Therapeutic Use Exemption (TUE's)

[Parker]

Re: Re:

Shouldn't be any TUE's.

I'm an athlete. I'm ill. I need a banned drug. Do I risk my health and refuse or accept a four year ban for doping? Death or disgrace, which?

Maybe take the drug but do not compete, do you go to work when you are ill?

Lots of people go to work when they're ill

Some TUEs are for permanent conditions - for example the Novo Nordisk team who take insulin for their diabetes. Jack Bobridge used to have a TUE for his arthritis (which eventually caused his retirement). Other conditions - Dowsett is a haemophiliac, Contador had epilepsy - I don't know if they needed TUEs.

It comes down to what you believe sport is. Is it an inclusive activity to be enjoyed by all? Or is it a pursuit of genertic purity? I go for the former.

 

[samhocking]

Re:

I thought Astana was a member of the MPC whatever and riders are tested for healthy cortisol levels, making cortisone abuse difficult?

Doubt you will see low cortisol unless abusing it. Sound like he was using it to target races, rather than continual abuse.

 

[Koronin]

Re: Re:

Shouldn't be any TUE's.

I'm an athlete. I'm ill. I need a banned drug. Do I risk my health and refuse or accept a four year ban for doping? Death or disgrace, which?

Maybe take the drug but do not compete, do you go to work when you are ill?

Lots of people go to work when they're ill

Some TUEs are for permanent conditions - for example the Novo Nordisk team who take insulin for their diabetes. Jack Bobridge used to have a TUE for his arthritis (which eventually caused his retirement). Other conditions - Dowsett is a haemophiliac, Contador had epilepsy - I don't know if they needed TUEs.

It comes down to what you believe sport is. Is it an inclusive activity to be enjoyed by all? Or is it a pursuit of genertic purity? I go for the former.

The Yates twins have TUEs for their asthma (which is documented that they've had since childhood).

As for go to work when you're ill. Yep. I'm a vendor, I don't work I don't get paid. I don't get sick days. Yes there are times I've take a ton of medication before leaving the house as well.

 

[Parker]

Re: Re:

The Yates twins have TUEs for their asthma (which is documented that they've had since childhood).

It's only Simon, I think

 

[ColonelKidneyBeans]

Re: Re:

Shouldn't be any TUE's.

I'm an athlete. I'm ill. I need a banned drug. Do I risk my health and refuse or accept a four year ban for doping? Death or disgrace, which?

Maybe take the drug but do not compete, do you go to work when you are ill?

Lots of people go to work when they're ill

Some TUEs are for permanent conditions - for example the Novo Nordisk team who take insulin for their diabetes. Jack Bobridge used to have a TUE for his arthritis (which eventually caused his retirement). Other conditions - Dowsett is a haemophiliac, Contador had epilepsy - I don't know if they needed TUEs.

It comes down to what you believe sport is. Is it an inclusive activity to be enjoyed by all? Or is it a pursuit of genertic purity? I go for the former.

I know, and they should not, in a better world, but i'm not the one trying to pass the decision to take a TUE as a choice between death and disgrace (a bit hyperbolic FMK no?) when there is also the possibility to simply not compete.
I don't entirely disagree with your point, but those TUE are a bit specific, they are for permanent conditions, if you were to suffer from, say, a banged up knee or a bad case of bronchitis, the best choice health wise is clearly to rest, and not to engage in one the most strenuous sport in the world at the highest level. Sport is certainly an activity to be enjoyed by everyone, but at the highest level it is largely a test of genetic "purity", i genuinely don't see how it can be argued, it's the nature of competition no?

 

[Parker]

Re: Re:

I know, and they should not, in a better world, but i'm not the one trying to pass the decision to take a TUE as a choice between death and disgrace (a bit hyperbolic FMK no?) when there is also the possibility to simply not compete.
I don't entirely disagree with your point, but those TUE are a bit specific, they are for permanent conditions, if you were to suffer from, say, a banged up knee or a bad case of bronchitis, the best choice health wise is clearly to rest, and not to engage in one the most strenuous sport in the world at the highest level. Sport is certainly an activity to be enjoyed by everyone, but at the highest level it is largely a test of genetic "purity", i genuinely don't see how it can be argued, it's the nature of competition no?

Do you remember Ivan Basso? Do you remember when he got diagnosed with cancer during a Tour de France? He wanted to continue the race and get treatment once it was over. It was only his team refused to let him that made him quit.

