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What are TUEs?

Alex Whitcomb explains what Therapeutic Use Exemptions are and why recent leaks of athletes’ TUE use have caused so many problems

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What are they?

The World Anti-Doping Agency (WADA) defines them as follows: “Athletes may have illnesses or conditions that require them to take particular medications. If the medication an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption (TUE) may give that athlete the authorization to take the needed medicine.” Basically, it is a pass to take banned substances, so long as a doctor prescribes them as medicine for an acute or chronic medical condition.

Why are they controversial?

There has always been debate over whether athletes are abusing the TUE system. While very few people dismiss the idea of TUEs in principle, questions arise over whether they are being administered fairly. High profile cases include Lance Armstrong’s cortisone TUE at the 1999 Tour de France [the first of the seven of his now-stripped wins]. This instance is more controversial because Armstrong’s TUE was requested after he had tested positive for the drug and was used by the team in a cynical move to purely use it for performance enhancement.

Also, as Tyler Hamilton and Daniel Coyle document in their 2012 book The Secret Race: “The UCI [cycling’s governing body] didn’t want to catch Lance, they accepted the prescription, and the Tour of Renewal rolled on.” The mixture of administrative corruption and Armstrong repeatedly lying about his drug use, including in this instance, has contributed to many people’s doubts that TUEs are handed out fairly.

Why are they in the news at the moment?

After the Olympics, a group of hackers going under the name of Fancy Bears disclosed the medical records of various athletes, including Serena Williams and a handful of Britons. The hackers are widely believed to be of Russian origin, with some implying links to the Russian government, a country who are currently banned from international athletics for engaging in “state-sponsored doping”.

So has anyone broken the rules?

No, is the short answer. All international athletes must have their TUE approved by a specialist and national and international anti-doping committees. All of the people implicated in the leaks have gone through this process.

So no problem then?

Not entirely. While no-one has questioned them following the letter of the law, their approach to the spirit of the law has been scrutinised. 2012 Tour de France winner Sir Bradley Wiggins has faced criticism for his use of injected corticosteroid drugs to combat his asthma and allergies.

One key element of TUE rules is that the drugs allowed must not be performance-enhancing. However, many, including his own doctor from his previous team Garmin Slipstream, who insist that these substances do improve performance.

Former drugs cheat turned anti-doping crusader David Millar recently stated that the drug should be banned from competition altogether. He described the drug in his book Racing Through the Dark in 2011: “It was probably the most potent drug out there, yet with a prescription it could be used legally”, going on to say that “A few days after the injection I began to lose weight. I was skinnier than I’d ever been… There were veins appearing all over my legs and my torso as the last bits of fat were eaten away by the cortisone.”

Team Sky emphasise that this is not the case, and that Wiggins and all Sky riders have acted within the rules and ethics of anti-doping. Team Sky maintain their zero-tolerance policy to doping and have previously sacked staff for their links to the Lance Armstrong saga, including British coach Sean Yates in 2012.

Wiggins and Team Sky Director Dave Brailsford have both been interviewed by the BBC since the leaks and have insisted that the drugs were taken for purely therapeutic reasons. Wiggins also explained on the Andrew Marr Show that the reason for the timing of his injections—immediately prior to the 2012 Tour—was due to this also being the height of the season of his allergies and that it was a preventative measure. He insisted that it was not about abusing the drug but placing himself “back on a level playing field”.

It’s worth saying that these leaks are not nearly the same as the Lance Armstrong revelations. No-one has suggested that Team Sky have broken any laws and there is no suggestion that Wiggins could conceivably be stripped of any of his titles. We will have to wait and see if any changes are made to a system that many consider to contain fundamental flaws.