Publisher Health

Yale researchers have discovered the underlying genetic cause of a rare childhood disorder that mimics inflammatory bowel disease, a finding that may help researchers uncover the roots of a host of other inflammatory and autoimmune disorders.
For the study, a team of Yale researchers investigated a mysterious case of a young boy who was treated at Yale New Haven Hospital for abdominal pain, intermittent bouts of fever, and diarrhea over multiple days, and canker sores in his mouth. Using genome sequencing of the child and his healthy parents, they revealed that the boy had a genetic defect that blocked ELF4, a transcription factor on the X chromosome that regulates expression of a large number of other genes.
Then, after reaching out to colleagues in the field of rare diseases, the research team identified two other male children with similar symptoms who also had ELF4 gene variants. This disorder is now termed “Deficiency in ELF4, X-linked,” or DEX for short. And an increasing number of cases are being identified.
“It is very exciting to start with patients who are sick and discover an unexpected new gene with a fundamental role in regulating inflammation.” said Carrie Lucas, an assistant professor of immunobiology at Yale School of Medicine and senior author of the paper published July 29 in the journal Nature Immunology.
The study was headed by Paul Tyler, Molly Bucklin, and Mengting Zhao, all of whom are members of Lucas’s lab.
Inflammatory diseases caused by a single gene mutation affect about 1 out of every 5,000 children.
According to the researchers, the symptoms experienced by the children in the study were similar to those associated with other inflammatory bowel diseases, including ulcerative colitis and Crohn’s Disease, thought to be caused by an overactive immune system response that damages tissues of the host.
After identifying the ELF4 variant, Lucas’s lab then studied its effects in cultured cells from patients, as well as in mice using CRISPR gene-editing to introduce patient-derived ELF4 mutations. They confirmed that the variant disrupted ELF4 function, and resulted in elevated inflammatory responses of a variety of immune cell types.
The widespread effects of the variant suggest ELF4 and its target genes likely play a role in regulating inflammation in multiple diseases, Lucas said.
“This gives us the opportunity to identify and study the effects not only of ELF4 but also the genes it regulates across immune cell types and inflammatory disease phenotypes,” she said. “This will help us create a new molecular roadmap relevant to understanding and treating human disease.”
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Materials provided by Yale University. Original written by Bill Hathaway. Note: Content may be edited for style and length.

Despite hopes of a summer free from Covid-19 worry, the Centers for Disease Control and Prevention is now recommending that vaccinated people wear masks in certain areas. While masks are important for protecting against infections, the United States must proceed carefully.Health officials spent months assuring vaccinated Americans that they didn’t need to mask up against Covid-19 because they were protected from illness and were unlikely to spread infections to others. A return to masking for everyone could be interpreted as moving the goal posts or as a signal that experts are no longer as confident as they were in the vaccines — especially if new masking rules are not tied to specific metrics like vaccinations or if masking rules are in effect in places where hospitals are not dealing with crisis-level admissions.There is a better way to carry out masking recommendations, by closely linking them to three specific factors:Is Covid-19 spreading in areas where mask mandates are in effect?Requiring everyone to wear masks may seem as if it can’t hurt, but experts shouldn’t waste time and credibility enforcing measures if they won’t have an impact.Bringing back masks for everyone will be most effective if a significant amount of Covid-19 transmission is occurring in public spaces like grocery stores and dance clubs. But health officials haven’t shared sufficient data showing this is the case, and that’s a problem.State and local health agencies need to have a better understanding of which activities are driving local transmission and tailor policy accordingly. For example, earlier in the pandemic, contact tracing