A recent article in Road Bike Action website (see article here) talks about the TUE debacle involving Bradley Wiggins. The former Great Britain and Team Sky coach Shane Sutton spoke about the exploitation of therapeutic use exemptions have “muddied the waters” around Bradley Wiggins, one top cyclist said. Sutton was asked in a BBC documentary broadcast on Sunday to justify the TUEs that Wiggins received in order to take a corticosteroid before his three biggest races in 2011, 2012 and 2013, including his 2012 Tour de France win. A TUE is a dispensation, approved by doctors and the world governing body, to take an otherwise banned drug for medical reasons.

Cyclists may appear superhuman at times, they are human and have ordinary ailments. Most of us take it for granted to be able to treat these ailments by going to the doctor and obtaining a prescription. For the athletes, it’s more complicated. This is because medicines used to treat a prevailing condition might contain substances that are banned by WADA. A Therapeutic Use Exemption (TUE) is designed so that an athlete can take their required medicine.

What is a Therapeutic Use Exemption (TUE)?

A TUE is special permission to use a prohibited substance or method for a legitimate medical condition.

(Per the WADA website) “Riders, like everyone else, may have illnesses or condition which requires a particular medication. If a substance contained in your medication or the method used appears on the Prohibited List, you must apply for a TUE before starting the treatment. After the UCI Therapeutic Use Exemption Committee (TUEC) has reviewed your application, you may be given authorization to obtain treatment.” The UCI TUEC is composed of independent experts in the fields of clinical sports and exercise medicine. And just for the record, WADA and USADA have granted TUE’s for just about everything including potent pain killers and testosterone.

Indeed, the use of TUEs has been increasing steadily in other sports than cycling. According to WADA’s own report, approved Therapeutic Use Exemptions (TUE) in ADAMs (Anti-Doping Administration & Management System) increased by between 40% and 50% every year. There were 636 approved TUEs in 2013, 897 in 2014 and 1,330 in 2015. In cycling, TUE’s have steadily decreased down to the teens in 2016 and 2017. In cycling, the numbers are way down (See table).

Are TUE’s abused? Certainly, the potential is present, especially when it comes to corticosteroids. The benefits of corticosteroids are well documented in peer-reviewed scientific research. Even more, you have also got the testimony from a large number of riders, including professionals such as David Millar, Tyler Hamilton, Laurent Fignon, Michael Rasmussen, Lance Armstrong, and many others, all who have admitted to using corticosteroids.

The use of corticosteroids as a performance-enhancer in cycling is, from an anecdotal perspective, very well founded. So you are Bradley Wiggins taking a long-acting corticosteroid just before every Grand Tour. Maybe not so good. Everyone knows that he suffers from asthma and pollen. He goes about it correctly and obtains a TUE. The chances are you can gain a performance benefit out of it.

Chris Froome has also received TUE’s for corticosteroids. Why isn’t he treated the same as Wiggins? Chris has always been open and transparent about his TUE’s. Even when he was offered a corticosteroid treatment and TUE for a chest infection in the 2015 Tour de France, he chose to refuse the treatment.

Finally, shift gears to another sport, Olympic gymnastics and Tennis. Simone Biles, Serena Williams and Venus Williams all have TUE’s for several medications. Serena and Venus seem to have used a brew of substances including prednisone, prednisolone, methylprednisone, hydromorphone and oxycodone; Biles used Ritalin for her ADHD. Biles and the Williams sisters were taking banned substances under entirely legal circumstances. Indeed, both the International Tennis Federation (ITF) and the Federation Internationale Gymnastic (FIG) have said there was no evidence of wrongdoing as the athletes had a TUE. No one is questioning their TUE practices.

Even the head of USADA, Travis Tygart was quoted in the New York Times, “In each of the situations, the athlete has done everything right in adhering to the global rules for obtaining permission to use a needed medication,” Travis Tygart, president of the US Anti-Doping Agency, told The Times.

I am not sure what the difference is between the cyclists, gymnasts, and tennis players but taking a drug like Ritalin, that increases your focus, where thousands of a second can be the difference between a Gold medal or not. Taking a corticosteroid injection that might increase your power by a small percentage, hopefully you get the point. Certainly, there are no good answers. But at least, gone are the days of cyclists infusing blood bags in their hotel rooms multiple days during the Tour de France.

Update:

Michael Rasumussen adds more insight to the corticosteroid controversy: Why even bother to get a TUE any longer? It’s a free ride as it cannot be determined if the corticosteroids has come into your body in a legal or prohibited way.That’s why there never are any positives for cortisones.The laps simply cannot distinguish. #NoBStalk #kenacort #60vials
https://twitter.com/MRasmussen1974/status/934384726651138050
https://twitter.com/MRasmussen1974/status/933771318662746112