A Canadian Olympian takes a banned drug to feel 'normal' — should that be allowed?
After years of grappling with mysterious medical setbacks, Canadian distance runner Lanni Marchant believes she has finally found a solution — a way to help her body meet the demands of an elite athlete.
But authorities say that, if she chooses to take the medication that has allowed her to feel "normal" again, she won't be allowed to compete.
"In 10 years, this is the most normal I have felt as a female," says the 34-year-old Olympian from London, Ont. "And they are going take this lifeline away."
Marchant owns the Canadian women's records in both the full and half marathons. She competed in the marathon and the 10,000 metres at the 2016 Rio Olympic Games, becoming the first Canadian to complete both those races at the Olympics. Since then, things have not gone well. She was supposed to run for Canada at the 2017 track and field world championships in London, but was scratched just before the event.
Marchant later revealed that she had been hospitalized in the months leading up to worlds. During what was supposed to be an uneventful procedure on her kidney, an infectious cyst was ruptured, sending her body into septic shock and leaving her hospitalized for eight days.
When she emerged and tried to get back into training, Marchant says she felt like "an alien in my own body, and every month it was worse." She would put on weight and feel bloated for long periods of time.
"This isn't a new thing," she adds. "I've been dealing with this since law school [she graduated in 2011]. It became my normal. It sucked, but it was manageable. We would skip races, move workouts to accommodate the extra weight I was carrying that made me run slow."
Marchant took a number of steps, including changing her diet. But her problems, which were caused by a hormonal issue, persisted.
"I was still getting very painful cystic zits across my face," she says. "I was basically going through puberty all over again every month."
Unable to quickly get an appointment with a Canadian specialist, Marchant sought treatment with an endocrinologist in Minnesota. After a series of tests, Marchant says doctors concluded she has Polycystic Ovary Syndrome. Women with PCOS may have infrequent or prolonged menstrual periods and excessive male hormone levels. In some cases, the latter may result in excessive body and facial hair, also known as hirsutism.
For Marchant, the diagnosis and a new medication amounted to a "lifeline." But the drug she was prescribed, Spironolactone, is on the list of banned substances in track and field. In order to compete while using it, Marchant had to seek what is known as a Therapeutic Use Exemption (TUE).
An athlete who obtains a TUE is allowed to use a drug that is otherwise prohibited. To get one, the athlete must prove that a legitimate medical issue is being addressed by taking the drug in question, and that the banned substance won't act as a performance enhancer.
TUEs are fairly common among elite athletes in a range of sports. Tennis stars Serena Williams and Rafael Nadal and Olympic gymnastics champion Simone Biles were among the athletes identified as TUE holders when a group of Russian hackers leaked confidential medical files from a World Anti-Doping Agency (WADA) database in 2016. Biles said the drug she was taking was to treat Attention Deficit Hyperactivity Disorder (ADHD), while Nadal said his drug was for treating a knee injury.
Marchant was under the impression that the Canadian Centre for Ethics in Sport, which oversees anti-doping efforts in Canada, would decide whether to grant her a TUE. She says the agency put her application through intense scrutiny and pushed her to explore alternatives to the banned drug she'd been prescribed.
"Why aren't I trying other methods? What does it mean that I don't tolerate birth control? Where are your Pap smear results? Blood tests? We need to evaluate all of this," Marchant says she was told.
The whole experience left her exhausted and exasperated, but CCES eventually approved her TUE application. She thought she was clear to compete again.
But in order for her to run internationally, Marchant's TUE still had to receive final approval from track and field's world governing body, the International Association of Athletics Federations. Last week, the IAAF denied Marchant's application, telling her to seek alternative treatments.
"If it was supposed to go through the IAAF, then why did I spend six weeks feeling scrutinized and violated by CCES, to feel like you are put up in stirrups and they are looking under the hood," Marchant wonders. "It would be nice to only have to go through that once."
CCES president Paul Melia says it's standard procedure.
"For athletes competing internationally, the IAAF always has the final authority over the TUE," he explains. "Typically, when we grant a TUE, the IAAF recognizes that TUE. But sometimes they may question it. They may ask for more information."
That's what is happening in Marchant's case. The IAAF considers her application incomplete, saying that an athlete living in Canada has access to alternative treatments that should be sought instead.
"I'm just trying to have a human body that works," Marchant argues."They are going to deny me that.
"I don't like the assumption that I haven't tried exhausting other things. [They could] direct me to a specialist that could fix me, but all they do is say no and leave you with no recourse."
The IAAF said it could not immediately comment on Marchant's case.
Melia wouldn't comment directly on Marchant's case, but he says it's important that TUE applications be carefully scrutinized.
"The request for medical documentation has to be very thorough because you can imagine the window of opportunity a TUE might provide for an athlete who may want to cheat the system," he says. "[Officials] have to have the medical documentation that gives them the confidence that this is a legitimate medical condition and that this is the only substance available to treat it."
Melia says if the IAAF ultimately makes a final decision to deny Marchant's TUE application, she can appeal to WADA for a final decision.
Marchant, meanwhile, believes she can still be competitive when the next Olympics come around in 2020. And she'll continue to fight for her right to run.
"Part of my quality of life is running and competing," she says. "They're trying to make me [decide between] pursuing sport in a body that wasn't letting me do much of anything half of the month or taking this medicine and then not being able to pursue sport.
"I shouldn't have to choose. It's a very close-minded approach to women's health and women's health issues."