revealed that high levels of transmission were happening at family and friend gatherings in people’s homes — like for holidays and birthdays — where masks are less common. If this remains true, then mask mandates alone will not be enough to cut back on rising cases.Also earlier in the pandemic, case control studies — which look for differences in behaviors between people who catch Covid-19 and people who haven’t been infected — found that people diagnosed with Covid-19 were more likely to have reported dining at restaurants than uninfected people. If this remains the case, then other measures like limiting occupancy at restaurants and bars might need to be considered in addition to masking, since diners can’t wear masks while eating or drinking.Genetic sequencing can also help provide clues as to how the coronavirus is spreading. With the increase in resources provided by the Biden administration to enable state agencies to use genetic sequencing to track variants, health agencies should embrace this technology as much as possible to identify large clusters of cases that share transmission patterns.Do local disease and vaccination rates support mask wearing by vaccinated people?The C.D.C. recommends that vaccinated people wear masks in areas “of substantial or high transmission” of Covid-19 to avoid getting infected and possibly spreading the virus to others.To know exactly where those areas are, it’s important to look at local conditions. But in the past few months, most states have scaled back on the amount and frequency of Covid data they share with the public.For example, Florida, which last week accounted for more than 20 percent of Covid-19 cases reported in the United States, has reduced its case reporting to once a week and no longer shares testing data or deaths broken down by county. The C.D.C. has a map that shows a summary of Covid-19 data for the nation, but it is less detailed than what states have typically reported.At this stage of the pandemic, state and local governments should present more data, not less. At a minimum, they should publish the frequency and demographic breakdown of cases, tests, hospitalizations and deaths, as well as vaccinations. And they should do so daily.County-level data is useful, but ZIP code or census tract level data is even better. Los Angeles County, for example, has been able to vaccinate more than 70 percent of eligible adults, but this statistic hides the fact that some parts of the county have much lower vaccination coverage. Highly localized data will help people understand the specific risks where they live and work and the need for mask recommendations more clearly.At the same time, health officials should continue to provide data that shows the benefits of vaccines. Without it, experts might inadvertently send the signal that masks are a suitable alternative to getting a vaccine. Breakdowns of cases and hospitalizations by vaccination status should be regularly reported. This will also help experts monitor how well the vaccines are continuing to prevent severe illness.When can masks come off?Local experts should provide people with metrics they are using — like infections or vaccinations — to decide when masks will no longer be needed. Doing so underscores why the masks are back in the first place and provides hope for those who don’t like to wear them.Since vaccines offer durable protection against serious illness, tying masking requirements to reasonable vaccination coverage goals and acceptable hospitalizations levels will provide a clearer view of progress than case numbers, which can fluctuate.Everyone is weary of the pandemic. Vaccines offer the way out, but the United States has not convinced enough Americans of this. The nation cannot simply revert to the broad tactics employed during previous surges and expect compliance. It must be made explicitly clear to the public how measures like mask mandates will cut transmission and can be used to incentivize vaccinations.Jennifer B. Nuzzo (@JenniferNuzzo) is an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and a senior fellow for global health at the Council on Foreign Relations. Beth Blauer (@biblauer) is the associate vice provost for public sector innovation and the executive director of the Centers for Civic Impact at Johns Hopkins University. They are on the leadership team of the Johns Hopkins Coronavirus Resource Center.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.

