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recently, there have been some seemingly incredible cases of athletes testing positive for doping but not being punished. one of them was an american athlete who tested positive for doping and said it was caused by touching a pillow stained with his father's eye drops. he was not banned and successfully participated in the paris olympics.

not long ago, the institute of physics of the chinese academy of sciences also felt that this matter was very strange and posted it on their official account:

just like the previously mentioned case of eating the wrong meat leading to a positive test for steroids (how did an american olympic sprinter test positive for doping after eating meat?), the relevant arbitration documents are public and can be found online. click the original text at the end of the article to read the full text of the arbitration.

according to the arbitration documents, the athlete is named calista liu, who is of asian descent, 18 years old, and a synchronized swimmer. in a urine test sample collected outside the competition on may 13, 2024, she was found to havedorzolamidepositive.

dorzolamide english namedorzolamide, is a carbonic anhydrase inhibitor belonging todiureticsin the field of anti-doping, diuretics are banned drugs. there are two main concerns. first, in weight-classified competitions such as boxing and weightlifting, athletes can use diuretics to lose weight and "downgrade" themselves. second, diuretics can accelerate the excretion of other drugs from the human body, that is, they can be used as a mask for other banned drugs.

a positive diuretic test is a very serious violation. calista should have been suspended. however, after a careful look at the arbitration documents, the matter was far less exaggerated than the hype.

dorzolamide is used in medicine in the form of eye drops to treat glaucoma and reduce intraocular pressure. by the way, the world anti-doping agency (wada) prohibits the use of dorzolamide other than eye drops, but eye drops for the treatment of glaucoma can be used.

dorzolamide is an old drug that was approved by the fda in 1994. it is also widely used. in 2021, it was the 202nd most prescribed drug in the united states, with a total prescription of more than 2 million.

dorzolamide has a characteristic as a drug that has a great impact on anti-doping inspections: its half-life is very long.half-life in blood is 4 monthsthis brings up a problem. as a glaucoma treatment drug, dorzolamide is administered three times a day in each eye, or 4 mg at a time. the dosage is not small. even if it is only used for the eyes, it will accumulate systemically in the blood. the drug test not only shows a positive result, but it can also be detected even after several months.

researchers working on drug testing have pointed this out a few years ago, for example in a paper published in 2021:

it mentioned a polish shooting athlete who was diagnosed with glaucoma in 2016 and used dorzolamide for treatment from may of the same year to february 2017. in july 2017, she participated in the polish shooting championship, which requires athletes to list the medications they have used in the past 7 days or received blood transfusions within 3 months. at this time, she had stopped taking the medication for more than 4 months, and according to regulations, she did not need to list the use of dorzolamide. however, due to the extremely long half-life of dorzolamide, she tested positive for doping.

there is also some very important information: the amount of dorzolamide detected in this polish athlete was 4ng/ml. there is a concept in doping control calledMRLP, is the minimum detection limit that a doping control laboratory must achieve for a certain drug as stipulated by wada. that is to say, if the mrlp of a certain drug is 10ng/ml, and a laboratory says that its detection limit can only be 20, then that is not acceptable, and you have to figure out how to improve the sensitivity; but if two laboratories, one with a detection limit of 10 and the other with a better level and a detection limit of 1, both are qualified in the eyes of wada, and there is no difference.

what is the mrlp of dorzolamide? 200ng/ml. that is to say, any laboratory that can measure 200 will meet the wada standard. but the reality is that the sensitivity of laboratory monitoring of dorzolamide is very good. for example, the polish athletes have a 4ng/ml.much lower than mrlp, it was still detected. if the laboratory had been a little bit worse - not really, but the sensitivity was at the passing line, she would not have been tested positive.

but unless wada has special regulations, mrlp only determines the laboratory qualifications and has nothing to do with reporting positive drug tests. in other words, even if the polish athlete's test level is far lower than mrlp, because this laboratory can detect such a low level, she must report it and start the investigation process of suspected doping violations.

there are also some discussions in anti-doping testing, such as whether drugs with particularly long half-lives need to adjust the standards for positive drug tests. one example is meldonium, which has been listed as a banned drug since january 2016. as a result, wada encountered nearly 200 positive cases in the next four months, many of which were probably used before the ban, but because the half-life of meldonium is too long, it caused "long positives". wada believes that these are not the fault of the athletes and can be exempted from the ban.

