The IOC and many international federations (IF) have clear regulations prohibiting participants in sanctioned events from refusing to compete against athletes from other countries for political, cultural or religious reasons. Failing to abide by these regulations can result in significant penalties for the offending athletes and their federations. However, being injured or ill provides plausible deniability for those committed to not competing for political purposes. PURPOSE: To explore the use of quantative analysis to uncover patterns of medical withdrawal from competitions that indicate systematic abuses of medical waivers for political purposes. METHODS: Demographic information (number of participants, event, country) was compiled from the official entry and results lists of the Federation Internationale d’Escrime (FIE) for 1.5 competition seasons 2014-2016 for 3 countries (Iran (IRI), Kuwait (KUW), Saudi Arabia (KSA)) anecdotally reported to be systematically avoiding competing against Israel (ISR) by using medical withdrawals. RESULTS: Athletes from the three countries had a total of 623 competition exposures during the observation period (IRI: 279 vs. other nations; 4 vs. ISR; KUW: 239 vs. other nations; 6 vs. ISR; KSA: 101 vs. other nations; 3 vs. ISR). For IRI there was 100% (279) participation against non-ISR opponents but 0% (0/4) participation against ISR athletes. KUW had 99% (233/235) participation against non-ISR athletes and 0% (0/6) against ISR. KSA had 100% (98/98) against non-ISR and 0% (0/3) for ISR. In each case, McNemar’s test indicated p<0.000001. CONCLUSION: Although it is not reasonable to determine the legitimacy of requests for medical withdrawal from competition on a case-by-case basis in instances where non-medical motivation may be involved, it is possible to identify systematic abuses of medical exemptions through data analyses. To reaffirm the integrity of sports competition and the independence of medical care, it is incumbent on the IOC and IFs to investigate suspect action using available entry and withdrawal data and move to hold non-conforming nations accountable.

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