Two of the three criteria are necessary to include a substance or method on The List. Currently WADA have three criteria for prohibiting a drug: if it enhances sport performance if it would be harmful to health if withheld or if it is against the spirit of sport. In 2004, the World Anti-Doping Agency (WADA) assumed responsibility for The List from the IOC-MC. Principally, drugs were prohibited because of their capacity to enhance performance. As analytical science improved and with the known misuse of drugs and doping methods by athletes to improve performance, additional classes of drug were added to The List, sometimes before a validated test to confirm their presence had been identified. Generally, an additional sanction was imposed by their sport. From 1968, athletes were required to provide urine samples (termed ‘doping controls’) at Olympic Games and those with prohibited drugs in their urine were disqualified. 1 Initially, only stimulants and narcotics, drugs that could be identified by urine testing, were prohibited. Its first task was to compile, in 1967, The List, which was a list of prohibited substances and methods. However, it was the death of a Danish cyclist at the 1960 Rome Olympics (he was alleged to have taken amphetamine) that provoked the International Olympic Committee (IOC) to establish a Medical Commission (IOC-MC). In 1904, during the third Olympiad of the modern era, Thomas Hicks, a 32-year-old athlete competing for the USA, although born in Birmingham, UK, won the marathon in oppressively hot conditions and was given strychnine (and brandy) during the race by his trainer. The use of drugs to enhance performance at Olympic Games started during the Games in Ancient Greece, when hallucinogens from fungi and possibly strychnine were used by competitors. This paper discusses Olympic athletes who have been known to dope at past Games and some medical indications and pitfalls in the TUE process. To overcome this, in 1992 the IOC introduced a system known now as Therapeutic Use Exemption (TUE). When the International Olympic Committee (IOC) prohibited beta blockers (beneficial in shooting), diuretics (assist weight classified athletes) and glucocorticosteroids, some athletes with genuine medical conditions were denied legitimate medical therapy. As analytical science validated improved techniques to identify these drugs, Olympic athletes, including many medallists were caught and disqualified. Although undetectable until 1975, from the 1950s androgenic anabolic steroids were administered for increased strength and power followed in the 1990s by erythropoietin for enhanced endurance. Stimulants were taken by the first Olympic athletes to be disqualified in 1972. Athletes have always sought to outperform their competitors and regrettably some have resorted to misuse of drugs or doping to achieve this.
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