Therapeutic Use Exemption (TUE's)

[heart_attack_man]

I had a dig around and couldn't find a thread dedicated solely to discussing TUE's and the process surrounding them.

If there is one, Mods please feel free to move this post...

I've cut and past some stuff from the Fancy Bears thread so that it doesn't get lost in there, as I think that thread will run on.

From ASADA Website...
https://www.asada.gov.au/therapeutic-use-exemption

Am I missing something, or does it appear from this that the MOST common form of TUE is retro-active?

Also, something very interesting:
https://www.asada.gov.au/retroactive-tue

If you are informed that your sample has returned an adverse analytical finding (positive test), you should apply to ASDMAC for a retroactive TUE.

Isn't that basically ASADA just telling you how to get out of a doping positive? Get popped, find a doctor to "diagnose" something that matches your medication...

Further to this, I had a look at the application form for a TUE from the ASADA website, and it has this statement on it, which opens the door pretty wide for misuse:
Source: https://www.asada.gov.au/sites/g/files/net126/f/asdmac-wada-tue-application-2016-en_0.pdf?v=1462258118

Evidence should be as objective as possible in the clinical circumstances. In the case of non-demonstrable conditions, independent supporting medical opinion will assist this application.

Is it any wonder that the TUE system is being abused? It's like the ADO's are inviting you to do it.

 

[nogav1ca]

Only certain, higher level athletes need to apply for a TUE in-advance. In-advance TUEs need to be applied for before taking the medication (except for emergency situations and hospital visits). Other athletes are able to apply for a planned retroactive TUE once they have been tested.

This is from: https://www.asada.gov.au/therapeutic-use-exemption
Link to emergency situations and hospital visits: https://www.asada.gov.au/substances...ption/medical-emergencies-and-hospital-visits

And to apply for retroactive TUE, one should also declare any medication he is taking on an antidoping form.

If you are tested you should declare any medication you are taking on your doping control form

And exceptions for retroactive TUE

Emergency treatment or treatment of an acute medical condition was necessary
Due to other exceptional circumstances, there was insufficient time or opportunity for the athlete to submit, or for ASDMAC to consider, an application for the TUE prior to sample collection
WADA and ASDMAC agree that fairness requires the granting of a retroactive TUE.

https://www.asada.gov.au/retroactive-tue

All in all, I don't think retroactive TUEs are the most common form used.

 

[Catwhoorg]

In elite sports certainly not.

Lets say I won my next half marathon (I will be well behind the winner but lets just say that), being a registered event, and me being a member of USATF affiliated running club, I could conceivably be asked to go to doping control.

I would declare anything I was taking on the doping form, and if necessary at that point apply for a retroactive TUE.


For British Cycling as an example. Proteam riders are obviously managed through the UCI and are in their registered testing pool

A (advance) TUE is required for athletes at the following levels of competition:
1. Cyclists in UK Anti-Doping's National Registered Testing Pool
2. Senior Academy Riders
3. Junior Academy Riders


A Retroactive TUE is required for athletes at the following levels of competition:
1. Olympic Development Apprentice Riders
2. Domestic Events not listed in National Level Section (e.g. National Championships & National Series Events)


There is simply no reasonable way to manage of formal advance TUE system for the potential pool of literally millions of hobby joggers, club cyclists, sunday league football players and the like.

 

[Bolder]

http://www.nytimes.com/2016/09/14/sports/simone-biles-serena-venus-williams-russian-hackers-doping.html

Both Venus AND Serena got TUEs?

In Biles's case -- who knows? There are plenty of instances where medicine for ADHD has been abused to focus the mind, and what better sport than gymnastics for that? None of us should be surprised.

If this was a Russian hack, then I think they're targeting black athletes for a nasty reason.

 

[D-Queued]

Re:

http://www.nytimes.com/2016/09/14/sports/simone-biles-serena-venus-williams-russian-hackers-doping.html

Both Venus AND Serena got TUEs?

