Doping controversy: TUE be or not to be?

Use of banned substances for therapeutic purposes is legal, but it is coming under increased scrutiny after high-profile cases

Published: 25th September 2016 05:39 AM  |   Last Updated: 25th September 2016 02:17 PM   |  A+A-

Rio Olympics Artistic_Mukh

United States' Simone Biles performs on the floor during the artistic gymnastics women's apparatus final at the 2016 Summer Olympics in Rio de Janeiro, Brazil. | AP

CHENNAI: “It looks bad, Brad.”

That was the four-word headline the Sunday Times had for a lengthy piece written by chief sports writer David Walsh. The column was aimed in the general direction of Sir Bradley Wiggins after Fancy Bears, a hacking group, released medical records of some of the biggest athletes (think Rafa Nadal, Simone Biles and Serena Williams) over the last week.

The medical records detailed Therapeutic Use Exemptions (TUE) of all athletes who figured on the list. It looks especially bad in the case of Wiggins because of whatever he had written in his autobiography, ‘My Time’.

“In British cycling culture,” he stated, “at the word needle – or the sight of one – you go, ‘Oh shit’. It’s a complete taboo… I have never had an injection, apart from my vaccinations and drips.” Fancy Bears have exposed Wiggins’ claims.

The hacks state the British rider, who has five Olympic gold medals, received three TUE-based jabs between 2011 and 2013. It has to be said that TUEs are legal. They are authorised by the World Anti-Doping Agency (WADA) and help athletes suffering from medical conditions (asthma or ADHD) compete in a level playing field.

However, since the leaks, a few people have questioned the veracity of the system. Is there a loophole that athletes or coaches can exploit to gain an unfair advantage through legal means?

Dr John Dickinson, the head of respiratory clinic at the University of Kent, has an interesting answer. “I don’t believe it is widespread (the practice of using TUE to gain unfair advantage). However, as with most processes, if somebody knows the system and the evidence that is required to obtain a TUE, it is possible to bend the rules.”

Dickinson, who was involved in screening Team GB athletes for exercise-induced asthma before the 2004 and 2008 Summer Games, says medications that require TUE come with their own side effects. “Although they may have a beneficial effect on one aspect of performance, they may have an equal or worse detrimental effect in another aspect of performance.”

While the issue of doping shouldn’t be conflated with that of a TUE — the former is illegal while the latter is perfectly within legal boundaries for starters — skeptics have argued the system is rigged in favour of athletes. While there is not enough evidence to back that claim, increasing numbers in the last three WADA reports do raise doubts. Approved TUEs in 2013 was 636, 2014 was 897 and it was 1330 in 2015.

TUEB.jpgThat’s an increase of more than 100% in just two years. Further, Wiggins’ jab for triamcinolone acetonide, a long-acting synthetic corticosteroid, is a potent steroid. “In his first Tour de France ‘victory’”, Walsh writes, “it was the corticoid found in Lance Armstrong’s urine.”

Another athlete who excelled in Rio but has since had her name in the mud was Biles. The American gymnast, who has been suffering from Attention Deficit Hyperactivity Disorder (ADHD) for a long time, was on methylphenidate, a banned substance.

It has to be said Biles did nothing wrong to warrant the negative shade but ADHD, in itself, may not be a bad thing for a sportsperson. “If an athlete is suffering from ADHD, this is not necessarily a bad thing,” according to Larissa Maier, a postdoc at the Swiss Research Institute for Public Health and Addiction. “Because impulsivity (a symptom of ADHD) can be beneficial in sports where athletes have short periods of concentration and high performance. Therefore, not all athletes with ADHD who actually have an indication for stimulant medication to treat the symptoms of their disorder are willing to use their medications as TUE.”

She further says conditions like restlessness is ‘desirable during a competition’. “Some symptoms of a mental disorder such as impulsivity, aggressiveness, or restlessness can be beneficial for the athlete with regard to his competitiveness. Thus, an athlete can be more competitive due to the symptoms of a disorder that might be uncomfortable in everyday life but desirable during a competition.”

But it’s worth noting that TUE isn’t a product available on the top shelf of a supermarket. “There is a procedure set in stone before an athlete gets recommended for TUE,” says Dr Ashok Ahuja, former head of sports medicine at NIS, Patiala.

“The entire medical history of the athlete has to be submitted and they take into consideration various parameters and threshold levels before recommending it. Even after saying ‘yes’, it is constantly reviewed.” But there does exist a grey area and while patient-doctor confidentiality means it will be difficult to let out which super athlete is suffering from what common medical condition, WADA can be more transparent about the whole issue.

What is Therapeutic Use Exemption

The WADA website describes TUE as thus. “Athletes may have illnesses or conditions that require them to take particular medications. If the medications an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a TUE may give the athlete the authorisation to take the needed medicine.”

ADHD, Asthma, Diabetes Mellitus and Growth Hormone Deficiency in Adults are some of the conditions that may be treated by drugs that fall under Prohibited List legally through a TUE.

Who or what are the Fancy Bears

They are understood to be a hacking organisation with roots in Russia. They have hacked into WADA’s medical files and have been releasing records of elite athletes — particularly from USA or UK — over the last week.

What is the process involved in trying to obtain a TUE

Robert Bobby George, Anju’s husband, guides Express through the process.

❶ First step, you have to fill forms. In that you need to specify whether you want permanent TUE or abbreviated TUE (just before or during a tournament).

❷ Anju wanted an abbreviated TUE because of an ankle injury (she had problems during take-off) suffered just before the Beijing Olympics. We discovered the problem a week before the Olympics.

❸ Since it’s tough getting a TUE in India just before a major event we decided to go to Beijing and apply.

❹ After we applied, she had to go through a series of tests, which included an MRI. Once they granted that, they themselves administered a single shot of a corticosteroid (anti-inflammatory) injection. However, it didn’t bring much relief to Anju.

Note: Anju was earlier denied a TUE for an asthma complaint.

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