Despite hopes of a summer free from Covid-19 worry, the Centers for Disease Control and Prevention is now recommending that vaccinated people wear masks in certain areas. While masks are important for protecting against infections, the United States must proceed carefully.Health officials spent months assuring vaccinated Americans that they didn’t need to mask up against Covid-19 because they were protected from illness and were unlikely to spread infections to others. A return to masking for everyone could be interpreted as moving the goal posts or as a signal that experts are no longer as confident as they were in the vaccines — especially if new masking rules are not tied to specific metrics like vaccinations or if masking rules are in effect in places where hospitals are not dealing with crisis-level admissions.There is a better way to carry out masking recommendations, by closely linking them to three specific factors:Is Covid-19 spreading in areas where mask mandates are in effect?Requiring everyone to wear masks may seem as if it can’t hurt, but experts shouldn’t waste time and credibility enforcing measures if they won’t have an impact.Bringing back masks for everyone will be most effective if a significant amount of Covid-19 transmission is occurring in public spaces like grocery stores and dance clubs. But health officials haven’t shared sufficient data showing this is the case, and that’s a problem.State and local health agencies need to have a better understanding of which activities are driving local transmission and tailor policy accordingly. For example, earlier in the pandemic, contact tracing revealed that high levels of transmission were happening at family and friend gatherings in people’s homes — like for holidays and birthdays — where masks are less common. If this remains true, then mask mandates alone will not be enough to cut back on rising cases.Also earlier in the pandemic, case control studies — which look for differences in behaviors between people who catch Covid-19 and people who haven’t been infected — found that people diagnosed with Covid-19 were more likely to have reported dining at restaurants than uninfected people. If this remains the case, then other measures like limiting occupancy at restaurants and bars might need to be considered in addition to masking, since diners can’t wear masks while eating or drinking.Genetic sequencing can also help provide clues as to how the coronavirus is spreading. With the increase in resources provided by the Biden administration to enable state agencies to use genetic sequencing to track variants, health agencies should embrace this technology as much as possible to identify large clusters of cases that share transmission patterns.Do local disease and vaccination rates support mask wearing by vaccinated people?The C.D.C. recommends that vaccinated people wear masks in areas “of substantial or high transmission” of Covid-19 to avoid getting infected and possibly spreading the virus to others.To know exactly where those areas are, it’s important to look at local conditions. But in the past few months, most states have scaled back on the amount and frequency of Covid data they share with the public.For example, Florida, which last week accounted for more than 20 percent of Covid-19 cases reported in the United States, has reduced its case reporting to once a week and no longer shares testing data or deaths broken down by county. The C.D.C. has a map that shows a summary of Covid-19 data for the nation, but it is less detailed than what states have typically reported.At this stage of the pandemic, state and local governments should present more data, not less. At a minimum, they should publish the frequency and demographic breakdown of cases, tests, hospitalizations and deaths, as well as vaccinations. And they should do so daily.County-level data is useful, but ZIP code or census tract level data is even better. Los Angeles County, for example, has been able to vaccinate more than 70 percent of eligible adults, but this statistic hides the fact that some parts of the county have much lower vaccination coverage. Highly localized data will help people understand the specific risks where they live and work and the need for mask recommendations more clearly.At the same time, health officials should continue to provide data that shows the benefits of vaccines. Without it, experts might inadvertently send the signal that masks are a suitable alternative to getting a vaccine. Breakdowns of cases and hospitalizations by vaccination status should be regularly reported. This will also help experts monitor how well the vaccines are continuing to prevent severe illness.When can masks come off?Local experts should provide people with metrics they are using — like infections or vaccinations — to decide when masks will no longer be needed. Doing so underscores why the masks are back in the first place and provides hope for those who don’t like to wear them.Since vaccines offer durable protection against serious illness, tying masking requirements to reasonable vaccination coverage goals and acceptable hospitalizations levels will provide a clearer view of progress than case numbers, which can fluctuate.Everyone is weary of the pandemic. Vaccines offer the way out, but the United States has not convinced enough Americans of this. The nation cannot simply revert to the broad tactics employed during previous surges and expect compliance. It must be made explicitly clear to the public how measures like mask mandates will cut transmission and can be used to incentivize vaccinations.Jennifer B. Nuzzo (@JenniferNuzzo) is an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and a senior fellow for global health at the Council on Foreign Relations. Beth Blauer (@biblauer) is the associate vice provost for public sector innovation and the executive director of the Centers for Civic Impact at Johns Hopkins University. They are on the leadership team of the Johns Hopkins Coronavirus Resource Center.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.

Removing a protein that is often overexpressed in a rare and aggressive subtype of leukemia can help to slow the cancer’s development and significantly increase the likelihood of survival, according to a study in mice led by scientists at the UCLA Jonsson Comprehensive Cancer Center.
The research, published today in the journal Leukemia, could aid in the development of targeted therapies for cancers that have high levels of the RNA-binding protein IGF2BP3 — especially acute lymphoblastic and myeloid leukemias that are characterized by chromosomal rearrangements in the mixed lineage leukemia (MLL) gene.
