In addition to the video, some supplementary thoughts. I’ll be brief!
Links to further reading
In the video, I refer to the interview with Dr Paul Dimeo that triggered the mull. Here is that article.
That interview was itself inspired by a piece Paul wrote last year, and you can read that article here.
I came across this piece on Tim Wellens, a professional cyclist who last year withdrew from the Tour de France rather than use salbutamol, the substance that Chris Froome is facing a potential ban for. Just one thought on this from me – you don’t actually need a TUE for salbutamol via inhalation. They changed that in about 2010, and so in the article, where it talks about Wellens refusing to apply for the TUE, that’s not necessary. It’s more, as I read it, that he refuses to use salbutamol.
The other health implication
In the video, I mention briefly Paul’s position that TUEs might have negative health consequences for the athlete, because they enable them to play or train through what may be an acute condition that should really be managed with rest (and medication, possibly). That’s undoubtedly true, but there is another side to that that I feel is worth mentioning, if only for completeness.
This possibility was raised to me by a doctor who approaches the issue from the medical “do no harm” ethos, and the argument is this: An athlete who has prepared and trained for a big event is not going to withdraw in the event because of an acute flare up in say, an allergy or asthma exacerbated by pollen. So they’ll compete, despite the problem, and the TUE may in this case be protective for that athlete. This doctor said to me that there is a real risk of a person being far worse off, possibly even catastrophically, if they were to compete without the TUE.
Now, I’m not 100% sure that I agree with the rationale, though I do understand that it is likely. Imagine the world champs for a sport are in a high pollen area, and the day before, the athlete’s condition flares up. More often than not, they’re competing anyway. That is arguably true, and it’s also true that they may be more at risk without the TUE than with it.
However, I’m not sure that this is enough to justify the abuse of TUEs by some in order to protect others. As I say in the video, I think the general injustice of denying valid TUEs is a stronger argument in favour of the current system. This particular argument feels like saying that just because people will be “reckless” with their health, we should allow other people to be reckless with the integrity of the sport. So no, I don’t think it sways me towards the side of TUEs.
However, I do offer it just to illustrate the complexity of the issue, and that the theoretically best solution (whichever you think it is), sometimes creates unintended consequences. They have to at least be acknowledged, even if one does proceed despite them.
So what’s the answer?
So I didn’t even get to what I think might be done to fix it, though I did say that the best case scenario is an overhaul. I think, and this is very brief and offered as a superficial overview of what might be done, that there four things that need to be looked at:
- Trim the list. There are too many TUEs, and some of them violate what I call “Darwinian” principles in the sport. I think that a sufferer of asthma or another long-term condition that requires chronic medication should be allowed to continue its use. I don’t think that acute conditions should be treatable with more powerful doses or methods of administration of those same drugs. So think Wiggins. If he genuinely has asthma, then the use of the inhaler is fine. There are policies in place to prevent their abuse (as Froome is now discovering, and others like Ulissi have before him). However, the use of Kenacort and other very powerful corticosteroids (and here too, Froome has made use of the drugs) should be stopped.So I think step 1 is to tighten the list, and maintain the granting of TUEs for chronic medication in doses that can be controlled through thresholds, and which don’t offer a performance benefit. But the granting of TUEs for acute conditions should banned, for the reasons described by Paul, and to which I added by thought on above. If an athlete cannot stay healthy, injury free, and physiologically “optimal”, then drugs shouldn’t be allowed to help that out.
- Change the timing. Currently, some pretty powerful drugs don’t even require TUEs out of competition (corticosteroids). That needs to change. They should be banned at all times. No TUEs for in-competition use, and possibly TUEs for medical use but then out of competition only. Extend the window that defines in-competition, so that an athlete can’t take a powerful drug and derive a benefit that might persist for a week. If an athlete is genuinely ill, and needs medical treatment, you can’t deny them that – it’s a violation of human rights, forget sporting rights. However, they don’t have the right to compete and sport, if it wants to be serious about this medicalization of doping, needs to impose longer periods after use of such medicines before competition.
- Independent oversight. I know that some would say this exists already, but it clearly fails. Part of this is because it’s done within a team then the sport. Would a third, independent body that handles only TUEs resolve it? Maybe. People will say it’s too costly and troublesome, but the way I figure, this is one of the big issues facing sport’s credibility today. It should be a priority. Testing is ineffective, so save money on that, and allocate some to this process, I think it’ll help the sport.Also, perhaps athletes with TUEs for those chronic conditions that I mentioned above need to be subject to independent testing, so that two separate tests are conducted before TUEs are granted. When I read Lauren Fleshman’s account of how Salazar used to make his athletes run up and down the stairs and repeat the test over and over until they failed it, it struck me that the system has a loophole that unscrupulous coaches with complicit doctors can fly right through.
The only way to close that, I think, is to change the process of application, and have procedures in place to evaluate the TUEs either at the time, or retrospectively. Perhaps if an athlete has a TUE that is subsequently evaluated in a second test, and they don’t meet the criteria, a third test is done, and if that also doesn’t meet the criteria, the athlete is stripped of the TUE for a minimum of six months. A second “offence” means a two-year exclusion. The second test would have to be done with rigorous methods to prevent the Salazar method or others like it.
- Transparency. I don’t necessarily mean that we should all know which athlete suffers from which condition, and what drugs they take (though this would be better). Though I think people are overly sensitive about many of these conditions. In Norway, I was reading (in the context of the latest Trump horror show) that they make every single person’s tax returns available on a public website. People are too precious about things like this, in my opinion. Norway have figured out that on finances, anyway, transparency is worth the “invasion” this causes to some. It’s much harder to cheat when things are in the open.And while TUEs are involve a medical issue, these are, for the most part, innocuous conditions.What I do think should be possible, moving beyond possible sensitivity issues around medical confidentiality, is to make available a sport-by-sport, country-by-country, month by month report of which TUEs were granted for which conditions. Tell the world that cycling had, say, 65 active TUEs in June, that 22 were new TUEs, and 19 of them are for chronic asthma, 12 were granted for acute problems like chest infections and allergies, and how many athletes have had multiple TUEs over given periods.
Disclosure helps because it will bring into the open the magnitude of the practice. That doesn’t yet tell you the magnitude of the problem, because you’d have no way of knowing how many of those 65 TUEs are legitimate compared to frivolous. But hopefully allied to point 3 above, you’ll start to work out what proportion of the TUEs are frivolous. Over time, you’ll develop a picture that reveals that cycling, or cross-country skiing, or maybe football, issues more questionable TUEs than other sports. That would be informative. Whenever something must be played out in public, it’s a lot harder to exploit.
Anyway, that’s my two cents’, which I offer a starting point for conversation. So far the response to Twitter has been good, lots of arguments for both sides of the debate. Keep it up!