Friday 11 February 2022

Kamila Valieva, trimetazidine and figure skating's elusive quad jumps

Interestingly I was contacted only a few weeks ago by the journalist Sarah Stodola who was writing an article for New York magazine [1] . She asked me whether I thought Russian skaters might be using drugs to enable them to do their quadruple jumps, given how they were so much better than anyone else. I replied that figure skating is not my area of expertise, but I didn’t think there was an obvious drug that would help so specific a goal. Power/weight ratio obviously matters but how that transfers into the number of spins possible (let alone what counts as a full rotation) was outside my expertise. So I didn’t have a view as to what drugs would or wouldn't benefit. And – of course – my view is always to assume an athlete’s innocence until proven otherwise.


My not seeing how drugs might improve figure skating performance doesn't mean people wouldn’t try though of course. Well, now we have the story that a Russian skater  - actually not just any old Russian skater but their golden girl, Kamila Valieva -  tested positive for the banned performance enhancing drug trimetazidine. This anti-angina drug inhibits fatty acid oxidation, allowing the heart to make greater proportion of the more efficient glucose as its metabolic fuel. 


The Russian anti-doping agency (RUSADA) originally banned her, then allowed her appeal the next day. The IOC are appealing the RUSADA appeal decision; the Court of Arbitration for Sport (CAS) will presumably deliver their verdict in the next couple of days


Obviously, this story has hit the news [2]. There’s not a lot I can add to what is being currently discussed until then. Still some points seem relatively uncontentious.




·       The anti-angina drug Trimetazidine has been banned at all times since 2015 [3] as it has the possibility to make the heart use fuel more efficiently. In this it has some features similar to meldonium, a drug that was frequently used by athletes in Eastern Europe until it was banned by WADA in 2016

·       Trimetazidine use within the World Anti-Doping Rules would require a TEU (therapeutic use exemption), presumably given for an athlete suffering from angina. 

·       A TUE seems unlikely for a teenager, but I am not a clinician so cannot really answer to this point

·       It seems unlikely a valid TUE was in place for Valieva or the case would not have got this far. 

·       There are rare circumstances where a positive case can result in a very short ban (or even very unusually no ban). This would require the athlete to provide definitive proof that they were not taking the substance knowingly and that - even then - there was no performance benefit. It is up to the athlete to prove this unequivocally. Ignorance is no defence.

I await the CAS decision with interest.....

[post original blog edit]. In the case of a minor like Valieva,  I have just realised that "strict liability" does not apply as she is a "protected person" under WADA's rules [4].  More flexible sanctioning rules apply to minors (persons under 18) with no requirement to establish how a prohibited substance entered the athlete’s system to benefit from the No Significant Fault or Negligence rule. The Minimum sanction is a reprimand when No Significant Fault is established. So I think this means that even if she does not know how the drug got into her system, she can still get away with just a reprimand. So no suspension for at all. But I’m not a lawyer. I [still] await the CAS decision with interest.....




 [3] Trimetazidine was originally banned as a “stimulant" in 2014. So only banned ”in competition”. But it was reclassified as a “metabolic modulator” in 2015 and thus banned at all times. This has resulted in some confusion in the press yesterday. Under the 2014 rules Valieva would not have been banned as the test was taken on Christmas Day (out of competition). But under the 2015 rules and beyond, she would have been banned. The 2015 change was well publicised. Again ignorance is no defence. Even in high profile doping cases like Maria Sharapova and meldonium, ignorance (arguing her team didn’t check the updated WADA list) only resulted in a shortening of the length of her ban.


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