Therapeutic Use Exemption (TUE's)

[42x16ss]

If you need a TUE you shouldn't be racing IMO, after all the UCI set the bar with Franck Bouyer when they refused his TUE request and effectively stopped his career from June 2004 until January 2009.

I wouldn't go that far. An action like that would remove riders like Alex Dowsett (haemophilia), Jack Bobridge (Rheumatoid Arthritis) and the entirety of the Norvo Nordisk team (Type 1 Diabetes) permanently. Surely there would be others as well, like genuine asthmatics. They do exist in elite sports, despite athletes using it to abuse the TUE system. Jimmy Casper was just one example.

 

[abc987]

If you need a TUE as a matter of course, say to treat ADHD or some emotional issues or something, then maybe you should move over to the paraolympics or something else. Or perhaps work to find some remedies that aren't abused for performance enhancement. Especially if privacy is a concern.

So if an individual requires TUE treatment, you think they shouldn't be allowed to compete, i.e. you would discriminate against a person because of a health condition?

Or, you think they should compete in the Paralympics, so presumably you think using a TUE is not acceptable in non Paralympic sport, but for some reason it's OK in Paralympic sport?

Or you think individuals should do R&D to produce their own non TUE treatments, and be denied the benefits of modern medicine that the rest of us enjoy?

Have you actually thought through anything that you wrote?

 

[chuckmicD]

Haven't seen anything in these releases of TUEs that's problematic. People need medicine sometimes.

 

[heart_attack_man]

Re:

Haven't seen anything in these releases of TUEs that's problematic. People need medicine sometimes.

Have you been reading any of the threads in here? Nothing problematic... You can't be serious, right?

 

[chuckmicD]

I've been reading some of the threads when I have the time. Just don't seem like a big deal in the end. Teams spew all kinds of pr crap about marginal gains, no needles etc., but when it comes to basic medicine for fundamental human needs...there's no problem. Show me actual doping, even a hint of it. Not asthma medicine.

 

[chuckmicD]

It's small potatoes, man.

 

[42x16ss]

Re:

I've been reading some of the threads when I have the time. Just don't seem like a big deal in the end. Teams spew all kinds of pr crap about marginal gains, no needles etc., but when it comes to basic medicine for fundamental human needs...there's no problem. Show me actual doping, even a hint of it. Not asthma medicine.

So Wigan's miraculously shifting (from July to April), late onset hayfever/allergies (miraculously appearing in his late 20's) that as of 2011 (coincidentally, the arrival time of a notorious doping Dr at Sky who has a reputation for prescribing these very drugs) suddenly requires extra, extra, extra strength intravenous corticosteroids that even specialists are reluctant to prescribe, is nothing to be suspicious about?

Man, I hope Rupert is giving you a good retainer...

 

[chuckmicD]

That would be alarming barring anaphylaxis in the ER. Hadn't read that. Like I said, I look at these boards when I have the time.

 

[King Boonen]

No one is advocating for release of all TUEs...

Really? Reading over the last couple of pages it seems like some people are.

I don't want to talk for thehog...

Then don't?

 

[King Boonen]

Re:

We now have two clear cases where UCI favored riders by means of the TUE system.

1. Froome.

2. Wiggins.

Cookson needs to step down.

No, this is wrong. We have an example of Froome being given preferential treatment.

With Wiggins we have seen TUEs applied for and granted within the rules. Unless you have access to every other cyclists TUEs that were both granted and refused you have absolutely no way of asserting that.

 

[sniper]

Re: Re:

We now have two clear cases where UCI favored riders by means of the TUE system.

1. Froome.

2. Wiggins.

Cookson needs to step down.

No, this is wrong. We have an example of Froome being given preferential treatment.

With Wiggins we have seen TUEs applied for and granted within the rules. Unless you have access to every other cyclists TUEs that were both granted and refused you have absolutely no way of asserting that.

Yeah, that's fair enough. I agree we need to see TUE forms of other cyclists first.

Do note that there is one other cyclist in the Fancybear database, the Dane Casper Mortensen.
His document nicely contrasts with Wiggins, as Mortensen only got an inhaler for his asthma.

 

[sniper]

No one is advocating for release of all TUEs...

Really? Reading over the last couple of pages it seems like some people are.

I don't want to talk for thehog...

Then don't?

I'm not. Just telling you how I interpreted his post.
Discussion forum and all that.

 

[King Boonen]

Re: Re:

We now have two clear cases where UCI favored riders by means of the TUE system.

1. Froome.

2. Wiggins.

Cookson needs to step down.

No, this is wrong. We have an example of Froome being given preferential treatment.

With Wiggins we have seen TUEs applied for and granted within the rules. Unless you have access to every other cyclists TUEs that were both granted and refused you have absolutely no way of asserting that.

Yeah, that's fair enough. I agree we need to see TUE forms of other cyclists first.

Do note that there is one other cyclist in the Fancybear database, the Dane Casper Mortensen.
His document nicely contrasts with Wiggins, as Mortensen only got an inhaler for his asthma.

