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All About Salbutamol

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What will the verdict in Froome's salbutamol case?

He will be cleared
43
34%
3 month ban
4
3%
6 month ban
15
12%
9 month ban
24
19%
1 year ban
16
13%
2 year ban
21
17%
4 year ban
3
2%
 
Total votes : 126

Re: All About Salbutamol

15 Oct 2018 15:27

samhocking wrote:Dr Daren Austin was a speaker at American Conference on Pharmacometrics regarding his work clearing Froome last week. Might be possible to get his slides perhaps MI?


Dunno. I tried Robert's link, I found the presentation listed, but it doesn't seem to be available at that site (i.e., I clicked on it, nothing happened). I have been checking Pub Med periodically since I communicated with Austin more than two months ago, and still nothing turns up. Something may be out there, but I don't know where.

Glucocorticosteroids and Beta-2 Agonists report a Presumptive Adverse Analytical That has nothing to do with B confirming A. Exclusively for Glucocorticosteroids and Beta-2 Agonists the rules clearly state the RMA, should verify the route of administration used as part of its Initial Review before prosecuting a case as an AAF. That is the part of the rules Froome's AAF got to. If UCI had begun prosecuting as an AAF, then Froome would have had to have take the pharmo test. This is the same as Ullissi exactly.


By this definition, every salbutamol concentration that is above the DL is presumed, and should get the same treatment Froome’s did. But in fact, there is no way to verify the route of administration other than the enantiomers test, which as far as we know Froome did not submit to, and which in any case can't actually prove oral use, anyway. Petacchi apparently had a high value in that test, which was taken as evidence that he was over the limit, but the CAS panel did not conclude that he had taken salbutamol orally. In fact, I’m not aware of any case where oral use has been proven, and the rider given a greater penalty. It may have happened, but it’s quite rare, at least.

The only difference between Froome and any other athlete with a salbutamol concentration above the DL is that he was able to hire some very good scientific advisors, who managed to convince WADA that there were on-the-road factors like dehydration and effects of previous stages that aren’t taken into account by the laboratory studies. Armed with this argument, Froome was able to avoid the pharmacokinetic study. Any other rider in the world could have done the same thing, given that scientific testimony. But there is nothing in the WADA rules that says that such scientific testimony can override the need for a controlled study. Froome did get special treatment, and so could have anyone else with the resources needed to circumvent the rules.

Also 20% of other above threshold salubutomol cases from 2013 to 2015 resulted in aquittal too, so hardly unique to Froome, other than Froome's circumstances it seems?


We have no idea why those athletes were exonerated, though. Perhaps they passed the controlled study? Or their urinary levels would have been under the limit if the USG correction were allowed? What we do know is that their cases were not resolved in the way Froome's was, because the arguments he used had never been used before. WADA was not aware of lognormal distributions before. They did not take into account dehydration. They did not appreciate the difference between MDI and dry powder inhalers. They did not use (did not have) a large number of negative tests to establish the range of variability.

That last factor is probably the most important one. Froome's 2017 Vuelta was nearly unique in that he was tested almost every stage, and therefore had a large number of samples that could be used to derive the relationship between amount inhaled (having to trust Froome's memory as well as his honesty, of course) and urinary level. Petacchi, e.g., only had four samples other than the one that exceeded the limit. We don't know who those exonerated athletes were, but it's highly unlikely that they tested positive in a GT in which they were wearing the leader's jersey almost from start to finish.

Now that I think of it, though, this is a little project that someone in the Clinic--or really, anyone who follows pro racing a little more closely tnan I do--might be able to help with. Have there been any riders who have been tested as often as, say, ten times in a recent GT? This would include stages ridden as the leader as well as stages won. If there are any riders satisfying those criteria--including Froome, in other GTs--then the next question would be, do we know if any of them take salbutamol? If any of them do, then the kind of analysis Austin did with Froome could be done with them. I would be interested in any data like these, because it would provide an empirical test of Austin's model. I.e., did any other riders show variability in urinary levels consistent with the degree implied by the exoneration of Froome?
Last edited by Merckx index on 15 Oct 2018 21:56, edited 3 times in total.
Merckx index
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Re: Re:

15 Oct 2018 21:06

samhocking wrote:
gillan1969 wrote:
samhocking wrote:gillan1969, you are stating the rules that apply to a confirmed AAF.
70kph. Glucocorticosteroids and Beta-2 Agonists report a Presumptive Adverse Analytical That has nothing to do with B confirming A. Exclusively for Glucocorticosteroids and Beta-2 Agonists the rules clearly state the RMA, should verify the route of administration used as part of its Initial Review before prosecuting a case as an AAF. That is the part of the rules Froome's AAF got to. If UCI had begun prosecuting as an AAF, then Froome would have had to have take the pharmo test. This is the same as Ullissi exactly.


that's the rules...there's no ambiguity...they are as quoted...and the reading's an AAF unless you do the test...and he didn't do the test

I know some ambigiuty has been introduced (that's what lawyers are for) but the rules themselves allow for none...if the reading is over a certain amount, the way around that is to undertake the study.......and he....er.....didn't undertake the study

there's only so many way to say that

I presume you'd like our hapless hero to release his own readings?...that way we could all see if his metabolism tended to act in the manner that might present a false postive?



