It Was Manslaughter

by Savannah

The ITF released it’s long anticipated ruling in the doping case of Maria Sharapova this morning. Needless to say there won’t be anything else discussed in the tennis universe for quite some time.

I recommend that every fan of tennis pour a glass of wine (or spirts if that’s your choice), turn off all distractions and read the entire ruling. It is damning of Maria Sharapova, her father Yuri, and her manager Max Eisenbud. Reading it you find that while Ms Sharapova employed a nutritionist and various other staff to keep track of her well being and compliance with anti doping laws (a sample is provided in the 33 page PDF is Eisenbud contacting the powers that be about a nasal spray that had been prescribed for Sharapova) but none of the staff outside of the player, her father and agent, knew that meldonium had been prescribed by a Russian doctor in 2006. Ms Sharapova left that doctors care in 2013 and no attempt was made by her or anyone in the know to have her assessed by a cardiologist or any medical professional who would’ve been able to determine if the use of meldonium should be continued.

Some excerpts:

16. In 2004, at the age of 17, Ms Sharapova won the women’s singles championship at
Wimbledon. In 2005 she was suffering from frequent cold-related illnesses, tonsil issues and
upper abdomen pain. Her father took her to be examined by Dr. Anatoly Skalny of the
Centre for Biotic Medicine in Moscow, which describes itself as specialising in system
diagnostics and treatment of medical imbalances.

17. The evidence from Dr. Skalny is that having conducted a detailed examination, considered
the family medical history, which included type II diabetes and heart disorder, he caused a
number of specialist consultations and analyses to be carried out which indicated, inter alia,
elevated glucose and cholesterol levels and mineral imbalances. Dr. Skalny concluded that
his patient had a mineral metabolism disorder, insufficient supply of nutrients from food
intake and other abnormalities which made it necessary to boost the immune system. He
proposed a detailed medicinal and nutritional regime which at the outset comprised about
18 medications and supplements.

21. The evidence before the Tribunal includes a report of Dr. Ford Vox who has analysed Dr.
Skalny’s diagnosis and treatment. Dr. Vox says that the diagnosis was immune deficiency,
mineral metabolism disorder and asthenia, ie. loss of energy. He states that the Russian
scientific literature supporting Mildronate’s clinical use to compensate for an immune deficiency is strong.
He does not state that Dr. Skalny actually diagnosed cardiovascular disease, the primary indication for the use of the drug, or diabetes, which is not listed as an indication by the manufacturers of Mildronate. But he does express the opinion that Dr.
Skalny was, in the light of Ms Sharapova’s family history, justified in prescribing Mildronate
both as a cardioprotective agent and as a preventative agent for diabetes. However it is
important to note that Dr. Skalny was not a cardiologist nor did he advise that Ms
Sharapova had a cardiac condition which required specialist medical attention. Having
reviewed the ECG results Dr. Skalny did not require a treadmill test, or any other standard
diagnostic approach, which would have been the next logical step if a significant cardiac
condition was suspected.

26. By the end of 2012 Ms Sharapova had decided to follow a different approach to her
nutritional intake. She found the taking of lots of pills overwhelming and she thought there
was a better way to handle her health than by taking a large number of pills 10. So she
retained a nutritionist, Nick Harris, as part of her team and ceased to follow the regime
prescribed by Dr. Skalny. She informed Dr. Skalny that she was not going to continue
working with him 11.

27. However Ms Sharapova took her own decision to continue to use 3 of the substances
previously recommended by Dr. Skalny, namely Magnerot, Riboxin and Mildronate.
Magnerot is a mineral supplement which contains magnesium. Riboxin contains inosine, a
natural compound which may have some anti-ischaemic benefit. That decision to continue
to use those 3 substances from Dr. Skalny’s list of 30 was taken without the benefit of any
medical advice, either from Dr Skalny or from any other medical practitioner. So Ms
Sharapova did not seek any advice about the therapeutic need to continue using Mildronate,
nor the possible side effects of doing so. She did not know the ingredients of Mildronate and
had not read the manufacturers’ instructions for use 12.