I thought the reason for Wiggins' TUEs were allergies? That's not the same as asthma.

I'm sure I don't have to point out that asthma is hardly a uniform disease with a single treatment.


I still feel people are trying to make a mountain out of a molehill on this, mainly because it pretty much disproves one of the ways people have accused Sky of gaming the system.

The TUE system is clearly a loophole that can be massively exploited but it's very difficult one to deal with and I really don't see much exploitation going on here. Maybe if glucocorticoids were finally added to the WADA list we would see a lot more abuse, but that's just speculation. Suggesting that peoples' medical history should be made public is insane, that is definitely not the answer but some people seem very happy to push that agenda. A much more independent system might be good but that would cost a lot of money and there doesn't seem to be much evidence to justify it at the moment.

 

[sniper]

KB:

I thought the reason for Wiggins' TUEs were allergies?

true, although ironically in Wiggins PR statement he gets this wrong, too, saying the shots were for his asthma.

it pretty much disproves one of the ways people have accused Sky of gaming the system

how so?

I agree with the rest of your post.
There is not much new to see here.
But the British press seem to think differently.
Funnily, for many previous 'believers' this injection story seems to have served as some kind of eyeopener.
Which of course I can only applaud.

 

[King Boonen]

Re:

KB:

I thought the reason for Wiggins' TUEs were allergies?

true, although ironically in Wiggins PR statement he gets this wrong, too, saying the shots were for his asthma.

I think people put much too much store in what non-medical professionals say in these cases. Wiggins likely wouldn't really know the difference or much care, he's hardly going to be listening attentively and taking notes so he can recall exactly what was said. Yes, he should just keep his mouth shut if he isn't sure but then it's Wiggins.

it pretty much disproves one of the ways people have accused Sky of gaming the system

how so?

Because there is no huge pile of TUEs for either Wiggins or Froome. I seem to remember suggestions in the past that this was one of the ways Sky were gaming the system but there is no evidence for this based on the information released. Froome has been shown to be completely honest and Wiggins had a few allergy shots before a GT which, while not great, is hardly proof of anything.

I would say though that to me, if we are going on the assumption that doping is/was happening at the team level, the TUEs for Wiggins, and for Froome although less so, feel more like a way to protect an investment. If you invest in doping a rider to with the Tour, but that rider suffers from allergies, it makes sense to give them something that will reduce the chances of them suffering and it of course makes sense to do it within the rules when you can. That's about the only conclusion I can draw from all this.

The non-doping conclusion is that the Team is also protecting their investment in the same way, just replace the doping with marginal gains training, and that this kind of thing sets a dangerous precedent if the team is willing to riders long term health for short term goals (of course the riders may be involved).

 

[abc987]

The other obvious question is, if the Sky TUEs are such a glaring abuse of the TUE system, why is everyone else not doing it? It's common sense to expect that lots of people would be helping themselves to some "legalised doping", but the UCI TUE web page records only 13 TUEs for 2015.

 

[veji11]

Re:

The other obvious question is, if the Sky TUEs are such a glaring abuse of the TUE system, why is everyone else not doing it? It's common sense to expect that lots of people would be helping themselves to some "legalised doping", but the UCI TUE web page records only 13 TUEs for 2015.

Many national doping agencies are allowed to issue TUE themselves....

 

[sniper]

Re: Re:

KB:

I thought the reason for Wiggins' TUEs were allergies?

true, although ironically in Wiggins PR statement he gets this wrong, too, saying the shots were for his asthma.

I think people put much too much store in what non-medical professionals say in these cases. Wiggins likely wouldn't really know the difference or much care, he's hardly going to be listening attentively and taking notes so he can recall exactly what was said. Yes, he should just keep his mouth shut if he isn't sure but then it's Wiggins.

it pretty much disproves one of the ways people have accused Sky of gaming the system

how so?

Because there is no huge pile of TUEs for either Wiggins or Froome. I seem to remember suggestions in the past that this was one of the ways Sky were gaming the system but there is no evidence for this based on the information released. Froome has been shown to be completely honest and Wiggins had a few allergy shots before a GT which, while not great, is hardly proof of anything.

I would say though that to me, if we are going on the assumption that doping is/was happening at the team level, the TUEs for Wiggins, and for Froome although less so, feel more like a way to protect an investment. If you invest in doping a rider to with the Tour, but that rider suffers from allergies, it makes sense to give them something that will reduce the chances of them suffering and it of course makes sense to do it within the rules when you can. That's about the only conclusion I can draw from all this.

The non-doping conclusion is that the Team is also protecting their investment in the same way, just replace the doping with marginal gains training, and that this kind of thing sets a dangerous precedent if the team is willing to riders long term health for short term goals (of course the riders may be involved).

all good points.

There must have been rampant corticosteroid abuse within team sky, the CIRC report clearly suggests it. But presumably only ooc, so no TUEs needed.
And they didn't sign up for MPCC, so no problem there either.