This is the mentality of a pro sportsman. They always want to continue. Given the choice of quitting or not getting healthcare, they go for the latter whenever possible. Denying TUEs is more detrimental to their health. Many glory in a crash victim continuing day to day for no real reason.

The amount of drugs allowed by TUEs these days has minimal performance effect, and very few are issued. It's not a major issue.

 

[ColonelKidneyBeans]

Re: Re:

I know, and they should not, in a better world, but i'm not the one trying to pass the decision to take a TUE as a choice between death and disgrace (a bit hyperbolic FMK no?) when there is also the possibility to simply not compete.
I don't entirely disagree with your point, but those TUE are a bit specific, they are for permanent conditions, if you were to suffer from, say, a banged up knee or a bad case of bronchitis, the best choice health wise is clearly to rest, and not to engage in one the most strenuous sport in the world at the highest level. Sport is certainly an activity to be enjoyed by everyone, but at the highest level it is largely a test of genetic "purity", i genuinely don't see how it can be argued, it's the nature of competition no?

Do you remember Ivan Basso? Do you remember when he got diagnosed with cancer during a Tour de France? He wanted to continue the race and get treatment once it was over. It was only his team refused to let him that made him quit.

This is the mentality of a pro sportsman. They always want to continue. Given the choice of quitting or not getting healthcare, they go for the latter whenever possible. Denying TUEs is more detrimental to their health. Many glory in a crash victim continuing day to day for no real reason.

The amount of drugs allowed by TUEs these days has minimal performance effect, and very few are issued. It's not a major issue.

Maybe it's time to change that mentality, and frankly physician should not allow it, they are enabler in that case.
It's... weird to claim that TUE have minimal performance effects given what we have learned during the past few years i believe, i completely disagree with you, but i don't think we need to argue much about that, we have irreconcilable positions there, no need to beat a dead horse.

 

[Parker]

Re: Re:

Maybe it's time to change that mentality, and frankly physician should not allow it, they are enabler in that case.
It's... weird to claim that TUE have minimal performance effects given what we have learned during the past few years i beleive, i completely disagree with you there, but i don't think we need to discuss that much, we have irreconcilable positions there, no need to beat a dead horse.

I really don't think you appreciate what pro sportsmen are like. They devote their life to competition. They are not going to give that up just because they are a little ill.

What if an athlete is ill but the medicine required to treat them isn't banned. Should they withdraw as well?

But you seem to think you know better than WADA. Spoiler: you don't.

 

[ColonelKidneyBeans]

Re: Re:

Maybe it's time to change that mentality, and frankly physician should not allow it, they are enabler in that case.
It's... weird to claim that TUE have minimal performance effects given what we have learned during the past few years i beleive, i completely disagree with you there, but i don't think we need to discuss that much, we have irreconcilable positions there, no need to beat a dead horse.

I really don't think you appreciate what pro sportsmen are like. They devote their life to competition. They are not going to give that up just because they are a little ill.

What if an athlete is ill but the medicine required to treat them isn't banned. Should they withdraw as well?

But you seem to think you know better than WADA. Spoiler: you don't.

When you need corticoids you are not "just a little ill"
Yeah because WADA has such a good track record at preventing doping, would it bother you just one time to respond to the actual content of the post instead of using thinly veiled personal attacks and shifting goalpost continuously? Like, where do you get that TUE aren't performance enhancing and abused after the whole sky mess, Zorzoli, Europcar, Horner, riders being unable to start because of low cortisol levels, and now Westra coming clean?

 

[Koronin]

Re: Re:

The Yates twins have TUEs for their asthma (which is documented that they've had since childhood).

It's only Simon, I think

You're most likely right, but I couldn't remember if it was just one or both of them.

 

[Koronin]

Re: Re:

Maybe it's time to change that mentality, and frankly physician should not allow it, they are enabler in that case.
It's... weird to claim that TUE have minimal performance effects given what we have learned during the past few years i beleive, i completely disagree with you there, but i don't think we need to discuss that much, we have irreconcilable positions there, no need to beat a dead horse.

I really don't think you appreciate what pro sportsmen are like. They devote their life to competition. They are not going to give that up just because they are a little ill.

What if an athlete is ill but the medicine required to treat them isn't banned. Should they withdraw as well?

But you seem to think you know better than WADA. Spoiler: you don't.

