the sharapova scandal

by now, you have likely heard of the latest maria sharapova news. the professional tennis player and former world #1 has tested positive for performance enhancing drugs. in a press conference on monday, sharapova admitted to taking a substance that has been placed on the banned substance list in the previous year. she claims that the drug in question, meldonium, was prescribed to her for legitimate medical concerns, a claim we will revisit in a moment. unfortunately for sharapova, both her and her medical team say they were unaware of the ban on the drug and therefore made a mistake in continuing to administer it. it is clear a mistake was made, but the regret is not for the drugs use.

wada stated that this substance was placed on the banned list for several reasons, but a primary concern was that the drug had been abused by athletes for a long period of time. with this high-profile case, it turns out those concerns were completely founded. for healthy athletes, meldonium acts as a carnitine inhibitor, through the inhibition of a carnitine biosynthesis enzyme.

although the inhibition of carnitine suggests an impaired aerobic performance, this reduction in fatty-acid metabolism can increase the efficiency of ATP generation by preferentially metabolizing carbohydrate, both through carnitine inhibition and increased hexokinase expression (1). this enables athletes to reduce mitochondrial stress during long duration activities and results in increased endurance performance, improved rehabilitation following injury, general stress protection and possibly increased central nervous system function. clearly, this drug has huge ramifications for medium-long duration aerobic load sports such as professional tennis.

now, the question is, did maria sharapova have a legitimate medical reason for taking meldonium? her explanation in the press conference was that her family had a history diabetes and possible mineral deficiencies, which on face value do not validate the drugs prescription. moreover, the stated medical uses for the drug include treating ischemia, neurodegerative disorders, bronchopulmonary diseases and immune disorders. it is highly unlikely that an elite athlete like sharapova would have any of these conditions, providing further speculation that the previous decade of use by sharapova was indeed an attempt to use a then-legal performance enhancing substance.

more than just the spotlight that this shines on sharapova, it is important to also consider how this reflects on the world anti-doping association. the fact that a drug that has clearly been abused by athletes (up to 60 athletes have so far tested positive for the substance) could be permitted for so long, is an obvious and high profile example that just because athletes do not test positive for a banned substance are competing ‘clean’. in the cat and mouse game between anti-doping associations and modern pharmacy, it is much like garfield trying to catch speedy gonzalez.

references

1. görgens, christian, et al. "mildronate (meldonium) in professional sports–monitoring doping control urine samples using hydrophilic interaction liquid chromatography–high resolution/high accuracy mass spectrometry." drug testing and analysis 7.11-12 (2015): 973-979.