, professor, doctor-cardiologist arrhythmology, Head arrhythmology Scientific and clinical and educational center "Cardiology" medical faculty of St. Petersburg State University.

Thus, some experts not only consider meldonium for doping, but in general see it, if not a placebo, it may be harmless, "Vitaminka".

- The drugs are relatively short, - says Yuri Shubik. - When he was appointed to restore the function of the cardiovascular system, for a short time, when a person takes meldonium, there is an effect. Stop taking - and the action stops immediately. On the other hand, no harm removal of the drug also does not work. All the same, as if you stopped drinking green tea and moved to some other.

- As I see it, it can not be called doping - concludes Yuri Shubik. - As a former athlete, I am very bad to doping. But this is clearly not the case.

However, when WADA meldonium included in the list of prohibited drugs, no representatives of the Russian side did not even try to push their counterarguments.

Since the beginning of the year in the use of mildronata (another name meldonium) "catch" more and more athletes. Mainly from the former Soviet Union. The WADA say that registered more than a hundred cases of detection of a prohibited drug present in the blood of athletes. Among them are the stars of the first magnitude.

Maria Sharapova in the story behaved correctly. As soon as it became aware of the results of the first sample, Sharapova, without waiting for the charges, brought together a large press conference and she announced that actually take the drug because of problems with health drinks mildronat for the past ten years, when there was not going to speech of his ban. Now the performance of athletes is an example of "crisis PR" by Western standards, but it is unclear how much love for her public can help in this case.

- I received in September by WADA email, which reported on the inclusion of meldonium the list of banned drugs. But I did not read, - said Maria.

But in the Russian Skating Union guilt they did not recognize - indeed, claim that Semyon and Pavel Elistratov Kulizhnikovu meldonium could pour, with the competitors in the command itself. True or not, but it looks so suspicious message. Figure skater Yekaterina Bobrova wonders how meldonium could get into her body: she and the entire medical team team knew that substance has got into the list of banned this year, and none of the skaters it did not take.

Faithful are athletes or not, but they have already lost in public opinion.

As it was forbidden

Structures WADA decision-making is not very transparent - at least in the case of the ban meldonium. In the first step the agency is a preliminary list of products that may fall under the ban. This usually occurs at the level of advice, and may recommend any member country of the Olympic Movement, including those of competitive reasons (nice and it is logical to prohibit something that you do not use). Sometimes the increased attention to drugs, which are often found in analyzes of competitors: there is always a chance that it's not a coincidence. Particularly if the drug is found in the samples of the suspicious instruction. A Russian team for various reasons, both objective and subjective nature may seem suspicious.

Preliminary list shall notify the athletes, and at this point the athletes, teams, sports federations and national anti-doping agencies need to start worrying. Just because the probability of a ban after being hit in the list is very large.

The next step - the study of these drugs (it is given approximately one year). Generally we need to conduct research in the laboratory by WADA, allowing to establish exactly how the drug affects the performance and the athlete.

Now the Russian side asked for information about this in the WADA; Information about the research is also needed in order to confirm or refute the information about the timing of excretion from the body meldonium athletes. Officially, it is 6-48 hours. But if traces meldonium detected much later, it is possible that the athletes take it before the ban. WADA Director General David Howman says that studies have been carried out, but no matter what documents are not referenced.

- We have conducted a comprehensive study of reliable mildronata before it was added to the list of prohibited substances, - he commented on the suspicions of political bias ban. - All told, that now there is a new list, there are new illegal drugs.

There WADA Code, which contains a clause stating that the decision on the list are not the subject of discussion among athletes and other persons. It is theoretically possible to appeal to the Arbitration Court of the CAS, although it is futile. But appeals to set aside a certain period: 21 days from the date of the decision. In other words, the Russian side is already too late.

It would be possible to somehow influence the situation at the level of Russian representatives in the WADA, for example insist on more precise and transparent investigations still in the first stage of administration in the list. But for some reason this one is not bothered - or in Russian sports officials do not have sufficient voting power or Russian representatives do not work. Probably both.

