The case of Robert Berger v. the World Anti-Doping Agency (WADA) before the Court of Arbitration for Sport (CAS) centered on the denial of a Therapeutic Use Exemption (TUE) for the beta-blocker Metoprolol, which Berger required for a serious heart condition. As a paraplegic shooter, Berger argued that the medication was medically necessary and that its prohibition under anti-doping regulations endangered his health. The case raised critical issues regarding the interpretation of the IPC Anti-Doping Code, the jurisdiction of CAS to review TUE decisions, and the criteria for granting exemptions.
The CAS panel clarified its jurisdiction under Article 13.4 of the IPC Anti-Doping Code, which permits appeals against WADA decisions reversing TUE grants or denials but not against decisions confirming earlier rulings. The panel emphasized the importance of contractual interpretation principles, noting that clear drafting errors could be corrected but mere suspicion of an error did not justify rewriting the text. The panel confirmed its jurisdiction based on the parties' procedural agreement and asserted its broad authority to review facts and law de novo, including new or previously unavailable medical evidence.
The burden of proof rested on Berger to demonstrate his entitlement to a TUE by satisfying four cumulative criteria under the International Standard for TUEs: significant health impairment without the prohibited substance, no additional performance enhancement beyond normal health restoration, no reasonable therapeutic alternative, and no prior non-therapeutic use of prohibited substances. The IPC and WADA TUE Committees relied on medical literature and their expertise but were required to consider all relevant information, including athlete-specific data. Berger's initial TUE application was rejected by the IPC TUEC, and WADA upheld this decision, leading to his appeal to CAS.
The case highlighted the tension between protecting athletes' health and maintaining fair competition. WADA argued that beta-blockers like Metoprolol could enhance performance in precision sports by reducing heart rate, hand tremor, and anxiety, citing scientific studies. Berger's medical team countered that his heart condition negated any performance-enhancing effects, presenting Holter monitor tests showing minimal heart rate changes. Expert testimony was divided, with WADA's experts emphasizing potential performance benefits and Berger's experts stressing individual variability and medical necessity.
The CAS panel ultimately upheld the TUE denial, concluding that Berger failed to disprove the potential performance-enhancing effects of Metoprolol. The panel affirmed that TUE committees could rely on general medical knowledge alongside athlete-specific evidence, provided their decisions were reasoned and justified. The ruling underscored the high evidentiary burden on athletes seeking exemptions for prohibited substances, even when medically necessary, and reinforced the principle that TUE decisions must align with anti-doping regulations to ensure fair competition. The case set a precedent for the rigorous scrutiny of TUE applications and the balance between therapeutic needs and sporting integrity.