What to Make of the Madisyn Cox Doping Suspension

Photo Courtesy: Peter H. Bick

By David Rieder.

When an athlete in any sport is sanctioned for use of banned substances, he or she will almost always respond with shock and outrage. They will release a statement claiming ignorance as to how the substance entered their system and that they had no intention to cheat. Even if the athlete did intend to cheat, their response to a positive would still be denying—and lying.

Far less common is the sanctioning body referring to the individual who tested positive as “an honest, very hardworking and highly credible athlete who is not a ‘cheat.’” And yet, that was exactly how FINA described Madisyn Cox in a report announcing her two-year suspension.

The past decade has been quiet as far as American swimmers receiving sanctions for doping. This year, both Amanda Kendall and Matthew Willenbring have served short suspensions, but Cox is the first U.S. national team swimmer to be suspended since Jessica Hardy withdrew from the 2008 Olympic team after testing positive at Olympic Trials. Hardy, however, later proved her positive test was due to a contaminated supplement.

That said, it’s impossible to prove that every single elite swimmer is clean, and in the wake of shocking breakthrough performances on any level, there will be scrutiny and doubts. There may be drug cheats out there, maybe even some swimming this week at U.S. Nationals in Irvine, Calif.

But right away, FINA’s report says that Cox is not one of those individuals. Cox tested positive for a metabolic agent known as “trimetazidine,” with 0.1 ng/mL detected in her urine sample. In English, that means one-tenth of a nanogram per milliliter. (A nanogram is one-billionth of a gram.) The report calls it a “very low sample” of the drug, right after pointing out Cox’s “moral character.”

And yet, she’s out for two years. Chinese distance star Sun Yang also tested positive for trimetazidine back in 2014, and his controversial suspension lasted only three months. But controls on trimetazidine have changed since then: An out-of-competition ban on the substance was instituted in 2015.


Photo Courtesy: Brooke Wright

Cox is 23 years old, a bit of a late bloomer by women’s swimming standards who only qualified for her first senior national team last year, when she went on to win bronze at the World Championships in the 200 IM. She stated last year that her goal was to swim through 2020, aim to make an Olympic team and then attend medical school.

The sanction could have been a four-year ban, but the FINA panel chose to reduce the ban to two years because it determined that she unintentionally ingested trimetazidine.

So why suspend her at all? Cox said in a statement that she expected to receive a “no fault.” Because the panel was not convinced of the reasoning Cox and a scientific expert she hired gave for the positive test, that she accidentally ingested the trimetazidine by drinking tap water within the previous 12 hours.

According to the report, a test conducted several weeks later found no evidence of trimetazidine in the water supply in Austin, Texas, and the panel found that evidence Cox provided for why trimetazidine could have entered the water was purely speculative.

For the next few paragraphs, assume that everything Cox said, both in her testimony to FINA and in the statement she released, is true. In that case, that’s some truly horrible luck—taking a drink of water from her sink derailed her career.

Think back to the summer of 2017, specifically a monthlong stretch that culminated in Cox winning that World Championship medal in Budapest. She only qualified for that meet after fighting through illness that sent her to the hospital for an IV as soon as she touched down in Indianapolis for U.S. Nationals.

In Budapest, her bronze felt like a launching point. After the race, she had the look of an inspired young woman on course for big things in 2018, 2019 and 2020.

If Cox truly is innocent, she has lost a huge opportunity, and you have to feel horrible for her. In her statement, she pondered an appeal to the Court of Arbitration for Sport, but even if such an appeal succeeded, she would have already missed this year’s Nationals, the qualifying meet for every major U.S. international team over the next two years.

So 2018 and 2019 are out of the question, and she hasn’t firmly committed to a comeback for 2020, either. All because of a few nanograms per milliliter of trimetazidine that Cox claims she ingested via tap water.

But here’s the problem: You can’t assume with 100 percent certainty that Cox is telling the truth here. When an athlete tests positive, they lose the benefit of the doubt.

A doper, someone who actively intends to cheat the system, deserves no sympathy. Cox, if truly wronged by the system, deserves all the sympathy in the world. That’s the logical conclusion from reading the FINA report, that Cox is not at fault—but after her positive test, can we really know for sure?

All commentaries are the opinion of the author and do not necessarily reflect the views of Swimming World Magazine nor its staff.

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4 years ago

History shows us that the really big cheaters usually get away with it, but I suspect that a high percentage of those who are caught are morally innocent.

4 years ago

I would say that shd seems to be guilty.

4 years ago

So no to drugs

4 years ago

Was the test that showed the “supposed” illegal substance (miniscule as it was described) redone again by another lab testing facility to affirm such findings? With all the testing that is done it would seem that there is more error in labs and the collection of samples than what is really reported……

A couple of hours in a laboratory, a few minutes of collecting a specimen versus hours, weeks, months and years of an athletes life and dreams seem an unfathomable sentence of suspension – for what was explained a no enhancement amount possible – Believe what you will, but if it was you or your child – it seems somebody screwed up and I am believing the athlete!

4 years ago

That medication is not used in the US. Therefore it would not be in the tap water.

4 years ago
Reply to  Jame


4 years ago
Reply to  Colorado Coach

Uhh, no….

Greg Stark
4 years ago
Reply to  Jame

A web search proves that false. Trimetazidine was found in New Jersey groundwater.