In Biles's case -- who knows? There are plenty of instances where medicine for ADHD has been abused to focus the mind, and what better sport than gymnastics for that? None of us should be surprised.

If this was a Russian hack, then I think they're targeting black athletes for a nasty reason.

Maybe it is just me, but none of this is a surprise.

Not the Williams sisters allegedly having TUEs
Not Simone Biles allegedly having a TUE (presumably for Ritalin...)
Not US athletes allegedly having TUEs
Not the Russians allegedly trying to expose US athletes
Not the Russians allegedly trying to expose black US athletes
Not the Russians allegedly having a nasty reason

Welcome to political sport (SIC)

Dave.

 

[More Strides than Rides]

Re:

In elite sports certainly not.

Lets say I won my next half marathon (I will be well behind the winner but lets just say that), being a registered event, and me being a member of USATF affiliated running club, I could conceivably be asked to go to doping control.

I would declare anything I was taking on the doping form, and if necessary at that point apply for a retroactive TUE.


For British Cycling as an example. Proteam riders are obviously managed through the UCI and are in their registered testing pool

A (advance) TUE is required for athletes at the following levels of competition:
1. Cyclists in UK Anti-Doping's National Registered Testing Pool
2. Senior Academy Riders
3. Junior Academy Riders


A Retroactive TUE is required for athletes at the following levels of competition:
1. Olympic Development Apprentice Riders
2. Domestic Events not listed in National Level Section (e.g. National Championships & National Series Events)


There is simply no reasonable way to manage of formal advance TUE system for the potential pool of literally millions of hobby joggers, club cyclists, sunday league football players and the like.

Right.

You also bring up the important point of declarations. There is a difference in the weight of a positive, both to the public (should be, at least) and to the governing body determining the sanction if something is declared on the doping control form. Salbutamol positives like Ulissi or Kenyan runner Chepkemei declared the salbutamol before the test.

And of course, we know that there are illegitimate prescriptions. But as a starting point in the conversation about backdating TUEs and whether that is a cover-up of sorts, the content of the declaration form matters.

 

[RobbieCanuck]

For quick information re: this topic here are the current requirements for a TUE

STANDARDS AND PROCESS FOR GRANTING TUE
S 4.0 Obtaining a TUE
4.1 An Athlete may be granted a TUE if (and only if) he/she can show that each of the following conditions is met:

a. The Prohibited Substance or Prohibited Method in question is needed to treat an acute or chronic medical condition, such that the Athlete would experience a significant impairment to health if the Prohibited Substance or Prohibited Method were to be withheld.

b. The Therapeutic Use of the Prohibited Substance or Prohibited Method is highly unlikely to produce any additional enhancement of performance beyond what might be anticipated by a return to the Athlete’s normal state of health following the treatment of the acute or chronic medical condition.

c. There is no reasonable Therapeutic alternative to the Use of the Prohibited Substance or Prohibited Method.

d. The necessity for the Use of the Prohibited Substance or Prohibited Method is not a consequence, wholly or in part, of the prior Use(without a TUE) of a substance or method which was prohibited at the time of such Use.

 

[Benotti69]

For quick information re: this topic here are the current requirements for a TUE

STANDARDS AND PROCESS FOR GRANTING TUE
S 4.0 Obtaining a TUE
4.1 An Athlete may be granted a TUE if (and only if) he/she can show that each of the following conditions is met:

a. The Prohibited Substance or Prohibited Method in question is needed to treat an acute or chronic medical condition, such that the Athlete would experience a significant impairment to health if the Prohibited Substance or Prohibited Method were to be withheld.

b. The Therapeutic Use of the Prohibited Substance or Prohibited Method is highly unlikely to produce any additional enhancement of performance beyond what might be anticipated by a return to the Athlete’s normal state of health following the treatment of the acute or chronic medical condition.

c. There is no reasonable Therapeutic alternative to the Use of the Prohibited Substance or Prohibited Method.

d. The necessity for the Use of the Prohibited Substance or Prohibited Method is not a consequence, wholly or in part, of the prior Use(without a TUE) of a substance or method which was prohibited at the time of such Use.

