The case revolves around Mr. J., a Danish Paralympic shooter with muscular dystrophy and dilated cardiomyopathy, who required the use of Carvedilol, a beta-blocker prohibited in shooting sports, for his medical condition. The dispute centered on the International Paralympic Committee's (IPC) refusal to recognize Therapeutic Use Exemptions (TUEs) granted to the athlete by Anti-Doping Denmark (ADD) and the World Anti-Doping Agency (WADA). The athlete had been granted TUEs since 2010, allowing him to compete while using Carvedilol, which was essential for his cardiovascular stability and life-saving treatment. However, the IPC refused to recognize these TUEs in 2012 and 2014, citing the performance-enhancing benefits of beta-blockers in shooting sports, as established in prior Court of Arbitration for Sport (CAS) rulings. The IPC argued that beta-blockers could reduce tremor, anxiety, and skeletal muscle tension, providing systemic performance benefits, even for Paralympic athletes who use support stands.
The case was brought before the CAS, which ruled on several key points. First, it clarified that in Paralympic sports, the relevant "state of health" is not one without any disability but rather the difference in the athlete's condition with or without the necessary medication. Second, it confirmed that the applicable standard for assessing performance-enhancing factors is the "balance of probability" test. Third, it emphasized that all four criteria under Article 4.1 of the WADA International Standard for Therapeutic Use Exemptions (ISTUE) must be met for a TUE to be granted, with the burden of proof lying on the athlete. The CAS panel retained discretion to grant a TUE if these criteria were satisfied.
The athlete's medical condition was severe, with muscular dystrophy causing progressive muscle weakness and cardiomyopathy reducing his heart function to a 25% ejection fraction. Carvedilol was deemed essential to prevent life-threatening complications, and discontinuation was not medically advisable. Despite IPC's concerns about performance enhancement, the CAS panel considered the athlete's specific circumstances, including his reliance on support stands in competition, and ultimately ruled in his favor. The decision highlighted the need for individualized assessments in TUE cases, particularly for Paralympic athletes with complex medical needs. The ruling also encouraged further research into whether beta-blockers have different systemic effects in Paralympic shooting compared to able-bodied shooting.
Medical experts testified that Carvedilol's primary role was cardio-protective, helping manage the athlete's dilated cardiomyopathy and muscular dystrophy. They argued that any potential reduction in heart rate would only compensate for the disadvantage caused by his heart condition, not provide an advantage over other athletes. The experts noted that Carvedilol has minimal effects on tremor and anxiety in this athlete due to his lack of muscle strength. The respondent's expert, Prof. Pope, countered that while the arguments were plausible, they remained speculative, highlighting the lack of definitive studies on Carvedilol's effects on tremor and anxiety. However, the panel found no contradictory evidence and concluded it was highly unlikely that Carvedilol enhanced performance through tremor reduction or anxiety relief.
The CAS panel distinguished this case from previous ones where beta-blockers were found to enhance performance in athletes with different medical conditions. In this case, the athlete's muscular dystrophy and lack of competitive advantage set it apart. The panel criticized the WADA Therapeutic Use Exemption Committee (TUEC) for applying an incorrect standard—requiring performance-enhancing effects to be "categorically excluded" rather than "highly unlikely." The panel concluded that the athlete had met the burden of proof, demonstrating that Carvedilol's therapeutic use did not enhance performance beyond compensating for his medical disadvantage.
The CAS ruled in favor of the athlete, setting aside the IPC’s decision of 19 August 2015 and WADA’s decision of 3 December 2015. The athlete was granted a TUE permitting the use of Carvedilol at a dosage of 25 mg twice daily for four years. The decision ensures the athlete can continue necessary treatment while maintaining consistency with prior WADA decisions and addressing the critical medical needs of his condition. The case underscores the complexities of balancing therapeutic needs with anti-doping regulations, particularly in sports where even marginal performance effects can influence outcomes. It also highlights the importance of individualized assessments for athletes with disabilities,