Heart Experts Cast Doubt on Claims That Russian Skater’s Drug Test Was Contaminated by Her Grandfather’s Medicine

The latest revelations about Russian figure skater Kamila Valieva’s doping case raise more questions about the substances found in her sample—and the reasons why the 15-year-old might have failed the drug test. TIME asked leading experts to help make sense of the claims, which have upended the women’s figure skating competition at the Beijing Olympics and cast a larger pall over the sport.

The Court of Arbitration for Sport held a hearing on Sunday. Anti-doping officials revealed that Valieva was positive for three drugs for heart disease. One of these is prohibited by the World Anti-Doping Agency as a performance-enhancing drug.
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Trimetazidine (TMZ), a prohibited substance, is also included in the New York Times reported that Valieva’s sample also contained hypoxen and L-carnatine, a supplement. They are all used to treat angina and improve blood circulation.

According to the documents that were reviewed by The Observer, Valieva stated that she had been taking L-carnatine and hypoxen in December. She also took supradyn which is a supplement that increases immunity. Times. All of these substances are permitted.

To explain the presence of the prohibited drug, TMZ, Valieva’s lawyer argued that she was “contaminated” with the medication, potentially via contact with her grandfather, who appeared by video to say that he takes the medication. TMZ can be used to treat angina. It is known to increase blood flow and improve the efficiency of the heart. It’s not approved in the U.S., but is approved by the European Medicines Agency and other regulatory bodies.

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Russian newspaper Pravda reported that Valieva’s lawyers argued during the hearing, “There can be completely different ways how it got into her body. A grandfather might have drunk something from a glass. The salvia was then absorbed into the glass and it was used later by an athlete. Or the drug lay down on some surface, traces remained, the drug lay down on this surface, which the athlete then drank.”

Can the drug pass that easily from one person to another, and if so, would it appear in the recipient’s urine sample, as Valieva’s lawyer is claiming? “It reminds me of kids I knew who said they got venereal disease from the toilet seat,” says Dr. Steven Nissen, a cardiologist at the Cleveland Clinic.

Nissen says he’s not familiar with how sensitive the assays, a scientific measurement procedure, being used by the WADA lab are, but says that testing positive for a substance by drinking from the same glass as someone taking it is “very far-fetched.”

“It’s hard to be definitive without knowing the assay [test] sensitivity, but it seems very, very unlikely,” he says.

Valieva’s lawyer also claimed she might have come into contact with the medication on a surface and then somehow ingested it. Dr. Donald Lloyd-Jones, president of the American Heart Association and chair of preventive medicine at Northwestern University’s Feinberg School of Medicine says, “I’ve seen no evidence it gets absorbed through the skin.” He admits he doesn’t know how much of the drug was detected in the athlete’s sample, which would inform whether a brief contact with a small amount of the drug could explain her positive test.

Lloyd-Jones points out that patients must take TMZ 3 times daily, as it is rapidly metabolized and excreted by the body. If the prescribed dose is taken, the drug will reach its maximum level in blood within 2-6 hours. The majority of the drugs would disappear in less than 24 hours. “It would seem implausible that a little bit on a glass or on her skin would have resulted in a positive test unless it happened to be just before she provided the sample,” he says. “One can draw inferences that either the exposure was very recent, very shortly before her test, or that she was exposed more chronically.”

Ideally, a performance-enhancing drug has the same feature. “The ideal performance-enhancing compounds get in to improve performance, then get out without leaving a trace,” says Lloyd-Jones.

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Nissen claims that TMZ isn’t available in the U.S. but there is a comparable drug called ranolazine which is approved by Food and Drug Administration. This drug shifts heart cells’ energy sources from fatty acids into glucose which makes them more efficient. “That’s why it works for angina,” says Nissen. “It allows people to do more with less blood flow. Conceivably for an athlete, it would have similar benefit and would make the heart work more efficiently and give them a little edge.”

Lloyd-Jones claims that this metabolic pathway results in less buildup of lactic acids, which could lead to muscle fatigue. “There are data from small trials in patients who have heart failure that that seem to indicate better heart performance for those who have a failing pump,” he says. “But whether that translates into the same benefit in a young, healthy person—I don’t think we know.”

It’s also unclear what the consequences are of taking these compounds while the body is younger. “It’s certainly concerning, especially in a young person whose body is still developing,” says Lloyd-Jones. “We really don’t understand the long term effects of changing someone’s physiology at this age.”

Although Valieva’s doping violations case was cleared by the Court of Arbitration for Sport, it remains open for investigation. That means the gold she and her teammates won in the team event, and any medal she wins in the women’s event could potentially be stripped if anti-doping officials conclude she doped and competed with an unfair advantage.

It will require additional testing to confirm positive results.