All that means is a Doctors note is required.

 

[RobbieCanuck]

[/quote] All that means is a Doctors note is required.[/quote]

I sincerely doubt a "doctor's note" is sufficient. It would require a full medical report for which the doctor is putting their reputation on the line. It has to be reviewed by the TUE committee (TUEC) pursuant to the International Standards for Approval adopted by WADA and every anti doping agency in the world.

See S 5.2 of the WADA TUE process on the WADA website. The tenor of the requirements hardly suggests a doctor's note is all that would be required. I understand your passion of scepticism, but the process clearly implies the applicant for the TUE has to submit extensive medical reports and supporting documentation.

The review process requires the application to be reviewed inter alia by,

"a. TUECs should include at least three physicians with experience in the care and treatment of Athletes and a sound knowledge of clinical, sports and exercise medicine."


It is unlikely if not impossible for these doctors to accept a "doctor's note" I accept that the rule says "should include" and whether or not these TUECs do in fact only WADA, the ADAs, or International Federations or Major Event Organizers can tell us.

 

[Benotti69]

I sincerely doubt a "doctor's note" is sufficient. It would require a full medical report for which the doctor is putting their reputation on the line. It has to be reviewed by the TUE committee (TUEC) pursuant to the International Standards for Approval adopted by WADA and every anti doping agency in the world.

See S 5.2 of the WADA TUE process on the WADA website. The tenor of the requirements hardly suggests a doctor's note is all that would be required. I understand your passion of scepticism, but the process clearly implies the applicant for the TUE has to submit extensive medical reports and supporting documentation.

The review process requires the application to be reviewed inter alia by,

"a. TUECs should include at least three physicians with experience in the care and treatment of Athletes and a sound knowledge of clinical, sports and exercise medicine."


It is unlikely if not impossible for these doctors to accept a "doctor's note" I accept that the rule says "should include" and whether or not these TUECs do in fact only WADA, the ADAs, or International Federations or Major Event Organizers can tell us.

Doctors really fear WADA and other ADAs. I mean it is not like Doctors have been prescribing doping for aeons....

 

[RobbieCanuck]

[/quote] Doctors really fear WADA and other ADAs. I mean it is not like Doctors have been prescribing doping for aeons....[/quote]

True but not reputable doctors. check out this https://en.wikipedia.org/wiki/Anthony_Galea

Re: Dr. Anthony Galea
On December 15, 2009, The New York Times and the Associated Press reported that Galea was the subject of a joint investigation by the Royal Canadian Mounted Police and the Federal Bureau of Investigation's Buffalo Field Office for allegedly providing elite athletes with performance-enhancing drugs,[5] as well as criminal conspiracy.[12] The drugs were Actovegin (legal in Canada, but not the US) and human growth hormone.Galea was arrested in Toronto on October 15, 2009 but never faced charges.

In the United States, Galea was charged with drug smuggling, conspiring to lie to federal agents, unlawful possession with intent to distribute and practising medicine without a licence. On July 6, 2011, Galea pleaded guilty to a lesser charge of bringing mislabelled drugs into the United States for the purpose of treating professional athletes.[13] According to the New York Times and CNN, Galea was convicted of a felony. As part of the plea agreement, he is required to cooperate with investigators and disclose the identities of his clients and their treatments.[13]

On December 16, 2011 Galea was sentenced to one year unsupervised release, and no accompanying jail time (above time already served, one day). He is not allowed to enter the United States without authorization from the United States Department of Homeland Security.[14]

vancouversun.com
Jun 1, 2016 - B.C. doctors have become the first in Canada to be legally bound by strict new standards for prescribing opioids and other addictive drugs. ... could face complaint hearings and disciplinary actions like fines and licence ... pills to either use themselves, give to others or sell on the street.