In these MLL-rearranged leukemias, IGF2BP3 attaches to certain RNA molecules that carry genetic instructions for cancer-related proteins, markedly amplifying cancer development. Children and adults diagnosed with this subtype have a poor prognosis and a high risk of relapse after treatment.
“This type of leukemia is more aggressive because of its ability to divide and spread faster,” said senior author Dr. Dinesh Rao, a member of the Jonsson Cancer Center and an associate professor of pathology and laboratory medicine at the David Geffen School of Medicine at UCLA. “The disease can be very difficult to treat, even with new targeted immunotherapies like CAR T cell therapy and blinatumomab.”
Leukemia begins in the bone marrow and is spurred by genetic mutations that cause stem cells in the marrow to produce too many white blood cells, affecting the body’s ability to fight infection. Rao and his team had earlier identified IGF2BP3 as a factor in driving the development of leukemia — particularly the MLL-rearranged subtype — by regulating various RNA messages that contribute to the disease.
Taking this into account, the researchers wondered whether removing the IGF2BP3 protein might stop the proliferation of leukemia cells. To answer the question, Rao and his team used the powerful gene-editing tool known as CRISPR-Cas9 to remove IGF2BP3 from both MLL-leukemic mice and cell lines. The effects on survival, they found, were striking.

A meta-analysis of nearly 200,000 men revealed 22 new genetic locations that could be susceptible to inherited testicular germ cell tumors (TGCT) — a 40 percent increase in the number of regions known to be associated with the cancer. The new findings, published online in Nature Communications, could help doctors understand which men are at the highest risk of developing the disease and signal them to screen those patients.
The multi-institutional meta-analysis was conducted by researchers from The international TEsticular CAncer Consortium (TECAC), led by Katherine L. Nathanson, MD,deputy director of Penn’s Abramson Cancer Center and Pearl Basser Professor of BRCA-Related Research in the Perelman School of Medicine at the University of Pennsylvania.
In 2017, the TECAC reported an additional 12 loci. The new study brings the total number to 78.
“This latest set of genetic locations is adding to our understanding of the inherited drivers of testicular cancer, as we look to improve screening among men who may be at high risk,” Nathanson said. “Although this cancer is curable, identifying these men earlier can help save them from having to undergo certain treatments, such as chemotherapy, which can have late and unwanted complications.”
Germ cell tumors account for 95 percent of testicular cancer cases. TGCTs are the most common cancer in the United States and Europe in white men between the ages of 20 and 39. The number of cases has continued to rise over the past 25 years in white men and more recently in Latino men. Despite significant evidence that susceptibility to these tumors is hereditary, CHEK2 is the only moderate penetrance gene in which pathogenic variants have been associated with risk of the cancer.
Genome-wide association studies (GWAS) have been more successful, identifying common variations associated with risk of the disease. Nathanson and TECAC teams have used the method to find locations on chromosomes — called loci — that contain variants associated with an increased risk of germ cell tumors.

Chronic viral infections and cancer can cause “killer” T cells in the immune system to take on a state of dysfunction or exhaustion whereby they can no longer react to infectious invaders or abnormal cells like normal “memory” T cells. Two new studies led by investigators at Massachusetts General Hospital (MGH) and published in Nature Immunology provide insights into T cell exhaustion, which could lead to potential strategies to overcome it.
One study, which was led by Georg M. Lauer, MD, PhD, of the Division of Gastroenterology at MGH, focused on differences between memory and exhausted T cells in individuals with human hepatitis C virus (HCV) infection before and after treatment. After patients were treated and cured, their exhausted T cells tended to take on some properties of memory T cells but did not function as well as memory T cells.
“We saw some cosmetic improvement of the T cells that in a more superficial study could have been interpreted as real recovery, whereas in reality the key parameters determining the efficacy of a T cell were unchanged,” says Lauer. “A significant number of molecules that were altered were normalized after treatment, but others were stuck, and these were clearly the ones associated with T cell function.” This lack of recovery was especially prominent with a long duration of T cell stimulation by the virus; a shorter stimulation allowed the cells to revert to functional memory T cells.