28. When asked in evidence to explain why she particularly selected these 3 substances she
stated that she believed that Dr. Skalny had put special emphasis on those substances to
protect her heart and for her magnesium deficiency 13. However her evidence is that she had
not discussed specific substances with Dr. Skalny during his treatment 14 and she does not
recall having had any discussion with Dr. Skalny about her decision to continue using
Mildronate 15. When asked why she did not consult any other doctor for advice about her
continuing use of the three substances 16 she stated that she did not need another doctor to
oversee her medical or health plan, but instead hired a nutritionist 17. However she did not
inform her nutritionist that she was continuing to take Mildronate 18, or, it seems, Magnerot
or Riboxin

29. After Ms Sharapova ceased in early 2013 to be under the care of Dr. Skalny there is no
evidence that any medical practitioner was consulted about or prescribed the taking of
Mildronate, or that the use of Mildronate was disclosed to any of the medical practitioners,
with one exception, who were consulted by Ms Sharapova between 2012 and 2015. During
this period Ms Sharapova was under the general care of her family doctor in California to
whom she would go for treatment when she became sick. She also relied on the medical
practitioners provided by the WTA from whom she would seek medical advice when she
suffered injury or became sick in competition. She also underwent MRI scans and ECG tests
and examination by a number of specialists during this period, particularly in 2015. To none
of the medical practitioners or specialists who treated her over 3 years did she disclose the
fact that she was taking Mildronate. Her explanation in evidence is that none of them had
asked what medication she was taking 19.

There is this comment, one of many asides in the PDF, about what was going on around Ms Sharapova regarding her medical status.

The underlying factual puzzle in this case is how an elite player in the position of Ms
Sharapova, with the assistance of a professional team including the very best sporting and
medical advice obtainable, could ever have placed herself in the position of taking a
Prohibited Substance, as is admitted, before each of the five matches she played at the
Australian Open. The case advanced for the player in her written submissions did not
explain why, even if Ms Sharapova was not personally aware of the inclusion of Meldonium
on the 2016 Prohibited List, her team did not warn her. Mr. Eisenbud’s first witness
statement, at paragraph 20, gave the clear impression that if any member of her team had
discovered that Meldonium had been added to the 2016 Prohibited List then the player
would have ceased to use Mildronate. He characterises this as an administrative error, for
which he takes the blame, but without explaining how it happened. It only emerged in
evidence at the hearing that no member of Ms Sharapova’s team, apart from Mr. Eisenbud,
actually knew that she was taking Mildronate.

The panel accepted the argument that had she known the substance had been banned she wouldn’t have taken it. It’s always been said that ignorance of the law is no excuse. If I go out and bash someone in the head just for the hell of it and say that I didn’t know hitting the person in the head so hard would kill them I’d still be in jail for a considerable length of time. But the jury may decide that the offense was manslaughter and not intentional murder since I didn’t know the person I randomly assaulted. This is what the panel decided in the case of Ms Sharapova.

I urge you to take your time and read the PDF. This is the link: http://www.itftennis.com/media/231178/231178.pdf

It’s a very sad day for tennis.

Of course Ms Sharapova has indicated that she will appeal the ruling. I think she does so at her own risk. The last paragraph of the report reads as follows:

Conclusion

104. The contravention of the anti-doping rules was not intentional as Ms Sharapova did not
appreciate that Mildronate contained a substance prohibited from 1 January 2016. However
she does bear sole responsibility for the contravention, and very significant fault, in failing
to take any steps to check whether the continued use of this medicine was permissible. If she
had not concealed her use of Mildronate from the anti-doping authorities, members of her
own support team and the doctors whom she consulted, but had sought advice, then the
contravention would have been avoided. She is the sole author of her own misfortune.

As the old people used to say “don’t press your luck”.

©Savannahs World 2016 All rights reserved except where indicated

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