The use of prohibited substances remains a global issue as evidenced by recent revelations of the high doping prevalence at the very elite level of sport (1), and is not confined only to Russia. Protection of the clean athlete is a top priority for the International Olympic Committee (IOC) and the World Anti-Doping Agency (WADA). The problem of doping in modern-day sport is exacerbated by the focus on winning at all costs. The winner gets fame, multimillion-dollar contracts, and becomes a role model for young aspiring athletes. For many athletes, especially from developing countries, modern-day sport is a social mobility tool, a means of survival, and a source of income for an extended family. This reality can lead vulnerable athletes to use any possible means to obtain success. The continuous exposure of doping by high-profile athletes serves to perpetuate the stereotype that doping is the only way to achieve sporting success (2-4). Despite the imperfections, drug testing remains the main source of doping information to prosecute cases. It makes little sense, therefore, to start afresh, especially given recent signs of progress. What is needed is an evolution of sport, building on the successes of WADA (established in 1999) and reflecting recent cultural, economic, and social changes. Combating the use of prohibited substances and methods is complex and must be addressed at multiple levels. One recently proposed holistic antidoping approach is comprised of three primary pillars (3P): prevent doping, protect the clean athlete, and promote peak performance without doping (4). A key development that underpins the first pillar, prevent doping, is the 2003 World Anti-Doping Code (Code) and the subsequent code amendments of 2009 and 2015 (currently being redrafted). Effective deterrent features of the 2015 Code allow antidoping authorities to test intelligently, retest smartly (i.e., samples stored for 10 years), work collaboratively, and impose quick meaningful sanctions. There also is an increased emphasis on evidence-based education to correct widely held beliefs among those involved in elite sport, such as that successful competitive performance in high-profile sports is not possible without the use of prohibited substances and methods. Furthermore, the use of prohibited substances by athletes varies considerably based on the culture of the sport. Therefore, antidoping enforcement and education programs targeting vulnerable athletes participating in sports with greater risk of doping and from countries with a culture of doping will be more effective.
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