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By Chelsea Little

Ever since Therese Johaug tested positive for the banned steroid clostebol – and said that it was an ingredient in a lip medication that she had been given by a team doctor – one question has kept bugging me: how could this happen?

Johaug is among the most famous cross-country skiers in the world. She has seven World Championships gold medals, a relay gold from the 2010 Olympics, and two other individual medals from the 2014 Olympics. She has been at the top of her sport for years and earns commensurate income.

And more than that, she is part of the Norwegian ski team, that organization whose staff size – coaches, directors, and trainers, ski technicians, doctors, a marketing manager (just for cross-country!) and a longtime professional media attaché – makes the U.S. or Canadian teams look like your middle school basketball squad.

Now, thanks to that positive test, Johaug is set to miss the 2018 Olympics. Depending on whether she wants to keep racing as long as Marit Bjørgen has, that may mean the end of her dream to have an individual Olympic gold medal.

This piece is not about whether 18 months is the right length for Johaug to sit out from competition. It’s an attempt to answer that perplexing question: how the heck did she end up testing positive at all?

The decision recently issued by the Court of Arbitration for Sport (CAS) details some of the checks in place on the Norwegian ski team to make sure that mistakes are not made.

That’s a good start. But after this point a breakdown happened. And thanks to the decision, we know how, with more specificity and explained in English.

The story does not look good. It starts in Livigno, Italy, with a team doctor (Fredrik Bendiksen) buying two lip creams at a pharmacy.

“On 3 September 2016, Dr Bendiksen purchased two non-prescription pharmaceutical products at a local pharmacy, Keratoplastica and Trofodermin,” the CAS decision states. “He noted that Trofodermin contained the antibiotic neomycin.”

This was important: Bendiksen wanted the antibiotic in order to treat oozing sores on Johaug’s lips caused by a sunburn.

“Once he had noted the Trofodermin contained Neomycin, he did not conduct any further inspection of the packaging and did not make the connection between Clostebol and the Prohibited List,” the decision later noted. “He did not notice the doping warning on the box. He then put the box in a carrier bag, where it remained until he handed the box to Ms Johaug. In normal circumstances, he would always conduct an internet search to verify the safety of any product. He cannot explain why he overlooked the presence of Clostebol and surmises that he failed to detect it due to the stresses affecting him.”

This is surprising. But was already known, as Johaug blamed her doctor from the start and he no longer has a position with the ski team.

The CAS decision continues: “Ms Johaug took the box containing the Trofodermin cream to her hotel room. She removed the tube of cream and the accompanying insert. She noticed the insert was in Italian but threw it away as she did not understand it. She did not inspect the box and threw it away without noticing that the box carried a red ‘doping warning’ on the side. Ms Johaug used the cream from 4 to 15 September 2016.”

That would come back to haunt her. At the opening of the CAS hearing, “[the International Ski Federation] FIS introduced as an exhibit a Trofodermin box displaying the doping warning.”

Ouch – cold as snow, FIS.

More than Bendiksen’s negligence, Johaug’s carelessness is, or should be, especially surprising, for a few reasons.

First of all, “check your medications” is hammered into the heads of athletes, certainly in North America and western Europe.

The high-profile case of Evi Sachenbacher-Stehle, a former Olympic gold medalist who was disqualified from the 2014 Olympics due to contaminated supplements, most recently reminded athletes of the consequence of taking a banned substance by accident.

And Johaug’s own team had recently been through a drugs scandal with Martin Johnsrud Sundby, which should have made all – doctors and athletes alike – more conscious of their obligations and protocols.

The decision noted that by asking Bendiksen whether the cream was “safe” – he reportedly replied that “this cream is not on the doping list” despite not checking – Johaug was fulfilling her contractual obligation to her team.

And in fact, it’s a smart provision in an athlete contract. But doctors are human. They aren’t flawlessly-functioning robots with encyclopedic knowledge of the Prohibited List and a wireless connection to their brains. Humans make mistakes, so the Norwegian team’s system is not perfect.