“We are currently studying whether treating HCV with direct acting antiviral therapy in the acute phase of infection, instead of many years later, will result in full memory differentiation of T cells. If correct, this could indicate a short window of opportunity early during chronic infections to protect T cell function,” says Lauer.
Also, the molecules that the researchers found to be expressed in severely exhausted T cells might be targeted to rescue these cells.
A complementary study in the same issue of Nature Immunology that was led by Debattama Sen, PhD, at the Center for Cancer Research at MGH, and W. Nicholas Haining, BM, BCh, at Merck found that these exhausted T cells in chronic HCV infection were regulated epigenetically, or through physical changes in the cells’ chromosomes that affect the expression of genes. The investigators discovered that after clearing the virus, the epigenetic landscape of exhausted T cells was partially remodeled, but maintained many exhaustion-specific alterations, which the authors termed “epigenetic scars.” The epigenetic patterns paralleled the findings of the first paper on the protein and transcriptional level, indicating a key role for epigenetic control in determining the fate of the T cells. “These scars might be locking the exhausted T cells and preventing return to proper function even if the chronic infection in the patient is cured,” notes Sen. “Thus, restoring the function of these cells will likely require directly removing or inactivating these scarred regions to unlock the cells’ functionality.”
By comparing T cell responses across a range of viruses that are either effectively cleared (like influenza) or become chronic (like HCV and HIV), the scientists produced a map of where these exhaustion-specific scars occur. “This will enable precision editing and allow us to target the specific regions relevant to exhausted T cells and minimize off-target effects in other T cell populations,” says Sen.
The two studies were performed within an NIH/NIAID-funded U19 Cooperative Center on Human Immunology (CCHI) located at MGH. A third study on exhausted T cells, which was conducted by MGH CCHI investigators at the University of Pennsylvania, accompanies these two articles in Nature Immunology. A News & Views article in the journal provides additional perspectives on the implications of the studies’ findings.
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Materials provided by Massachusetts General Hospital. Note: Content may be edited for style and length.

Emergency department visit rates because of an opioid overdose increased by 28.5% across the U.S. in 2020, compared to 2018 and 2019, recent Mayo Clinic research finds. Emergency visits overall decreased by 14% last year, while visits because of an opioid overdose increased by 10.5%. The result: Opioid overdoses were responsible for 0.32 out of 100 visits, or 1 in every 313 visits, which is up from 0.25, or 1 in every 400 visits, the previous two years.
This trend is supported by preliminary data recently released by the Centers for Disease Control and Prevention (CDC), which recorded more than 93,000 opioid overdose deaths in 2020. That’s a 29.4% increase from the year prior and the most opioid overdose deaths every recorded in the U.S.
The research was published in the Annals of Emergency Medicine and was presented in June at the AcademyHealth annual research meeting. The research also was presented at the Society for Academic Emergency Medicine’s conference, where it was selected for a plenary session.
“COVID-19, and the disruptions in every part of our social and work lives, made this situation even harder by increasing the risk of opioid misuse and relapse because people were separated from their social support and normal routines,” says Molly Jeffery, Ph.D., a researcher in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and senior author. “While institutions across the U.S. are keenly aware that opioid misuse is a major health concern, this shows that there is more work to be done, and it provides an opportunity for institutions and policymakers to expand evidence-based treatments and resources.”
Over 70% of drug overdose deaths in 2019 involved an opioid, according to the CDC, though trends were leveling off before the COVID-19 pandemic. Since then, that trend has reversed significantly, data are showing.
The research team studied visits to 25 emergency departments in six states — Alabama, Colorado, Connecticut, North Carolina, Massachusetts and Rhode Island — from January 2018 through December 2020. Opioid-related overdose visits increased to 3,486 in 2020 from 3,285 and 3,020 in 2019 and 2018, respectively. Previous research by this team found an immediate and significant decrease in emergency department visits during the first few months of the COVID-19 pandemic, a trend that continued throughout 2020.

