3 Less Obvious Angles About Amanda Kendall’s Doping Suspension

Editorial content is the opinion of its author and does not necessarily reflect the views of SwimSwam.

Earlier today, SwimSwam reported on the 3-month doping suspension of U.S. National Team swimmer Amanda Kendall. Kendall, her attorney, and USADA all acknowledged her personal fault for the issue, if unintentional, but there are 3 key points to this case that I want to focus on separate from that, which I think are going to be largely overlooked in the typically (and appropriately) ravenous response to any doping case:

1. She didn’t actually fail a test

A percentage of you who are going to comment are going to read this headline, and not this sentence, and perceive this to be excusing her test. This is not that.

The reason this is crucial is that Kendall, who was taking a banned substance, was only caught and punished because she confessed when asked. This story is going to provide incentives for people to lie on their declarations, hoping they won’t get caught, even if scientifically that’s unlikely. She was taking a banned substance 7 days before she was tested, and the test came back clean.

That’s bad news for the integrity of the testing system, if the biggest loophole is “just don’t tell the tester that you’re taking any medicines,” although her confession probably saved her time on her suspension.

2. Inhaler abuse is real in sports

Kendall was prescribed her inhaler by a doctor, for acute, temporary symptoms that it sounds like would benefit from inhaler use.

But, this is a gateway into a broader conversation about inhaler use in swimming.

I got my first taste of this phenomenon when I was in high school and print newspapers were still a thing. The Houston Chronicle ran an investigative story on inhaler in Houston club swim teams, including looking at The Woodlands Swim Team – one of the most successful clubs in the state. The story was done by Richard Justice – now a national baseball writer, but also the parent of a daughter who swam collegiately at the University of Houston. The story involved doctor shopping to find one who would prescribe asthma medicine.

Since then, the problem doesn’t seem to have improved. A recent study by Popular Science found that athletes with asthma are more likely to win medals at the Winter Olympics than athletes without asthma – a counter-intuitive statistic. The study cites a professor at the University of Kent who says that “up to 70 percent” of swimmers have asthma.

The results are inconclusive, but inhaler use is being looked at as a potential culprit for the disparity. According to the CDC, about 8% of Americans have asthma. One could imagine forces of selection bias acting in both directions on the swimming population – asthmatics avoiding the sport because of chlorine’s ability to inflame the condition, or in the opposite direction doctors who recommend swimming as a treatment for asthma in order to help force the lungs to expand.

Full disclosure: I had moderate asthma as a child that at least once required hospitalization, was prescribed swimming as a treatment, along with an inhaler, by a doctor, who was not my mother, who was also a doctor. I don’t remember when I stopped using my inhaler, but it was sometime around age 12 or 13. I still occasionally have mild bouts of exercise or allergy-induced asthma, but have more-or-less outgrown it.

But in either case – the math on numbers of elite athletes diagnosed with asthma just don’t add up, and needs more investigation. Every time this subject is broached, parents come to the comments, saying that anybody who claims inhaler abuse is belittling their child’s condition of “real asthma.” But that’s not what’s actually happening. We’re trying to make sure that healthy individuals aren’t using the condition as an excuse to gain an edge.

3. Comparing the suspension to the last similar TUE violation

The last TUE violation that feels similar to this (the athletes were open about taking a medication, under a doctor’s direction, but failed to take the proper administrative steps) was the case of Brazil’s World Record holder Etiene Medeiros. In 2016, she failed an anti-doping test for asthma medication that she was prescribed by a doctor.

Medeiros did file a TUE, but according to reports, her doctor failed to list this specific medicine among the others she was taking. She was consistent in filing appropriate TUEs throughout the year, but at some point hit an administrative lapse.

Medeiros received just a warning, whereas Kendall received a 3-month suspension.

  • The similarities: both were taking prescribed asthma medications, both of which would have been cleared with proper TUE paperwork.
  • The differences: One case was adjudicated by the USADA, one by the Brazilian Anti-Doping Authority. In Medeiros’ case, she was regularly filing a TUE, while in Kendall’s case, she was not. Kendall’s was prescribed for treatment of bronchitis, an acute condition, while Medeiros’ was for treating an ongoing condition, asthma.

Both stories carry an equal level of credibility, given the respective circumstances, and there are some nuanced differences that can explain the different suspensions. Overall, I would deem these suspensions ‘consistent with each other’ based on the facts presented.