That's not ambiguity, that is how WADA stated Froome's AAF as 'presumed' not me, because that is how the lab reports it and WADA guidelines describe it too until confirmed. The lab doesn't know if it's theraputic via route of allowed administration. Also 20% of other above threshold salubutomol cases from 2013 to 2015 resulted in aquittal too, so hardly unique to Froome, other than Froome's circumstances it seems?

Anywya we went round and round in circles at the time. I'm happy the rules were followed, you are not convinced they were, so not much we can do about that.


see MI's response however we know that there is a discrepnacy between what WADA stated and what WADA's actual rules state...I'm with the rules and you're with their press releases

I'll stick to the rules thanks....
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16 Oct 2018 09:07

The rules allow the athlete explanation gilian, you seem to believe the opposite regardless of what the rules say, which I don't understand? It was WADA who decided the pharmo test would be invalid due to Froome's circumstances and reported use of salbutomol and illness. Now we know the pharmo test was essentially designed for one event like a swimming race on one days use, not 3 weeks, perhaps they made the correct decision with all aspects of the circumstances considered, not just purely simply the urine reading perhaps?
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16 Oct 2018 11:14

Perhaps you'd eat ****, Sam, if Sky said it was ok.
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Re: All About Salbutamol

16 Oct 2018 14:15

Following up on my last post, I see that both Yates in this year's Giro (13) and Thomas in the Tour (11) held the leader's jersey for more than ten stages. Yates has asthma, but maybe has a TUE. I don't know if he takes salbutamol, it was terbutaline he tested positive for before. But it would be interesting to see his urinary salbutamol levels for those thirteen tests.

Thomas apparently does not have asthma, in fact made this interesting statement in an interview back in 2012:

If you’ve got asthma, go and work in an office or something,


https://road.cc/content/news/214380-interview-geraint-thomas-tues-disc-brakes-shane-sutton-and-more

Also, Froome held the MJ for 15 stages in the 2017 TDF, 14 stages in the 2016 TDF, 15 stages in the 2015 TDF, and 14 stages in the 2013 TDF. Wiggins 14 stages in 2012. So a lot of potential data there.

Quintana had the leaders's jersey for 12 stages in the 2016 Vuelta, Dumo ten stages in the 2017 Giro, but AFAIK, neither has asthma.
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Re:

16 Oct 2018 15:05

topcat wrote:Perhaps you'd eat ****, Sam, if Sky said it was ok.

I quoted WADA, not Sky thanks.
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Re: All About Salbutamol

16 Oct 2018 15:12

Wiggins- cough,cough held the MJ for 15 stages 2012 tdf
He had Asthma TUEs for Salb before 2011

ImageDr Leinders
Last edited by 70kmph on 17 Oct 2018 13:00, edited 1 time in total.
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Re: All About Salbutamol

16 Oct 2018 16:25

Merckx index wrote:Following up on my last post, I see that both Yates in this year's Giro (13) and Thomas in the Tour (11) held the leader's jersey for more than ten stages. Yates has asthma, but maybe has a TUE. I don't know if he takes salbutamol, it was terbutaline he tested positive for before. But it would be interesting to see his urinary salbutamol levels for those thirteen tests.

Thomas apparently does not have asthma, in fact made this interesting statement in an interview back in 2012:

If you’ve got asthma, go and work in an office or something,


https://road.cc/content/news/214380-interview-geraint-thomas-tues-disc-brakes-shane-sutton-and-more

Also, Froome held the MJ for 15 stages in the 2017 TDF, 14 stages in the 2016 TDF, 15 stages in the 2015 TDF, and 14 stages in the 2013 TDF. Wiggins 14 stages in 2012. So a lot of potential data there.

Quintana had the leaders's jersey for 12 stages in the 2016 Vuelta, Dumo ten stages in the 2017 Giro, but AFAIK, neither has asthma.


