My points are related more to any investigation into Wiggins TUEs not being therapeutic in terms of him requiring evidence if it ever came to that either for himself to prove innocence or to disprove theories the package was Triamcinolone and he received an injection. He has access to all the information and ENT reports if he wants to do both once UKAD allow him to speak and release documents.
The history of his first Triamcinilone injection really begins in 2008 and earlier and as the years go by his doctors from before Garmin, within Garmin and then Sky move him to more powerful Corticosteroid allergy treatments that follow the British Society for Allergy and Clinical Immunology advice pretty much to the letter. So assuming the documents back up what is claimed the TUE itself can be justified not only legally, but ethically too because that is in line with those setting the treatment guidance at least in UK at the time.
>3 years before 2011 (so at least from 2007) Maximal treatment using Flixotide inhaler + Ventolin, Clarityn, Avamys & Opticrom
2007 -Cofidis - Flixotide inhaler + Ventolin, Clarityn, Avamys & Opticrom (assume Salbutomol too?)
2008 - Team High Road Salbutomol TUE + allowance for 250ng of Fluticosone Corticosteroid nasal spray per day also + Antihistamines etc from above list
2009 - Garmin–Slipstream Salbutomol TUE + More powerful inhaled Budesonide Corticosteroid TUE replaces last years Fluticosone Corticosteroid + Antihistamines etc from above list
2010 - Team Sky TUE no longer required for Salbutomol or inhaled Budesonide Corticosteroid under WADA, so why there are no 2010 TUEs + Antihistamines etc from above list. Treatment at sky same as at Garmin previous year it seems.
2011 - Team Sky Triamcinolone TUE replaces Budesonide & Flixotide after Endoscopy despite maximal therapy of Budesonide & Flixotide etc. Assume still taking Salbutomol within WADA limits.
2012 - Team Sky As 2011 with additional ENT documents
2013 - Team Sky As 2012 with additional ENT documents
So he went from oral antihistamines at Cofidis to Corticosteroid nasal sprays at High Road, to more powerful Corticosteroid inhalers at Garmin to injected IM Corticosteroid after a year at Sky which is the treatment progression British Society for Allergy and Clinical Immunology advised. i.e. you can't go straight into an injection, you have to exhaust all oral treatments first to maximal therapy first according to their guidance and this is what the ENT confirms has been done.
My overriding argument is for Wiggins to want to apply illegally for an IM Triamcinilone injection in 2011 and for CAS to be satisfied it was, the history and supporting medical evidence already exists or not at WADA and passes back through doctors and consultants while riding at Garmin, High Road & Cofidis. Sky might have looked at his medical history at Garmin, High Road & Cofidis and noticed the Corticosteroid theme throughout his road career so far and then decided there was enough history that with a fake endoscopy and fabricated maximal treatment in 2010 his first year at Sky, it would allow an injection in 2011 TUE. The claims so far are not that the TUE was illegally applied for and/or illegally granted using false documents. The history of treatment looking at Wiggins several TUE notes seems to build the history of long-term allergy treatment an expert witness such as a Dr from British Society for Allergy and Clinical Immunology might be called on by CAS should any of this ever go to CAS.
The history of his first Triamcinilone injection really begins in 2008 and earlier and as the years go by his doctors from before Garmin, within Garmin and then Sky move him to more powerful Corticosteroid allergy treatments that follow the British Society for Allergy and Clinical Immunology advice pretty much to the letter. So assuming the documents back up what is claimed the TUE itself can be justified not only legally, but ethically too because that is in line with those setting the treatment guidance at least in UK at the time.
>3 years before 2011 (so at least from 2007) Maximal treatment using Flixotide inhaler + Ventolin, Clarityn, Avamys & Opticrom
2007 -Cofidis - Flixotide inhaler + Ventolin, Clarityn, Avamys & Opticrom (assume Salbutomol too?)
2008 - Team High Road Salbutomol TUE + allowance for 250ng of Fluticosone Corticosteroid nasal spray per day also + Antihistamines etc from above list
2009 - Garmin–Slipstream Salbutomol TUE + More powerful inhaled Budesonide Corticosteroid TUE replaces last years Fluticosone Corticosteroid + Antihistamines etc from above list
2010 - Team Sky TUE no longer required for Salbutomol or inhaled Budesonide Corticosteroid under WADA, so why there are no 2010 TUEs + Antihistamines etc from above list. Treatment at sky same as at Garmin previous year it seems.
2011 - Team Sky Triamcinolone TUE replaces Budesonide & Flixotide after Endoscopy despite maximal therapy of Budesonide & Flixotide etc. Assume still taking Salbutomol within WADA limits.
2012 - Team Sky As 2011 with additional ENT documents
2013 - Team Sky As 2012 with additional ENT documents
So he went from oral antihistamines at Cofidis to Corticosteroid nasal sprays at High Road, to more powerful Corticosteroid inhalers at Garmin to injected IM Corticosteroid after a year at Sky which is the treatment progression British Society for Allergy and Clinical Immunology advised. i.e. you can't go straight into an injection, you have to exhaust all oral treatments first to maximal therapy first according to their guidance and this is what the ENT confirms has been done.
My overriding argument is for Wiggins to want to apply illegally for an IM Triamcinilone injection in 2011 and for CAS to be satisfied it was, the history and supporting medical evidence already exists or not at WADA and passes back through doctors and consultants while riding at Garmin, High Road & Cofidis. Sky might have looked at his medical history at Garmin, High Road & Cofidis and noticed the Corticosteroid theme throughout his road career so far and then decided there was enough history that with a fake endoscopy and fabricated maximal treatment in 2010 his first year at Sky, it would allow an injection in 2011 TUE. The claims so far are not that the TUE was illegally applied for and/or illegally granted using false documents. The history of treatment looking at Wiggins several TUE notes seems to build the history of long-term allergy treatment an expert witness such as a Dr from British Society for Allergy and Clinical Immunology might be called on by CAS should any of this ever go to CAS.