Phil Zeitler, MD, PhD, has been treating youth with type 2 diabetes for more than 20 years. He and a team of researchers published a paper today on the TODAY2 study in the New England Journal of Medicine on the long-term complications of type 2 diabetes. (TODAY stands for Treatment Options for type 2 Diabetes in Adolescents and Youth. The first phase of the study took place from 2004 — 2011; phase two from 2011 — 2020. Both studies involved more than 550 participants from across the country.)
Zeitler is the chair of the TODAY study group and is a professor of pediatrics, endocrinology at the University of Colorado School of Medicine and medical director of the pediatric Clinical and Translational Research Center at Children’s Hospital Colorado, both located on the University of Colorado Anschutz Medical Campus.
The TODAY2 study focused on complications of youth-onset type 2 diabetes. Overall, researchers saw a steady decline in blood glucose control over 15 years. In addition, 67% of participants had high blood pressure nearly 52% had dyslipidemia, or high fat levels in the blood nearly 55% had kidney disease 32% had evidence of nerve disease 51% had eye disease.Rates did not differ based on the original TODAY study treatment group assignment.
In addition, certain participants had a higher likelihood to develop multiple complications over time, with 28% developing two or more over the follow-up period. Participants who belonged to a minority racial or ethnic group, or who had high blood glucose, high blood pressure, and dyslipidemia were at higher risk for developing a complication.
The study shows that not only is the disease having an impact on youth and young adults at a young age, but it also shows a clustering of complications. Eighty percent of participants had some complication. The majority had two, three or more complications.

The shortage of vaccines and slow vaccine rollouts in many parts of the world, has sparked a trend of vaccine tourism, with many tourists heading to the United States to get vaccinated. Nearly 50% of US residents are fully vaccinated but the rates are much lower in many countries. The BBC’s Cindy Sui has been speaking to some ‘vaccine tourists’ at San Francisco International Airport, where anyone who is allowed to pass through customs can get a free shot as long as they do not currently have Covid, have not had another Covid vaccination and are at least 18 years old.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesUS sprinter Sha’Carri Richardson will be missing the Tokyo Olympics because she tested positive for marijuana during the US Track & Field trials. With cannabis legal in many states across America, why is it still outlawed in sports?With her flowing tangerine orange hair, killer smile and lightning speed, Sha’Carri Richardson was unmissable in the lead-up to the Olympic Games. Considered the sixth-fastest woman in history, with a best-ever time for the 100m of 10.72, the Texas sprinter was expected to be a major contender for the Gold medal in Tokyo.But when her teammates take to the track for the women’s 100m heats on Friday, she won’t be there.In early July, it was announced that Ms Richardson would not be representing the US at the games because she had tested positive for cannabis use during the qualifying race.As punishment, the US Anti-Doping Agency banned her from competing for one month and expunged her qualifying victory. Although the 30-day suspension technically ended during the Tokyo games, US Athletics chose not to include her on the team.Her disqualification has reignited a long debate over marijuana prohibition in Olympic sports. image copyrightGetty ImagesGiven that it is legal in many US states, and that its performance-enhancing properties are disputed, many wonder why cannabis should still be banned.A ‘performance enhancing’ substance?Marijuana (cannabis) has been banned by the World Anti-Doping Agency (Wada) since the organisation first created its list of prohibited substances in 2004. Items on the list meet two out of three criteria:Criteria 1: They harm the health of the athleteCriteria 2: They are performance enhancingCriteria 3: They are against the spirit of sportIt is the second point that people seem to take the most issue with when it comes to weed, and it has become the subject of many late-night punchlines.”The only way it’s a performance-enhancing drug is if there’s a big [expletive] Hershey bar at the end of the run,” joked the late comedian Robin Williams.In 2011, Wada defended the ban on cannabis in a paper published in the journal Sports Medicine. Citing a study on marijuana’s ability to reduce anxiety, Wada found cannabis could help athletes “better perform under pressure and to alleviate stress experienced before and during competition”.image copyrightGetty ImagesBut those findings aren’t enough to warrant concluding marijuana