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Mar 2018
12:04pm, 8 Mar 2018
4,103 posts
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larkim
If I'm consistent about one thing, it's that I don't believe TUEs form a real and substantial story about doping. I'm not saying that there won't be cases of medical need being exaggerated to obtain a TUE, nor that there won't be any instances of TUEs being obtained completely on fraudulent bases either.
But abusing TUEs would be akin to hiding in plain sight - your governing body gets all the necessary documentation, you're tied down in terms of the period of use allowed, it needs reasonably good levels of certification, and there is a chance that your TUE would be rejected if it wasn't a reasonable request (admittedly the controls are better today than they were though).
Given what we saw with the Fancy Bears leaks, which broadly confirmed all the facts that athletes and organisations like NOP had stated about their TUE use, I took huge comfort that there wasn't a swathe of clearly borderline TUEs being issued left right and centre.
But it feels like the journalists haven't moved on, and are still beating the TUE drum hard. I fear its a blind alley, and they would be better diverting their resources to the drug supply chain, to prodding the consciences of potential whistle blowers etc. But they seem obsessed with TUEs for no really good reason!
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Mar 2018
12:10pm, 8 Mar 2018
25,634 posts
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SPR
It can be, to quote Sky, a marginal gain and I presume the MPCC ban it in competition because of that and previous abuse (although I haven't actually checked that).
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Mar 2018
12:17pm, 8 Mar 2018
4,104 posts
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larkim
Of course it can be. But the evidence suggests that if TUEs are used at all, they are in frequent and the vast majority are related to non-competition use to treat acute issues.
Now, I'll readily agree that Wiggins appears to be different in that there was a consistent use of the same TUE approach before 3 GTs, but I can excuse that - if (as is well documented) he has a significant allergy issue which could cause respiratory issues when riding at full tilt, and if you've avoided allergic reactions in the past by use of triamcinolone, why wouldn't you seek authorisation to use it in the 2nd and 3rd GTs. And as I've said before, if you're a doctor employed by a sporting team, why wouldn't you choose a medication route that has the potential for some upside over one that doesn't if its within the rules? I'd certainly have a clear conscience about that.
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Mar 2018
12:19pm, 8 Mar 2018
12,344 posts
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Chrisull
I actually believe Brad's side of the story too... he hasn't broken the rules. He didn't intend to. But was it unethical? Quite probably.
However, the main bone of contention for me is that some TUE's can be used for things like triamcinolone that dopers like David Millar ranked equally as effective as EPO/blood transfusion. You can dispute his testimony (but he is by far one of the best commentators on the cycling), but he has at least tried all three and is in a position to comment on that.
And if that is the case that triamcinolone can be as effective in some situations (I know steroids enhance difference characteristics to EPO, so they are not directly comparable) then it starts being about the semantics of the rules and choosing one aid as its legal, instead of the other to me is against the spirit of it. Some fetchies have said taking caffeine is against the spirit of racing/running. It is actually hard to argue against that. It is known to be performance enhancing.
Before Lance got caught I wondered/speculated was he given EPO as part of his recovery from cancer/chemo (I think it has been used as a treatment after chemo, waits for V'rap to come and correct me) and Ok in retrospect he hadn't it was his own cheating, BUT if it had would it have been ethical to have cycled again on something like EPO that might have formed a legitimate part of his recovery? I believe the answer is no it wouldn't be permitted or ethical, even with such mitigating circumstances. In which that's why I have the tough line with triamcinolone.
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Mar 2018
12:24pm, 8 Mar 2018
4,106 posts
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larkim
The Millar position on triamcinolone I've not seen backed up by anyone else, so that is a question in my mind. I know he said he felt boosted by it, but he does seem to be the only one who holds Kenacort in such high regards. Though I can't see what axe he would have to grind with that, so his opinion does carry weight with me.
For me, the "spirit" bit doesn't matter - if its legal, its legal. But I would agree that from Sky's perspective it would appear to be counter to their stated aims.
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Mar 2018
12:48pm, 8 Mar 2018
25,267 posts
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Derby Tup
DM was taking a right cocktail of drugs iirc
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Mar 2018
12:55pm, 8 Mar 2018
37,924 posts
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Velociraptor
It'll be interesting if David Millar pops up again and goes, "Oopsy-daisy, tee-hee, when I said triamcinolone I got the word wrong because I was on so many drugs I can't keep track of them all, and what I meant was [something else that there's no suggestion Team Sky has been acquiring]." It would fit with the pharmacological properties of triamcinolone giving no indication of its potential as a miracle weight loss drug.
Chrisull, I can't comment on whether EPO is routinely used in the management of patients who have had chemotherapy in the USA. It isn't in the UK.
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Mar 2018
1:04pm, 8 Mar 2018
4,110 posts
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larkim
@Velo - I was interested in your post a few pages back which dismissed triamcinolone as the prescribers optimal drug for treating the sort of condition that Wiggins describes. What would be the more standard approach these days? And when might that standard approach have switched from use of triamcinolone?
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Mar 2018
1:23pm, 8 Mar 2018
37,925 posts
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Velociraptor
Normally we would treat asthma with inhaled corticosteroids, long- and short-acting beta-agonists, possibly montelukast, and occasional short courses of a glucocorticoid by mouth (usually prednisolone) for acute flare-ups. For respiratory allergies and hay fever, which is what Wiggins appears to be claiming to suffer from (and there's no reason not to believe that he does) we'd use nasal corticosteroids and oral antihistamines, and we have effective non-sedating antihistamines available. Triamcinolone, although it has been marketed and used as a depot injection (as Kenalog) to cover the hay fever season, has never been the recommended treatment for the condition due to the potential for adverse effects, but in the past (I'd like to think it was no longer happening) some GPs and patients have opted for it due to the convenience of one jab at the start of the season, and there may have been a time before my working lifetime when they could have scraped together a body of their peers who would defend this form of management.
Triamcinolone is still used for upper respiratory allergies in the form of nasal sprays, and it's useful for some joint or soft tissue injections, although it's not the first choice drug in either of these situations.
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Mar 2018
1:30pm, 8 Mar 2018
4,113 posts
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larkim
Thanks Velo. I'm conscious in so much of this debate, people like me with zero medical insight are commenting on things which really are the domain of medics!
I wonder if the "convenience" factor is the most important one here. One jab before the race, don't worry about it thereafter would seem a useful approach when there's other things to worry about? (Is that what "depot" means, a slow release type concept?)
On a different note, copied from Bike Radar, this is the history of TUEs in cycling in recent years:-
Year TUEs granted
2009 239
2010 97
2011 55
2012 46
2013 31
2014 25
2015 13
2016 15
2017 20
With a large proportion of the reduction being due to Salbutamol no longer needing a TUE from 2010 (?) onwards. Out of about 1200 riders covered, that's not very many.
Though of course you can then argue that Wiggins' 1 represents a substantial proportion of the numbers issued each year.
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Cheating in amateur sports
Apr 2017
