Objectives The percentage of athletes with Therapeutic Use Exemptions (TUEs) competing in elite sport and the association with winning medals has been a matter of speculation in the absence of validated competitor numbers. We used International Olympic Committee (IOC) and World Anti-Doping Agency (WADA) data to identify athletes competing with TUEs at five Olympic Games (Games) and a possible association between having a TUE and winning an Olympic medal.
Methods We used the IOC’s competition results and WADA’s TUE database to identify the number of TUEs for athlete competitions (ACs, defined as one athlete competing in one event) and any associations with medals among athletes competing in individual competitions. We calculated risk ratios (RR) for the probability of winning a medal among athletes with a TUE compared with that of athletes without a TUE. We also reported adjusted RR (RRadj) controlling for country resources, which is a potential confounder.
Results During the Games from 2010 to 2018, there were 20 139 ACs and 2062 medals awarded. Athletes competed with a TUE in 0.9% (181/20 139) of ACs. There were 21/2062 medals won by athletes with a TUE. The RR for winning a medal with a TUE was 1.13 (95% CI: 0.73 to 1.65; p=0.54), and the RRadj was 1.07 (95% CI: 0.69 to 1.56; p=0.73).
Conclusion The number of athletes competing with valid TUEs at Games is <1%. Our results suggested that there is no meaningful association between being granted a TUE and the likelihood of winning a medal.
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Contributors Each of the authors contributed to the writing and revision of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests AV and DH both work for the World Anti-Doping Agency.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Unfortunately we are not able to make the information publicly available. The Games data were obtained from a third party, the International Olympic Committee. The Therapeutic Use Exemptions data are sensitive medical information from the World Anti-Doping Agency (WADA) Anti-Doping Administration and Management System database and are subject to the WADA International Standard for Protection of Privacy on Privacy and Personal Information.
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