The Landscape of the "Spirit of Sport" : A Systematic Review.

The World Anti-Doping Agency (WADA) sets out a detailed description of what its own conception of the "spirit of sport" as employed in the World Anti-Doping Code (WADC) entails. However, controversies as to the significance and meaning to be ascribed to the term abound in the literature. In order to unravel the core of the debates and to move discussions forward, the authors aimed at reviewing understandings of the spirit of sport in the conceptual literature. The main databases were searched using relevant keywords. After the inclusion and exclusion criteria were applied, eighteen publications were included in the review. The most striking result to emerge from the data is the multivalence of the concept of spirit of sport. Our thematic analysis generated the contestability of the spirit of sport as the predominant theme in the conceptual literature. There is a need for empirical research to generate data about perspectives on the spirit of sport from other stakeholders especially those of the athletes themselves.

Treating the elite athlete: anti-doping information for the health professional.

Physicians and health professionals are a vital component in preserving the integrity of competition and the core principles of true sport. When treating an athlete, health professionals need to be cognizant of the anti-doping rules of the relevant sport organization. This review aims to provide an overview of the World Anti-Doping Agency Prohibited List, Therapeutic Use Exemptions, roles and responsibilities of the health professional, as well as provide resources that will guide their work with athletes.

Women with hyperandrogenism in elite sports: scientific and ethical rationales for regulating.

The recent implementation by some major sports-governing bodies of policies governing eligibility of females with hyperandrogenism to compete in women's sports has raised a lot of attention and is still a controversial issue. This short article addresses two main subjects of controversy: the existing scientific basis supporting performance enhancing of high blood T levels in elite female athletes, and the ethical rationale and considerations about these policies. Given the recently published data about both innate and acquired hyperandrogenic conditions and their prevalence in elite female sports, we claim that the high level of androgens are per se performance enhancing. Regulating women with clinical and biological hyperandrogenism is an invitation to criticism because biological parameters of sex are not neatly divided into only two categories in the real world. It is, however, the responsibility of the sports-governing bodies to do their best to guarantee a level playing field to all athletes. In order not cloud the discussions about the policies on hyperandrogenism in sports, issues of sports eligibility and therapeutic options should always be considered and explained separately, even if they may overlap. Finally, some proposals for refining the existing policies are made in the present article.

Between medical treatment and performance enhancement: an investigation of how elite athletes experience Therapeutic Use Exemptions.

BACKGROUND: Athletes can be allowed to use substances from the prohibited list (the doping list) if they have a medical condition. If so, a Therapeutic Use Exemption (TUE) is required. The boundaries between the use of pharmacological substances due to a medical need and doping are sometimes blurred. Although manipulating the system of TUE granting potentially represents an entry stage for doping, few studies examine how athletes perceive TUE management and relate this to current anti-doping policy. METHODS: 645 Danish elite athletes (mean age 22.12, SD=5.82) representing 40 sports completed a web-based questionnaire about their experience and perception of TUE (response rate: 43%). RESULTS: 19% of the respondents had been granted a TUE. 85% of athletes granted a TUE regarded their use of the TUE system as necessary to compete on equal terms with other athletes. Administrative hurdles for TUE prevented 7% of athletes from applying. 53% of the athletes considered that being "allowed" to dope by means of a TUE was of importance for their (hypothetical) wish to try out doping. 51% believed that athletes in their sport received TUEs without a medical need. Athletes granted TUEs had more than twice as high odds to distrust the efficacy of the system than athletes never granted a TUE. The belief that TUEs were misused was especially common among endurance athletes, regardless of them having experience with TUEs or not. 4% believed it would be okay to receive a TUE without a medical need. CONCLUSION: The results confirm that TUE is a problem in anti-doping policy. The fact that distrust in TUE administration increases once an athlete has experience of TUEs represents a challenge for anti-doping policy. We suggest more critical research on TUEs be carried out in order to improve harmonization and increase transparency in the regulations.

Human genetic variation: new challenges and opportunities for doping control.

Sport celebrates differences in competitors that lead to the often razor-thin margins between victory and defeat. The source of this variation is the interaction between the environment in which the athletes develop and compete and their genetic make-up. However, a darker side of sports may also be genetically influenced: some anti-doping tests are affected by the athlete's genotype. Genetic variation is an issue that anti-doping authorities must address as more is learned about the interaction between genotype and the responses to prohibited practices. To differentiate between naturally occurring deviations in indirect blood and urine markers from those potentially caused by doping, the "biological-passport" program uses intra-individual variability rather than population values to establish an athlete's expected physiological range. The next step in "personalized" doping control may be the inclusion of genetic data, both for the purposes of documenting an athlete's responses to doping agents and doping-control assays as well facilitating athlete and sample identification. Such applications could benefit "clean" athletes but will come at the expense of risks to privacy. This article reviews the instances where genetics has intersected with doping control, and briefly discusses the potential role, and ethical implications, of genotyping in the struggle to eliminate illicit ergogenic practices.

