Br J Sports Med 42:944-945 doi:10.1136/bjsm.2008.053371
  • Editorial

Why glucocorticoids should be removed from the World Antidoping Agency’s list of banned products

  1. John W Orchard
  1. University of Sydney, Australia
  1. John W Orchard, Sports Medicine at Sydney University, Cnr. Western Ave. & Physics Rd., University of Sydney NSW 2006, Australia; jorchard{at}
  • Accepted 10 September 2008
  • Published Online First 29 October 2008

Sports medicine clinicians and researchers should all be familiar with the concepts of false positives and false negatives. Research to test a hypothesis about a link between, say, a risk factor and a disease can potentially be wrong in either of two ways. The findings might falsely show a link when in reality one does not exist (a type I or α error), or they might fail to show a link when there really is one (a type II or β error).1 2 Hopefully most of the time, if studies are well conducted, the likelihood of both of these errors is reduced.

Similar errors in both directions can potentially occur in drug testing in sport, although the nature of false positives and false negatives is somewhat different from that in other clinical testing. The rigorous methods of collection and the use of “A” and “B” samples mean that many sources of potential laboratory error are minimised. The false positive and false negative phenomena in doping may be better referenced to the athlete’s intent to cheat using performance-enhancing drugs. An athlete who takes a so-called “undetectable” anabolic steroid is a true “drug cheat”, but one who might produce a “false-negative” drug test because the structure of the undetectable drug is not yet known by the testing authorities. By comparison, the athlete who inadvertently takes a banned drug (particularly one with minimal performance-enhancing potential) not to cheat, but to treat a legitimate medical condition, may test positive in a doping test. Such a result may be considered a “false positive” with respect to intent to cheat using a performance-enhancing drug, even though the testing process was accurate in finding the drug in the athlete’s system.

Intent to cheat is so difficult to prove or disprove that WADA takes a pragmatic approach …

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