 

[webvan]

With all this TUE talk it seems a good question would be, what would have happened to these champions who sometimes trounced the competition if they hadn't taken that "medication" (asthma, allergy, etc...), might they have simply been at a level closer to those they beat and who didn't take "medication" ?

Take Asthma, it's a pretty scary illness and it's hard to imagine someone's who's stricken by that disease being at the top of his sport, yes I know it's "sports induced asthma", but still...in fact isn't the fact that sports induced asthma kicks in a sign that they shouldn't be exerting themselves so much? Why allow them to bypass the limit their body is putting?

On the other hand you have Vaughters who can't get a cortisone shot to help with a closed eye after being stung by a wasp. Typically a valid TUE !

 

[Benotti69]

Re:

With all this TUE talk it seems a good question would be, what would have happened to these champions who sometimes trounced the competition if they hadn't taken that "medication" (asthma, allergy, etc...), might they have simply been at a level closer to those they beat and who didn't take "medication" ?

Take Asthma, it's a pretty scary illness and it's hard to imagine someone's who's stricken by that disease being at the top of his sport, yes I know it's "sports induced asthma", but still...in fact isn't the fact that sports induced asthma kicks in a sign that they shouldn't be exerting themselves so much? Why allow them to bypass the limit their body is putting?

On the other hand you have Vaughters who can't get a cortisone shot to help with a closed eye after being stung by a wasp. Typically a valid TUE !

Yep, TUEs should not be allowed. If you are ill, dont compete. Sports induced asthma is your body telling you to stop.

 

[abc987]

Many national doping agencies are allowed to issue TUE themselves....

I noticed on the UCI website that TUEs may be issued by national anti doping agencies, and these will be accepted by the UCI. However it wasn't clear to me if the total on the UCI site was all TUEs or only TUEs issued directly by the UCI. Does anyone have a definitive answer to this?

 

[King Boonen]

Re: Re:

all good points.

There must have been rampant corticosteroid abuse within team sky, the CIRC report clearly suggests it. But presumably only ooc, so no TUEs needed.
And they didn't sign up for MPCC, so no problem there either.

As clearly as every other team.

Yep, OOC so no TUEs for any sports person who has to adhere to the WADA code. This clearly needs to be addressed and the easiest way is to just ban corticosteroids out of competition as well.

MPCC is only for intra-articular corticosteroid use, everything else is fine as long as they watch their cortisol levels and those only matter when they are tested.

 

[King Boonen]

Many national doping agencies are allowed to issue TUE themselves....

I noticed on the UCI website that TUEs may be issued by national anti doping agencies, and these will be accepted by the UCI. However it wasn't clear to me if the total on the UCI site was all TUEs or only TUEs issued directly by the UCI. Does anyone have a definitive answer to this?

This is a very good spot. Based on the wording of the website I think that they are only talking about TUEs that are actually granted by the UCI, not all TUEs accepted.

 

[veji11]

Re: Re:

all good points.

There must have been rampant corticosteroid abuse within team sky, the CIRC report clearly suggests it. But presumably only ooc, so no TUEs needed.
And they didn't sign up for MPCC, so no problem there either.

As clearly as every other team.

Yep, OOC so no TUEs for any sports person who has to adhere to the WADA code. This clearly needs to be addressed and the easiest way is to just ban corticosteroids out of competition as well.

MPCC is only for intra-articular corticosteroid use, everything else is fine as long as they watch their cortisol levels and those only matter when they are tested.

There were strong suspicions that 2010/2012 super Europcar team's performance was down partly to rampant corticoid abuse... see the Cortisol issue with some of their riders (Charteau in 2011, Rolland in 2013)... I wouldn't be surprised if after the whole blood doping supervision thing with the passport we learnt that many teams and riders went back to some old recipes...

EDIT : See this interesting article from 2011 in Le Monde (very serious french newspaper) where they quote Michel Rieu, the scientific counsel of the French antidoping agency saying "the info we have from the field is that corticoid usage has picked up again, not only in cycling"
http://www.lemonde.fr/sport/article...-nouveau-accro-aux-corticos_1550422_3242.html

Michel Rieu also said this in the article in 2011 :

"Aujourd'hui, si on sait bien utiliser un produit comme le Kenacort, un corticoïde à effet ***, on ne prend pas de risque d'atteindre ce seuil. C'est pourquoi on en voit beaucoup dans les pharmacies des équipes et que nous n'arrivons pas à le retrouver aux contrôles antidopage

which can be translated as :

Today if you know how to use a substance like Kenacort, a corticoid which has delayed effect, you have no chance of crossing the detection threshold (AKA 30 ng/ml). This is why we see it a lot in the medication bags of teams without being able to find any in antidoping controls

Hmmmm...

At least Fancy bears will have brought back to light and confirmed suspicions about cortico use...

 

[webvan]

It is indeed a bit hard to explain how a guy like Voeckler was able to mix it with the best in the mountains just that one year...yeah I know the yellow jersey gives you extra strength, but still...has he ever been asked?