Cape Town - The South African Medical Association (SAMA) has expressed its "deep concern" regarding the proposed rule changes by the International Association of Athletics Federations (IAAF) to impose an upper hormonal limit for athletes wishing to compete in the female category in international athletics competitions.
In a media release on its official website, SAMA stated:
“We deem the requirement for hormonal manipulation in these athletes unethical and invasive. It runs in stark contrast to the entrenched principle of athletes competing in their natural state. Such rules are - in our view - excessive and would constitute a systematic affront to the dignity of all female athletes,” says Dr Angelique Coetzee, chairperson of SAMA.
Dr Coetzee says in the interest of medical ethics, the medical profession is compelled to denounce any policies in sport, or any other fields, which are not compatible with the basic human rights principles of individual choice, confidentiality, consent, dignity, non-discrimination, and equity. The IAAF and other international sporting bodies should not be allowed to violate these core principles. Any medical decisions and interventions should be based on evidence from well-designed and well-conducted research.
“We are concerned that the arguments by the IAAF for regulating testosterone levels in such athletes are most likely based on a single, flawed study in which reporters were highly conflicted. SAMA urges medical scientists and doctors involved in the IAAF’s medical procedures and tests to pay due regard to scientific rigour, evidence-based practice and medical ethics. Until sound scientific evidence is generated, SAMA dismisses such flawed arguments,” notes Dr Coetzee.
She says the World Medical Association’s (WMA) Declaration of Geneva and its International Code of Medical Ethics require doctors to maintain the highest standards of professional conduct, not to allow their judgment to be influenced by unfair discrimination, to act in the patient’s best interest, and to do no harm. Furthermore, the WMA Statement on Principles of Health Care for Sports Medicine requires that physicians oppose or refuse to administer any such means or method which are not in accordance with medical ethics, and/or might be harmful to the athlete using it, especially procedures which artificially modify blood constituents or biochemistry, amongst others.
“Therefore,” Dr Coetzee adds, “artificially lowering endogenous testosterone in athletes has to be considered unethical. In addition, doctors prescribing treatment of this nature for a condition that is not recognised as a pathology will be in violation of medical ethics.”
Apart from this, Dr Coetzee says it is of concern that medical manipulation in sport is being implemented disproportionally.
“It is baffling that natural advantages in sport are being critiqued for athletics, but not for other sports. Basketball, high jump, and goal-keeping in soccer are examples where acromegaly - a condition responsible for excessive tallness - would confer a clear advantage.”
According to Dr Coetzee this problem also sharply brings to the fore the issue of economic and social injustice.
She says it would appear that better resourced people or societies have more opportunities or exposures to environments that enhance sporting prowess, such as professional training programs. When individuals from such environments compete with those from disadvantaged societies, such as in the case of Ms Caster Semenya, the playing field is obviously not level. It is also concerning that debates on natural attributes such as body shape and genetic composition seem to arise disproportionately more often with successful athletes from low- and middle income countries.
“It be should be an essential principle of sport that athletes must perform in their natural state; unmodified by medical interventions,” notes Dr Coetzee.
SAMA has carefully followed Ms Semenya’s involvement with sex verification policies for the past few years, including her recent high-profile appeal case against the IAFF’s new rules, which were scheduled to come into effect in November 2018. Due to her appeal these are now expected on 26 March 2019.
“We support Ms Semenya in this legal battle and look forward to a successful outcome for her. We urge the IAAF to reconsider their stance on this issue and to rely on better and more extensive research emanating from the world’s greater medical community,’ concludes Dr Coetzee.