There will me much more data than that MI for dozens of riders. Perhaps not so much today, but back in 2004 estimates were around 30% - 40% of the pro peloton were using Salbutomol for EIB in one way or another. It only needed an abbreviated TUE and there was no limit to number of inhalations. In fact I remember reading all the 2004 British Cycling Athens athletes were assessed for EIB before Athens and 40% were diagnosed with EIB in the lab and given Salbutomol inhalers to take with them. Obviously it didn't make much difference we only won two golds, but IOC had No stated maximum dose, you just had to medically prove you had asthma to get the ATUE if your urin had >1000 and that was the same for pro cycling at the time too under IOC and/or French Federation etc.
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16 Oct 2018 16:51

Doesn't to be any maximium inhalations now either.
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Re:

16 Oct 2018 18:06

samhocking wrote:The rules allow the athlete explanation gilian, you seem to believe the opposite regardless of what the rules say, which I don't understand? It was WADA who decided the pharmo test would be invalid due to Froome's circumstances and reported use of salbutomol and illness. Now we know the pharmo test was essentially designed for one event like a swimming race on one days use, not 3 weeks, perhaps they made the correct decision with all aspects of the circumstances considered, not just purely simply the urine reading perhaps?


can you point me to the bit of the rules that "allow" the athlete explanation and I will eat humble pie??
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17 Oct 2018 11:35

I already did, it's part of WADA Results Management, same as it has been for 20% of all the other Salbutomol cases that resulted in no sanction after a presumed AAF also.
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Re:

17 Oct 2018 11:43

veganrob wrote:Doesn't to be any maximium inhalations now either.


There does, that 1600 μg rule came in 1997 under IOC, then was removed in 2004 until 2010 when it got re-introduced.
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Re:

17 Oct 2018 12:36

samhocking wrote:I already did, it's part of WADA Results Management, same as it has been for 20% of all the other Salbutomol cases that resulted in no sanction after a presumed AAF also.


that's a flow chart as an annex to 'the rules'....shoddily worded as it doesn't reflect the rules in the case of salbutomol as the 'explanation' can only be a pharmokinetic study....that's what the rules state

and...notice the wording associated with b sample box and how it doesn't say that alongside the explanation box...were your analysis of the flowchart correct then the 'explanation' should also have an annotaion beside it stating that the "Procedure is terminated if explanation does not confirm AAF"....but it doesn't ;)
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Re: All About Salbutamol

17 Oct 2018 12:38

samhocking wrote:
Merckx index wrote:Following up on my last post, I see that both Yates in this year's Giro (13) and Thomas in the Tour (11) held the leader's jersey for more than ten stages. Yates has asthma, but maybe has a TUE. I don't know if he takes salbutamol, it was terbutaline he tested positive for before. But it would be interesting to see his urinary salbutamol levels for those thirteen tests.

Thomas apparently does not have asthma, in fact made this interesting statement in an interview back in 2012:

If you’ve got asthma, go and work in an office or something,


https://road.cc/content/news/214380-interview-geraint-thomas-tues-disc-brakes-shane-sutton-and-more

Also, Froome held the MJ for 15 stages in the 2017 TDF, 14 stages in the 2016 TDF, 15 stages in the 2015 TDF, and 14 stages in the 2013 TDF. Wiggins 14 stages in 2012. So a lot of potential data there.

Quintana had the leaders's jersey for 12 stages in the 2016 Vuelta, Dumo ten stages in the 2017 Giro, but AFAIK, neither has asthma.


There will me much more data than that MI for dozens of riders. Perhaps not so much today, but back in 2004 estimates were around 30% - 40% of the pro peloton were using Salbutomol for EIB in one way or another. It only needed an abbreviated TUE and there was no limit to number of inhalations. In fact I remember reading all the 2004 British Cycling Athens athletes were assessed for EIB before Athens and 40% were diagnosed with EIB in the lab and given Salbutomol inhalers to take with them. Obviously it didn't make much difference we only won two golds, but IOC had No stated maximum dose, you just had to medically prove you had asthma to get the ATUE if your urin had >1000 and that was the same for pro cycling at the time too under IOC and/or French Federation etc.


to the bolded...it would be more correct to say you needed a doctor's sign off...the two things are different
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18 Oct 2018 08:47

That is the wording in the IOC rules of the time gillian. It's very easy to prove asthma medically using Peak flow, Spirometry, Methacholine challenge, Nitric oxide, Imaging tests etc etc.
Bradley Wiggins was diagnosed in that Athens test as he was in Asthma UK magazine 2004.
Last edited by samhocking on 18 Oct 2018 08:51, edited 1 time in total.
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Re: Re:

18 Oct 2018 08:50

gillan1969 wrote:
samhocking wrote:I already did, it's part of WADA Results Management, same as it has been for 20% of all the other Salbutomol cases that resulted in no sanction after a presumed AAF also.