When you need corticoids you are not "just a little ill"
Yeah because WADA has such a good track record at preventing doping, would it bother you just one time to respond to the actual content of the post instead of using thinly veiled personal attacks and shifting goalpost continuously? Like, where do you get that TUE aren't performance enhancing and abused after the whole sky mess, Zorzoli, Europcar, Horner, riders being unable to start because of low cortisol levels, and now Westra coming clean?

These guys want to race at all costs. Last year Tour Valverde broke his kneecap and his ankle. 6 weeks later he was riding out on the road (first Vuelta rest day he showed up for the team's training ride). He'd tried to talk to the team into letting him start la Vuelta less than 8 weeks after that injury. Then he tried to talk them into letting him race at Lombardia, and then China the final race of the season. The flat out refused because they didn't want to risk him re-injuring anything. Now, yes, this might be a bit extreme on his part, but this is very much the mentality of elite athletes.

 

[El Pistolero]

TUEs should be canned all-together. Join the paralympics if you have asthma or diabetes. Most TUEs are fabrications anyway.

 

[brownbobby]

Re: Re:

Shouldn't be any TUE's.

I'm an athlete. I'm ill. I need a banned drug. Do I risk my health and refuse or accept a four year ban for doping? Death or disgrace, which?

Maybe take the drug but do not compete, do you go to work when you are ill?

Yes. I do if there are drugs I can take legally to make me feel ok enough to work.

 

[Ferminal]

Re:

Lieuwe Westra (Vacansoleil 2009-2013, Astana 2014-2016) admits cortisone use throughout his career on the back of fraudulent TUEs: https://www.lc.nl/sport/Lieuwe-Westra-biecht-gebruik-cortisonen-op-23137654.html

(some quotes Google translated):

"In my first professional year it became clear to me that with only hard training no victories were achieved. If you wanted to join the big boys, you had to look up the limits of the permissible.

"The medical certificate I received often with a feigned injury, for example an inflammation in the knee. It paid off years to fend an injury to the knee. According to the rider's book, I had been suffering from knee problems for years. This enabled me to start a course of cortisone at important peak times in the season.

"I am happy today that my professional career started in 2009. Had I made the switch from the amateurs before, the temptation would have been too strong for me. My hand would have grabbed to epo or a variant of it.

"Every rider of name provided a medical certificate for classics and other big competitions.

"I think the team management did not want to know what was going on in those years: they could not be called on. Although they often knew it, of course, but we did not talk about it openly. We had to perform and it did not matter to them, as long as we were not caught. Ignorance is bliss.

"I think I can tell the story about the cortisone injections open, because I do not feel that I really did something wrong. Almost everyone from my generation worked on peak times in this way."

Nothing vastly surprising at this stage, especially considering it's Vacansoleil and Astana, but another data point nonetheless.

Hmm, I'm not buying that Vacansoleil A-listers were just your standard cortisone happy team, but it's a nice story for Westra to be able to maintain he never crossed the line.

 

[ColonelKidneyBeans]

Re: Re:

Maybe it's time to change that mentality, and frankly physician should not allow it, they are enabler in that case.
It's... weird to claim that TUE have minimal performance effects given what we have learned during the past few years i beleive, i completely disagree with you there, but i don't think we need to discuss that much, we have irreconcilable positions there, no need to beat a dead horse.

I really don't think you appreciate what pro sportsmen are like. They devote their life to competition. They are not going to give that up just because they are a little ill.

What if an athlete is ill but the medicine required to treat them isn't banned. Should they withdraw as well?

But you seem to think you know better than WADA. Spoiler: you don't.

When you need corticoids you are not "just a little ill"
Yeah because WADA has such a good track record at preventing doping, would it bother you just one time to respond to the actual content of the post instead of using thinly veiled personal attacks and shifting goalpost continuously? Like, where do you get that TUE aren't performance enhancing and abused after the whole sky mess, Zorzoli, Europcar, Horner, riders being unable to start because of low cortisol levels, and now Westra coming clean?

These guys want to race at all costs. Last year Tour Valverde broke his kneecap and his ankle. 6 weeks later he was riding out on the road (first Vuelta rest day he showed up for the team's training ride). He'd tried to talk to the team into letting him start la Vuelta less than 8 weeks after that injury. Then he tried to talk them into letting him race at Lombardia, and then China the final race of the season. The flat out refused because they didn't want to risk him re-injuring anything. Now, yes, this might be a bit extreme on his part, but this is very much the mentality of elite athletes.

