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In its move towards “more transparency” and the promotion of “fair competition”, when will the PGA a

The PGA Tour developed its Anti-Doping Program “to protect the integrity that is inherent in the sport of golf and to ensure the health and safety of all players. The use of doping substances is contrary to the spirit of fair competition that has always been a part of golf.” The PGA has been keen to substantiate the integrity of golf as a “clean sport”, and has recently added blood testing to its anti-doping policy. This brings its list of banned substances in line with the World Anti-Doping Association. (WADA).

In its move towards “more transparency” and the promotion of “fair competition”, what about the issue of golf’s unmentionable “little helpers”?

Adderall and Ritalin are stimulants used to treat A.D.H.D. They are amphetamines or psychostimulants and are amongst drugs banned by WADA. They directly affect the central nervous system, increasing blood flow and heart rate. Colloquially known as ‘Uppers’, this class of substances includes Cocaine. They can produce a wide range of adverse effects and can be addictive.

However, systematic reviews show when used at low (therapeutic) doses, amphetamines produce improvements in cognition. These include memory and inhibitory control, which is the cognitive process permitting an individual to inhibit their impulses and natural, habitual, or dominant behavioural responses to stimuli, so that they can select a more appropriate behaviour that is consistent with completing their goals. Therapeutic doses of amphetamine also improve working memory in all individuals. Amphetamine and other A.D.H.D. stimulants also improve task saliency or motivation to perform a task and increase arousal, in turn promoting goal-directed behaviour. Evidence shows they can can improve performance on difficult and boring tasks and increase endurance and alertness. In healthy people at oral therapeutic doses, amphetamine has been shown to increase muscle strength, acceleration, athletic performance in anaerobic conditions, and endurance by delaying the onset of fatigue.

When asked approximately how many of the top 125 players on Tour have either diagnosed or undiagnosed A.D.H.D., Robert Garrigus replied, "About half." Bob Rotella, a sports psychologist to several Tour Pros, including a handful of major champions, believes this approximation is probably about right.

If assumptions are to be believed, are around 50% of Tour Pros benefitting from the use of amphetamines? Why does the PGA allow some golfers to take advantage of their use under the guise of medication? Is this in the spirit of “fair competition” and what makes it ok for a Pro to take a Prohibited Substance?

Prescription drugs can be a problem for Tour Pros because many are on the Tour's banned-substances list. Luckily, PGA Tour rules make it all too easy. Tour Pros can apply for a Therapeutic-Use Exemption (TUE) to use Adderall, Ritalin or other medications classed as Prohibited Substances. The PGA Tour does not disclose who, if anyone, has done so.

A TUE will only be granted if all four of the following criteria are fulfilled:

1. The player would experience a significant impairment to health if the Prohibited Substance were to be withheld in the course of treating an acute or chronic medical condition.

2. The therapeutic use of the Prohibited Substance would produce no additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition.

3. There is no reasonable therapeutic alternative to the use of the otherwise Prohibited Substance.

4. The necessity for the use of the otherwise Prohibited Substance is not a consequence, wholly or in part, of a prior non-therapeutic use of any substance on the PGA TOUR Prohibited List.

The first question Is whether or not A.D.H.D. is “an acute or chronic medical condition” and why does it appear to be so common in the world of professional golf?

Although A.D.H.D. is defined as a psychiatric disorder it is becoming increasingly apparent it is in fact a fictitious illness, made up strictly for the purpose of making money. It is often described as an umbrella of symptoms and not actually a disease. Child psychiatry researcher, Leon Eisenberg, who is often identified as the “inventor” or “founding father” of A.D.H.D. said in his last interview with SPIEGEL in 2009, just seven months before he died at age 87, “ADHD is a prime example of a fictitious disease.”

This apparently fictitious disorder, for which there are no medical tests available and diagnosis is based on subjective assessment, has conveniently allowed athletes in many sports to benefit from the use of amphetamines. Little wonder it has even been suggested A.D.H.D. can be a tremendous asset to the golfer.

Even more convenient is the fact the Tour will not disclose who, if anyone, has applied for a TUE for A.D.H.D. medication, (as it appears the players do not want the “stigma” attached to the “medical condition”). It was written a top American Pro’s coach was recently asked if the player had the condition to which he responded, "Yes, but you didn't hear it from me." He then went on to describe the player's "high energy" and his ability to "putt in the middle of an interstate once he's locked in."

The reality is some Pros are taking powerful, addictive drugs they do not need. The PGA Tour and their medical advisors would do well to reassess their belief that A.D.H.D. is “an acute or chronic medical condition”, and that there are no alternatives ways to treat any “A.D.H.D.” type symptoms.

Research proves there is little doubt the therapeutic use of Adderall and other stimulants, which are Prohibited Substances, can produce “additional enhancement of performance”. Who knows what performance levels might be attained if a player discontinues their use of medication and “returns to a state of normal health”? Doesn’t “the spirit of fair competition” require the PGA to recognise A.D.H.D. medication as stimulants with potential to enhance performance?

There have been many recent suspensions in professional sports related to the use of Adderall. Questions are being asked about a drug whose prevalence of use continues to increase exponentially in the world of professional sport, just as in the general population. People who were not previously on A.D.H.D. medication are now turning to it to improve their performance at work.

Any Tour Pro who believes he has A.D.H.D. symptoms affecting his game has access to some of the best psychologists in the world. Just as with the first two criteria of the Tour’s TUE, the third, “There is no reasonable therapeutic alternative to the use of the otherwise Prohibited Substance” just doesn’t stack up in the case of A.D.H.D. and stimulants.

In 2017, for the first time, the PGA announced that any suspensions of players abusing any banned substance would be announced publicly. Whilst a step forward for increased transparency and the promotion of golf as a clean sport, are they failing to address the abuse of the one banned substance happening right in front of their very eyes?

It seems to be generally accepted that in some walks of life a diagnosis of A.D.H.D. and the use of stimulants might have its benefits. If the PGA wish to be transparent, maintain the integrity of golf as a clean sport and ensure the health and safety of their players, the world of professional golf cannot be one of them!

It is about “fair competition”…………. isn’t it?

bthorpe@medconsulting.co.uk

23 March, 2018

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