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How a medicine became a banned drug, and tripped tennis player Maria Sharapova

Like all things associated with the tennis world’s biggest brand, meldonium too has benefited Sharapova. It is now among the most-searched on Google; it’ll no longer be just another hard-to-pronounce word in medical journals.

Written by Shivani Naik | Updated: March 9, 2016 7:12:56 am
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What is meldonium that Maria Sharapova tested positive for?

The chemical name of meldonium is mildronate. It is manufactured by Grindeks, a Latvian pharmaceutical company, and is used to treat ischemia, a condition in which body tissues are deprived of blood supply, causing a shortage of oxygen and glucose. According to Sharapova, she was taking the drug, prescribed by her family doctor, for the last 10 years. It is widely available over the counter across east Europe and Russia, but is not approved by the US FDA. It gives sufferers of heart and circulatory conditions more “physical capacity and mental function” — and a similar boost to healthy people.

Why was it banned by WADA?

Because it aids oxygen uptake and endurance, and several athletes have been caught using it. It was previously monitored by the World Anti-Doping Agency (WADA), and added to its list of banned substances on September 16, 2015 — effective starting January 1, 2016. WADA classifies the drug as a “metabolic modulator”, like insulin. A December 2015 study in the journal Drug Testing and Analysis said that meldonium “demonstrates an increase in endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system (CNS) functions”.

Where did Sharapova fail the test?

The testing sample was taken on January 26, the day she lost to World No. 1 Serena Williams in the quarterfinal of the Australian Open. WADA’s analysis returned a positive for meldonium. Sharapova was subsequently charged on March 2. WADA had sent her an email on December 22 informing her of changes to the banned list, but according to Sharapova, she didn’t “click” on the link.

Who else has failed this drug test?

One of the world’s top ice dancers, a former European champion who was part of the Gold winning Russian team at the 2014 Winter Olympics, Ekaterina Bobrova, told Russian media that the positive test was “a big shock”. Russian cyclist Eduard Vorganov tested positive last month. In 2013, Swedish media reported that 2013 1,500 m world champion Abeba Aregawi had tested positive for meldonium. Two other cases involved Ukrainians competing in the winter sport of biathlon.

Meldonium was banned on January 1. Meldonium was banned on January 1.

What is Sharapova’s excuse?

She said, “I was getting sick very often. I had a deficiency in magnesium. I had irregular EKG (electrocardiogram) results, and I had a family history of diabetes and there were signs of diabetes.” She said that for 10 years, meldonium was not on WADA’s banned list and she had been “legally taking that medicine for the past 10 years”. “But, on January 1, the rules changed and meldonium became a prohibited substance, which I had not known.”

Does the excuse stand?

WADA declared the decision to ban meldonium on its web site more than three months before the ban, and it was also announced by the Russian anti-doping agency. Her admission that she had missed “opening the email” points to an epic oversight. The plot thickens because Grindeks, the Latvian company that manufactures meldonium, told The Associated Press that the normal course of treatment is 4-6 weeks — not the 10 years over which Sharapova says she used the substance. “Treatment course can be repeated twice or thrice a year,” the company said in an emailed statement. “Only physicians can follow and evaluate patient’s health condition and state whether the patient should use meldonium for a longer period of time.”

What are drugmakers saying about meldonium’s performance enhancing capabilities?

While Grindeks has previously said the drug can provide an “improvement of work capacity of healthy people at physical and mental overloads and during rehabilitation period”, it said on Tuesday that it believed the substance would not enhance athletes’ performance in competition, and might even do the opposite. “It would be reasonable to recommend them to use meldonium as a cell protector to avoid heart failure or muscle damage in case of unwanted overload,” the company told The AP.

So, is meldonium a bad word now?

A sizable minority of athletes was using it before it was banned. In October, the US-based Partnership for Clean Competition, an anti-doping group, said meldonium was found in 182 of 8,300 urine samples from athletes as part of a study part-funded by it. It is too much of a coincidence that they all suffered from the same ailment. WADA confirmed that since meldonium was put on the banned list, it has been found in 55 samples.

What will Sharapova do now?

Former UK Sport anti-doping chief Michele Verroken says she could receive some leniency if she can prove she needed to take meldonium for medical purposes. Verroken told BBC Radio Five Live: “The challenge facing Maria Sharapova and her team is to bring forward the diagnostic evidence that she has a condition that required the prescription of this treatment.”

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