The steroids used by ex-Premier League players Carlos Tevez, Dirk Kuyt and Gabriel Heinze during the 2010 World Cup should be completely banned, says Fifa’s former chief medical officer.
Tevez, Kuyt and Heinze were among 25 players able to take banned medicines in South Africa after being given therapeutic use exemptions (TUEs).
But Professor Jiri Dvorak says glucocorticoids cause long-term damage.
He told BBC Sport use of the steroid “should be stopped – full stop”.
Glucocorticoids are commonly used to treat inflammation, joint pain, asthma and skin problems such as eczema.
They are prohibited by the World Anti-Doping Agency (Wada), but athletes can ask for a TUE depending on how the substance will be administered.
Dvorak, who left Fifa in 2016 after 22 years, was governed by those guidelines but said “as a physician” he believes glucocorticoids should not be permitted under any circumstances.
It is not clear why Tevez and Heinze used the steroid betamethasone during the World Cup, but it is thought Kuyt was given dexamethasone for tooth pain.
There is no suggestion any of the footballers have done anything wrong.
In a statement to BBC Sport, Fifa said it has “a clear, robust and stringent policy in place” concerning TUEs.
World football’s governing body added: “This policy is applied strictly to avoid any abuse and ensure the process of granting TUEs is the same for all players.”
Are the exemptions a cause for concern?
On Tuesday, hackers Fancy Bears made public the list of TUEs issued at the 2010 World Cup.
As well as then Manchester City forward Tevez, ex-Liverpool winger Kuyt and one-time Manchester United defender Heinze, a group of players from Argentina, Netherlands and Germany were also reportedly given permission to use the banned substances.
Dvorak has no concerns about those exemptions, but acknowledges the decision to prescribe any drugs is subjective.
“We had quite a strict process,” he said. “We required full documentation to support the application, including medical documents. There were justified medical declarations to support the exemptions.
“We were happy everything was declared. But sometimes it depends on how the doctor is feeling whether he prescribes the steroids.
“I was always warning about the use of them and trying to educate people.”
Why is there concern about glucocorticoids?
Glucocorticoids can be used to treat a range of ailments – including for pain relief or inflammation – and can be injected into a joint or administered via pills or creams.
They differ from anabolic steroids, which can be used by some athletes and body-builders to improve performance.
But steroids can weaken the immune system and thin cartilage, and there is also a risk of infection from injections.
Dvorak, now senior consultant in neurology at the Schulthess Clinic in Zurich, says they must be taken seriously.
“It is a very potent drug, there can be serious side-effects,” he said. “They can cover the symptoms but it is the long-term effect I am concerned about.
“At the moment, with an application for use, they are allowed. As a physician I am against glucocorticoids – their use should be stopped – full stop. The lesson is not being learnt.”
Does football have a problem with anti-doping procedures?
In 2010, players could either seek a TUE, for the manner of administrating a substance not directly on the prohibited list, or a declaration of use (DoU) when an exemption from a doctor was required.
Now, TUEs are required for both banned substances and methods of administration.
Dvorak, who has warned in the past about the overuse of legal painkillers in sport, said he has confidence in Fifa’s systems.
“I don’t think Fifa has changed the process since I left, so I am not worried that the system is being abused. When I look at other sports, like athletics and tournaments like the Olympics, compared to World Cups, we had far fewer TUEs in football.”
A report by Canadian law professor and sports lawyer Dr Richard McLaren, published in December 2016, claimed Russian footballers were among more than 1,000 sportspeople to benefit from a state-sponsored doping programme between 2011 and 2015.
And Dvorak admits there may be some discrepancies in the different systems used around the world.
“Some anti-doping committees are not so stringent,” he said.
“There are many good national anti-doping bodies – like the Swiss and UK bodies – which are of a really high quality. But there are some countries in Asia or Africa that don’t have such good processes, they don’t have the resources or the experience.”