I think the law is starting to close in on the unreputable doctors. I suspect any doctor with a brain would not jeopardize their career to help an athlete cheat, but then again.....

 

[IndianCyclist]

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

 

[LaFlorecita]

Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

 

[veji11]

To me the simple thing is that the TUE system has to be changed and Froome is a perfect and simple example : he only used it twice in 9 years it seems. My point would simply be, why then did'nt he retire from the 2014 Romandie and the other race to be healed for what he had at the time ? It surely wouln't have broken his career would it ?

There could be many less TUEs, or rather most of the those TUEs should have been assorted with a work stoppage period : the doctor prescribes a medication allowing the athlete to get better, in the meanwhile, he rests.. This is exactly the same impression I had yesterday with Serena Williams' shitty 2014 spring with lots of med : just stop competition, get your TUE to get healed and then go back to the sport... That would be so much simpler.

 

[Bolder]

Re:

To me the simple thing is that the TUE system has to be changed and Froome is a perfect and simple example : he only used it twice in 9 years it seems. My point would simply be, why then did'nt he retire from the 2014 Romandie and the other race to be healed for what he had at the time ? It surely wouln't have broken his career would it ?

There could be many less TUEs, or rather most of the those TUEs should have been assorted with a work stoppage period : the doctor prescribes a medication allowing the athlete to get better, in the meanwhile, he rests.. This is exactly the same impression I had yesterday with Serena Williams' shitty 2014 spring with lots of med : just stop competition, get your TUE to get healed and then go back to the sport... That would be so much simpler.

Yes, maybe. But consider that you are a professional athlete and at least half of your job -- like all of us -- is showing up. "he played through pain" is a compliment.

 

[veji11]

Re: Re:

To me the simple thing is that the TUE system has to be changed and Froome is a perfect and simple example : he only used it twice in 9 years it seems. My point would simply be, why then did'nt he retire from the 2014 Romandie and the other race to be healed for what he had at the time ? It surely wouln't have broken his career would it ?

There could be many less TUEs, or rather most of the those TUEs should have been assorted with a work stoppage period : the doctor prescribes a medication allowing the athlete to get better, in the meanwhile, he rests.. This is exactly the same impression I had yesterday with Serena Williams' shitty 2014 spring with lots of med : just stop competition, get your TUE to get healed and then go back to the sport... That would be so much simpler.

Yes, maybe. But consider that you are a professional athlete and at least half of your job -- like all of us -- is showing up. "he played through pain" is a compliment.

True, but this is where you have to change mentalities : if you allow athletes to compete while medicated, than you open the door to doping.

 

[King Boonen]

Re: Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

This.

Simone Biles is a perfect example. She has ADHD, she doesn't want to have to discuss it and that's her choice. This leak has not only made it public knowledge, it has forced her to defend herself when she has done nothing wrong.


There is no doubt that the TUE system can be and is abused, but there are also many legitimate reasons for athletes to have them. The system seems to need changing, that would be a worthwhile discussion in here, rather than focussing on the athletes which is going on in the other threads.

 

[King Boonen]

Re: Re:

To me the simple thing is that the TUE system has to be changed and Froome is a perfect and simple example : he only used it twice in 9 years it seems. My point would simply be, why then did'nt he retire from the 2014 Romandie and the other race to be healed for what he had at the time ? It surely wouln't have broken his career would it ?

There could be many less TUEs, or rather most of the those TUEs should have been assorted with a work stoppage period : the doctor prescribes a medication allowing the athlete to get better, in the meanwhile, he rests.. This is exactly the same impression I had yesterday with Serena Williams' shitty 2014 spring with lots of med : just stop competition, get your TUE to get healed and then go back to the sport... That would be so much simpler.

Yes, maybe. But consider that you are a professional athlete and at least half of your job -- like all of us -- is showing up. "he played through pain" is a compliment.

True, but this is where you have to change mentalities : if you allow athletes to compete while medicated, than you open the door to doping.