by the way, maria sharapova, the former no. 1 tennis player (in terms of appearance), was banned because of a positive test result of meldonium, but she admitted that she was not aware that the drug was banned and did not stop taking it in time. in order to solve the problem caused by the long half-life of meldonium, wada's regulations on this drug are that if the test result is less than half of the mrlp value, 100ng/ml, it does not need to be reported as a positive drug test.

however, there are no regulations on dorzolamide at present, and any test result is considered a positive for stimulants. how much did calista detect?3.6ng/ml. it’s similar to the polish athlete. by the way, the polish athlete was later found to be innocent and did not need to be suspended.

according to calista, her father used dorzolamide eye drops to treat glaucoma from the end of june 2023 to the end of march 2024. her father also confirmed this and another statement of calista, that he would lie in bed and drip dorzolamide every day, and the excess drops would often flow onto the pillow. calista no longer lived at home at the age of 16, but she would go home a few nights a month. she was used to lying on her parents' bed and chatting with her family since she was a child, and she still does so now. she argued that she would be exposed to dorzolamide during this process.

dorzolamide can be absorbed through the skin, coupled with a very long half-life, led the arbitral tribunal to accept calista's defense that there was no fault or negligence.

there are some facts about dorzolamide that also help calista's defense. dorzolamide is available in the united states in the form of eye drops, which is probably the same everywhere in the world. this means that calista and any athlete who is exposed to dorzolamide will basically only be exposed to eye drops. eye drops are almost impossible to use orally as a diuretic, and it is easy to overdose and cause health risks.

in addition, dorzolamide eye drops have another ingredient, timolol, a beta-blocker. the presence of timolol makes it even more unlikely that dorzolamide eye drops will be used as a diuretic, given the side effects of this drug.

moreover, calista is a synchronized swimmer, and the weight loss effect of diuretics is not helpful for the competitions she participates in. the dose of 3.6ng/ml is also far lower than the dose required to cover up other drugs. this value is actually close to the lower limit of laboratory detection. usada informed calista on june 20 that the drug test was positive. before that, on may 31, calista was tested again without knowing that she had tested positive before, and the result was negative. this is also consistent with the previous accidental intake of a small amount of dorzolamide, and not multiple use of the drug as a diuretic or masking agent.

in fact, there is no precedent in the united states or the world for judging dorzolamide eye drops as a diuretic or masking agent. on the other hand, the proportion of dorzolamide in diuretic-positive cases is increasing. perhaps the calista case is not as rare as some speculators think.

taking all this into consideration, the arbitration panel finally concluded that calista had established that it was more likely that she had caused trace amounts of dorzolamide to be detected through repeated skin contact. although she still violated the doping rules regarding the detection of doping (i.e., a record of the violation was left), she was not at fault and did not need to be banned.

finally, diuretic positives caused by factors other than athlete fault, such as contamination, are not limited to dorzolamide. in 2021, wada issued a technical guidance to establish a reporting limit of 20ng/ml for 6 diuretics that may appear as contaminants in other drugs (including prescription and over-the-counter drugs, but this level of contamination does not affect the safety of the drugs). urine tests below this level will not be reported as positive doping. because this dose cannot cover up other drugs, and it may be caused by taking contaminated drugs.

it may seem incredible that a pillow stained with eye drops could lead to a positive doping test, but as sherlock holmes said: when you have eliminated the impossible, whatever remains, no matter how absurd, is the truth.

of course, caslita's eye drops contamination theory is a possibility she established. everyone can have their own opinions and judge whether this possibility is reasonable. however, opinions are best based on facts, especially when some facts are public and not difficult to find.

although the public account is not an academic journal, it is the number one of the xx institute of the x academy of sciences. it is better to verify the facts. for example, it is said that a certain anti-doping organization approves and allows xx athletes to participate in the olympics. no anti-doping organization has the power to allow or not allow any athlete to participate. doping penalties are only proposed by anti-doping organizations. whether to punish and how to sentence are decided by independent arbitration tribunals, which is the case in china, the united states and other countries. in fact, since calista's positive doping test has reached the arbitration stage, it means that usada has accused her of violating doping regulations.

i believe that when x institute of science and technology wrote academic papers in english for foreigners to read, they must have been very careful and feared mistakes. how come such low-level mistakes were made when writing in chinese for chinese people to read? if they were all truly talented and learned but wrote in english for foreigners and used chinese to fool around, what would happen to the domestic ai models that urgently need reliable data training?

references:

https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/dta.3156

https://www.wada-ama.org/sites/default/files/resources/files/tl24_diuretics_eng_2021_0.pdf