WADA study reveals no meaningful link between TUEs and the likelihood of winning an Olympic medal

There is no meaningful association between an athlete having a Therapeutic Use Exemption (TUE) and winning a medal at the Olympic Games, according to a study carried out by the World Anti-Doping Agency (WADA) and recently published in the British Journal of Sports Medicine.

The study, conducted by WADA Medical Director, Dr. Alan Vernec, and WADA TUE Manager, David Healy, examined the prevalence of athletes with TUEs at the five summer and winter Olympic Games between 2010 and 2018 and looked for an association to determine if those with TUEs won more medals than those without.

Dr. Vernec said: "The percentage of athletes with TUEs competing in elite sport and the association with winning medals has been a matter of speculation in the absence of validated competitor data. The Olympic Games provides a unique opportunity to analyze sport at the highest level with a clearly defined group of competing athletes.

"The data showed that the number of athletes competing with valid TUEs (in individual competitions) at the selected Games was less than 1%. Furthermore, the analysis suggests that there is no meaningful association between competing with a TUE and the likelihood of winning a medal."

A TUE is special permission granted by Anti-Doping Organizations (ADOs) to an athlete allowing them to use a prohibited substance as long as there is a legitimate medical need. TUEs are only granted by ADOs following a robust review process, under the terms of the International Standard for TUEs (ISTUE), including an evaluation by a panel of physicians on the medical relevance of the request in an anti-doping context. Granted TUEs are then subject to further evaluation by other relevant ADOs and WADA, which reviews the TUEs granted by World Anti-Doping Code Signatories and has the right to appeal in case of any non-conformity with the ISTUE.

Dr. Vernec added: "The TUE Program is a necessary part of sport allowing athletes with legitimate medical conditions to compete on a level playing field. It has overwhelming acceptance from athletes, physicians and anti-doping stakeholders, and there is a stringent process in place to avoid abuse of the system. The results of this study provide objective data to dispel some of the misunderstandings and misgivings surrounding TUEs."

The researchers used the competition results and WADA’s TUE database to identify the number of TUEs for each athlete competition (defined as one athlete competing in one event) and any associations with medals among athletes competing in individual competitions. They calculated risk ratios for the probability of winning a medal among athletes with a TUE compared with that of athletes without a TUE. They also reported adjusted risk ratios controlling for country resources, which is a potential confounder. This reflects the fact that athletes from countries with greater resources may produce better performances due to other factors such as access to superior training facilities, medical care, coaching etc.

During the five Olympic Games between 2010 and 2018, there were 20,139 athlete competitions and 2,062 medals awarded. Athletes competed with a TUE in 0.9% (181 out of 20,139) of athlete competitions. There were 21 out of 2,062 medals won by athletes with a TUE. The risk ratio for winning a medal with a TUE was therefore 1.13 (CI:0.73-1.65 p=0.54) and the adjusted risk ratio was 1.07 (CI: 0.69-1.56 p=0.73).

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