Confidentiality rules flouted

“Confidential” and “confidentiality” are words that together appear eight times in the document published by the International Association of Athletics Federations (IAAF) on hyperandrogenism in 2011.

The word “confidential” appears ten times in the document circulated by the Union Sports Ministry last year on standard operative procedures (SOP) on hyperandrogenism.

Yet, the name of Dutee Chand, the 18-year-old Odisha sprinter, has appeared in media reports the past few days as though the right of the media to disclose a name in such a case is more important than the right and dignity of the individual.

To complicate matters, the Sports Authority of India (SAI) on Wednesday (July 16, 2014) put out a ‘Press note’ for “favour of publication!” It did not mention her name but explained why she was being made ineligible to compete. Short of providing details of the test results, the note was clear how the tests went and what the final outcome was.

Things couldn’t have been more ludicrous than this.

How did this happen despite the Government having issued an SOP on female hyperandrogenism last year? How did this happen when SAI is now claiming “confidentiality protocol” prevents it from naming the athlete? How did this happen when SAI is insisting that it was only following regulations set out by the International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC)?

When officials are responding to queries from the media without too much of concern about ‘confidentiality’ this is bound to happen.

Though the first report on the subject in the Indian Express did not mention her by name, it was very clear who the athlete was since her pet events were mentioned, the fact that it was a junior athlete was mentioned, an official was quoted to confirm that she was part of the team for the World Junior championships in Eugene, US.

You did not need someone to state her name in a press release to know who the athlete was who was being investigated.

Reporters are seeking confirmation on any tip-off that they could be following. The higher the designation of the source the better. If the source is willing to be quoted, that is a bonus. Your story becomes more credible and your editors are happier than they would have been had you kept on writing "sources said..." You would be wary of publishing the report if the source refuses to say anything at all on the subject.

The follow-ups by other publications were predictable. But her name being disclosed even as investigations and tests were going on was unexpected. Worse, her photograph was also published. It was cruel, to say the least.

No matter how much the authorities including the IAAF and the IOC try to avoid the terminology ‘gender test’, it keeps appearing in media reports. The SAI on Wednesday tried to explain that there cannot be ‘gender test’ since it was banned by the IAAF and the IOC, and it was only trying to verify the athlete’s androgen levels. By then the damage had been done.

The gender rules were amended by the IAAF in 2011 and next year the IOC also brought in a new set of regulations in time for the London Olympic Games.

The changes were brought in because of the furore caused by the revelation in 2009 that South African athlete Caster Semenya had been asked to undergo a gender test by the IAAF following her victory in the 800m at the World Championships.

The tests conducted on Semenya were kept a secret while she was allowed to return to competition in July, 2010. She took the silver in the London Olympics but had not been very impressive in 2013 and this season. There is still secrecy as far as Semenya's post-2012 progress is concerned.

Now, a more complex procedure is in place to determine whether a female athlete could be allowed to compete under that category despite having hyperandrogenism. There could be conditions where the athlete is unable to derive any advantage out of the excess of androgens (male hormones) she could be having and in such cases the athlete is permitted.

AFI sought tests

The genesis of the ‘Dutee Chand story’ is a little clouded. It was the AFI which sought tests to be done by the SAI, as per procedures laid down in the SOP. Did AFI get a protest from any athlete or coach? Why did it report the matter? Was it late in waking up?

This could be fodder for the media in the coming days.

Whatever could have been the provocation for the AFI to bring up the matter and report it to the SAI the federation should be complimented for acting on it at least at this stage unlike in the past where “suspect cases” were allowed to drag on and never sought to be investigated.

The rules have made it that much tougher for anyone to initiate an investigation. There is no barometer available for a federation to refer the matter to a a medical panel. It cannot be done just because of an abnormal improvement in performance. The immediate suspicion is doping, not hyperandrogenism. It also cannot be done just because a few rivals and coaches are complaining.

The Santi Soundarrajan ‘gender case’ was handled shabbily by the Olympic Council of Asia and the Indian Olympic Association (IOA) when her eligibility to compete in the female category was questioned in the Doha Asian Games. She was eventually stripped of the silver medal in the 800 metres and sent back home alone, utterly humiliated, with no one to turn to even for advice.

Recent reports indicated that Santi, a Tamil Nadu athlete, after having done some work in a brick kiln, had continued to struggle to make a living. A colleague from Bangalore informed me that she had in fact passed out a coach's course from the SAI, Bangalore. It was not known how she was coping in life after getting the coach's diploma. 

Will Dutee Chand’s recent results be annulled if she does not appeal and is determined to be ineligible eventually?

Confusing rules

The Government SOP is confusing in this respect. It says, “In case, it is finally decided that the Sports person is not eligible to compete in the female category, any medal won by the Sports person / position obtained by virtue of participation in a sports competition in a female category will stand withdrawn. Nodal officers of SAI and NSF will take necessary action in this regard.”

There is no mention when this happens. If an investigation is done when there is no competition and it turns out an athlete is ineligible, can the results be annulled going back? And how far should one go back?