Relatedly, Johaug’s contractual obligation to her team is not the same as her responsibility under the World Anti-Doping Agency’s rules (called the Code), which is to personally check everything herself.

The Code stipulates that athletes must “take responsibility, in the context of anti-doping, for what they ingest and use,” and “take responsibility to make sure that any medical treatment received does not violate anti-doping policies and rules adopted pursuant to the Code.”

And yet, from Johaug’s team at the tribunal: “Ms Johaug has vigorously submitted that she conducted herself with a great level of care and even went beyond what could ordinarily be expected of someone in her circumstances.”

Beyond what could be expected? Great level of care?

Even I have heard anti-doping personnel say – often in the news after a scandal – “don’t trust anything just because it is given to you by a doctor.”

And WADA’s “Athlete Reference Guide to the 2015 World Anti-Doping Code,” easily available online, says right on page seven, “It is not a defense to an anti-doping rule violation that, for instance, someone in your entourage or camp gave you a substance…”

As FIS argued, “Ms Johaug implies that her contractual obligations… oblige her to ‘blindly follow the doping-related information from her team doctor’. This is misleading in several respects… nothing in Ms Johaug’s contract required her to deviate from strictly observing her personal duty to make sure no prohibited substance entered her body… On the contrary, Article 5.2.1 h. of her contract explicitly reminds her of her doping-related duties.”

If the Norwegian ski team does not remind athletes of their responsibilities under the WADA Code, and instead relies on its internal system and vast staff which coddle top athletes, it should take a good hard look at its culpability in Johaug’s mess.

(In the decision, there is a note that Johaug only took Anti-Doping Norway’s e-learning test after the positive test arose – not a good indicator of the level of education she received, although who is to blame for that is unclear.)

If the ski team did educate athletes and Johaug simply relied totally on Bendiksen anyway, she should own up and rescind the puzzling claim that she went above and beyond all expectations in her diligence.

Before progressing further I have to admit that, in my past, I took medication from a coach without checking the ingredients against the Prohibited List. I asked what was in it and what the purpose was, and then I took it. So in one sense, I get it.

But there are a few differences: I was 22 and fresh out of college, and Johaug is 29. I had never been drug tested (and never would be, because I wasn’t competing at a high enough level), whereas Johaug had reportedly passed 140 doping tests. I never had to fill out a whereabouts report, which is a constant reminder that one is under anti-doping surveillance, whereas Johaug surely logged her trip to Livigno in the whereabouts database before it happened. And I had never received training about how to check the legality of medications.

That’s not to excuse my behavior – although there almost certainly was nothing banned in my medication, I should have personally made sure before taking it (and checked with a doctor!). I am ashamed that I didn’t fulfill my responsibility to others and to my own health those years ago.

But I’m mentioning this for two reasons. The first, of course, is to admit that I’m being a bit hypocritical.

The second is because I think it’s an instructional example. That behavior is already deemed poor coming from a very mediocre, new-to-full-time-training U23 – and it’s even more confusing coming from someone like Johaug, who won her first World Championships gold in 2011, has been a senior top-level athlete for years, and should definitely have known better how important such precautions can be.

But enough about that. The second surprising aspect of Johaug’s tossing of the medication package is that checking whether a medication is banned could hardly be called difficult.

For Johaug (and Bendiksen), the ingredient was right there on the packaging. A website called Global DRO is free and available to anyone, and lets you type in a medication and see if it is prohibited. A check of “clostebol” gives a pretty clear result.

(It’s true that the website asks for where you are located, and only has a subset of countries as possible answers; that is for users who want to type in the name of their medications, like Trofodermin. The results are always the same for individual ingredients/substances like Clostebol, so users could select any country and use it in this manner.)

