New study shows strong support from elite athletes for anti-doping, but less so for intrusive control measures

Sigmund Loland
Norwegian School of Sport Sciences

Anna Qvarfordt
Anti-doping – a legitimate effort? Elite athletes’ perspectives on policy and practice
170 sidor, hft.
Stockholm: Gymnastik- och idrottshögskolan, GIH 2018 (Avhandlingserie för Gymnastik- och idrottshögskolan)
ISBN 978-91-983151-6-5

On February 8, 2019, Anna Qvarfordt, lecturer in sport science at the University of Gävle, defended her doctoral thesis entitled Anti-doping – a legitimate effort? Elite athletes’ perspectives on policy and practice. Qvarfordt has been part of the doctoral program of the Swedish School of Sport and Health Sciences (GIH). Supervisors have been Nadir Ahmadi, Åsa Bäckström, and David Hoff who are co-authors on the four articles upon which the thesis is built.

As external examiner, I have had the pleasure of studying Qvarfordt’s thesis. Departing from challenges of the current anti-doping regime linked to measures such as urine and blood samples, biological passports, whereabouts information, and therapeutic use exemptions (TUE), Qvarfordt sets out ‘to analyse the legitimacy of global anti-doping policy and practice from the perspective of international elite athletes’ (p. 15).

Theoretically, Qvarfordt turns to David Beetham’s three-dimensional theory of legitimacy combined with Tom R. Tyler’s perspectives on procedural justice. In terms of methods, Qvarfordt employs critical discourse analysis of World Anti-Doping Agency’s (WADA) guide to athletes, and quantitative and qualitative data collection procedures. The quantitative approach consisted of an online survey among individual and team athletes belonging to the registered testing pools of four international federations. Respondents, 261 in number, came from all five continents and from 51 different countries. The qualitative approach took the form of semi-structured interviews with 13 athletes recruited from online survey respondents.

The first article is based on what Qvarfordt refers to as a ‘top-down perspective’ and consists of discourse analysis and comparison of three editions of WADA’s Athlete Guide. Qvarfordt finds a gradual transition from an authoritarian towards a rational legitimation strategy with an athlete-centred stance. The following three articles comprise a ‘bottom-up perspective’ in terms of examining athletes’ experiences and perceptions of anti-doping. Approximately 80 percent of elite athletes support anti-doping in principle. In terms of implementation, however, many experience problematic issues and doubts. Four out of ten reported discomfort linked to urine samples, half of the athletes felt monitored in negative ways in the whereabouts system, and six out of ten had doubts about the efficiency of the anti-doping system. Nine out of ten held the view that athletes should be included to a larger extent in the development of anti-doping work. Furthermore, many athletes reported that they experienced an uneven playing field as some had a supportive entourage, access to anti-doping education and technology, whereas others had not. Qvarfordt concludes that even if the vast majority of athletes supports anti-doping in principle, there is significant potential for improvement of policy and practice. Only in this way can the anti-doping campaign be considered legitimate among those who are at the center of regulation, scrutiny, and control: elite athletes.

As any other scientific work, Qvarfordt’s thesis has room for improvement. Her findings could have been contextualized even more, for instance with perspectives from medicalization processes in wider society. How can anti-doping be sustainable in a possible future with more liberal attitudes to non-therapeutic use of drugs? The response rate on the online survey was 28%. The 13 athletes being interviewed were all recruited from survey respondents. Selection bias and generalization challenges could have been discussed in more detail. One of the most controversial principles in anti-doping, the strict liability principle, is not examined in any significant way.

The overall impression, however, is that Qvarfordt’s doctoral work is original and of high quality. She presents a well-designed and unified work being driven by one main research question and followed by sub-questions that are operationalized systematically with the help of theory. In discussions of the empirical material, theoretical premises are integrated in seamless ways. Her sample of international athletes is unique in empirical studies of attitudes towards anti-doping. Methodologically, the dissertation is ambitious in applying three different approaches. The results are relevant and topical and should be of significant interest to WADA, national anti-doping organizations, international sport federations, testing agencies and all others who take an interest in the anti-doping campaign in elite sport.

Copyright © Sigmund Loland 2019


I Qvarfordt, A., Hoff, D., Bäckström, Å., & Ahmadi, N. From fighting the bad to protecting the good: legitimation discourses in WADA’s athlete guides. Manuscript.
II Efverström, A., Ahmadi, N., Hoff, D., & Bäckström, Å. (2016). Anti- doping and legitimacy: an international survey of elite athletes’perceptions. International Journal of Sport Policy and Politics, 8(3), 491–514.
III Efverström, A., Bäckström, Å., Ahmadi, N., & Hoff, D. (2016). Contexts and conditions for a level playing field: elite athletes’ perspectives on anti-doping in practice. Performance Enhancement & Health, 5, 77–85.
IV Qvarfordt, A., Ahmadi, N., Bäckström, Å., & Hoff, D. Obligations and opportunities: elite athletes, anti-doping and compliance. Submitted.
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