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Sam
6 years ago

The evidence that asthma meds help those without asthma is sketchy at best. The lungs move plenty of air to meet our needs (in a healthy person anyway under normal conditions, i.e, sea level). http://www.cyclist.co.uk/news/4053/salbutamol-can-be-performance-enhancing-says-wada. The amount of a med one needs to take is pretty large to get an anabolic effect—something that is not going to help immediately. http://thorax.bmj.com/content/56/9/675 https://www.outsideonline.com/1783866/will-inhaler-enhance-my-performance

Taa
6 years ago

I feel the system breaks down in this case. You get sick and you skip practice and go see a doctor. It is usually late in the day and now you get a prescription and of course you want to get it filled immediately that day. Can someone explain to me how a TUE would be immediately available in this situation or is it expected that you tell your doctor to give you a less effective medication and risk not getting better? So basically you pay the doctor to diagnose you and prescribe an effective treatment and then you tell them you can’t use it? This makes no sense.

I would also like to comment on getting a TUE for… Read more »

Steph
6 years ago

One of the most interesting articles I have read in a long time. Very informative.

swimmer
6 years ago

I have exercise induced asthma and I really need an inhaler before races however, after reading this, I feel like I will be judged and labeled a cheater by taking an inhaler…

Ummmm
Reply to  swimmer
6 years ago

Absolutely makes me nervous about the same!!! Its hard enough to get especially teenagers to follow medical regiments. The MOST important thing about this condition is to avoid attacks through using inhalers not use them as rescue methods! So over use is like other drugs, inhaler usage medically prescribed should error on using side not the other way around! Talk to any allergist, pulmonary or peds doc.

Ivy Swammer
6 years ago

I think it’s worth considering whether there is some endogeneity in the relationship between asthma diagnoses and elite athletes (particularly swimmers). What if it’s the athletic activity and/or chronic exposure to chlorine that is causing the poor lung function? I was a competitive swimmer for 16+ years and was diagnosed with sports-induced asthma at about age 14. I used an albuterol inhaler prior to every practice/competition and I could actively feel in my lungs within minutes of starting a warmup if I hadn’t used it. My lung function deteriorated through college to the point where I basically had bronchitis and breathing problems for my entire senior season; I couldn’t be in kitchens with any amount of smoke and I would… Read more »

Supercompensationmcsupercompensationface
Reply to  Ivy Swammer
6 years ago

If you used it prior to every practice, it means you likely developed massive tolerance to its effects, making your baseline condition worse and worse over time. My doctor told me I shouldn’t use it more than 2-3 times a week to avoid rendering the treatment ineffective.

3generationsofasthmatics

You need a different doctor that actually understands corticosteroids…

Swimmer
Reply to  Ivy Swammer
6 years ago

@ivyswammer well put. Thanks for helping me think about this issue more broadly. And I agree about the ventilation issue. My kids swim in the Northeast and are indoors about 10 months of the year. You can hear the kids coughing in the indoor pool at least 3 times a week,especially towards the end of practice. It is a poorly ventilated pool and perhaps over-chlorinated at times. I have often wondered what the long term effects will be. I spoke to the pool director once and he agreed to try to open a door or two. Not a great solution because of the cold air.

FaultyRespiratorySystemFamily
6 years ago

I understand the concerns regarding the abuse of inhalers, but our family (my father, myself, and 3 of my 4 swimming children) have to use steroid inhalers, albuterol inhalers, prednisone, and generally a round or two of antibiotics almost any time we get any sort of virus. It inevitably turns into a bacterial infection in our chest and lungs. Often, if not treated quickly with inhalers, it turns into pneumonia. I blame my dad for bad respiratory genetics:) So, while we look into the usage of inhalers, it is important to keep in mind, that some of us deteriorate very quickly with asthma-related illnesses without these treatments. Of course, you can tell a lot by a person’s history (my children… Read more »

sven
6 years ago

I would be super down for a “steroid league” in swimming. My first thought is that we need to put Florent Manaudou on every PED we can find and then see what he can do in a 50 free. Do the same with Dressel at the end of his career (that’s not necessarily an implication that Manaudou is at the end of his career, just that we more or less know what he’s capable of by now and we should see where Dressel’s ceiling is before we juice him up).

The ethics question is out of the way since we can actually be sure, for once, that everyone is on the same playing field, and we get to just see… Read more »

Jill
6 years ago

My daughter’s pulmonologist thought it was a miracle more competitive swimmers didn’t develop it considering the number of hours per day they were breathing in large volume of chemical filled air at the surface level where it’s the worst. It’s basically an occupational hazard. So yeah, there is going to be a MUCH higher rate of legitimately diagnosed asthmatics in competitive swimming than in the general population.

DrSwimPhil
Reply to  Jill
6 years ago

“Chemical filled air”….

Ever study what’s in “air”?

About Braden Keith

Braden Keith

Braden Keith is the Editor-in-Chief and a co-founder/co-owner of SwimSwam.com. He first got his feet wet by building The Swimmers' Circle beginning in January 2010, and now comes to SwimSwam to use that experience and help build a new leader in the sport of swimming. Aside from his life on the InterWet, …

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