Sharapova case underscores holes in doping, anti-doping efforts

Maria Sharapova's two-year suspension announced Wednesday by the International Tennis Federation was half the maximum she could have received, but stands as the most serious imposed on a top tennis player in the decade-plus that the sport has been governed by the World Anti-Doping Agency code.

That is a shallow pool. Relatively few tennis players of any stature have been sanctioned for performance-enhancing drugs as opposed to the occasional bad decision about cocaine.

Those who predicted star treatment for Sharapova may have been right, although not in the way they envisioned. Her success and wealth appeared to cut against her in the ruling by a three-man tribunal, which wondered aloud how an athlete with such a large professional entourage and vast resources could possibly have let this slip through the safety net.

In her mea-culpa news conference back in March, Sharapova admitted she didn't know the medication -- which she'd been taking since 2006, and in recent years without a prescription -- had been added to the banned list. In her testimony to the tribunal, she said she purposefully took it on match days, including at the 2016 Australian Open, where she tested positive. She consistently omitted it on her doping control forms, where athletes are expected to list all medications.

All of those factors were covered in a ruling that took into account the minutiae of notification as well as the broad issue of responsibility. Sharapova said she will appeal. WADA also has that option if the agency finds the sanction too soft or harsh.

Sharapova's case rightfully has focused attention on the way athletes are informed of changes to the prohibited substance list. That process should be reviewed regularly sport by sport and made as foolproof as possible, since it's only as strong as its weakest link. Sport federations and anti-doping authorities should fly banners over stadiums if necessary to avoid any hint of entrapment.

WADA also had to do what is called a "skinback'' in the journalism business when, with almost 300 positive meldonium tests entering the pipeline since the beginning of this year, it became clear that more research was needed on how long it takes for the drug to leave an individual's system. Credit to the agency for admitting the knowledge gap this spring and scrambling to collect data, but that research done in the preceding months could have saved everyone involved a lot of grief.

Among the scores of other athletes with pending meldonium cases, there's every chance that some did the right thing and stopped popping it before Jan. 1. Others committed the sin of neglect or took the risk of continuing to use it. Positive tests have come in a range of sports, from figure skating to wrestling to distance running -- the vast majority from Russia and Eastern Europe. Anecdotally, athletes from that region have said the medication was handed out like a vitamin.

Finally, there is at least the seed of an informed debate about the actual performance-enhancing effect of meldonium. The fact that its use was widespread, especially in a Russian sports system laced with corruption, is certainly suspect. On the other hand, that survey data doesn't mean that Sharapova or any other athlete necessarily became faster and stronger or recovered more quickly as a result of taking it.

Dr. David J. Greenblatt, a Tufts University School of Medicine professor who studies drug interactions, recently co-wrote a review of medical literature on meldonium that challenges the medication's therapeutic and potential doping efficacy.

"The vast majority of data is on animals or in-vitro systems, which is of minimal or no relationship to what goes on in humans," Greenblatt said in an interview with ESPN.com last month. "There are a couple of human studies, and as best we could tell, we cited every human English-language study. Basically, there's little or nothing there.

"I would say, there is no substantive evidence that meldonium does anything to help human disease. And certainly, there's no evidence that it does anything to enhance athletic performance in athletes or otherwise normal people.''

In response, WADA's medical director, Dr. Alan Vernec noted that "potential of performance enhancement is not an absolutely necessary criterion."

In an email to ESPN.com, Vernec wrote, "It is often very difficult and even unethical, to do meaningful studies on elite-level athletes for many substances. Therefore, decisions must be made extrapolating from existing data, use patterns, pharmacology, etc.

"It is true that the product has not been evaluated in North America and Western Europe, even though the product is used by athletes from those regions. This did not stop WADA from investigating papers from Eastern Europe although admittedly and not surprisingly, there are limited good quality studies on the potential for performance-enhancing effect.''

It would be the height of irony if Sharapova's disregard for the rules, careless or reckless or both, cost her so mightily for a drug that may or may not have made much of a difference. That is unknowable. But as we are learning on almost a daily basis now, neither doping nor the anti-doping effort is an exact science.