Return-to-play decisions.

Concussions occur as a result of forces directed to the head or neck, or from impulsive forces transmitted from the body to the head. They result in the rapid onset and spontaneous recovery of short-lived impairment of neurologic function. Concussions represent a functional, rather than structural, disturbance, and do not result in abnormalities on standard structural imaging. This article discusses a comprehensive approach to return to play in sports concussion, including managing athletes returning after prolonged postconcussion syndrome, multiple concussions, and intracranial hematomas and craniotomy.

A false start in the race against doping in sport: concerns with cycling's biological passport.

Professional cycling has suffered from a number of doping scandals. The sport's governing bodies have responded by implementing an aggressive new antidoping program known as the biological passport. Cycling's biological passport marks a departure from traditional antidoping efforts, which have focused on directly detecting prohibited substances in a cyclist's system. Instead, the biological passport tracks biological variables in a cyclist's blood and urine over time, monitoring for fluctuations that are thought to indirectly reveal the effects of doping. Although this method of indirect detection is promising, it also raises serious legal and scientific concerns. Since its introduction, the cycling community has debated the reliability of indirect biological-passport evidence and the clarity, consistency, and transparency of its use in proving doping violations. Such uncertainty undermines the legitimacy of finding cyclists guilty of doping based on this indirect evidence alone. Antidoping authorities should address these important concerns before continuing to pursue doping sanctions against cyclists solely on the basis of their biological passports.

White Anglo-Saxon hopes and black Americans' Atlantic dreams: Jack Johnson and the British boxing colour bar.

This article examines the controversy surrounding Jack Johnson's proposed world heavyweight title fight against the British champion Bombardier Billy Wells in London (1911). In juxtaposing African Americans' often glowing discussions of European tolerance with the actual white resistance the black champion faced in Britain, including the Home Office's eventual prohibition of the match, the article explores the period's transnational discourses of race and citizenship. Indeed, as white sportsmen on both sides of the Atlantic joined together in their search for a "White Hope" to unseat Johnson, the boxing ring became an important cultural arena for interracial debates over the political and social divisions between white citizens and nonwhite subjects. Although African Americans had high hopes for their hero's European sojourn, the British backlash against the Johnson-Wells match underscored the fact that their local experiences of racial oppression were just one facet of a much broader global problem. At the same time, the proposed prizefight also made the specter of interracial conflict in the colonies all the more tangible in the British capital, provoking public discussions about the merits of U.S. racial segregation, along with the need for white Anglo-Saxon solidarity around the world. Thus, this article not only exposes the underlying connections between American Jim Crow and the racialized fault lines of British imperialism, but it also traces the "tense and tender ties" linking U.S. and African American history with the new imperial history and postcolonial studies.

Legal nutritional boosting for cycling.

Several nutritional strategies have been used in cycling to improve performance. Carbohydrate feeding during exercise has been shown to be effective, but recent studies have suggested that recommendations may have to be adjusted to take into account recent findings. Protein co-ingested with carbohydrate during exercise has received a lot of recent interest, but the evidence is equivocal, at best. Thus, in the absence of a plausible mechanism, it is difficult to see how protein would increase endurance performance. There also has been a lot of interest in training with low glycogen to maximize training adaptations, but the longer-term effects upon performance are still unclear. Various supplements have been suggested to improve endurance performance, but most of these nutrition supplements lack the scientific support that would warrant the recommendation.

Physical enhancement of human performance: is law keeping pace with science?

In the area of genometry-the nascent field of science and technology that proposes to apply enhanced understanding of the human genetic code to reshaping our individual and collective destinies-no topic has generated more interest among the general public, as well as in the athletic community, than the potential for physical enhancement of the human body and its performance. Genometric experiments have produced physically enhanced mice, and the production of similarly enhanced humans may not be far off. Although it is not the objective of most genometric research, the day will come when gene-based "treatments" will enable individuals to build muscle or increase endurance faster than is possible through conventional methods. This article describes developments in the area of physical enhancement that may find application in the "gene doping" of athletes. For example, human performance-related genes may be delivered to athletes using tools developed for research in gene therapy; the protein products of these genes may be administered in recombinant form; and recently discovered small-molecule activators of the major genetic regulatory pathways of physical prowess may be taken orally, providing "exercise in a pill". This article also describes US and international attempts to regulate and punish the use of prohibited techniques for performance enhancement among athletes. As science advances, defining and detecting "gene doping" becomes increasingly complex. Thus, the study of physical enhancement provides an ideal starting point for the interdisciplinary Redefined Destinies Colloquium's examination of the intersection between law and science.