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A decision of the supreme international sports arbitration tribunal (the CAS in Lausanne) has recently pronounced on the admissibility or inadmissibility of beta-blockers in the shooting sports.

The importance of this decision (both in its procedural and its material aspects) cannot be overestimated.

Link to the full-text decision follows below:

http://www.tas-cas.org/d2wfiles/documen ... 201948.pdf

Regards,
Alexander

We need to remember that this case regarded the non-issue of a TUE under the International Paralympic Committee's anti-doping code.

They are not linked in any way to the ISSF.

It is interesting to note that whilst the ISSF rules previously stated that TUEs for beta-blockers would not be granted or accepted, that changed in the 2009 rules to:-

"Therapeutic Use Exemptions for Beta-Blockers will be granted by the ISSF only under strict guidelines and under extremely exceptional medical circumstances."

I don't know if anyone has yet tested the "extremely exceptional medical circumstances" but it wouldn't surprise me of they were as likely as hell freezing over.

I did recently discuss with some of the ISSF docs what these circumstances might be (reason for the inquiry was an unconcluded South African doping case). It boils down to veterans class, and to maximally national competitions, not international ones.

The importance of the CAS decision lies in the long and extensive medical argument contained therein, which is fully valid for (and transferable to) the proper ISSF rulework as well.

Alexander

In this case , was the athlete already taking beta blockers and then wanted to start to shoot competitively in the international arena? The pdf says he's been on them for a long time, I assume a period of several years. It would seem that indeed, shooting at local/state competitions you will never be tested, you would only need the TUE to "get around" the pee test that is inevitable at international comps (especially if you place) and perhaps national level events.

My opinion on doping is simple. If I'm shooting on the line in a significant competition, I would like to be on a level playing field. If the guy next to me has an exemption for betablockers, then he has an unfair advantage. Now if instead he's decided to snort coke or smoke some meth, or have 5 cups of coffee, that I don't care about, because it will only degrade his performance potential. No unfair advantage.

Does that seem too "black and white" without gray areas? Of course in real life there are many gray areas but anytime lawyers get involved we have to be very specific.

Lilly wrote:In this case , was the athlete already taking beta blockers and then wanted to start to shoot competitively in the international arena? The pdf says he's been on them for a long time, I assume a period of several years.

His TUE was denied. Under his (rather compelling) circumstances and given the denial, I doubt there could be any conceivable set of circumstances where a TUE for beta blockers would be granted (unless beta blockers somehow became allowed for everyone).

In a nutshell, CAS said the burden is on the athelete to show that the drug gives him/her no advantage. If the drug is banned, it's because it does give humans in general some advantage over those not taking them. Proving specific and different in vivo effects on an individual in particular is, as a practical matter, virtually impossible and in a case where it were possible would confirm no advantage.

I had recently tried to summarize the decision, using lay language. I am not sure whether I succeeded, I am not always good at "dumbing down".

What the tribunal said, was in essence:

1. They were not competent to hear such an adversarial dispute when jurisdiction is not agreed upon, but if both parties consent, they accept this as competence by consent (like in a mediation).

2. Burden of proof in case of therapeutic use exemptions is on part of the athlete.

3. This means: the athlete must positively PROVE that the ingestion of a forbidden substance does not in any way alter his performance positively / favourably. Or in other words: he must PROVE that the medication's effects on him or her will not be a grain more than merely the remedy of an illness's symptoms or debiliation.

4. In the case of beta-blockers, the CAS itself sifted the available medical evidence and the various expert opinions, including newly adduced evidence. They found that beta-blockers are typically likely to produce positive side effects beyond a mere reduction of heart rate, and that these secondary effects would constitute an illicit advantage.

5. Therefore, the shooter would have to prove beyond resaonable doubt that in his specific case no positive side effect whatsoever (e.g. steadying of hand, less muscle tremor) would be expected. This is typically impossible to prove. And was not proven in this case either.

6. Therefore, the appeal of the shooter (against a refusal of a therapeutic use exemption) was rejected, and the negative IPC and WADA decisions were upheld by the CAS.

Alexander

It's sort of interesting that one must prove that there is no performance benefit, when in reality WADA provides no such proof to actually put a substance on the list in the first place. Most substances on the list are there because of theoretical or anecdotal improvement of performance and many others are on there simply because they can be used as masking agents or for moral standards.

I cannot say how it is for "most" substances. But for beta-blockers, the positive effect (not only on shooting) is pretty well documented, and the CAS panel deals with that in some extent.

