Doping Round Up: SKY, TUEs and More Grey Areas

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This year has had it’s fair share of doping stories and they keep on coming.

 

The year started with a bang – Maria Sharapova failed a drugs test at the Australian Open tennis tournament for the little known (at the time!) drug meldonium (Mildronate). I wrote a few bits about that here: Sharapova and Meldonium Doping

Shortly after that I wrote a piece about the ‘grey areas’ in doping – ‘Black and White or Shades of Grey‘ – a piece which has been very relevant as the year wore on.  In this I outlined several ‘legal’ ways of using drugs which may enhance your performance one of which was using Therapeutic Use Exemptions (TUEs). More of which to follow.pharmacy-1507606-640x480

In thew build up to the Rio Olympics there was the Russian doping scandal explained in Russia, Doping and Rio. The first McLaren report told of ‘disappearing positive methodology’ – how samples were either switched for clean ones or the results were simply entered into the World Anti Doping Agency system as negative instead of positive.  The initial report suggested 600 tests had been ‘disappeared’, across many Olympic sports. Perhaps surprisingly it did not lead to Russia being banned from the Olympic games (although the International Paralympic Committee did take the brave stance of a blanket ban of Russian athletes).  Some sporting federation banned the Russians (weightlifting and athletics for instance) whilst others didn’t (cycling and boxing among others).  The second McLaren report expanded on the first (published in December 2016), with over 1000 suspected at this point.

After Rio there were the ‘Fancy Bear’ hackings. These revealed the use of TUEs by many big name athletes. On the face of it most of them were fairly straight forward to explain away, asthma medications on the whole.  There were a few that stood out and the one, for Sir Bradley Wiggins, that won’t go away.  The TUE was for a drug ‘triamcinolone’ – a corticosteroid used via injection for the treatment of joint and soft tissue inflammation or in this case the treatment of allergic disorders (both listed as legitimate treatments in the pharmacists handbook the BNF 2016).  It was claimed that Wiggins had an allergy to certain pollen prevalent in the summer months and had particularly affected his breathing. This has rumbled on as on one side it is claimed a legitimate use and others are claiming it is used for performance enhancement.  It is claimed to help shed excess weight and also give a performance boost, making an athlete feel much stronger. The argument is to whether the granting of the TUE was necessary.  The WADA regulations for TUEs state:

An Athlete may be granted a TUE if (and only if) he/she can show, by a balance of probability,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…

b: The Therapeutic Use of the Prohibited Substance or Prohibited Method is highly unlikely to produce any additional enhancement of performance…

c: There is no reasonable Therapeutic alternative to the Use of the Prohibited Substance… and

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

trustmeThis can be argued but according to the regulations and the paperwork a medic suggested that this was the most suitable treatment available, the TUE was countersigned by the relevant person at the UCI (the system now involves WADA scrutiny of each TUE) and so no rules are broken.  That is true as long as the treatment was necessary and there were no legal alternatives. These can be argued over but it would be very hard to prove otherwise 5 years later.  to me this shows a weakness in the system, all TUEs should probably require independent medics to evaluate the athlete, rather than the team employed doctor.

 

The next grey area came along yesterday.  A House of Commons select committee questioned a few British Cycling people, including Team Sky boss David Brailsford.  One particular issue was a ‘jiffy bag’ sent from Manchester to France to give to the Team Sky medic for treatment of Wiggins.  The drug in the package was revealed as fluimucil, a drug unlicensed in the UK but available (and often used) as a ‘special’ formulation. This drug is used to “helps protect the lung from the harmful effects of inflammation and prevent further decline in your lung function”.  Off license or ‘special’ drugs are available for use when required by a medic for a particular patient. This is where the testimony gets slightly difficult to follow.  My reading of the regulations is that the drug can only be used for one patient. From the testimony it sounded like the drug taken from a general store in the British Cycling offices, which doesn’t sound right. Also an interesting part of the patient information sheet I found was that it is often used in conjunction with corticosteroids! So, more questions to follow here.

The year is almost out but this will still be running next year! Thanks for reading.

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Dr Tom Bassindale

About Dr Tom Bassindale

Dr Tom Bassindale is a forensic scientist, and the founder of We Are Forensic. He's managed hundreds of forensic toxicology cases, and is an experienced court witness. He has specialist expertise in forensic toxicology and drug testing in sport. Dr B is currently a senior lecturer at Sheffield Hallam University. And yes... he watches CSI.