State of the Russian Anti-Doping Agency (RUSADA) is not such as to help someone other than yourself. As a result of the scandal last year, it was deprived of the license. As already wrote "PP" (number 25 (401) dated 26 November 2015), in December 2014 released a documentary film called Hajo Zeppelta on ARD German TV "Secret doping: as Russia prepares its champions." The main witnesses of the investigation became the wife Julia and Vitaly Stepanov, the former athlete and former officer of the Russian Anti-Doping Agency. It was after the release of the film WADA initiated the proceedings, the results of which was disqualified, all the Russian national team in athletics (the eve of the 2016 Olympics in Rio) and RUSADA lost accreditation. In the report WADA claimed that the admission of doping blame for not only athletes, but also the system doctors and officials.

It is no secret that the sport of high achievement - it is not only coaching and sports technology, but also a medicine to pharmaceuticals. The problem is that Western sports pharmaceuticals, may be supposed to be leaning towards a less dangerous forms of promoting sports results, and Russian sport of high achievement are still adheres tested Soviet methods.

In the world there are two ways of receiving performance-enhancing drugs. First - this is when the athlete himself secretly from all consume illegal drugs. This was the case with the cyclist Denis Galimzyanov, who in 2012 admitted to the use of erythropoietin, refusing doping tests. And the second - when there is a whole system. The chain can be short: the physician-athlete and coach, and can be long, involving corrupt officials in the Anti-Doping Agency and state agencies - is exactly what is trying to accuse Russia of an investigation into the athletics team.

But the system expose rarely - only when its effect becomes quite obvious. So it was with race walking team Russia. For a long time it was thought that only athletes are guilty, even though that was revealed 18 cases of doping pupils head coach Victor Chegin. And only when the retreat has been nowhere, all the sports management center distance Saransk resigned.

Control in Russia carries RUSADA, but it was his, and deprived of the license after the scandal with athletes. Now it is not clear exactly who could fix the violations and help the team to work on removing doping (at least, banned), not to fall in international trials.

It is understood that in Russia there is a problem with the management of activities and the control of illicit drugs. But Maria Sharapova out of the system: it trains in the United States, she has her own medical team. However, the ban meldonium they somehow missed. Perhaps the doctors did not know what it takes Sharapova (because she drinks it for a long time) and buys in Russia (in the United States and some of its purchase especially nowhere).

However, there is another oddity - Trial Kulizhnikova. He doping test first was clean, and the next day - since meldonium, and this despite the fact that he knew about the ban the substance. It is clear that meldonium - not doping, and because it is not exactly worth it to take a risk, especially after you have already served a suspension.

Obviously, the situation requires a thorough investigation teams. Is it possible that the athletes took the drug without knowing it - for example, as part of any support mixes?

What's next

Predict how the situation will develop, until no one can. There is a microscopic chance that the competent work of lawyers and properly structured protection campaign, including around Maria Sharapova, will achieve meldonium exclusion from the list of prohibited drugs. However, WADA has declared that such a scenario is unlikely. In addition, the exclusion of meldonium will likely not allow athletes to avoid punishment according to the law they used the drug when he was on the list of banned.

Another option - to achieve the minimum punishment for athletes (for a period of about four months). Given the extenuating circumstances, such a development is quite real. And the third scenario - the worst: if you have a long time, if ever (in the case of doping Kulizhnikova re) separate from the sports leaders of the Russian team, but at the same time recognize the systemic errors in the management of Russian sports and begin to rebuild the entire system.

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Will Health Care Reform Force You to Pay for Abortions?

Dear Members of Congress and President Obama:

We understand the tremendous task that lies before you as you try to reform our nation's health care system. While there are many concerns that must be addressed when tackling such a gargantuan task, one such concern is of high importance to over 70 percent of Americans. Under no circumstances should taxpayers contributing to any system give up what they have now, which is a firewall between taxpayer funds and abortion. We urge you to follow the example of the Federal Employee Health Benefits system, which excludes coverage for the induced destruction of unborn human life. Because of the many ways health policy can be crafted to finesse this issue, as happened under the health insurance connector in Massachusetts, our position is explicit: "If the legislation that is put to a vote in Congress does not explicitly exclude abortion, it will unquestionably include it and we will oppose it."

Additionally, no health care reform should force participants to perform or be complicit in actions they find offensive. A right of conscience protects physicians and other health providers from being compelled to do things that violate their religious or moral briefs.

Thank you for your efforts on this matter, and may God bless the work you do.

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