Alexander

It is Alexander? Where are the double blind studies on top athletes as to the effects of the drugs on performance, I've never seen them? That's how efficacy in the drug world is proven in drugs. The only one that I've seen is a very recent one that was done on HGH, on recreational athletes, that did show some appreciable gain in performance yet even the studies authors didn't want to extrapolate this to elite athletes. As far as I'm aware most drugs on the list are on there because of how they potentially work in sick and ill people and theses results are extrapolated to healthy individuals.

I'm in no way doubting that PED's exist but arguing this perception that the science on PED's is some how complete, or has even started or been attempted on many drugs.

The science most likely won't ever exist as no one wants to subject otherwise healthy individuals to the potential negative side effects of many of these drugs.

Richard, et.al.

I Googled this and found this reference. While not very recent, it no doubt is one that has been looked at. It also reminded me of a session at an ISSF Coach course, that Dr. Loesel (long time medical chief for ISSF) had done some studies on the efficacy of the use of beta blockers in 1976 and 1977. They were either double blind or supposed to be double blind (that probably means that it leaked out which athletes were getting what). The samples were small but in the 1976 study there was no statistically significant difference between the two groups. Though there was a placebo effect. The 1977 study showed that there was a significantly greater calming effect on the pulse rate than the placebo.

I know there is a wish on most everyone's part to stay active in our great sport and that it is indeed possible to do so even at an advanced age. (Which I seem to be approaching rapidly.) But, it is the rule. If I may, this probably has more to do with protecting those who do not have a medical need for beta blockers than trying to eliminate those who need them to live.

Marcus

J Appl Physiol. 1986 Aug;61(2):417-20.

beta-Blockade used in precision sports: effect on pistol shooting performance.
Kruse P, Ladefoged J, Nielsen U, Paulev PE, Sørensen JP.

Abstract
In a double-blind cross-over study of 33 marksmen (standard pistol, 25 m) the adrenergic beta 1-receptor blocker, metoprolol, was compared to placebo. Metoprolol obviously improved the pistol shooting performance compared with placebo. Shooting improved by 13.4% of possible improvement (i.e., 600 points minus actual points obtained) as an average (SE = 4%, 2P less than 0.002). The most skilled athletes demonstrated the clearest metoprolol improvement. We found no correlation between the shooting improvement and changes in the cardiovascular variables (i.e., changes of heart rate and systolic blood pressure) and no correlation to the estimated maximum O2 uptake. The shooting improvement is an effect of metoprolol on hand tremor. Emotional increase of heart rate and systolic blood pressure seem to be a beta 1-receptor phenomenon.

PMID: 2875053 [PubMed - indexed for MEDLINE]

3. This means: the athlete must positively PROVE that the use of a eyeglasses does not in any way alter his performance positively / favourably. Or in other words: he must PROVE that the vision correction effects on him or her will not be a grain more than merely the remedy of an illness's symptoms or debiliation (myopia).

4. In the case of eye glasses, the CAS itself sifted the available medical evidence and the various expert opinions, including newly adduced evidence. They found that eyeglasses are typically likely to produce positive side effects beyond a mere being able to see the target, and that these secondary effects would constitute an illicit advantage.

5. Therefore, the shooter would have to prove beyond resaonable doubt that in his specific case no positive side effect whatsoever (e.g. drive safely, does not shoot the competitor next to them) would be expected. This is typically impossible to prove. And was not proven in this case either.

While I was on beta blockers for almost two years (long story), my heart rate was still 80 bpm and my blood pressure was 130 over 80. Obviously the beta blockers were significantly helping my performance - hardly. Heck, I could barely get through the day because I was so exhausted.

Now that things are corrected and I'm not nearly as medicated, my pulse is still 80, but my BP is certainly lower. Do I have a competitive advantage now?? Sorry, couldn't resist.

This is a re-post of a post that I made here in 2008. There is scientific research, including blind studies, regarding the utility of beta-blockers in shooting:

Back when the U.S. NRA actually published research on shooting, they produced the following book: Landers, Daniel M. (ed), and Hunt, Karen J. (ed), Shooting Sports Research, Education and Training Division, NRA, 1988. The book has not been available from the NRA in some years, and no follow-on volumes were produced, although it was supposed to be the first in a series of volumes on shooting sports research. The book was a compendium of serious, world-wide, research articles on various aspects of competitive shooting. Two articles "The Benefits of Oxprenolol in Skill Sports" and "Psychic Conditions and Oxprenolol" discussed the possible positive advantages to a competitive shooter in using Oxprenolol, a beta-blocking drug. The studies found that beta-blockers reduced strong psychic stress, without reducing skill performance abilities, in sports where aerobic endurance was not a factor in performance. Tranquilizers - including ethol alcohol - on the other hand, reduced stress, but also reduced performance. Among the tests noted was one conducted by Dr. Laslo Antal, the noted British pistol shooter, coach and author, using the British national pistol squad in 1980. I'll quote from the abstract of Antal's tests:

"Results showed that on 40 mg dosages of oxprenolol, slow fire scores averaged 2.9 points above those who were given the placebo....On 80 mg doses of oxprenolol..., the average score was 3.4 points above those who were given the placebo....analysis further showed that the number of 'wild' shots (outside the nine ring) significantly decreased on both dosages of oxprenolol." Oxprenolol was much more effective with slow fire scores than with rapid fire scores.

Since finals at major world slow-fire shooting events are settled by much closer scores than these, the potential advantages are clear. The article "The Benefits of Oxprenolol in Skill Sports" went on to state:

"Shooters on oxprenolol generally reported less nervousness before shooting, higher assessments of well-being, and better concentration during shooting. The improvement in scores and subjective feelings tended to be more dramatic in those with lower scores when not on the drug. The drug reduces the cardiovascular and the metabolic effects of stress, so it would seem likely that those who were more affected by stress...might derive relatively more benefits from beta-blocking drugs."

A pasted in note in Shooting Sports Research indicated that the International Shooting Union and International Olympic Committee had concluded that Beta-blockers could be an artificial aid and had banned them.

Several other articles on the subject:

Krause, P., Ladefoged, J., Nielsen, P. E. P., & Sorensen, J. P., "Beta Blockage Used in Precision Sports: Effects on Pistol Shooting Performance", Journal of Applied Physiology, 61, (1986), pp. 417-420.

S'Jongers, J.J., Willain, P., Sierakowski, J., Vogelaere, P., Van Vlaenderen, G., & De Rudder, M. (1978), "Effects of Placebos and of Small Doses of a Beta Blocker (Oxprenolol) and Ethyl Alcohol on the Precision of Pistol Shooting. Bruxelles medical, 58 (8), 395 399.

Schmid, P. (1990), "The Use of Beta Blocking Agents in Competitive Sports," Wiener Medizinische Wochenschrift, 140 (6 7), 184 188.

Siitonen, L., Sonck, T., & Janne, J. (1977)., "Effect of Beta Blockade on Performance: Use of Beta Blockade in Bowling and Shooting Competitions," Journal of International Medical Research, 5359 366

Regards,

Don

Richard H wrote:It's sort of interesting that one must prove that there is no performance benefit, when in reality WADA provides no such proof to actually put a substance on the list in the first place. Most substances on the list are there because of theoretical or anecdotal improvement of performance and many others are on there simply because they can be used as masking agents or for moral standards.

Exactly. Can anyone suggest that taking any drug in the "stimulant" category would assist scores in a positive manner? It's the opposite of a betablocker, I'd like to see the results of the British team on a few doses of meth. I'm thinking its not going to be +3 points.

Also, was there testing with ethyl alcohol versus placebo? How did that go? AFAICT there is no max blood alcohol level for issf. Presumably if you aren't in danger of tipping over on the line or doing something incredibly unsafe with the gun this would seem to the route of the "legal" drug taker?

Don wrote:This is a re-post of a post that I made here in 2008. There is scientific research, including blind studies, regarding the utility of beta-blockers in shooting:

Thanks very much to Don for the very substantial repost. I take the liberty to include the link to the mentioned thread, which remains quite informative in our context:
http://www.targettalk.org/viewtopic.php?p=93414

Alexander

Lilly wrote:Also, was there testing with ethyl alcohol versus placebo? How did that go? AFAICT there is no max blood alcohol level for issf. Presumably if you aren't in danger of tipping over on the line or doing something incredibly unsafe with the gun this would seem to the route of the "legal" drug taker?

I recollect that Modern Pentathlon competitors used to consider a beer a normal pre-shoot prep.

Richard H wrote:<snip> As far as I'm aware most drugs on the list are on there because of how they potentially work in sick and ill people and theses results are extrapolated to healthy individuals.

I'm in no way doubting that PED's exist but arguing this perception that the science on PED's is some how complete, or has even started or been attempted on many drugs.

The science most likely won't ever exist as no one wants to subject otherwise healthy individuals to the potential negative side effects of many of these drugs.

You forget that (almost) all drugs are tested on heathy human volunteers before going into patients and so that information is out there already. There are a number of clinical trials databases freely accessible to all, if you care to do the searching for anything specific.

Rob.

Is this to see if there are any side effects of the drug on healthy people first.Colin