I don't know what Valverde has to do with anything i wrote here, yes pro sportsmen push their bodies very far, yes sometimes TUE might be justified, but that doesn't mean they aren't abused, and to claim the contrary sounds absurd right now.

Shouldn't be any TUE's.

I'm an athlete. I'm ill. I need a banned drug. Do I risk my health and refuse or accept a four year ban for doping? Death or disgrace, which?

Maybe take the drug but do not compete, do you go to work when you are ill?

Yes. I do if there are drugs I can take legally to make me feel ok enough to work.

Fair enough, but what is well enough to work a "normal" job (no offence, i have no idea what is yours) and what is well enough to cycle at the elite level are two very different standards.

 

[Bolder]

Re: Re:

Lieuwe Westra (Vacansoleil 2009-2013, Astana 2014-2016) admits cortisone use throughout his career on the back of fraudulent TUEs: https://www.lc.nl/sport/Lieuwe-Westra-biecht-gebruik-cortisonen-op-23137654.html


Hmm, I'm not buying that Vacansoleil A-listers were just your standard cortisone happy team, but it's a nice story for Westra to be able to maintain he never crossed the line.

I don't think that cortisone shots are something to build your doping program around. they are handed out with abandon if you have any kind of undiagnosed pain, whether you're an athlete or just sprain your thumb picking up a bag of groceries. Also not sure (having received a few) that there are any benefits to getting more than one at a time in any specific spot.
However, I agree with ^^ that Westra is probably holding back a somewhat. But why hold back? If you really want to sell books nowadays you'll have to do better than TUE abuse...

 

[vedrafjord]

No motivation for Westra to tell all while his active years as a rider are within the statute of limitations and Vino can sue him.

I think the main flaws with the TUE situation currently are
a) doctors are employed by the teams so their motivation is results as well as rider health
b) no distinction between chronic/acute conditions eg diabetes where a rider will need insulin for the rest of their life vs say a chest infection
c) no distinction between serious cases and minor niggles - rider motivation is to get the strongest treatment with the most performance-enhancing side-effects (eg Wiggins) rather than treatment proportional to the condition.

I think at minimum the list of banned substances needs to be categorised into compete/no-compete lists - you get a TUE for something minor like sudafed for congestion and you can still race, but if you need, say, morphine, it means it's yoiu're not healthy to race and you need a one or two week break before you can come back.

 

[ColonelKidneyBeans]

Re:

No motivation for Westra to tell all while his active years as a rider are within the statute of limitations and Vino can sue him.

I think the main flaws with the TUE situation currently are
a) doctors are employed by the teams so their motivation is results as well as rider health
b) no distinction between chronic/acute conditions eg diabetes where a rider will need insulin for the rest of their life vs say a chest infection
c) no distinction between serious cases and minor niggles - rider motivation is to get the strongest treatment with the most performance-enhancing side-effects (eg Wiggins) rather than treatment proportional to the condition.

I think at minimum the list of banned substances needs to be categorised into compete/no-compete lists - you get a TUE for something minor like sudafed for congestion and you can still race, but if you need, say, morphine, it means it's yoiu're not healthy to race and you need a one or two week break before you can come back.

This is more or less my view on the matter, thank you.

 

[Benotti69]

Re: Re:

Lieuwe Westra (Vacansoleil 2009-2013, Astana 2014-2016) admits cortisone use throughout his career on the back of fraudulent TUEs: https://www.lc.nl/sport/Lieuwe-Westra-biecht-gebruik-cortisonen-op-23137654.html


Hmm, I'm not buying that Vacansoleil A-listers were just your standard cortisone happy team, but it's a nice story for Westra to be able to maintain he never crossed the line.

I don't think that cortisone shots are something to build your doping program around. they are handed out with abandon if you have any kind of undiagnosed pain, whether you're an athlete or just sprain your thumb picking up a bag of groceries. Also not sure (having received a few) that there are any benefits to getting more than one at a time in any specific spot.
However, I agree with ^^ that Westra is probably holding back a somewhat. But why hold back? If you really want to sell books nowadays you'll have to do better than TUE abuse...

Wiggins might disagree......

 

[Koronin]

Re: Re:

Maybe it's time to change that mentality, and frankly physician should not allow it, they are enabler in that case.
It's... weird to claim that TUE have minimal performance effects given what we have learned during the past few years i beleive, i completely disagree with you there, but i don't think we need to discuss that much, we have irreconcilable positions there, no need to beat a dead horse.