is a performance-enhancing drug, argues Alain Steve Comtois, director of the department of sports science at the University of Quebec at Montreal.”You have to take the big picture,” he tells the BBC. “Yes anxiety levels go down, but in terms of actual physiological data, it shows that performance is reduced.”Mr Comtois was one of the authors of a 2021 Journal of Sports Medicine and Physical Fitness review of research on marijuana use before exercise and its capacity to enhance athletic performance.The paper found that most research points to marijuana hindering physiological responses necessary for high performance, by raising blood pressure and decreasing strength and balance.The paper did not look at the effects of marijuana on anxiety, but Mr Comtois says its other negative effects would counteract any benefits, giving the idea that marijuana can enhance athletic performance “no merit”.image copyrightGetty ImagesDrugs and the spirit of sportBut there is more to Wada’s rule than just a ban on performance-enhancing drugs.Founded in 1999 after several high-profile doping scandals at the Olympics, Wada aimed to lead the charge to end doping in sports around the globe. When coming up with its list of banned substances in 2004, marijuana was illegal in almost every country in the world.”They didn’t want to get in social respectability trouble,” says John Hoberman, a cultural historian who researches the history of anti-doping at the University of Texas-Austin.Its status as an illicit drug was cited by Wada in the 2011 paper as one of the reasons why marijuana offended the “spirit of sport” (criteria 3) and was “not consistent with the athlete as a role model for young people around the world”. The rule has led to reprimands for not only Ms Richardson, but also dozens of other athletes.In 2009, Michael Phelps was banned from competition for three months, and lost his Kellogg’s sponsorship, after photos of him smoking marijuana were leaked online. image copyrightGetty ImagesUS sprinter John Capel was banned for two years after testing positive for a second time in 2006. Before Wada created the prohibited drug list, the International Olympic Committee tried to take away Canadian snowboarder Ross Rebagliati’s gold medal because he tested positive. It was returned after a court ruled there was no official rule against it – the IOC banned it two months later. Why are so many countries now saying cannabis is OK?But over the past decade, marijuana’s legal status – and society’s attitude towards it – has begun to shift. Uruguay was the first to make it legal to buy and sell marijuana for recreational use in 2013, with Canada following suit in 2018.Many more countries have decriminalised it to a some degree, including South Africa, Australia, Spain and the Netherlands. In the US, it is illegal federally, but it is legal in about a third of states – including the state of Oregon where Ms Richardson tested positive.image copyrightGetty ImagesThere has also been an increasing acceptance of cannabis use for medical purposes, with many countries, including the UK, allowing medical marijuana.In fact, in 2019, Wada removed cannabidiol (CBD), a component of cannabis, from the banned list, even though the chemical remains illegal in some countries, like Japan, where the Olympics are hosted this year.Could CBD become ‘like protein shakes’?’CBD oil helps me cope with my anxiety’These changes have fuelled the current criticism of Ms Richardson’s ban.The runner told NBC News that she had used marijuana to cope with the death of her mother a week before the qualifier.”I greatly apologise if I let you guys down – and I did. This will be the last time the US comes home without a gold in the 100m,” she said. Amid an outpour of sympathy for Ms Richardson, Wada faced a dilemma. As Mr Hoberman puts it: “You can’t run an organisation that is rules bound, and simply dissolve a rule at a convenient moment”.Because the cannabis ban is still on the books, an exception could not be easily made for Ms Richardson.”And so this young woman was victimised by the existence of this rule,” says Mr Hoberman.What next?It’s unclear if or when Wada will reconsider the ban on cannabis but pressure is mounting for it to do so.Ms Richardson’s suspension prompted US President Joe Biden to question the current law, although he fell short of saying it should be overturned, prompting rumours the White House could step in.”Rules are the rules. Everybody knows what the rules are going in,” Biden told reporters Saturday in Michigan. “Whether they should remain that way, whether that should remain the rule, is a different issue.”Even the United States Anti-doping Agency, the American authority that enforces Wada’s rules, said “it’s time to revisit the issue.”Until then, Ms Richardson, and other athletes like her, will have to stay away from cannabis, or stay on the sidelines.