Cape Town - The South African Medical Association (SAMA) has expressed its "deep concern"
regarding the proposed rule changes by the International Association of
Athletics Federations (IAAF) to impose an upper hormonal limit for
athletes wishing to compete in the female category in international
In a media release on its official website, SAMA stated:
“We deem the requirement for hormonal manipulation in these athletes
unethical and invasive. It runs in stark contrast to the entrenched
principle of athletes competing in their natural state. Such rules are -
in our view - excessive and would constitute a systematic affront to
the dignity of all female athletes,” says Dr Angelique Coetzee,
chairperson of SAMA.
Dr Coetzee says in the interest of medical ethics, the medical
profession is compelled to denounce any policies in sport, or any other
fields, which are not compatible with the basic human rights principles
of individual choice, confidentiality, consent, dignity,
non-discrimination, and equity. The IAAF and other international
sporting bodies should not be allowed to violate these core principles.
Any medical decisions and interventions should be based on evidence from
well-designed and well-conducted research.
“We are concerned that the arguments by the IAAF for regulating
testosterone levels in such athletes are most likely based on a single,
flawed study in which reporters were highly conflicted. SAMA urges
medical scientists and doctors involved in the IAAF’s medical procedures
and tests to pay due regard to scientific rigour, evidence-based
practice and medical ethics. Until sound scientific evidence is
generated, SAMA dismisses such flawed arguments,” notes Dr Coetzee.
She says the World Medical Association’s (WMA) Declaration of Geneva
and its International Code of Medical Ethics require doctors to maintain
the highest standards of professional conduct, not to allow their
judgment to be influenced by unfair discrimination, to act in the
patient’s best interest, and to do no harm. Furthermore, the WMA
Statement on Principles of Health Care for Sports Medicine requires that
physicians oppose or refuse to administer any such means or method
which are not in accordance with medical ethics, and/or might be harmful
to the athlete using it, especially procedures which artificially
modify blood constituents or biochemistry, amongst others.
“Therefore,” Dr Coetzee adds, “artificially lowering endogenous
testosterone in athletes has to be considered unethical. In addition,
doctors prescribing treatment of this nature for a condition that is not
recognised as a pathology will be in violation of medical ethics.”
Apart from this, Dr Coetzee says it is of concern that medical manipulation in sport is being implemented disproportionally.
“It is baffling that natural advantages in sport are being critiqued
for athletics, but not for other sports. Basketball, high jump, and
goal-keeping in soccer are examples where acromegaly - a condition
responsible for excessive tallness - would confer a clear advantage.”
According to Dr Coetzee this problem also sharply brings to the fore the issue of economic and social injustice.
says it would appear that better resourced people or societies have
more opportunities or exposures to environments that enhance sporting
prowess, such as professional training programs. When individuals from
such environments compete with those from disadvantaged societies, such
as in the case of Ms Caster Semenya, the playing field is obviously not
level. It is also concerning that debates on natural attributes such as
body shape and genetic composition seem to arise disproportionately more
often with successful athletes from low- and middle income countries.
“It be should be an essential principle of sport that athletes must
perform in their natural state; unmodified by medical interventions,”
notes Dr Coetzee.
SAMA has carefully followed Ms Semenya’s involvement with sex
verification policies for the past few years, including her recent
high-profile appeal case against the IAFF’s new rules, which were
scheduled to come into effect in November 2018. Due to her appeal these
are now expected on 26 March 2019.
“We support Ms Semenya in this legal battle and look forward to a
successful outcome for her. We urge the IAAF to reconsider their stance
on this issue and to rely on better and more extensive research
emanating from the world’s greater medical community,’ concludes Dr