There is a fine line to be walked here. Wiggins had TUEs for allergy medication. If we take it at face value then I really don't see a problem with that, if I worked outdoors and suffered from hayfever there would be no problem with me taking medication to do my job, in fact it would be expected. Being an athlete is just a job and we need to make sure we stay focussed on that when discussing legitimate medical issues.

 

[Benotti69]

Re: Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

This.

Simone Biles is a perfect example. She has ADHD, she doesn't want to have to discuss it and that's her choice. This leak has not only made it public knowledge, it has forced her to defend herself when she has done nothing wrong.


There is no doubt that the TUE system can be and is abused, but there are also many legitimate reasons for athletes to have them. The system seems to need changing, that would be a worthwhile discussion in here, rather than focussing on the athletes which is going on in the other threads.

I disagree.

I think athletes long lost the right to privacy. if they are taking medications which may affect performance the public has a right to know.

If a person does not want to declare their 'illness/medical disorder', then don't compete. Simples.

I dont think a minority of athletes are abusing it, i think the majority are.

ADHD is hardly an embarrassing disorder, now is it.

 

[King Boonen]

Re: Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

This.

Simone Biles is a perfect example. She has ADHD, she doesn't want to have to discuss it and that's her choice. This leak has not only made it public knowledge, it has forced her to defend herself when she has done nothing wrong.


There is no doubt that the TUE system can be and is abused, but there are also many legitimate reasons for athletes to have them. The system seems to need changing, that would be a worthwhile discussion in here, rather than focussing on the athletes which is going on in the other threads.

I disagree.

I think athletes long lost the right to privacy. if they are taking medications which may affect performance the public has a right to know.

If a person does not want to declare their 'illness/medical disorder', then don't compete. Simples.

I dont think a minority of athletes are abusing it, i think the majority are.

ADHD is hardly an embarrassing disorder, now is it.

Sorry but I completely disagree. You have no more right to know what is wrong with an athlete than you have a right to know what is wrong with anyone you happen to walk past in the street. A persons' medical history is private and should remain so, to think otherwise is, frankly, disturbing to me.

It doesn't matter whether it is embarrassing or not, and I'll point out you can't presume to know what people find embarrassing, it's personal and should remain so. No one should have their medical history passed around and examined, especially when it leads to people with no knowledge of the subject making incorrect assumptions and throwing out accusations.

 

[Ryo Hazuki]

Re: Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

This.

Simone Biles is a perfect example. She has ADHD, she doesn't want to have to discuss it and that's her choice. This leak has not only made it public knowledge, it has forced her to defend herself when she has done nothing wrong.


There is no doubt that the TUE system can be and is abused, but there are also many legitimate reasons for athletes to have them. The system seems to need changing, that would be a worthwhile discussion in here, rather than focussing on the athletes which is going on in the other threads.

I disagree.

I think athletes long lost the right to privacy. if they are taking medications which may affect performance the public has a right to know.

If a person does not want to declare their 'illness/medical disorder', then don't compete. Simples.

I dont think a minority of athletes are abusing it, i think the majority are.

ADHD is hardly an embarrassing disorder, now is it.

oh god, you are taking sports way too seriously we aren't talking here about criminals of war or anything

 

[BullsFan22]

Re: Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

This.

Simone Biles is a perfect example. She has ADHD, she doesn't want to have to discuss it and that's her choice. This leak has not only made it public knowledge, it has forced her to defend herself when she has done nothing wrong.


There is no doubt that the TUE system can be and is abused, but there are also many legitimate reasons for athletes to have them. The system seems to need changing, that would be a worthwhile discussion in here, rather than focussing on the athletes which is going on in the other threads.

I disagree.

I think athletes long lost the right to privacy. if they are taking medications which may affect performance the public has a right to know.

If a person does not want to declare their 'illness/medical disorder', then don't compete. Simples.

I dont think a minority of athletes are abusing it, i think the majority are.