It doesn’t seem that there is anything in the IAAF rules that would allow annulment of results with retrospective effect unless an athlete had been allowed ‘provisionally’ to compete even as an investigation is going on about hyperandrogenism. In such a case, if the final verdict goes against the athlete the results would be annulled from the date when the matter was first reported and recorded.

It was easy to disqualify Santi’s results since there was a competition at which she was investigated. In the case of Bengal athlete Pinki Paramanik there was a criminal case that led to her medical examination and, unfortunately, subsequent humiliation. It had nothing to do with a sports authority, least of all the AFI.

Allegations

Dutee Chand can of course come back if she is able to undergo treatment and bring her androgen levels to permissible limits. But we don’t know what her condition is and how abnormal her values are. Or whether the only criterion that the expert panel or any one depended on while pronouncing her "ineligible to compete as female" happened to be just the testosterone levels.

Not unexpectedly, the Odisha girl has alleged “conspuracy” 

There is no clarity (and there shouldn’t be either) about the nature of tests done in the case of the junior athlete. It is to be expected the SAI has followed the book and the doctors have gone through the prescribed drill before coming to the conclusion that she is to be declared ineligible because of hyperandrogenism.

The fact that an athlete was declared ineligible because of hyperandrogensim should have been kept confidential, informing only the athlete and the federation. The details of the tests should be known only to the medical panel and a few others associated with the evaluation (and not even to the federation, according to the SOP, though one would presume at least the IAAF would be interested in knowing such details) and her personal physician, who should have been kept informed throughout the procedures through ‘confidential’ communications.

The way things have gone it is possible Dutee Chand and her doctor would be getting to know much of the information through media reports. She of course has the right of appeal to get the decision re-evaluated by the same panel which went into her case or another panel under the rules framed by the Indian Government.

In the meantime, the Government needs to amend the SOP to lay down clear guidelines for maintaining confidentiality in such investigations.

The discrepancy

While the Government-issued SOP on female hyperandrogenism has helped evolve a system in cases of doubtful nature, it has also seemingly provided a discrepancy in the threshold prescribed for the primary androgen, testosterone.

The SOP states, “If the serum testosterone level is less than 2ng/ml; the doubt on the concerned Sports person will be addressed and she will be considered eligible to compete as a female Sports person is accordance with the present norms of IOC.”

The IAAF document on hyperandrogensim among females, however, states “Normal male range Total Testosterone Levels - ≥10 nmol/L”
Now, 2ng/ml (nanograms per millilitre) comes to 200ng/dL (nanograms per decilitre) while 10nmol/L (nanomoles per millilitre) comes to 288.1844ng/dL.(nanogram is one-billionth of a gram)

The SOP level has somehow been pegged at a lower threshold.

However, we have no clue about the actual readings that Dutee Chand’s blood samples returned and should thus presume that the doctors/experts were convinced about the higher range of androgen levels for them to have returned a verdict by which SAI announced that she was ineligible to compete as a female.

The normal testosterone level for a female could be 30 to 95ng/dL while that for a male could vary from 300 to 1200ng/dL. There could be variations, too, in certain cases.

Testosterone levels in males vary with age. Females have mainly estrogen, one source of its supply being testosterone. That explains the presence of testosterone in females, much against popular perception.

Obviously, the IAAF has kept that testosterone level quite high to avoid any kind of controversy. Even if the level is high there could be explanations for such high levels and a female can compete as a female provided further investigations prove that she is not deriving any advantage from such levels.

A clinical examination is of utmost importance in evaluating all referred cases  And this will include examination of external genitalia. This is the primary stage of investigation, which may also include examination of secondary sexual characteristics. 

The second stage involves endocrinal assessment in which testosterone levels are measured. It may also include tests for other androgenic hormones including dehydrotestosterone and dehydroepiandrotestosterone. Tests will have to be done at a WADA-accredited laboratory.

If the medical panel rules that further evaluation is necessary, the case could be referred to a third stage where the athlete would be put through further examination and tests at a pre-determined medical centre where a complete evaluation is again made. In the Indian case it is the AIIMS, New Delhi which is the designated centre. In case of an adverse report the athlete can request AIIMS itself to review the initial report.
Note-It was not my intention to establish the range of normal testosterone levels when I quoted an article available on the internet to state that the normal female level could be 30 to 95ng/dL. A link has now been provided to that statement so that it could be made out that the article does quote an official agency. However, there is still no official sanctity about that figure in sports since we go by the IAAF cut-off at least in the present case. And that has been clearly stated. If you happen to check another website you may get a different range, nothing very serious, though. And for those who could be interested in knowing how it varies through age, another article link is being given here. The point about writing the normal range_available in a variety of articles on a Google search_was not to assert that the IAAF had fixed such a range (30 to 95ng/dL) but to show that the IAAF in eventually fixing 288ng/dL as the 'lowest' male range (that was not expected to be crossed by a female) pegged it rather high. In fact very high.

(last update 20-07-2014)