And finally, the decision is obviously a summary of proceedings written by a different party and cannot be used to infer Johaug’s attitude or state of mind, but throwing away medication packaging because she couldn’t read it simply seems careless and perhaps even arrogant.

There is a tool called Google Translate, and other tools called smartphones and laptops. Most of us use those tools every day.

Furthermore, “clostebol” is the same in several languages as it is the name of a substance. As CAS writes, “The Panel also observes that the front of the Trofodermin tube clearly indicates ‘Clostebol acetate’ as an ingredient. There was no need even to consult a long list of ingredients to know the important active ingredients in the product.”

Thus, “I don’t understand Italian” is a shockingly naïve defense.

“Although an athlete may not always be expected to follow all the steps outlined in [a prior CAS case], in every circumstance, the Panel finds it striking that Ms Johaug did not perform the most important of them,” CAS wrote in its decision. “She was given the packaging of the Trofodermin but did not conduct even a cursory check of the label. Had she done so, she would most likely have noticed the doping-related warning on the box. Instead, she threw away the box and the accompanying leaflet.”

The takeaway is this.

The Norwegian ski team had a good system to try to prevent mistakes that could lead to costly and embarrassing positive tests. But either the team itself, or individual athletes, became too reliant on this system. They stopped believing that doctors are human and that mistakes happen. They apparently forgot that if they do happen, it is the athlete who bears responsibility. By trusting someone completely, you are taking a big risk.

It’s very unfortunate.

As much as Johaug touts that her situation is crazy and unique, in fact such cases have come to CAS several times before.

In all of them, the jurisprudence has established that “athletes always bear personal responsibility and the failure of a doctor does not exempt the athlete from personal responsibility… An athlete cannot abdicate his or her personal duty to avoid the consumption of a prohibited substance by simply relying on a doctor… It has been consistently held in CAS decisions that an athlete cannot delegate away his or her responsibilities to avoid doping.”

In other words: there is no such thing as a mistake. Mistakes have consequences. That should strike care into the actions of all athletes, if not fear into their hearts.

Comments

comments

3 Responses to “How the Heck Did This Happen? Detailing Johaug’s Breakdown of Responsibility”

  1. David George Says:

    Thanks for the extensive analysis. I’ve just come back from Italy and you can buy a lot of drugs over the counter that would require a prescription in my home country (France).
    However the “doping” sign is obvious on the packets I bought and would be hard to miss for a pro athlete.

    Is the story of sun-cream just a convenient story for Clostebol taken in some other way, either accidentally or deliberately as part of a doping programme? The Ventoline case in Norwegian skiing doesn’t build confidence. If I understood correctly the amounts detected were minimal.

    If it is an accident, then it is a big shame that Johaug is missing the Olympics, for us as well as her. However WADA has been tough on other athletes, it can hardly go easy on Johaug.

  2. Matthew T. Pauli Says:

    The Red Circle / over “DOPING” is not clear whatsoever. It can mean either it does not contribute to doping or do not use since it is a doping product. A review of the Italian packaging intent would be needed. Is it a common labeling convention? Does or is it suppose to mean that this is a “DOPING” product? The parties involved needed to review the INGREDIENTS list. I only say this because a necessary part of my regular job in fatality and catastrophe inspections requires the review of equipment and instructional controls, labeling, placement, movement, color, ease of initiation, training and so on. Needless to say, I have seen the aforementioned as contributing factors in every investigation I have conducted in my career as an occupational safety and health professional.

  3. Roger Says:

    Missing in all this – and what makes the doping rules dubious in the way they are enforced – is even the lack of any claim that what she took could have served as a performance enhancer.

    The irony – and apparent injustice – in all this is that Sharapova can get her suspension reduced by CAS even though the only medical evidence she presented for taking Meldonium, which she admits using as a performance enhancer, was “daddy says,” while Johaug by all indications could get no benefit from the lip cream, yet has her suspension extended. Doesn’t exactly promote respect for such a system.