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However, the translation of these norms into practice depends heavily on national anti-doping organizations (NADOs) and their capacity, resources, and consistency with local cultural norms ( 2.2 Doping, contamination, and the athlete integrity framework Beyond the biomedical risks, supplement contamination challenges the athlete integrity framework, a normative model that shifts focus from punitive enforcement to moral reasoning and transparency ( However, the presence of undeclared pharmacological agents creates a situational vulnerability where athlete integrity is eroded by systemic failures rather than individual intent ( 2.3 Policy gaps, cultural and religious dimensions in anti-doping: A critical gap A significant gap in existing literature pertains to how cultural and religious perspectives influence supplement use and anti-doping compliance

Dupre J, Ross SA, Watson D, Brown JC

Only about 40 cases of oral MA have been reported in the literature

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