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Proefschrift Door STRIKING THE RIGHT BALANCE Effectiveness of Anti-Doping Policies ZOEKEN NAAR HET JUISTE EVENWICHT Effectiviteit van het anti-dopingbeleid (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof.dr. G.J. van der Zwaan, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op vrijdag 18 november 2016 des middags te 2.30 uur door Olivier Matthijs de Hon geboren op 3 september 1972 te Amsterdam Promotor: Prof.dr. M. van Bottenburg Dit proefschrift werd mede mogelijk gemaakt met financiële steun van het Ministerie van Volksgezondheid, Welzijn en Sport. In mooie herinnering aan Julie, die altijd overal bij zal zijn In loving memory of Julie, who will always be present at all occasions Assessment Committee: Prof.dr. F.J.G. Backx (Utrecht University) Prof.dr. J.P.P.E.F. Boselie (Utrecht University) Prof.dr. J. Hoberman (University of Texas at Austin) Prof.dr. M.J. McNamee (Swansea University) Prof.dr. V. Møller (Aarhus University) On the day of thesis defence the Doctoral Examination Committee will also include: Prof.dr. M. van den Berg (Utrecht University) Prof.dr. M. Olfers (VU University Amsterdam) Prof.dr. S.H. Backhouse (Leeds Beckett University) The time to write this thesis was partially made available by means of a grant from the Dutch Ministry of Health, Welfare, and Sports. Printing this thesis has been financially enabled by Anti-Doping Authority Netherlands, also known as ‘Dopingautoriteit’. All views presented in this thesis are solely the individual views of the author and are by no means official policy statements of any organisation. TABLE OF CONTENTS SUMMARY ...................................................................................................................................................................... 7 NEDERLANDSTALIGE SAMENVATTING (SUMMARY IN DUTCH) ...................................................................15 1. INTRODUCTION & METHODS ............................................................................................................................23 1.1 A short history of anti-doping ......................................................................................................................23 1.2 Research questions ......................................................................................................................................24 1.3 The current anti-doping framework .............................................................................................................25 1.4 Backgrounds of the current study ................................................................................................................28 1.5 Epistemological position ..............................................................................................................................31 1.6 Methodology ...............................................................................................................................................34 2. RESULTS & DISCUSSION ....................................................................................................................................37 2.1 Conceptualising effectiveness .......................................................................................................................37 2.2 Effectiveness and anti-doping policy ...........................................................................................................38 2.3 The extent of doping use ..............................................................................................................................42 2.3.1 The prevalence of intentional doping use in elite sports ..........................................................................42 Article I Prevalence of doping use in elite sports – a review of numbers and methods .........................43 2.3.2 True dopers or negligent athletes? .........................................................................................................73 Article II True dopers or negligent athletes - An analysis of Anti-Doping Rule Violations reported to the World Anti-Doping Agency 2010-2012 ......................................................................74 2.4 The effectiveness of doping substances and methods...................................................................................99 2.4.1 Case 1: Mind sports and anti-doping, or the boundaries of sports .........................................................100 Article III Mind sports and doping - An investigation of pharmacological substances that may enhance performance in mind sports ................................................................................102 2.4.2 Case 2: Commonly used medications, or the impact of anti-doping policies on one’s medical care .........134 Article IV Four weeks of corticosteroid inhalation does not augment maximal power output in endurance athlete ...................................................................................................136 Article V β2-agonists and physical performance: a systematic review and meta-analysis of randomised controlled trials .............................................................................................146 2.4.3 Case 3: Gene doping, or when to ban a potential doping problem .........................................................179 Article VI Gene doping: an overview and current implications for athletes..........................................181 2.4.4 Discussion on the effectiveness of doping substances and methods .....................................................213 2.5 The consequences of anti-doping policies ..................................................................................................217 2.5.1 Case 4: Finding the athletes, or the burden of whereabouts regulations .................................................217 Article VII Doping control, providing whereabouts and the importance of privacy for elite athletes.......219 2.5.2 Case 5: Commonly used supplements, or the impact of anti-doping policies on a non-doping issue.......237 Article VIII The continuing story of nutritional supplements and doping infractions ...........................239 2.5.3 Case 6: Non-competitive fitness athletes, or the true importance of anti-doping policies .......................260 Article IX Prevalence of use of performance enhancing drugs by fitness centre members .....................262 2.5.4 Discussion on the consequences of anti-doping policies ......................................................................274 5 TABLE OF CONTENTS 3. PROPOSED WAYS TO BRING THE DISCUSSION FORWARD ...................................................................277 3.1 Factors of a successful anti-doping policy ...................................................................................................277 3.2 Towards improving anti-doping policies ...................................................................................................284 3.3 Measuring effectiveness of anti-doping policies .........................................................................................291 3.4 Revised instrumentalisation of the concept of doping ...............................................................................293 Article X The redundancy of the concept of ‘Spirit of Sport’ in discussions on the prohibited list of doping substances ............................................................................................................294 4. OVERALL CONCLUSIONS ..................................................................................................................................309 4.1 Effectiveness in anti-doping .......................................................................................................................309 4.2 The intricacies of doping use .....................................................................................................................311 4.3 Building anti-doping regulations ...............................................................................................................313 4.4 Directions towards a more effective anti-doping policy .............................................................................315 4.5 Concluding remarks ..................................................................................................................................317 5. EPILOGUE ..............................................................................................................................................................321 6. APPENDICES .........................................................................................................................................................325 Appendix 1 Doping glossary ............................................................................................................................325 Appendix 2 References ....................................................................................................................................326 Appendix 3 Contribution of the author to this thesis ......................................................................................340 Appendix 4 Curriculum Vitae .........................................................................................................................342 7. MANY MANY THANKS ........................................................................................................................................345
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