I really don't think you appreciate what pro sportsmen are like. They devote their life to competition. They are not going to give that up just because they are a little ill.

What if an athlete is ill but the medicine required to treat them isn't banned. Should they withdraw as well?

But you seem to think you know better than WADA. Spoiler: you don't.

When you need corticoids you are not "just a little ill"
Yeah because WADA has such a good track record at preventing doping, would it bother you just one time to respond to the actual content of the post instead of using thinly veiled personal attacks and shifting goalpost continuously? Like, where do you get that TUE aren't performance enhancing and abused after the whole sky mess, Zorzoli, Europcar, Horner, riders being unable to start because of low cortisol levels, and now Westra coming clean?

These guys want to race at all costs. Last year Tour Valverde broke his kneecap and his ankle. 6 weeks later he was riding out on the road (first Vuelta rest day he showed up for the team's training ride). He'd tried to talk to the team into letting him start la Vuelta less than 8 weeks after that injury. Then he tried to talk them into letting him race at Lombardia, and then China the final race of the season. The flat out refused because they didn't want to risk him re-injuring anything. Now, yes, this might be a bit extreme on his part, but this is very much the mentality of elite athletes.

I don't know what Valverde has to do with anything i wrote here, yes pro sportsmen push their bodies very far, yes sometimes TUE might be justified, but that doesn't mean they aren't abused, and to claim the contrary sounds absurd right now.

Just an example of a rider wanting to race regardless of reasons why he shouldn't be racing.
Are TUEs abused, I'm sure they are. What's the best way to fix that problem, not really sure because there are reasons for them and are legitimate reasons that some riders need them while racing (such as the one Yates twin).

 

[fmk_RoI]

Re: Re:

I know, and they should not, in a better world, but i'm not the one trying to pass the decision to take a TUE as a choice between death and disgrace (a bit hyperbolic FMK no?) when there is also the possibility to simply not compete.

It will never cease to amuse me how those who open with hyperbolic statements calling for all TUEs to be banned quickly admit exceptions to their brave new world.

"You have a permanent problem, like diabetes? OK, you can be an exception, once we get a doctor to confirm the situation. You need a banned drug for an injury? You can be an exception, but you'll have to stop competing for a period of time."

How is that different to the situation we have today? Will it just be a name change? We'll call them Medical Need Exceptions, will we?

So what is actually meant by such radical calls to ban all TUEs? Is it just AD virtue signalling? Frustration? "I'm angry now. Look, this is how angry I am, I'm willing to say something very, very, stupid. Because I'm angry."

Virtually nobody who calls for the banning of all TUEs is actually willing to defend such a ban to the hilt, to admit that athletes with certain permanent medical conditions will be banned from all WADA-accredited sport, which includes the Paralympics. Virtually nobody who calls for the banning of all TUEs is actually willing to defend such a ban to the hilt, to admit that athletes in extreme situations with be asked to choose between death and disgrace. Virtually nobody who calls for the banning of all TUEs is actually willing to defend such a ban to the hilt, to admit that this is a fascistic vision of sport, games for the übermensch.

 

[Benotti69]

Due to the abuse of medications by those in the sport, TUEs should be banned. Tough luck on diabetics, asthmatics and others who require such meds. That as they say is life.

Might as well say, give me a motor as i was not born with the same consitution as Merckx..............

Give mountain climbers motors for TTs and sprinters motors for climbs.......or put weights on bikes.

 

[Craigee]

Re: Re:

Shouldn't be any TUE's.

I'm an athlete. I'm ill. I need a banned drug. Do I risk my health and refuse or accept a four year ban for doping? Death or disgrace, which?

You sound like Choppy Warburton.

 

[Craigee]

If a rider breaks his collar bone a week before a big race or tour, no TUE can help him. He has to withdraw from the race. But you can take steroids in case you might get asthma? It's a joke and all the Pro Sports Organisations and WADA are doing the bare minimum to look like they're against doping. This is a fact because doping is so rampant world wide.

 

[fmk_RoI]

Re: Re:

Shouldn't be any TUE's.

I'm an athlete. I'm ill. I need a banned drug. Do I risk my health and refuse or accept a four year ban for doping? Death or disgrace, which?

You sound like Choppy Warburton.

You sound like Colin from the Fast Show.