How many? This is one of the most important questions to ask and answer in any policy-making setting. How many immigrants live in the UK [1]? How many people have polio [2]? How many Bluefin tuna are caught each year [3]? Effective management or regulation in any policy setting would not be possible without an ability to answer such questions. "How many?" is easy to ask, but in many cases, it can be fiendishly difficult to answer. Often, empirical research using multiple methods are necessary to determine a useful answer, and even then estimates can be clouded by uncertainties and areas of fundamental ignorance. The question of how many? is just as important to answer in the context of anti-doping (prohibitions against the taking of certain banned substances) in elite sport [4]. Fortunately, the accurate quantification of the number of athletes who dope presents no more complicated a methodological challenge than counting British immigrants, those afflicted with polio, or the number of fish in the sea. In fact, it`s probably much easier to answer. However, for reasons both scientific and political, it has proven difficult to develop robust estimates of the number of elite athletes who take banned performance-enhancing substances. In a 2015 review, De Hon et al. [5] observed, "Remarkably, few scientific articles have addressed this subject so far, and the last review dates to 1997. As a consequence, the true prevalence of doping in elite sports is unknown." There are of course understandable reasons for sports organizations to wish to remain ignorant about the prevalence of doping. As a World Anti-Doping Agency (WADA) Working Group concluded in 2012, "There is no general appetite to undertake the effort and expense of a successful effort to deliver doping-free sport" [6]. In their review, De Hon et al. [5] recommended the use of a survey technique called the "randomized response technique" (RRT), which allows the athlete to maintain both anonymity of his/her identity and his/her answer. Lensvelt-Mulders et al. [7] concluded that "using randomized response questions in surveys on sensitive topics significantly improves the data quality of the surveys. Currently available research has not demonstrated the superiority of any data collection method to RRT." Despite almost a half-century of the use of RRT methods to elicit data on sensitive topics, until now there has been only one study to apply RRT to doping prevalence [8], which found that 20-39% of German Olympic-level athletes admitted to using banned substances in the previous year. The publication by Ulrich et al. [9] in this journal, presents a second empirical study of doping prevalence using RRT. This is a very important paper for at least three reasons: First, it offers addition empirical evidence on the prevalence of doping in elite sport. Second, the journey that the paper took from initial commissioning to publication illustrates the challenges of conflicts that sport organizations face in anti-doping. And third, the paper provides a clear proof-of-concept for the implementation of an evidence-based approach to documenting the prevalence of doping in elite sport.
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