ADHD is hardly an embarrassing disorder, now is it.

oh god, you are taking sports way too seriously we aren't talking here about criminals of war or anything

Well, some are taking things way too seriously, as in trying to ban countries from the Olympics.

 

[simoni]

Re: Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

This.

Simone Biles is a perfect example. She has ADHD, she doesn't want to have to discuss it and that's her choice. This leak has not only made it public knowledge, it has forced her to defend herself when she has done nothing wrong.


There is no doubt that the TUE system can be and is abused, but there are also many legitimate reasons for athletes to have them. The system seems to need changing, that would be a worthwhile discussion in here, rather than focussing on the athletes which is going on in the other threads.

I disagree.

I think athletes long lost the right to privacy. if they are taking medications which may affect performance the public has a right to know.

If a person does not want to declare their 'illness/medical disorder', then don't compete. Simples.

I dont think a minority of athletes are abusing it, i think the majority are.

ADHD is hardly an embarrassing disorder, now is it.

Fertility problems, mental/behavior issues are two that fairly quickly spring to mind that I wouldn't want the general public to know about personally. Athletes are still people and people (in most of the world) have some rights.

 

[BullsFan22]

Re: Re:

All the leaks and with the athletes themselves saying that they are not ashamed, then why not make all info public so that no issue arises

Because it compromises the athletes' right to privacy.

This.

Simone Biles is a perfect example. She has ADHD, she doesn't want to have to discuss it and that's her choice. This leak has not only made it public knowledge, it has forced her to defend herself when she has done nothing wrong.


There is no doubt that the TUE system can be and is abused, but there are also many legitimate reasons for athletes to have them. The system seems to need changing, that would be a worthwhile discussion in here, rather than focussing on the athletes which is going on in the other threads.

I disagree.

I think athletes long lost the right to privacy. if they are taking medications which may affect performance the public has a right to know.

If a person does not want to declare their 'illness/medical disorder', then don't compete. Simples.

I dont think a minority of athletes are abusing it, i think the majority are.

ADHD is hardly an embarrassing disorder, now is it.

Fertility problems, mental/behavior issues are two that fairly quickly spring to mind that I wouldn't want the general public to know about personally. Athletes are still people and people (in most of the world) have some rights.

Of course everyone should be treated fairly and have rights, but if leaks uncover doping and cover ups, should fans not know about it? Everyone was drooling over the Russian stories that were breaking out. What about those athletes that were never implicated in anything, didn't fail tests and were tested by WADA approved labs/testers and/or WADA's employees/mechanisms? Should those athletes have been banned from Rio? It wasn't a privacy issue, but they lost their 'right' to compete by a blanket ban based on a report that allegedly didn't follow a thorough investigation. It called for a ban based on what 'may have happened.' So now these athletes have to live with that, while others get 'permission' to use PED's masked as "TUE's" during or just prior to the biggest events of the year (which they go on to win or win medals in). I don't get that at all.

The recent stories coming out of Norway regarding the national xc ski team there is a PERFECT example of the abuse of PED's. The Norwegian Ski Federation, with the help from the Norwegian Olympiatoppen, encouraged the National team skiers in taking strong asthma meds, even those athletes that had no asthma or no symptoms of asthma. For years they were denying use and denying that it had any performance enhancement apart from helping real asthmatics cope with their illness. If it didn't help performance, then why encourage everyone to take it? And why did the athletes actually take them? Seems like it would be a waste of time, energy, resources and money to go years doing that. Since the 1992, 69% of Norwegian medals at the Olympics in XC skiing were won by athletes 'suffering' from asthma. That's a rather large percentage.

Where do you draw the line?

 

[buckle]

Hog posted an image from Hamilton's book. It was surprising how very little attention is paid by TH to the TUE phenomenon if that was the only extract he could offer. The only positive is that TUEs are less important to the doper than is being claimed here or by the hackers. This whole story is proving a triumph for the West and a disaster for the Clinic.