that's a flow chart as an annex to 'the rules'....shoddily worded as it doesn't reflect the rules in the case of salbutomol as the 'explanation' can only be a pharmokinetic study....that's what the rules state

and...notice the wording associated with b sample box and how it doesn't say that alongside the explanation box...were your analysis of the flowchart correct then the 'explanation' should also have an annotaion beside it stating that the "Procedure is terminated if explanation does not confirm AAF"....but it doesn't ;)


Agreed, the flow chart is for all AAFs, so is not explicit, however athlete explanation was not invented for Froome, it's always existed for Salbutomol even back to IOC days.
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Re:

18 Oct 2018 09:09

samhocking wrote:That is the wording in the IOC rules of the time gillian. It's very easy to prove asthma medically using Peak flow, Spirometry, Methacholine challenge, Nitric oxide, Imaging tests etc etc.
Bradley Wiggins was diagnosed in that Athens test as he was in Asthma UK magazine 2004.


sam...yeah, I don't doubt it's the wording...that's the problem and one of the grey areas.......you 'medically prove' to a doc who is on the payroll to make you go faster..

so with regards the TUE business and Wiggins...the basis of that is the docs sign off...which may or may not be correct and may or may not be wilfully incorrect........BUT, there is a big upside for a certain diagnosis and one which does not have to be verified by a third party....

lucky we had fancy bears/russian state :)
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Re: Re:

18 Oct 2018 09:19

samhocking wrote:
gillan1969 wrote:
samhocking wrote:I already did, it's part of WADA Results Management, same as it has been for 20% of all the other Salbutomol cases that resulted in no sanction after a presumed AAF also.


that's a flow chart as an annex to 'the rules'....shoddily worded as it doesn't reflect the rules in the case of salbutomol as the 'explanation' can only be a pharmokinetic study....that's what the rules state

and...notice the wording associated with b sample box and how it doesn't say that alongside the explanation box...were your analysis of the flowchart correct then the 'explanation' should also have an annotaion beside it stating that the "Procedure is terminated if explanation does not confirm AAF"....but it doesn't ;)


Agreed, the flow chart is for all AAFs, so is not explicit, however athlete explanation was not invented for Froome, it's always existed for Salbutomol even back to IOC days.


well of course there is an explanation.......see also 'they were for my mum...it was cough sweets from columbia....i had sex 40 times last night, i bought a steak in spain, (insert crazy explanation of choice) and the dog ate my homework......however for salbutomol they have in place a very specific 'explanation' by way of the PKC test....which, as we know, was not completed by our hapless hero......

they wanted/needed to believe Froome and his army of lawyers (with their layered attack) made that outcome more likely........

simply put...he didn't offer the only 'explanation' he was allowed to offer under the rules...and WADA were complicit...if nothing else...

even if a study didn't replicate the rigours of a 3 week tour it would have given an insight into his own...shall we say, unique metabolism. I imagine for example his friend Swart would be very interested in getting hold of that data as it would be far more complete in helping him understand what makes the winner of a 3 week race by having data for 3 weeks instead of the one day publicity stunt from which the only outcome was.....'he just lost the weight'...scientific rigour indeed......
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18 Oct 2018 09:26

British Olympic team in 2004 were all diagnosed externally of their federations. There's a report somewhere online about it. 21% of athletes were diagnosed with EIB in NHS Clinics. Rates of EIB were found higher in sports requiring heavy breathing through mouth and upto 40% diagnosed in swimming, running and cycling. In sports like Archery, basically normal polulation of 8-10%.

As for Froome, WADA would not confirm the AAF would they. To do so, would mean they would have to disprove not only the expert that helped write the rules for them in the first place, but also that Austin's 10% claim too, otherwise Froome simply appeals and wins anyway. Basically you can't disprove good science no matter how expensive your lawyer is.
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Re:

18 Oct 2018 14:22

samhocking wrote:British Olympic team in 2004 were all diagnosed externally of their federations. There's a report somewhere online about it. 21% of athletes were diagnosed with EIB in NHS Clinics. Rates of EIB were found higher in sports requiring heavy breathing through mouth and upto 40% diagnosed in swimming, running and cycling. In sports like Archery, basically normal polulation of 8-10%.

As for Froome, WADA would not confirm the AAF would they. To do so, would mean they would have to disprove not only the expert that helped write the rules for them in the first place, but also that Austin's 10% claim too, otherwise Froome simply appeals and wins anyway. Basically you can't disprove good science no matter how expensive your lawyer is.


yup...quite interesting study :D

"In the case of our own data, 21% of athletes previously diagnosed with asthma and using inhalers did not meet the IOC-MC criteria. This indicates that a large number of British Olympic athletes were receiving medication for which there was no clinical indication."

the expert that got it wrong that last time? That expert? That demonstrates he has the capacity to get things....er...wrong ;)
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